Acyl Hydrazides as Insecticides: Synthesis, Biochemical, Structure-Activity Relationship Studies and Insecticidal Activity of some IGRs Analogues Against Spodoptera littorallis (Boisd.).

The exponential rise in pesticide resistance to conventional chemical pesticides is another major factor driving the development of novel insecticidal active agents. One approach to solving this problem is to investigate novel classes and environmentally safe insecticidal chemicals with a variety of modes of action. Among these techniques is the creation of novel tebufenozide derivatives. Tebufenozide belongs to the insect growth regulator class of insecticides and is regarded as one of the safest chemical insecticides ever. The toxicological and biochemical efficiency of each analog was assessed against the Spodoptera littoralis pest in both its second and fourth instar larvae. The bioassay results show that compound 7 was the most effective insecticidal agent, with LC50 values of 10.6.5 and 18.7 mg/L against S. littoralis larvae in their second and fourth instar larvae, respectively. Finally, it was shown how treatment with the LC50 of the examined substances affected the activity of many enzymes involved in the cuticle production of S. littoralis larvae in their fourth instar. From this study, it was concluded that Acyl hydrazide are helpful for the management of S. littoralis and will be an effective replacement for other synthetic insecticides.

The missing link between cancer stem cells and immunotherapy.

Cancer stem cells (CSCs) are cancer cells that can self-renew and give rise to tumors. The multipotency of CSCs enables the generation of diverse cancer cell types and their potential for differentiation and resilience against chemotherapy and radiation. Additionally, specific biomarkers have been identified for them, such as CD24, CD34, CD44, CD47, CD90, and CD133. The CSC model suggests that a subset of CSCs within tumors is responsible for tumor growth. The tumor microenvironment (TME), including Fibroblasts, immune cells, adipocytes, endothelial cells, neuroendocrine (NE) cells, extracellular matrix (ECM), and extracellular vesicles, has a part in shielding CSCs from the host immune response as well as protecting them against anticancer drugs. The regulation of cancer stem cell plasticity by cancer-associated fibroblasts (CAFs) occurs through specific signaling pathways that differ among various types of cancer, utilizing the IGF-II/IGF1R, FAK, and c-Met/FRA1/HEY1 signaling pathways. Due to the intricate dynamics of CSC proliferation, controlling their growth necessitates innovative approaches and much more research. Our current review speculates an outline of how the TME safeguards stem cells, their interaction with CSCs, and the involvement of the immune and inflammatory systems in CSC differentiation and maintenance. Several technologies have the ability to identify CSCs; however, each approach has limitations. We discuss how these methods can aid in recognizing CSCs in several cancer types, comprising brain, breast, liver, stomach, and colon cancer. Furthermore, we explore different immunotherapeutic strategies targeting CSCs, including stimulating cancer-specific T cells, modifying immunosuppressive TMEs, and antibody-mediated therapy targeting CSC markers.

Intermolecular interactions in water and ethanol solution of ethyl acetate: Raman, DFT, MEP, FMO, AIM, NCI-RDG, ELF, and LOL analyses.

CONTEXT: The intermolecular interactions of ethyl acetate (EtOAc)-water (H2O)/ethanol (EtOH) mixtures were investigated using a combination of Raman spectroscopy and quantum chemical calculations. The computational approach was used to analyze the structure of hydrogen-bonded complexes of ethyl acetate with water/ethanol molecules, based on density functional theory (DFT). The calculated frequencies closely matched the experimental Raman values, with differences being under 4%. Experimental data show that when the concentrations of ethyl acetate in the ethyl acetate/water/ethanol solutions were reduced, almost all Raman spectral bands are blue-shifted. The AIM analysis reveals that all the given complexes possess a positive energy density, indicating that the molecules interact electrostatically. The energy and bond length indicate that the methyl group forms relatively weak hydrogen bonds. Analysis indicates that EtOAc forms weak H-bonding C = O∙∙∙H and C-H∙∙∙O, which are recognized as van der Waals interactions. As the amount of ethyl acetate decreases in the complex, the interaction forces also decrease. This could also explain why the bands are blue-shifted. It was discovered that the title complexes' hydrogen bond energy decreased exponentially as bond length increased. METHODS: The geometries of the molecular complexes were optimized using the Gaussian 09W program and the B3LYP/6-311 + + G(d,p) set of functions. The potential energy distribution (PED) analysis was performed using VEDA 4.0 software. Raman spectra were drawn using the Origin 8.5 software. The Multiwfn 3.8 software was used to calculate topological parameters of electron density in molecular systems. GaussView 6.0 and Visual Molecular Dynamics (VMD) 1.9.3 tools were used to visualize all computational results.

