Validation of the Individualized Metabolic Surgery score in predicting long-term remission of diabetes after duodenal switch-type procedures.

AIM: To validate the Individualized Metabolic Surgery (IMS) score and assess long-term remission of type 2 diabetes (T2D) after duodenal switch (DS)-type procedures in patients with obesity. In addition, to help guide metabolic procedure selection for those patients categorized as having severe T2D. MATERIALS AND METHODS: This is a retrospective single cohort study of all patients with T2D and severe obesity, who underwent DS-type procedures at a single institution from December 2010 to December 2018. Study endpoints included validating the IMS score in our cohort and evaluating the impact of DS-type procedures on long-term (≥ 5 years) remission of T2D, especially in patients with severe disease. A receiver operator characteristic curve was used to assess the accuracy of the IMS score using the area under the curve (AUC). RESULTS: The study cohort included 30 patients with complete baseline and long-term glycaemic data after their index DS-type surgery. Twelve patients (40%) were classified with severe T2D, and the distribution of IMS-based severity groups was similar between our cohort and the original IMS study (P = .42). IMS scores predicted long-term T2D remission with AUC = 0.77. Patients with IMS-based severe diabetes achieved significantly higher long-term remission after DS-type procedures compared with gastric bypass and/or sleeve gastrectomy from the original IMS study (42% vs. 12%; P < .05). CONCLUSIONS: The IMS score properly classifies the severity of T2D in our study cohort and adequately predicts its long-term remission after DS-type procedures. While T2D remission decreases with more severe IMS scores, long-term remission remains high after DS-type procedures among patients with severe disease.

Ambulatory bariatric surgery: a prospective single-center experience.

BACKGROUND: Ambulatory bariatric surgery has recently gained interest especially as a potential way to improve access for eligible patients with severe obesity. Building on our previously published research, this follow-up study delves deeper in the evolving landscape of ambulatory bariatric surgery over a 3-year period, focusing on predictors of success/failure. METHODS: In a prospective single-center follow-up study, we conducted a descriptive assessment of all eligible patients as per our established protocol, who underwent a planned same-day discharge (SDD) primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 03/01/2021 and 02/29/2024. Trends in SDD surgeries over time were assessed over six discrete 6 month intervals. Primary endpoint was defined as a successful discharge on the day of surgery without emergency department visit or readmission within 24 h. Secondary outcomes included 30-day postoperative morbidity. RESULTS: A total of 811 primary SG and 325 RYGB procedures were performed during the study period. Among them, 30% (n = 244) were SDD-SGs and 6% (n = 21) were SDD-RYGBs, respectively. At baseline, median age of the entire SDD cohort was 43 years old, 81% were females, and body mass index (BMI) was 44.5 kg/m2. The planned SDD approach was successful in 89% after SG (n = 218/244) and in 90% after RYGB (n = 19/21). Nausea/vomiting was the main reason for a failed SDD approach after SG (46%). The 30-day readmission rate was 1.5% (n = 4) for the entire SDD cohort including only one readmission in the first 24 h. The percentage of SDD-SGs performed as a proportion of total SGs increased over the initial five consecutive six-month intervals (14%, 25%, 24%, 38%, and 49%). CONCLUSION: Our SDD protocol for bariatric surgery demonstrates a favorable safety profile, marked by high success rate and low postoperative morbidity. These outcomes have led to a continued increase in ambulatory procedures performed over time especially SG.

Clinical and radiographic peri-implant tissue changes for implants restored with convex or concave abutment shapes: A 3-year randomized controlled trial.

