National training and development curriculum training program impact on placement, permanency, and stability.

BACKGROUND: Resource parent trainings are an important factor in caregiver readiness and retention, which can improve placement stability and permanency achievement for children and youth, especially those who are marginalized. OBJECTIVE: Resource parents need access to evidence-based training programs attentive to caring for children and youth from a variety of diverse backgrounds. This study evaluates placement, permanency, and stability outcomes of children whose resource parents were trained in one such program: the National Training and Development Curriculum (NTDC). PARTICIPANTS AND SETTING: Participants include adults who completed a resource parent training program (N = 3822) and children in their care (N = 2565) in the U.S. states of Florida, Georgia, Illinois, and Missouri. METHODS: This quasi-experimental study involved statistical testing of caregivers and children using AFCARS data. Propensity-score matching was used to control for differences in the child permanency analysis. RESULTS: With a better understanding of the realities of fostering, NTDC participants were slightly less likely to foster after training (OR = 0.6; p < .001), self-selecting out before taking a child into the home. Those who did foster were more likely to foster a child who is a teen (OR = 1.4; p = .004), Asian/Asian American (OR = 3.8; p = .02), Black/African American (OR = 1.6; p < .001), or Hispanic/Latinx (OR = 1.7; p = .002). Children of NTDC caregivers entered legal adoptions (OR = 2.0; p = .003) and guardianships (OR = 2.9; p = .03) at higher rates than children of comparison caregivers, while rates of reunification (OR = 1.3; p = .11) were not statistically different. CONCLUSIONS: Evidence points to the effectiveness of NTDC in preparing resource parents to provide care for a diverse range of children by age, race, and ethnicity, and for those children to achieve permanency.

Pharmacokinetic and pharmacodynamic exploration of various combinations of tegoprazan immediate and delayed-release formulations.

AIMS: The new modified-release formulation of tegoprazan, a novel potassium-competitive acid blocker, is expected to improve the management of acid-related disease, including nocturnal acid breakthrough, by prolonging the duration of acid suppression. This study aimed to explore the pharmacokinetics (PK) and pharmacodynamics (PD) of various combinations of tegoprazan with immediate-release (IR) and delayed-release (DR) formulations. METHODS: A three-cohort, open-label, randomized, single-dose, three-treatment, six-sequence, three-period crossover study was conducted. Various combinations of tegoprazan IR and DR formulations (50, 75 or 100 mg) were administered orally once per period. The 24-h intragastric pH was monitored before and after each administration. PK blood samples were collected for up to 48 h. PK and PD were compared among treatments. RESULTS: Eighteen healthy Korean subjects completed the study. All treatment groups showed intragastric pH above 4 approximately 1 h following tegoprazan administration. Among the various combinations, the IR and DR combination at a 1:1 ratio induced greater gastric acid suppression (%Time pH ≥ 4) than IR alone in each dose group, both for 24 h (50 mg; 59% vs. 52%, P = .2188, 95% confidence interval [CI] -6.92-22.27, 100 mg; 85% vs. 70%, P < .05, 95% CI 8.92-22.19) and at night (50 mg; 27% vs. 16%, P = .1563, 95% CI -11.79-37.71, 100 mg; 77% vs. 49%, P < .05, 95% CI 16.14-42.98), with similar systemic exposure. CONCLUSIONS: The combinatorial tegoprazan in the IR and DR 1:1 ratio formulation was found to induce stronger gastric acid suppression throughout the day and at night, compared to the conventional IR formulation.

Impaired Cortisol and Growth Hormone Counterregulatory Responses among Severe Hypoglycemic Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Elevated levels of cortisol and growth hormone are critical counterregulatory responses to severe hypoglycemia. However, the proportion and clinical characteristics of patients with type 2 diabetes mellitus (DM) who fail to show appropriate cortisol and/or growth hormone secretion in response to severe hypoglycemia have not been investigated. METHODS: We measured plasma cortisol and growth hormone levels in type 2 DM patients with severe hypoglycemia who visited the emergency department between 2006 and 2015. RESULTS: Of 112 hypoglycemic patients, 23 (20.5%) had an impaired cortisol response (<18 µg/dL) and 82 patients (73.2%) had an impaired growth hormone response (<5 ng/mL). Nineteen patients (17.0%) had impaired responses to both cortisol and growth hormone. The patients with impaired responses of cortisol, growth hormone, and both hormones were significantly older and more likely to be female, and had higher admission rates, lower growth hormone levels, and lower adrenocorticotropic hormone levels than the patients with a normal hormonal response. Multivariate logistic regression analysis indicated that an impaired growth hormone response was significantly associated with advanced age, shorter DM duration, a higher admission rate, and a higher body mass index (BMI). An impaired cortisol response was significantly associated with growth hormone levels. Patients with an impaired growth hormone response had higher admission rates than patients with a normal response. CONCLUSION: A considerable number of type 2 DM patients had impaired cortisol and/or growth hormone responses to severe hypoglycemia. Advanced age, shorter DM duration, and higher BMI were independently associated with an abnormal growth hormone response.