Future Prospects of Metabolic and Bariatric Surgery: A Comprehensive Review.

BACKGROUND: The field of metabolic and bariatric surgery (MBS) is currently an expanding surgical field with constant refinements in techniques, outcomes, indications, and objectives. MBS has been effectively applied across diverse patient demographics, including varying ages, genders, body mass indexes, and comorbidity statuses. METHODS: We performed a comprehensive literature review of published retrospective cohort studies, meta-analyses, systematic reviews, and literature reviews from inception to 2024, reporting outcomes of MBS using databases such as PubMed, ScienceDirect, and Springer Link. RESULTS: MBS is a safe and efficient therapeutic option for patients with obesity and associated medical conditions (mortality rate 0.03-0.2%; complication rates 0.4-1%). The favorable safety profile of MBS in the short-, mid-, and long-term offers the potential to treat patients with obesity and type 2 diabetes mellitus, immunosuppression, chronic anticoagulation, neoplastic disease, and end-organ failure without increased morbidity and mortality. CONCLUSIONS: In conclusion, the future of MBS lies in the ongoing innovation and adapted therapeutic strategies along with the integration of a variety of other techniques for managing obesity. Careful preoperative assessments, coupled with a multidisciplinary approach, remain essential to ensure optimal surgical outcomes and patient satisfaction after MBS.

Effect of Diabetes Education on Complications and Diabetic Control Amongst Adult Patients with Diabetes in Madinah, Saudi Arabia.

BACKGROUND: Diabetes is a chronic condition that may become dangerous if there is insufficient insulin to help the body function properly. The proper care for diabetes depends on how well patients observe guidelines and prescriptions; consequently, patient education is critical. Poor learning may cause bad treatment and complications or other problems related to the disease. OBJECTIVES: This study aims to evaluate patients' knowledge of diabetes, assigning a knowledge (K) score out of 100, and investigate the possible impact of educating patients, through general means or via healthcare professionals, on patient knowledge of diabetes control demonstrated in the absence/presence of diabetic complications. METHODS: This multi-center interview-based cross-sectional study used a questionnaire in Madinah, Saudi Arabia. This study was conducted on adults with diabetes who were aged 15-80. We used the Michigan Diabetic Knowledge Test (MDKT) to assess the knowledge of patients with diabetes. RESULTS: This study included 364 participants. The gender distribution was 48.33% male and 51.67% female. Most of them had type 2 diabetes (T2DM) without insulin (48.63%), followed by those with T2DM on insulin (36.26%), and patients with type 1 diabetes (T1DM) (15.11%). Patients with T2DM had significantly higher K scores than patients with type 1. Additionally, T2DM non-insulin patients' k-scores significantly exceeded those with T1DM. General and healthcare education both helped increase patients' K-scores. Mostly, patients with diabetes without any complications had significantly higher knowledge compared to those having them. Lastly, regardless of whether the education was delivered by general or professional means, the effect on glycated hemoglobin (HbA1C) levels was not significant. CONCLUSIONS: Our study revealed that patients with T2DM exhibited higher knowledge than patients with T1DM. Furthermore, receiving education, whether by a healthcare professional or by general means, improved the knowledge levels of patients with T2DM but not patients with T1DM. Regarding diabetes complications, it was found that those with a higher level of knowledge had fewer complications. However, no evidence receiving education influenced the levels of HbA1C, neither in patients with T1DM nor T2DM.

New Antibacterial and Antioxidant Chitin Derivatives: Ultrasonic Preparation and Biological Effects.

This work focuses on the first use of ultrasonic phenol-ene coupling as a polymer analogous transformation. The ultrasonic reaction was introduced into chitin chemistry, resulting in the fast and convenient preparation of new water-soluble cationic chitin derivatives. Since water-soluble derivatives of fully deacetylated chitin are poorly described in the literature, the synthesis of each new type of these derivatives is a significant event in polysaccharide chemistry. Polycations, or cationic polymers, are of particular interest as antibacterial agents. Consequently, the resulting polymers were tested for their antibacterial activity and toxicity. We found that the highly substituted polymer of medium molecular weight exhibited the most pronounced in vitro antibacterial effect. We prepared nanoparticles using the ionic gelation technique. The most effective in vitro antibacterial chitin-based systems were tested in vivo in rats. These tests demonstrated outstanding antibacterial effects combined with an absence of toxicity. Additionally, we found that the resulting polymers, unlike their nanoparticle counterparts, also exhibited strong antioxidant effects. In summary, we demonstrated the effectiveness of ultrasound in polymer chemistry and highlighted the importance of the sonochemical approach in the chemical modification of polysaccharides. This approach enables the synthesis of derivatives with improved physicochemical and biological properties.