OBJECTIVES: The aim was to evaluate peri-implant tissue levels over a 3-year period for implants connected to either convex or concave final abutments at the time of implant placement. MATERIALS AND METHODS: In this randomized, double-masked, controlled clinical study, 28 patients with one missing maxillary premolar were assigned to receive one single implant with a permanent abutment of either convex (CONVEX Group) or concave (CONCAVE Group) emergence shape at the time of implant placement. Clinical and radiographic data were collected at the time of implant placement (IP), final prosthesis delivery (PR), 12 months (FU-1), and 36 months (FU-3) following implant placement. RESULTS: At the FU-3 13 patients were available from the CONCAVE Group (n = 13) and eleven from the CONVEX Group (n = 11). The mean change in buccal peri-implant mucosa position (MP) from IP to FU-3 was -0.54 ± 0.93 mm for the CONVEX Group and - 0.53 ± 0.87 mm for CONCAVE Group (p = .98). The amount of bone remodeling above the implant platform from IP to FU-3 was -0.69 ± 0.48 mm for the CONVEX Group and -0.16 ± 0.22 mm for the CONCAVE Group (p = .005). CONCLUSION: The study failed to support the hypothesis that abutment macro-design has an effect on buccal peri-implant mucosa margin position over time.

Longitudinal Studies of Wearables in Patients with Diabetes: Key Issues and Solutions.

Glucose monitoring is key to the management of diabetes mellitus to maintain optimal glucose control whilst avoiding hypoglycemia. Non-invasive continuous glucose monitoring techniques have evolved considerably to replace finger prick testing, but still require sensor insertion. Physiological variables, such as heart rate and pulse pressure, change with blood glucose, especially during hypoglycemia, and could be used to predict hypoglycemia. To validate this approach, clinical studies that contemporaneously acquire physiological and continuous glucose variables are required. In this work, we provide insights from a clinical study undertaken to study the relationship between physiological variables obtained from a number of wearables and glucose levels. The clinical study included three screening tests to assess neuropathy and acquired data using wearable devices from 60 participants for four days. We highlight the challenges and provide recommendations to mitigate issues that may impact the validity of data capture to enable a valid interpretation of the outcomes.

Audio-Based Drone Detection and Identification Using Deep Learning Techniques with Dataset Enhancement through Generative Adversarial Networks.

Drones are becoming increasingly popular not only for recreational purposes but in day-to-day applications in engineering, medicine, logistics, security and others. In addition to their useful applications, an alarming concern in regard to the physical infrastructure security, safety and privacy has arisen due to the potential of their use in malicious activities. To address this problem, we propose a novel solution that automates the drone detection and identification processes using a drone's acoustic features with different deep learning algorithms. However, the lack of acoustic drone datasets hinders the ability to implement an effective solution. In this paper, we aim to fill this gap by introducing a hybrid drone acoustic dataset composed of recorded drone audio clips and artificially generated drone audio samples using a state-of-the-art deep learning technique known as the Generative Adversarial Network. Furthermore, we examine the effectiveness of using drone audio with different deep learning algorithms, namely, the Convolutional Neural Network, the Recurrent Neural Network and the Convolutional Recurrent Neural Network in drone detection and identification. Moreover, we investigate the impact of our proposed hybrid dataset in drone detection. Our findings prove the advantage of using deep learning techniques for drone detection and identification while confirming our hypothesis on the benefits of using the Generative Adversarial Networks to generate real-like drone audio clips with an aim of enhancing the detection of new and unfamiliar drones.

Microbioreactor for lower cost and faster optimisation of protein production.

Optimisation of bioprocesses relies on approaches that are either labour intensive or require expensive robotic systems. There is a need for fluidic processing at low volume that can be integrated with existing bioprocess analytics to provide analytical information for the development and optimisation of bioprocesses. We demonstrate a 1 mL polymer inkjet 3D printed (i3DP) microbioreactor with integrated sensing (pH, oxygen and cell density) for optimisation of recombinant protein production with different feeds. A pressurised fluid driving system was used to control flow rates down to 0.7 µL min-1 with fluid switching from four reservoirs using a manifold controlled by solenoid valves. Oxygen transferred from a headspace via a gas-permeable membrane achieved a kLa of up to 90 h-1 at 1500 rpm. Cultivation of E. coli within the microbioreactor was comparable with a 2 L bench scale bioreactor, with optical densities of respectively 7.1 ± 0.4 and 6.5 ± 0.35. Triplicate batch cultivations within the microbioreactor of Pichia pastoris, with diauxic growth on glycerol (0.20 ± 0.02 h-1) and methanol (0.02 ± 0.04 h-1), showed good control of pH and DO and achieved a maximum dry cell weight of 10 ± 1 g L-1. For continuous cultivations, recombinant protein production was higher in pure methanol (314 ± 23) than methanol-sorbitol (202 ± 17) but reduces over time with lower cellular viability for methanol-glucose mixed feed, with less total protein produced and increases in DNA and proteases released. The developed system could be used in different applications including within synthetic biology, cell and gene therapy and organ-on-chips.