New diagnostic criteria for subclinical hypercortisolism using postsurgical hypocortisolism: the Co-work of Adrenal Research study.

OBJECTIVE: There is no consensus on the biochemical diagnostic criteria for subclinical hypercortisolism (SH). Using parameters related to the hypothalamic-pituitary-adrenal axis, we aimed to develop a diagnostic model of SH for predicting postsurgical hypocortisolism and metabolic complications. DESIGN: Prospective and cross-sectional, observational, multicentre study in Korea. METHODS: After exclusion of overt Cushing's syndrome, adrenal incidentaloma (AI) patients who underwent unilateral adrenalectomy (n = 99) and AI patients (n = 843) were included. Primary outcome was defined as the presence of postsurgical hypocortisolism; secondary outcome was the presence of ≥4 complications (components of the metabolic syndrome and low bone mass). Postsurgical hypocortisolism was determined on the fifth postsurgery day using the ACTH stimulation test. RESULTS: Thirty-three of the 99 patients developed postsurgical hypocortisolism. Analysis of the presurgery overnight 1-mg dexamethasone suppression test (1-mg DST) showed that all patients with cortisol levels of >138 nmol/l experienced postsurgical hypocortisolism, whereas those with levels of ≤61 nmol/l did not. The models of (i) 1-mg DST >138 nmol/l or (ii) >61 nmol/l with the presence of one among low levels of ACTH and dehydroepiandrosterone-sulphate had the highest accuracy (89·9%, P < 0·001) and odds ratio [OR 111·62, 95% confidence interval (CI) 21·98-566·74, P < 0·001] for predicting postsurgical hypocortisolism. Finally, patients with the same criteria in the 843 AI patients showed the highest risk for having ≥4 complications (OR 3·51, 95% CI 1·84-6·69, P < 0·001), regardless of gender, age, body mass index and bilaterality. CONCLUSIONS: Our proposed model is able to accurately predict subtle cortisol excess and its chronic manifestations in AI patients.

Symptom-dependent cut-offs of urine metanephrines improve diagnostic accuracy for detecting pheochromocytomas in two separate cohorts, compared to symptom-independent cut-offs.

The development of advanced imaging techniques has increased the detection of subclinical pheochromocytomas. Because of the substantial proportions of subclinical pheochromocytomas, measurement of urine metanephrine concentrations is crucial due to detect or exclude pheochromocytoma. Although urine metanephrines are elevated in symptomatic subjects, diagnostic cut-offs according to the presence of adrenergic symptoms have not been studied. Pheochromocytomas patients who underwent adrenalectomy at Samsung Medical Center and a control group were compared to determine cut-off concentrations of urine metanephrines. An independent population was analyzed for urine metanephrines with different kits to validate the improvement in diagnostic accuracy using adjusted cut-offs. Symptom-dependent cut-offs of urine metanephrines were higher for symptomatic patients (307 µg/day in males, 235 µg/day in females for urine metanephrine, and 1,045 µg/day in males and 457 µg/day in females for urine normetanephrine) than for asymptomatic patients (206 µg/day in males, 199 µg/day in females for urine metanephrine, and 489 µg/day in males and 442 µg/day in females for urine normetanephrine). Symptom-dependent cut-offs of urine metanephrines improved a specificity from 92.7 % to 96.3 % and a high sensitivity of 97.8 % was maintained. Using the Symptom-dependent cut-offs raised diagnostic accuracy by 5.5 % (p <0.001). Similar trend was also observed in an independent population using different hormone kits. Using symptom-dependent cut-offs of urine metanephrines in symptomatic patients for pheochromocytomas resulted in a significant improvement in diagnostic accuracy in two separate cohorts.

Is an Oral Glucose Tolerance Test Still Valid for Diagnosing Diabetes Mellitus?

