Insulin Requirements for Basal and Auto-Correction Insulin Delivery in Advanced Hybrid Closed-Loop System: 4193 Days' Real-World Data of Children in Two Different Age Groups

BACKGROUND

The insulin requirements of people with type 1 diabetes (T1D) can vary throughout the day due to factors such as biorhythm, exercise, and food intake. The MiniMed 780G system delivers micro boluses to adjust basal insulin and delivers auto-correction boluses to meet insulin needs when micro bolus increases are insufficient. Through analysis of MiniMed 780G data, this study investigates the variations in insulin requirements throughout the day.

METHODS

4193 days' pump and continuous glucose monitoring (CGM) data of 34 children using MiniMed 780G were collected from Medtronic CareLink. Micro and auto-correction boluses were analyzed on an hourly basis for two age groups: below nine years old and above nine years old. Glycemic metrics were analyzed based on International CGM consensus.

RESULTS

The mean age was 12.3 years and mean duration of diabetes was 6.1 years. The mean time in range (TIR) and glucose management indicator (GMI) were 80.5% and 6.6%, respectively. The micro bolus (basal) ratio between 05.00 and 07.00 was significantly higher than the ratio between 10.00 and 03.00 (P < .01), whereas micro bolus was significantly lower between 19.00 and 21.00 than those between 00.00 and 10.00 (P < .001). The auto-correction ratio between 21.00 and 00.00 was significantly higher than those between 03.00-17.00 (P < .001) and 19.00-21.00 (P = .008), whereas auto-correction was significantly lower between 07.00 and 10.00 than those between 10.00 and 03.00 (P < .001). The micro bolus ratio was significantly higher in children below nine years old than in children above nine years old between 21.00-00.00 (P = .026) and 00.00-03.00 (P = .003).

CONCLUSION

The basal insulin need follows a diurnal pattern with two significantly different periods-high between 00.00 and 10.00 and low between 10.00 and 00.00. The auto-correction rates are low between 05.00 and 10.00 and show an increasing pattern peaking between 21.00 and 00.00. These findings are compatible with the dawn and reverse dawn phenomena.

The Closure of Grade 1 Coronary Perforation by the Snowplow Phenomenon

We report an extremely rare case of spontaneous closure of grade 1 coronary perforation by the snowplow phenomenon during the revascularization of a subtotal occlusion in the left anterior descending coronary artery. Coronary artery perforation is usually a nightmare during coronary intervention in the cardiac catheterization laboratory. While large coronary perforation requires the deployment of a covered stent, small perforations require heparin reversal, prolonged balloon inflation, deployment of small coils, or gel foam closure. The coronary segment with a small perforation was stented with a drug-eluting stent (DES), which might have resulted in the shifting of the fatty plaque toward the perforation and subsequently sealing the coronary perforation.

Halo Phenomenon in Lobular Capillary Hemangioma: A Case Report of a Pyogenic Granuloma With Surrounding Cutaneous Hypopigmentation and Review of Tumors With Halo Phenomenon

A halo phenomenon describes a skin neoplasm that is surrounded by a hypopigmented or white halo. Halo lesions have been observed in association with an epithelial neoplasm (seborrheic keratosis), a fibrous lesion (surgical scar), a keratinocyte malignancy (basal cell carcinoma), melanocytic neoplasms, and vascular lesions. Benign lesions (café au lait macules and nevi) and malignant tumors (primary and metastatic melanoma) are melanocytic neoplasms that have developed perilesional halos. Halo nevi are a commonly occurring manifestation of a halo phenomenon; however, perilesional hypopigmented halos have also been observed around nevi in patients following treatment with antineoplastic drugs, acquisition of COVID-19 (infection and vaccine), the occurrence of a visceral tumor (including not only melanoma, but also papillary thyroid carcinoma and neuroendocrine cancer of the lung), surgery (such as the excision of a primary melanoma), and Turner syndrome. A halo phenomenon has also been observed in patients with congenital (capillary malformation-arteriovenous malformation and congenital hemangioma) or acquired (angioma, eruptive pseudoangiomatosis, infantile hemangioma, and lobular capillary hemangioma) vascular lesions. In summary, a halo phenomenon can occur in association with primary lesions of various embryologic derivations. Most commonly, they have been observed in around nevi and vascular tumors. Halo lobular capillary hemangioma can be added to the list of acquired vascular lesions with the potential to develop a halo phenomenon. The preservation of melanocytes with loss of melanin pigment expression in the reported patient suggests the possibility that a post-inflammatory etiology may be responsible for the genesis of her halo lobular capillary hemangioma.

Heavy drinking as phenomenon: gender and agency in accounts of men's heavy drinking

Alcohol consumption is a significant public health concern in Australia, with men disproportionately represented in treatment for health issues related to heavy drinking. Despite this, little is known about the experiences of these men or the gender dynamics that may shape heavy drinking. Increasingly, the treatment of alcohol and other drug-related issues, including those related to heavy drinking, is based on a biopsychosocial approach. Within this framework, heavy drinking is understood as a symptom of individual pathology in the context of various social 'factors' that influence individual capacity to exercise agency. Following the work of Karen Barad, this article employs a feminist science studies account of agency to formulate heavy drinking as a gendered 'phenomenon': enacted and sustained through the 'intra-action' of other phenomena. Drawing on interviews with men who drink heavily, our analysis explores how the phenomenon of men's heavy drinking materialises through the intra-actions of gender, isolation and healthcare. We argue that heavy drinking is not a sign of failed individual agency but an expression of entangled agencies. In concluding, we suggest it is possible to enhance the well-being of men who drink heavily by addressing specific gendered intra-actions in the making of heavy drinking.