The influence of abutment macro-design on clinical and radiographic peri-implant tissue changes for guided, placed, and restored implants: A 1-year randomized controlled trial.

OBJECTIVES: The aim was to evaluate the peri-implant tissue levels over a 1-year period for implants connected to either convex or concave final abutments at the time of implant placement. MATERIALS AND METHODS: In this randomized, double masked, controlled clinical study, twenty-eight patients with one missing maxillary premolar were allocated to receive one single implant with abutment of either convex (CX Group) or concave (CV Group) emergence shape. A block randomization sequence was used to allocate treatments. Opaque sealed randomization envelopes were used for allocation concealment. All implants received final abutments and interim crowns at implant placement and permanent crowns following 3 months. Clinical and radiographic data were collected at the time of implant placement (IP), final prosthesis delivery (PR), and 12 months following implant placement (FU-1). RESULTS: One patient from the CX Group (n = 13) dropped out from the study and for one patient from CV Group (n = 13), the implant failed to integrate. The mean change in peri-implant buccal mucosa position (MP) from IP to FU-1 was -0.76 ± 0.72 mm for CX Group and -0.69 ± 0.89 mm for CV Group (p = 0.8). The amount of bone remodeling above the implant platform from IP to FU-1 was -0.66 ± 0.46 mm for the CX Group and -0.24 ± 0.25 mm for the CV Group (p = 0.007). Buccal bone thickness was significantly correlated with the amount of buccal MP change from IP to FU-1 (r = 0.4, p = 0.038). CONCLUSION: The study failed to support the hypothesis that abutment macro-design has an effect on peri-implant mucosa margin position changes over time.

Further studies on the role of the residue 890 cysteine to tyrosine mutation in the M70 primase ORF of the temperature-sensitive mutant (tsm5) of murine cytomegalovirus.

A mutation (C890Y) introduced into the M70 primase gene of murine cytomegalovirus (MCMV) resulted in reduced viral replication in murine embryo fibroblasts at 40°C and the mutant was severely attenuated in vivo. The attenuated replication of the M70 mutant was also observed in Raw 264.7 macrophages at 37°C, demonstrating that the mutation produced a defective rather than an unstable protein possibly reducing the amount of functional protein under different environmental conditions. Many synonymous mutations were introduced into this ORF by changing codon preferences that should reduce the efficiency of gene translation, but not change protein sequence or structure. Two Bacterial Artificial Chromosome (BAC) constructs were produced with 155 codons (at the distal third of the M70 gene) changed to MCMV less preferred codons and with either cysteine (BAC70(155Cys) ) or tyrosine (BAC70(155Tyr) ) at residue 890. Upon transfection of these BACs into NIH 3T3 cells, only BAC70(155Cys) produced virus and this mutant Mt70(155Cys) replicated similarly to its revertant and the wt MCMV K181 (Perth) variant. A metagenomic analysis of the protein structure of the primase using PredictProtein showed that the change from cysteine (M70Cys) to tyrosine (M70Tyr) has a marked effect on protein structure. However, when the cysteine residue was replaced by serine (M70Ser) or methionine (M70Met), which produced mutant viruses with a wild-type phenotype, the predicted structure was similar to the wild-type structure. J. Med. Virol. 88:1613-1621, 2016. © 2016 Wiley Periodicals, Inc.

The effect of variations in translucency and background on color differences in CAD/CAM lithium disilicate glass ceramics.