Novel Surgical Interventions for the Treatment of Obesity.

Metabolic and bariatric surgery is widely recognized as the most effective and durable treatment for the disease of obesity and its associated comorbidities. In recent years, the field has seen significant advancements, introducing numerous innovative surgical options. This review aims to comprehensively examine these emerging surgical techniques, which have recently received endorsement from the American Society for Metabolic and Bariatric Surgery (ASMBS). Additionally, we will explore new technologies and methodologies supported by the latest scientific evidence. Our analysis will include a critical evaluation of the efficacy, safety, and long-term outcomes of these novel approaches, providing a detailed update on the current state of metabolic and bariatric surgery, highlighting key developments and their potential implications for clinical practice.

Analysis of UNOS: Berlin Heart Bridge-to-Transplant in Acquired versus Congenital Heart Disease.

BACKGROUND: We evaluated long-term survival in pediatric patients bridged-to-transplant with Berlin Heart, comparing those with congenital heart disease (CHD) to those with acquired heart disease (AHD). METHODS: The United Network for Organ Sharing Database was queried for patients (<18years) who received a heart transplant in the United States and were preoperatively supported with Berlin Heart. Patients were stratified by AHD versus CHD diagnosis. Univariable and multivariable analysis was performed to assess baseline characteristics and post-transplant survival. RESULTS: This cohort included 806 patients (n=573 AHD, n=233 CHD). CHD and AHD patients were of similar size (weight[kg], 12.8±9.27 versus 15.3±13.6, p=0.107) and most were aged<1 year (34.9%, n=281) or 1-5 years (45.3%, n=365). Ventricular assist device configuration differed between CHD and AHD patients-70.4%[n=164] versus 75%[n=430] were supported with left ventricular assist device, 9.9%[n=23] versus 0.7%[n=4] were supported with right ventricular assist device, and 19.7%[n=46] versus 24.3%[n=139] were supported with biventricular assist device (p<0.001). CHD patients were more often male (57.1%[n=133] versus 46.9%[n=269], p=0.011) and had worse estimated 5-year post-transplant survival at 74.3%(95% CI=67.5%-81.7%) compared to 85.8%(95% CI=82.5%-89.2%) in patients with AHD. However, for patients who survived the first year post-transplant, post-transplant survival was similar between groups (p>0.05 at 2-,3-,4-, and 5-years). In multivariable analysis, CHD diagnosis was significantly associated with an increased risk for mortality (HR=1.645, 95% CI=1.075-2.487, p=0.021). CONCLUSIONS: After controlling for demographic variations and pretransplant risk factors, patients with CHD bridged-to-transplant with Berlin Heart had worse long-term survival than patients with AHD bridged-to-transplant with Berlin Heart.

Teaching trainees to implement functional communication training with multiple schedules: An evaluation of training effects and durability.

We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules when working with a confederate. Behavioral skills training produced mastery-level responding for all six participants who required training, providing the first empirically supported training for this functional communication training approach. Next, we assessed durability during training challenges with (a) procedural changes to the original protocol, (b) a novel confederate with different discriminative stimuli and reinforcers, and (c) relapsed confederate destructive behavior. Training effects degraded at least once for all participants and in 62% of training challenges, although continuing to expose the participant to the challenging situations or providing postsession booster training resolved the degradation in most cases. We discuss these findings in relation to their clinical implications and directions for future research.

Effect of adding diaphragmatic myofascial release to corrective exercise on the thoracic curvature angle and pulmonary function testing in hyperkyphotic adolescent girls: A randomized controlled trial.