BACKGROUND: We evaluated the diagnostic rate of diabetes using fasting plasma glucose (FPG), 2-hour plasma glucose (2h PG) after 75 g oral glucose tolerance test (OGTT), and glycosylated hemoglobin (HbA1c) levels, and we elucidated the pathophysiologic characteristics and risk factors that give rise to diabetes in patients with prediabetes. METHODS: The data of 236 patients who had the OGTT at Konkuk University Hospital were analyzed. Fasting, 30, and 120 minutes blood glucose levels and insulin levels were measured. The diagnostic rate of diabetes was assessed using FPG, 2h PG, and HbA1c levels. The clinical data and insulin resistance and secretion evaluations were compared using indexes according to the fasting glucose level. RESULTS: Among 236 subjects, 97 (41.1%) were diabetics and 102 (43.2%) were prediabetics. The rate of diabetes diagnosis by one of the individual criteria was 56.7%, 53.6%, and 84.5% for FPG, HbA1c, and 2h PG, respectively. When two criteria were used to diagnose diabetes, 72.2% of the diabetic patients were identified by FPG and HbA1c, while 100% were identified by FPG and 2h PG, and 91.7% were identified by 2h PG and HbA1c. The HbA1c cut-off value for 2h PG ≥200 mg/dL was 6.1%, and the FPG cut-off value was 115 mg/dL. In impaired fasting glucose subjects, the HbA1c level, Matsuda index, and insulinogenic index were associated with risk of occurrence of overt diabetes (P<0.01). CONCLUSION: This study suggests that performing additional OGTT for patients with FPG ≥110 mg/dL or HbA1c ≥6.1% is helpful to reclassify their glucose tolerance status and evaluate their potential for progressing to overt diabetes.

Tailoring the physical properties of molybdenum disulfide monolayers by control of interfacial chemistry.

We demonstrate how substrate interfacial chemistry can be utilized to tailor the physical properties of single-crystalline molybdenum disulfide (MoS2) atomic-layers. Semiconducting, two-dimensional MoS2 possesses unique properties that are promising for future optical and electrical applications for which the ability to tune its physical properties is essential. We use self-assembled monolayers with a variety of end termination chemistries to functionalize substrates and systematically study their influence on the physical properties of MoS2. Using electrical transport measurements, temperature-dependent photoluminescence spectroscopy, and empirical and first-principles calculations, we explore the possible mechanisms involved. Our data shows that combined interface-related effects of charge transfer, built-in molecular polarities, varied densities of defects, and remote interfacial phonons strongly modify the electrical and optical properties of MoS2. These findings can be used to effectively enhance or modulate the conductivity, field-effect mobility, and photoluminescence in MoS2 monolayers, illustrating an approach for local and universal property modulations in two-dimensional atomic-layers.

Myxoid liposarcoma involving the liver, subcutaneous tissue, and epidural space in a polycystic disease patient.

We present a case of a myxoid liposarcoma involving the liver, subcutaneous tissue, and epidural space in a polycystic disease patient with minimally increased F-18 FDG activity and review the image findings of myxoid liposarcoma.

Comparison of virtual cystoscopy, multiplanar reformation, and source CT images with contrast material-filled bladder for detecting lesions.

OBJECTIVE: The objective of our study was to compare the diagnostic accuracy of virtual cystoscopy, multiplanar reformation, and source CT images for lesion detection in the contrast material-filled bladder. SUBJECTS AND METHODS: Two observers independently evaluated 47 patients (28 men and 19 women; mean age +/- SD, 59 +/- 16 years) with virtual cystoscopy, multiplanar reconstruction, and source CT images acquired with contrast material-filled bladder using an MDCT scanner (detector array, 4 x 1.25 mm; beam pitch, 0.75). Agreement between the two observers was evaluated for the three reconstruction methods using kappa statistics. Using the conventional cystoscopic findings as a reference, we compared the results of the three reconstruction techniques both by bladder site and by patient using the McNemar test. RESULTS: The interobserver agreement for the number of positive sites was excellent for virtual cystoscopy (kappa = 0.816), fair for multiplanar reconstruction (kappa = 0.461), and good for source CT images kappa = 0.676). For both observers, the sensitivity for lesion detection by bladder site was significantly greater with virtual cystoscopy (observer 1, 95%; observer 2, 90%) than with multiplanar reconstruction (78% and 60%) and source CT (68% and 65%) images (p < 0.05), whereas the specificity by bladder site and the sensitivity and specificity by patient did not differ with the three methods (p > 0.05). For determining the presence or absence of lesion at each site, virtual cystoscopy was more accurate than multiplanar reconstruction and source CT images for both observers (p < 0.05). CONCLUSION: Virtual cystoscopy is more accurate than multiplanar reconstruction and source CT images for the detection of lesions in the bladder.

Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging.