PURPOSE: The purpose of this study was to compare the effect of variations in translucency and background on color differences (ΔE) for different shades of computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate glass ceramics. MATERIALS AND METHODS: A pilot study suggested n = 10 as an appropriate sample size for the number of lithium disilicate glass ceramic cylinders per group. High-transparency (HT) and low-transparency (LT) cylinders (diameter, 12 mm; length, 13 mm) were fabricated in three ceramic shades (BL1, A2, C3) using CAD/CAM technology and were cut into specimen disks (thickness, 1.2 mm; diameter, 12 mm) for placement on Natural Die (ND1 and ND4) backgrounds. Four combinations of translucency and background color were evaluated in terms of color differences for the three ceramic shades: group 1 (HT ND1, reference), group 2 (HT ND4), group 3 (LT ND1), and group 4 (LT ND4). A spectrophotometer was used to measure the color differences. Nonparametric tests (Kruskal-Wallis tests) were used to evaluate the color differences among the tested groups, and Mann-Whitney U tests with Bonferroni correction were used as post hoc tests. Furthermore, for each ceramic shade, the HT groups were compared to the LT groups using the Mann-Whitney U test. RESULTS: Significant differences were present among the tested groups of the same ceramic shade (p < 0.001). The highest ΔE values were observed in the HT ND4 group for BL1, while the lowest ΔE values were found in the LT ND1 group for both A2 and C3. Further, the HT groups and the groups with a darker background (ND4) showed increased ΔE values compared with the other groups (p < 0.001). CONCLUSIONS: Within the limitations of this study, the results suggested that the translucency and background color significantly influenced the lithium disilicate glass ceramic color among the BL1, A2, and C3 ceramic shades. Changing the underlying color from a lighter background to a darker background resulted in increased color differences.

The potential liver injury induced by metronidazole-provoked disturbance of gut microbiota: modulatory effect of turmeric supplementation.

It has been reported that the gut-liver axis and intestinal microbiome contribute crucially to different liver diseases. So, targeting this hepato-intestinal connection may provide a novel treatment modality for hepatic disorders such as drug-induced liver injury (DILI). The present study thought to investigate the protective effect of turmeric (TUR) on metronidazole (MNZ)-induced liver damage and the possible association of the gut-liver axis and gut microbiota as a suggested underlying mechanism. In the first experiment, a MNZ-induced liver injury rat model was reproduced after 130 mg/kg oral MNZ administration for 30 days. Meanwhile, the treatment group was orally treated with 100 mg/kg turmeric daily. In the second experiment, fecal microbiome transplantation (FMT) was conducted, in which the fecal microbiome of each group in the first experiment was transplanted to a healthy corresponding group in the second experiment. The liver enzymes (aminotransferase (ALT) and aspartate aminotransferase (AST)) and histopathological examination were estimated to assess liver function. Inflammatory cytokines and oxidative markers were evaluated in the liver tissues. Histological analysis, intestinal barrier markers, and expression of tight junction proteins were measured for assessment of the intestinal injury. Changes in the gut microbial community and possible hepatic bacterial transmission were analyzed using 16S rRNA sequencing. MNZ induced intestinal and liver injuries which were significantly improved by turmeric. Increased firmicutes/bacteroidetes ratio and bacterial transmission due to gut barrier disruption were suggested. Moreover, TUR has maintained the gut microbial community by rebalancing and restoring bacterial proportions and abundance, thereby repairing the gut mucosal barrier and suppressing bacterial translocation. TUR protected against MNZ-induced gut barrier disruption. Reshaping of the intestinal bacterial composition and prohibition of the hepatic microbial translocation were suggested turmeric effects, potentially mitigating MNZ-related liver toxicity.

An attenuated temperature-sensitive strain of cytomegalovirus (tsm5) establishes immunity without development of CD8(+) T cell memory inflation.