OBJECTIVE: To investigate whether adding diaphragmatic release to corrective exercise could improve the Cobb angle and pulmonary function more than corrective exercise alone in hyperkyphotic adolescent girls. DESIGN: Single-blinded, randomized, controlled trial. METHODS: 118 adolescent hyperkyphotic girls were allocated randomly into two equal groups. Control group received only corrective exercise, while study group received diaphragmatic release in addition to corrective exercise. Primary outcome was Cobb angle, assessed by lateral radiographs. Secondary outcomes were pulmonary function testing, assessed by computerized spirometery. Outcomes were assessed pre- and post-treatment, after three months of interventions, in both groups. RESULTS: Two-way ANOVA revealed that both Cobb angle and pulmonary function testing significantly improved after treatment in both groups (p < 0.001). Time*group interaction revealed that the study group had a superior improvement in Cobb angle and pulmonary function testing compared to the control group (p < 0.003 and p < 0.001, respectively). CONCLUSION: Adding diaphragmatic release to three months of multimodal corrective exercise program showed superior improvements in Cobb angle and pulmonary function testing than corrective exercise alone in hyperkyphotic adolescent girls within a shorter timeframe compared to previous studies. These results strengthen the hypothesis of its potential as a beneficial addition to the treatment of thoracic hyperkyphosis.

Parsimonious System Identification from Fragmented Quantized Measurements.

Quantization is the process of mapping an input signal from an infinite continuous set to a countable set with a finite number of elements. It is a non-linear irreversible process, which makes the traditional methods of system identification no longer applicable. In this work, we propose a method for parsimonious linear time invariant system identification when only quantized observations, discerned from noisy data, are available. More formally, given a priori information on the system, represented by a compact set containing the poles of the system, and quantized realizations, our algorithm aims at identifying the least order system that is compatible with the available information. The proposed approach takes also into account that the available data can be subject to fragmentation. Our proposed algorithm relies on an ADMM approach to solve a ℓ p , 0 < p < 1 , quasi-norm objective problem. Numerical results highlight the performance of the proposed approach when compared to the ℓ 1 minimization in terms of the sparsity of the induced solution.

Quality of Postoperative Pain Management in Orthopedic Patients and Its Impact on Sleep Quality and Patient Satisfaction: An Integrative Review.

Pain is one of the most common manifestations in the postoperative stage and it has a detrimental effect on both sleep and patient satisfaction. Consequently, this integrative review seeks to identify the outcomes of pain management specifically concerning sleep quality and patient satisfaction among the patients receiving orthopedic surgeries. In a stepwise manner, peer-reviewed articles manually searched in four databases including Scopus, Science Direct, PubMed, and CINAML (Cumulated Index to Nursing and Allied Health Literature) published between 2019 and 2023 were selected. The current review finally encompassed 22 studies. The review elaborates and reaffirms the notion that pain after surgery is still a critical issue that impacts the quality of patients' sleep as well as their overall satisfaction. Chronic sleep disturbance is generally linked with pain while other factors such as light exposure and hospital environment were found to influence sleep quality. It is thus crucial to develop clear multifaceted pain management guidelines that include patient-tailored pharmacological and non-pharmacological interventions aimed at helping patients recover better, sleep better, and be satisfied with the procedures and results.

Periprosthetic Joint Infection: What's New?

Total joint arthroplasty (TJA) ranks among the most commonly performed orthopedic surgeries, with its annual incidence on the rise globally. Periprosthetic joint infection (PJI) remains a leading cause of arthroplasty failure. This review aims to summarize recent literature updates on the epidemiology, diagnosis, and management of PJI.

Procurement Trends, Indications, and Outcomes of Heart-Lung Transplantation in the Contemporary Era.

BACKGROUND: Evolving trends in organ procurement and technological innovation prompted an investigation into recent trends, indications, and outcomes following combined heart-lung transplantation (HLTx). METHODS: The United Network for Organ Sharing database was queried for all adult (≥18 years) HLTx performed between July 1, 2013 and June 30, 2023. Patients with previous transplants were excluded. The primary endpoint was the effect of donor, recipient, and transplantation characteristics on 1- and 5-year survival. Secondary analyses included a comparison of HLTx at high- and low-volume centers, an assessment of HLTx following donation after circulatory death (DCD), and an evaluation of HLTx volume over time. Cox proportional-hazards models were used to assess factors associated with mortality. Temporal trends were evaluated with linear regression. RESULTS: After exclusions, 319 patients were analyzed, of whom 5 (1.6%) were DCD. HLTx volume increased from 2013 to 2023 (p < 0.001). One- and 5-year survival following HLTx was 84.0% and 59.5%, respectively. One-year survival was higher for patients undergoing HLTx at a high-volume center (88.3% vs. 77.9%; p = 0.012). After risk adjustment, extracorporeal membrane oxygenation support 72 h posttransplant and predischarge dialysis were associated with increased 1-year mortality (HR = 3.19, 95% CI = 1.86-5.49 and HR = 3.47, 95% CI = 2.17-5.54, respectively) and 5-year mortality (HR = 2.901, 95% CI = 1.679-5.011 and HR = 3.327, 95% CI = 2.085-5.311, respectively), but HLTx at a high-volume center was not associated with either. CONCLUSIONS: HLTx volume has resurged, with DCD HLTx emerging as a viable procurement strategy. Factors associated with 1- and 5-year survival may be used to guide postoperative management following HLTx.