[The sensitization phenomena and regularity of Hegu (LI 4) based on bibliometrics]

The sensitization phenomena and regularities of Hegu (LI 4) were preliminarily explored. The relevant literature regarding Hegu (LI 4) sensitization were collected by computer retrieval at Cochrane Library, Pubmed, Embase (OvidSP), China Journal Full Text Database (CNKI), China Biomedical Literature Database (CBM), VIP and Wanfang (WF) databases as well as manual searching, and a modern literature database of Hegu (LI 4) sensitization was established. The information of disease type, sensitization type, detection method and index were collected. Frequency statistics method was used for analysis. As a result, 47 literatures were included, of which heat sensitivity was the most common type of sensitization, and diseases of liver and gallbladder, limb meridians, lung system, and spleen-stomach system were the most common types of diseases. The detection method of sensitization was various, among them, potassium ion introduction method and hot-water tail-flick method were mainly used for pain sensitivity, while acupoint resistance measuring instrument was mainly used for electric sensitivity, while thermal infrared imager was mainly used for heat sensitivity, while infrared spectrometric analyzer was mainly used for light sensitivity, while pressing pain measuring instrument was used for pressing sensitivity. Detection index was different, pain sensitivity detected pain threshold, electric sensitivity mainly detected acupoint resistance, heat sensitivity mainly detected temperature, light sensitivity detected average sharpness and average energy of infrared radiation, pressing sensitivity detected pressing-pain threshold. In conclusion, the regularities of sensitization of Hegu (LI 4) were preliminarily summarized, which involved five sensitization types: heat sensitivity, electric sensitivity, pain sensitivity, pressing sensitivity and light sensitivity. The sensitization of Hegu (LI 4) was commonly seen in facial paralysis, bronchial asthma, allergic rhinitis, tinnitus, ulcerative colitis. The temperature, pain threshold, pressing-pain threshold, average sharpness and average energy of infrared radiation of Hegu (LI 4) in pathological condition were lower than those in healthy subjects, and the resistance value was higher than that of healthy subjects.

Scanning speed phenomenon in contact-resonance atomic force microscopy

This work presents data confirming the existence of a scan speed related phenomenon in contact-mode atomic force microscopy (AFM). Specifically, contact-resonance spectroscopy is used to interrogate this phenomenon. Above a critical scan speed, a monotonic decrease in the recorded contact-resonance frequency is observed with increasing scan speed. Proper characterization and understanding of this phenomenon is necessary to conduct accurate quantitative imaging using contact-resonance AFM, and other contact-mode AFM techniques, at higher scan speeds. A squeeze film hydrodynamic theory is proposed to explain this phenomenon, and model predictions are compared against the experimental data.

Triple-Valve Endocarditis in a Diabetic Patient: Case Report and Literature Review

BACKGROUND

Despite major advancements since its first description in the 19th century, infective endocarditis remains a significant medical challenge. Although commonly involving a single valve, multiple valve involvement may occur, complicating matters even further. Triplevalve endocarditis is a very rare phenomenon. Poorly studied and described only a handful of times in the literature, little is known about the optimal therapeutic and management options in dealing with this complex entity.

CONCLUSION

In this paper we describe the case of a 48-year-old male who was diagnosed with triple-valve endocarditis and provide a review of the literature to delineate what is already known and improve our understanding of this rare phenomenon.

Prerequisites for sustainable care improvement using the reflective team as a work model

Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

The dynamic function of the atrial diastole of the heart and motion of venous valves in humans

This study demonstrates dynamic function of atrial diastole for the first time in the history of medicine, following the revelation of ventricular function by Sir William Harvey. This study consists of two parts. First part is the study of humans and the discovery of the rhythmic opening and closing of venous valves in the femoral vein segment during each cardiac cycle under fluoroscopy. Its relationship to the right atrial diastole is discussed. Second part is an experimental model developed in a dog's heart. Experiments are conducted in an erect posture, in which the right atrium is partially and totally isolated physically and/or functionally. The right atrium was found to function as a suction pump, readily demonstrated on graphic curves by voluntary stretching of muscle fibers of the empty atrium, creating considerable negative pressure during diastolic function, and responsible for venous return to the heart. Motive forces in the venous return are common knowledge in present medical literature, but are limited to respiration and skeletal muscle contraction of the extremities. The discovery of the right atrium as a suction force due to stretching of muscle fibers during diastolic function, thereby creating negative pressure, represents a departure from the currently accepted paradigm established by Sir William Harvey (1576-1652), with the heart as an organ functioning solely by contraction of its chambers. This is the first time since then a fundamental new discovery concerning cardiac mechanical function has been made utilizing experimental evidence.

Pathological fantasy friend phenomenon

Fantasy friend or imaginary companions is usually regarded as normal phenomenon and commonly seen in children. The index case is presented for highlighting the pathological nature of fantasy friend phenomenon, role of psychological, social and cultural factors in its genesis and its course. Onset and persistence of this phenomenon throughout adolescence, its longer duration and non-recognition of its imaginary component by the patient indicates its pathological nature. The patient developed schizophrenia after experiencing this phenomenon for 12-13 years. It is concluded that pathological fantasy friend phenomenon may carry risk of schizophrenia if continued without any intervention for longer duration. Hence, there is a need to identify and intervene early in such kind of cases. The findings of this case report needs to be corroborated by other case reports or studies.