Cytomegalovirus (CMV) is a widely prevalent herpesvirus that is well tolerated by an immune competent host yet establishes a state of chronic infection. The virus is thought to undergo frequent subclinical episodes of reactivation which leads to an unusually large accumulation of CMV-specific CD8(+) T lymphocytes in the peripheral blood, a phenomenon termed "memory inflation." The high magnitude of the CMV T cell response has been implicated in impaired immunity to heterologous pathogens such as EBV, influenza and West Nile virus. Here, using murine CMV (MCMV), we show that memory inflation of virus-specific CD8(+) T cells is avoided if mice are infected with a replication defective virus called temperature-sensitive mutant 5 (tsm5), which carries an attenuating mutation within the DNA primase gene. Mice infected with tsm5 do generate primary T cell responses towards viral proteins but these do not amass to skew the memory repertoire of CD8(+) T cells. Therefore, attenuation of the virus replication machinery may be valuable in future CMV vaccine designs because the virus remains immunogenic but does not contribute to CMV associated T cell immune senescence.

Accuracy of Non-Contrast CT Brain Interpretation by Emergency Physicians: A cohort study.

OBJECTIVE: To assess the accuracy of emergency physicians (EPs) in the interpretation of non-contrast CT Brain (NCCT Brain) by examining the inter rater reliability between EPs and radiology specialists. METHODOLOGY: A four months prospective cohort study was conducted at emergency department of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. We studied the daily performance of our EPs, and compared it to the radiological report issued within the week after. Data were analyzed by calculating sensitivity, specificity, accuracy and agreement (kappa statistic), using radiology report as the reference standard. Results : Out of 241 cases eligible for the study, 210 (87.14%) were concordant, and 31 (12.86%) were discordant. The agreement (kappa) was to be 0.64. Conclusion : We concluded that our EPs are moderately accurate at interpreting NCCT Brain studies. Further education and training programs were necessary for all our EPs to improve the accuracy. Further studies are required to determine the most cost-effective method of minimizing consequential misinterpretations.

Ionic Liquid Functionalized Metal-Organic Framework ([DEIm][PF6]@MOF-5): Synthesis, Characterization, and Catalytic Application in the Reduction of 4-Nitrophenol.

A novel, unique, highly effective, and recyclable heterogeneous catalyst, diethyl imidazolium hexafluorophosphate ionic liquid supported metal-organic framework ([DEIm][PF6]@MOF-5), has been synthesized using a simple impregnation method at ambient temperature. Characterization of the catalyst was done through various techniques such as Fourier transform infrared (FTIR), energy dispersive X-ray, X-ray diffraction (XRD), transmission electron microscopy, scanning electron microscopy (SEM), elemental mapping, Raman spectroscopy, X-ray photoelectron spectroscopy, and thermogravimetric analysis (TGA) analyses. The kinetic study has shown the high catalytic performance of [DEIm][PF6]@MOF-5 for the reduction of 4-nitrophenol (NP) compared to other catalysts. The catalyst also exhibited efficient electrochemical activity toward 4-NP reduction. The catalyst was recyclable for more than seven cycles without any significant loss in its catalytic performance. The recycled catalyst was further studied using XRD, FTIR, SEM, and TGA analyses to investigate the structural changes that occurred during the reaction. The catalyst maintained its structural integrity even after seven cycles.

Cardiovascular autonomic neuropathy is associated with increased glycemic variability driven by hyperglycemia rather than hypoglycemia in patients with diabetes.