Fate of Abstracts Presented at Annual Meetings of The Society of Thoracic Surgeons from 2015 to 2019.

BACKGROUND: Society of Thoracic Surgeons (STS) annual meetings provide opportunities to disseminate cardiothoracic research. We assessed rates of publication of STS abstracts as manuscripts in peer-reviewed journals over five years and determined factors associated with successful publication. METHODS: The STS "Annual Meeting Archive" was searched online for abstract books from STS annual meetings from 2015-2019. Abstract books were reviewed for information about presented abstracts. A PubMed and Google search was then performed to identify corresponding peer-reviewed journal publications. RESULTS: A total of 1451 abstracts were presented at STS annual meetings from 2015-2019. Overall publication rate of accepted abstracts as manuscripts in peer-reviewed journals was 1097/1451=75.60%. Most published manuscripts were published in The Annals of Thoracic Surgery (750/1097=68.37%). Median duration between abstract presentation and peer-reviewed journal publication was 313[IQR=212.5-458] days. Only 29/1451=2.00% of abstracts won an award, and all 29 of these award-winning abstracts were published as a manuscript. Oral presentation was associated with increased odds of publication compared to poster presentation (OR=1.28[95% CI=1.04-1.71], p=0.021). Median 5-year impact factor of peer-reviewed journals containing these manuscripts was 5.04[IQR=5.04-5.04], and corresponding manuscripts were cited a median of 4[IQR=1-9] times. Overall, 836/1097=76.20% of manuscripts published in peer-reviewed scientific journals had a corresponding North American author. CONCLUSIONS: Annual STS meetings are a forum for the presentation of high-quality research. The rate of publication of accepted STS abstracts as manuscripts in peer-reviewed journals is >75%, comparing favorably with national meetings of other surgical societies, and >2/3 of published manuscripts are published in STS's official journal.

Bibliometric Research in Neurosurgery: A Review of the 50 Most Cited Bibliometric Publications in the Neurosurgical Literature.

Bibliometry is a popular research method that is used to explore and analyze large volumes of data in an effort to highlight trends, patterns, and impacts within a specific field. This review aimed at highlighting the characteristics and citation patterns of the high-impact bibliometric research studies that were published in the neurosurgical literature. Using PubMed and Google Scholar, the 50 (52 due to identical citation numbers for the lowest three articles) most cited bibliometric research publications were identified and reviewed. Information relating to the articles' publication and bibliometric features were retrieved. The articles' citation numbers were collected. The median article age and journal impact factor (IF) were eight years and 2.76, respectively. The majority of studies were published in World Neurosurgery and the Journal of Neurosurgery, which were the publishing journals for 18 (35%) and 12 (23%) articles, respectively. Twenty-six (50%) articles were first authored by researchers from the United States of America (USA). The highest bibliometric component was science mapping, which was the theme in 30 (58%) articles. The majority of the bibliometric focus was clinical topics/fields (22 (42%) articles) and neurosurgeons/departments (21 (40%) articles). The most popular bibliometric metric was the h-index (±variants), which was employed in 22 (42%) articles. The median size of analyzed data was 188, and the most frequently utilized databases were Scopus (22 (42%) articles) and Web of Science (21 (40%) articles). The median (range) citation numbers were 52 (29-238). The citation analysis showed significantly higher citation numbers for older articles (aged ≥ 8 years) and studies published in the Journal of Neurosurgery. The citation rates were not influenced by the size of the data, the searched databases, or the bibliometric features. In conclusion, the most cited bibliometric research publications in the neurosurgical literature were predominantly descriptive analyses of clinical topics/fields and performance analyses of neurosurgeons/departments. Their citation numbers were relatively modest and were positively influenced by the publication's age and by a specific publishing journal but not by the bibliometric features of the study. Bibliometric research provides useful analytic tools that can be utilized in review studies and other practical purposes such as scholarly practices and policy decision-making.

Rhabdomyolysis Induced by Levetiracetam: A Case Report in Kuwait.