PURPOSE: To evaluate the enhancement pattern of bladder cancer and the accuracy of multi-detector row helical computed tomography (CT) in the detection and staging of bladder cancer. MATERIALS AND METHODS: In 20 patients, the attenuation value of bladder cancer was measured on dynamic contrast material-enhanced multiphasic CT images obtained with scanning delays of 40, 60, 80, and 100 seconds. In 67 patients, CT data were obtained with a 60-second scanning delay that covered the bladder (section thickness, 2.5 mm; beam pitch, 1.5) and a 180-second scanning delay that covered the abdomen (section thickness, 5 mm; beam pitch, 1.5). We prospectively evaluated CT images and compared findings at CT with findings at histologic examination. We evaluated cancer detection rate, positive predictive value of cancer detection, and sensitivity and specificity in the diagnosis of perivesical invasion. RESULTS: The attenuation value of bladder cancers was significantly higher on 60- (105 HU +/- 16) and 80-second (97 HU +/- 15) delayed CT images than on the other images (P <.05). The cancer detection rate and positive predictive value for cancer detection were 97% and 95%, respectively, in 67 patients and increased to 100% and 100%, respectively, in 44 patients with a time interval of 7 or more days between transurethral resection of the bladder (TURB) and CT examination. Sensitivity and specificity in the diagnosis of perivesical invasion were 89% and 95%, respectively, in 67 patients and increased to 92% and 98%, respectively, in 44 patients with a time interval of 7 or more days between TURB and CT examination. CONCLUSION: Bladder cancer tends to show peak enhancement with the 60-second scanning delay. Multi-detector row helical CT is useful in the detection and staging of bladder cancer.

Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT.

PURPOSE: To compare various computed tomographic (CT) features of angiomyolipoma (AML) with minimal fat with those of size-matched renal cell carcinoma (RCC). MATERIALS AND METHODS: Eighty-one patients (19 with AML with minimal fat [mean diameter, 2.8 cm; range, 1.5-4.5 cm] and 62 with RCC [mean diameter, 3.1 cm; range, 1.8-4.5 cm]) who had undergone biphasic CT (ie, CT with unenhanced, corticomedullary, and early excretory phase scanning) were evaluated. Two reviewers who were unaware of the diagnosis retrospectively recorded tumor attenuation on unenhanced scans, enhancement characteristics (ie, homogeneity of enhancement, amount of enhancement, enhancement pattern over time), tumor margin, location of tumor center, intratumoral calcification, perinephric changes, and patient age and sex. The predictive value of each CT finding was determined by using multivariate logistic regression analysis. RESULTS: Homogeneous enhancement (observed in 79% of AMLs vs 5% of RCCs; odds ratio, 37) and prolonged enhancement pattern (observed in 58% of AMLs vs 10% of RCCs; odds ratio, 42) were valuable predictors for differentiating AML with minimal fat from RCC at multivariate analysis (P <.05 for both). When both CT findings were used as a criterion for differentiating AML from RCC, positive and negative predictive values were 91% (10 of 11 tumors) and 87% (61 of 70 tumors), respectively. Fifty-three percent of AMLs versus 13% of RCCs showed high tumor attenuation on unenhanced scans (P =.04), whereas RCCs showed greater mean enhancement than AMLs (114 HU +/- 44 [SD] vs 73 HU +/- 30 in corticomedullary phase and 66 HU +/- 24 vs 49 HU +/- 20 in early excretory phase) and a male predominance (male-to-female ratio, 50:12 vs 8:11; P =.001). CONCLUSION: Biphasic helical CT may be useful in differentiating AML with minimal fat from RCC, with homogeneous tumor enhancement and prolonged enhancement pattern being the most valuable CT findings.

Living donor kidneys: usefulness of multi-detector row CT for comprehensive evaluation.

PURPOSE: To evaluate in living renal donors the usefulness of multi-detector row computed tomography (CT) in the assessment of renal vasculature and the upper urinary tract. MATERIALS AND METHODS: Four-channel multi-detector row CT scans were obtained in 77 patients. Vascular phase scans were used for CT angiography; excretory phase scans, for CT urography. At CT angiography, two independent observers evaluated the number of arteries and veins and the presence of early-branching arteries. CT urographic images were evaluated with regard to the opacification of the urinary tract and for abnormalities. Findings of CT angiography and urography were compared with surgical findings. Interobserver agreement between CT angiographic and surgical findings was quantified with weighted kappa statistics. Sensitivity and specificity of CT angiography in identifying supernumerary vessels and early-branching arteries were also evaluated. To evaluate the radiation dose to patients, weighted CT dose index (DI) was assessed for each scan. RESULTS: Agreement between CT angiographic and surgical findings was excellent for the number of renal arteries (kappa = 0.896) and veins (kappa = 0.843). Detection rate of CT angiography was 98% (89 of 91) for arteries and 98% (83 of 85) for veins. The respective sensitivity and specificity of CT angiography were 86% (12 of 14) and 100% (65 of 65) for supernumerary arteries, 100% (11 of 11) and 100% (66 of 66) for early-branching arteries, and 75% (six of eight) and 100% (69 of 69) for supernumerary veins. At CT urography, collecting systems and proximal ureters were well opacified in all patients; two patients had underrotated kidneys without obstruction. The weighted CT DI was 10.19 mGy for unenhanced and excretory phase scans and 12.88 mGy for the vascular phase scan. CONCLUSION: Multi-detector row CT can help assess well the renal vasculature and the urinary tract of living renal donors.