AIM: Cardiac autonomic neuropathy (CAN) has been suggested to be associated with hypoglycemia and impaired hypoglycemia unawareness. We have assessed the relationship between CAN and extensive measures of glucose variability (GV) in patients with type 1 and type 2 diabetes. METHODS: Participants with diabetes underwent continuous glucose monitoring (CGM) to obtain measures of GV and the extent of hyperglycemia and hypoglycemia and cardiovascular autonomic reflex testing. RESULTS: Of the 40 participants (20 T1DM and 20 T2DM) (aged 40.70 ± 13.73 years, diabetes duration 14.43 ± 7.35 years, HbA1c 8.85 ± 1.70%), 23 (57.5%) had CAN. Despite a lower coefficient of variation (CV) (31.26 ± 11.87 vs. 40.33 ± 11.03, P = 0.018), they had a higher CONGA (8.42 ± 2.58 vs. 6.68 ± 1.88, P = 0.024) with a lower median LBGI (1.60 (range: 0.20-3.50) vs. 4.90 (range: 3.20-7.40), P = 0.010) and percentage median time spent in hypoglycemia (4 (range:4-13) vs. 1 (range:0-5), P = 0.008), compared to those without CAN. The percentage GRADEEuglycemia (3.30 ± 2.78 vs. 5.69 ± 3.09, P = 0.017) and GRADEHypoglycemia (0.3 (range: 0 - 3.80) vs. 1.8 (range: 0.9-6.5), P = 0.036) were significantly lower, while the percentage median GRADEHyperglycemia (95.45 (range:93-98) vs. 91.6 (82.8-95.1), P = 0.013) was significantly higher in participants with CAN compared to those without CAN. CONCLUSION: CAN was associated with increased glycemic variability with less time in euglycemia attributed to a greater time in hyperglycemia but not hypoglycemia.

Role of mutations identified in ORFs M27, M36, m139, m141, and m143 in the temperature-sensitive phenotype of murine cytomegalovirus mutant tsm5.

A mutant of murine cytomegalovirus (MCMV), tsm5, which is temperature-sensitive for replication in murine embryo fibroblasts at 40°C, failed to replicate to detectable levels in mice. A total of 18 non-synonymous mutations have been identified in tsm5. In a previous study, a mutation (C890Y) identified in the M70 primase gene, when introduced into the wt M70 primase, resulted in a mutant with reduced viral replication at 40°C in vitro and which was severely attenuated in vivo. Five other previously identified mutations may also contribute to the tsm5 phenotype: (1) an A658S mutation in a protein expressed by the M27 ORF; (2) a V54I mutation in M36; (3) a Y565* mutation in m139; (4) a V195M mutation in m141; and (5) an M232I mutation in m143. In the present study, the above-mentioned mutations were introduced individually (M27, M36, m139, m141, m143) or together (M27/M36) into the MCMV K181 (Perth) variant bacterial artificial chromosome (BAC) using RecE/T homologous recombination. Growth in culture revealed that, apart from the double mutant (M27 and M36) and the m139 mutant, the introduced mutations in the above-mentioned genes did not show a temperature-sensitive phenotype in MEF or Raw 264.7 macrophage cells compared to their revertants or the wt virus. In contrast, replication of the M27/M36 double mutant was drastically reduced in MEFs at 40°C and in macrophages at 37°C. Replication of the m139 mutant was reduced in MEF cells at 40°C but not in macrophages. Thus, at least three further mutations contribute to the tsm5 phenotype.

Effectiveness of the Superiorly Based Pharyngeal Flap in Treating Velopharyngeal Insufficiency.

Velopharyngeal insufficiency (VPI) is a condition characterized by failure of the posterior part of the soft palate to reach the pharyngeal wall and separate the nasopharynx from the oropharynx during speech and swallowing. VPI may persist following cleft palate repair. This study aimed to determine the outcomes of the superiorly based pharyngeal flap to treat VPI post cleft palate repair. Methods: A retrospective cohort study included patients with VPI post cleft palate repair who underwent secondary speech surgery. The criteria were based on clinical symptoms, physical examination, nasometry, and videofluoroscopy/nasoendoscopy findings. Data were analyzed by using SPSS program, version 22.0. A P value less than 0.05 was considered significant. Results: Thirty-five patients were identified. VPI was reduced to 14.3% postoperatively. Before the surgery 25.7% of the patients had severe hypernasality, 68.6% had moderate hypernasality, and 5.7% had mild hypernasality. After the surgery, only 8.6% of the patients still had severe hypernasality, 22.9% had moderate hypernasality, 57.1% had mild hypernasality, and hypernasality became absent in 11.4%. Articulation disorders were present in 91.4% of patients before surgery, and decreased to 71.4% postoperatively. Speech intelligibility improved postoperatively in comparison with preoperative findings. Conclusion: The present study concluded that the superiorly based pharyngeal flap was successful in treating VPI that persisted post cleft palate repair.