Epilepsy is a common disorder caused by a myriad of drugs, of that levetiracetam is being commonly used late because of its strong safety profile and efficacy. With the increasing usage of drugs, some rare side effects may sometimes appear that can escape the most stringent checks, possibly due to the rarity of their occurrence. Rhabdomyolysis is known to occur in some patients owing to a variety of causes, even leading to kidney injury. When a drug has a side effect that is not well recognized in the literature, especially when the side effect can mimic an adverse effect of an uncommon primary illness, identifying the causal factor can be doubly difficult. To date, only limited studies have been published suggesting rhabdomyolysis linked to levetiracetam use. We report the first case of levetiracetam-induced rhabdomyolysis in Kuwait.

Interventions to mitigate pregnancy-related mortality and morbidity in Black birthing people: a systematic review.

OBJECTIVE: To conduct a systematic review of interventions to improve perinatal outcomes to mitigate pregnancy-related mortality and morbidity in Black birthing people. DATA SOURCES: We searched 5 databases from 2000 through the final search date of April 5, 2023: Cumulative Index of Nursing and Allied Health Literature Plus with Full Text (EBSCOhost), Embase (Elsevier), PubMed, and Scopus (Elsevier) and ClinicalTrials.gov. STUDY ELIGIBILITY CRITERIA: Only quantitative studies were eligible including observational and randomized controlled trials. All participants in selected studies must identify as Black or study results must be stratified by race that includes Black birthing people. The study must (1) measure a perinatal outcome of interest (2) occur in the United States and (3) be written in the English language. Studies were excluded if they were published prior to 2000, not published in the English language, or did not meet the criteria above. STUDY APPRAISAL AND SYNTHESIS METHODS: A data extraction template identified intervention type and perinatal outcome. Perinatal outcomes included but were not limited to: cardiovascular disorders, mortality, or preterm delivery. Interventions included: community programs, educational enhancement, individual counseling, medical intervention, or policy. Risk of bias was assessed using the Mixed Method Appraisal Tool. Three investigators assessed studies individually and group consensus was used for a final decision. RESULTS: From 4,302 unique studies, 41 studies met inclusion criteria. Community programs such as the Supplemental Program for Women, Infants, and Children (WIC) and Healthy Start (n=17, 41.5%) were the most common interventions studied. Individual counseling closely followed (n=15, 36.6%). Medical interventions were not among the more commonly used intervention types (n=9, 21.9%). Most articles focused on preterm delivery (n=28, 68.3%). Few articles studied cardiovascular disorders (n=4, 9.8%) or hemorrhage (n=3, 7.3%). No articles studied pregnancy-related morbidity. CONCLUSIONS: Despite current conversations on Black maternal mortality, there is currently limited literature examining interventions addressing perinatal morbidity and mortality in Black birthing people in the United States. These interventions do not address how to mitigate perinatal outcomes of interest. Patient-centered outcomes research is warranted to better understand as well as to resolve inequities related to Black maternal health.

Using Pre-operative Insulin Dose to Predict Diabetes Remission After Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.

BACKGROUND: Obesity is intricately associated with type-2 diabetes (T2D) and other cardiovascular conditions, increasing morbidity, mortality, and health care costs. Metabolic and bariatric surgeries (MBS) have shown promising results in significant weight loss and T2D remission, but existing predictive scores for post-MBS diabetes remission do not consider insulin dosage, potentially overlooking a critical factor. METHODS: A retrospective analysis of patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The study focused on insulin dosage impact, divided into quartiles, on remission rates post-MBS. The effectiveness of RYGB vs SG was compared within insulin dose quartiles with up to 5 years of follow up. RESULTS: A total of 508 patients (64% female, 94.9% White, mean age 53.5 ± 10.5 years, BMI (46.0 ± 8.3 kg/m2) were included in the analysis. This study demonstrates a profound association between insulin dosage quartiles and T2D remission after MBS. Patients with lower insulin requirements showed superior remission rates; those in the lowest quartile had remission rates of 73%, 70%, and 62% at 1, 3, and 5 years, respectively, compared to 34%, 37%, and 36% in the highest quartile (P < 0.001 across all intervals). RYGB surgery showed a significantly better remission in the second and third insulin quartiles, suggesting its effectiveness over SG for patients with mid-range insulin requirements. CONCLUSION: This study underscores the importance of considering insulin dosage when predicting T2D remission post-MBS. The findings advocate for a more nuanced selection of MBS procedures based on individual insulin profiles, potentially enhancing diabetes remission outcomes.