Sense and Learn: Recent Advances in Wearable Sensing and Machine Learning for Blood Glucose Monitoring and Trend-Detection.

Diabetes mellitus is characterized by elevated blood glucose levels, however patients with diabetes may also develop hypoglycemia due to treatment. There is an increasing demand for non-invasive blood glucose monitoring and trends detection amongst people with diabetes and healthy individuals, especially athletes. Wearable devices and non-invasive sensors for blood glucose monitoring have witnessed considerable advances. This review is an update on recent contributions utilizing novel sensing technologies over the past five years which include electrocardiogram, electromagnetic, bioimpedance, photoplethysmography, and acceleration measures as well as bodily fluid glucose sensors to monitor glucose and trend detection. We also review methods that use machine learning algorithms to predict blood glucose trends, especially for high risk events such as hypoglycemia. Convolutional and recurrent neural networks, support vector machines, and decision trees are examples of such machine learning algorithms. Finally, we address the key limitations and challenges of these studies and provide recommendations for future work.

Breath Analysis for the In Vivo Detection of Diabetic Ketoacidosis.

Human breath analysis of volatile organic compounds has gained significant attention recently because of its rapid and noninvasive potential to detect various metabolic diseases. The detection of ketones in the breath and blood is key to diagnosing and managing diabetic ketoacidosis (DKA) in patients with type 1 diabetes. It may also be of increasing importance to detect euglycemic ketoacidosis in patients with type 1 or type 2 diabetes or heart failure, treated with sodium-glucose transporter-2 inhibitors (SGLT2-i). The present research evaluates the efficiency of colorimetry for detecting acetone and ethanol in exhaled human breath with the response time, pH effect, temperature effect, concentration effect, and selectivity of dyes. Using the proposed multidye system, we obtained a detection limit of 0.0217 ppm for acetone and 0.029 ppm for ethanol in the detection range of 0.05-50 ppm. A smartphone-assisted unit consisting of a portable colorimetric device was used to detect relative red/green/blue values within 60 s of the interface for practical and real-time application. The developed method could be used for rapid, low-cost detection of ketones in patients with type 1 diabetes and DKA and patients with type 1 or type 2 diabetes or heart failure treated with SGLT2-I and euglycemic ketoacidosis.

Continuous glucose monitoring reveals a novel association between duration and severity of hypoglycemia, and small nerve fiber injury in patients with diabetes.

Objective: Continuous glucose monitoring (CGM) has revealed that glycemic variability and low time in range are associated with albuminuria and retinopathy. We have investigated the relationship between glucose metrics derived from CGM and a highly sensitive measure of neuropathy using corneal confocal microscopy in participants with type 1 and type 2 diabetes. Methods: A total of 40 participants with diabetes and 28 healthy controls underwent quantification of corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and inferior whorl length (IWL) and those with diabetes underwent CGM for four consecutive days. Results: CNBD was significantly lower in patients with high glycemic variability (GV) compared to low GV (median (range) (25.0 (19.0-37.5) vs 38.6 (29.2-46.9); P = 0.007); in patients who spent >4% compared to <4% time in level 1 hypoglycemia (54-69 mg/dL) (25.0 (22.9-37.5) vs 37.5 (29.2-46.9); P = 0.045) and in patients who spent >1% compared to <1% time in level 2 hypoglycemia (<54 mg/dL) (25.0 (19.8-41.7) vs 35.4 (28.1-44.8); P = 0.04). Duration in level 1 hypoglycemia correlated with CNBD (r = -0.342, P = 0.031). Duration in level 1 (181-250 mg/dL) and level 2 (>250 mg/dL) hyperglycemia did not correlate with CNFD (P > 0.05), CNBD (P > 0.05), CNFL (P > 0.05) or IWL (P > 0.05). Conclusions: Greater GV and duration in hypoglycemia, rather than hyperglycemia, are associated with nerve fiber loss in diabetes.