Background. One in three adolescents and young adults with type 1 diabetes have at least one early diabetes-related complication/comorbidity. However, the prevalence, patterning, and risk factors for co-occurring complications in this population are not well understood. Methods. The SEARCH for Diabetes in Youth observational cohort study includes 1327 individuals diagnosed with type 1 diabetes before 20 years of age from 5 United States locations. Sociodemographic and metabolic risk factors were assessed at baseline (mean diabetes duration = 0·8 years, mean age = 10·9 years) and follow-up (mean diabetes duration = 7.8 years, mean age = 18·0 years). Early diabetes complications (diabetic kidney disease, diabetic retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, and arterial stiffness) were assessed at follow-up. We aimed to describe co-occurrence of complications and examine differences in co-occurrence within demographic and metabolic risk factor clusters identified using cluster analysis. Findings. Overall, co-occurrence of any ≥2 complications was observed in 5·9% of all participants, more frequently than expected by chance alone (4·4%, p=0·015). Specifically, retinopathy and diabetic kidney disease, retinopathy and arterial stiffness, and arterial stiffness and cardiac autonomic neuropathy all co-occurred more frequently than expected (all p<0·05). The cluster analysis produced four unique clusters characterized by progressively worsening metabolic risk factor profiles (longer duration; higher A1c, non-HDL cholesterol, and waist to height ratio) and differences in sociodemographic characteristics (race/ethnicity, household income, type of health insurance). Prevalence of ≥2 complications progressively increased with worsening metabolic profiles (from 2·3% to 20·8%, p<0·001). Interpretation. We report that early complications co-occur in adolescents and young adults with type 1 diabetes more frequently than expected after an average of less than eight years of diabetes duration. A cluster of high risk factors identifies groups that may benefit most from interventions to reduce complications.

Thorny catfishes produce stridulation (SR) sounds using their pectoral fins and drumming (DR) sounds via a swimbladder mechanism in distress situations when hand held in water and in air. It has been argued that SR and DR sounds are aimed at different receivers (predators) in different media. The aim of this study was to analyse and compare sounds emitted in both air and water in order to test different hypotheses on the functional significance of distress sounds. Five representatives of the family Doradidae were investigated. Fish were hand held and sounds emitted in air and underwater were recorded (number of sounds, sound duration, dominant and fundamental frequency, sound pressure level and peak-to-peak amplitudes). All species produced SR sounds in both media, but DR sounds could not be recorded in air for two species. Differences in sound characteristics between media were small and mainly limited to spectral differences in SR. The number of sounds emitted decreased over time, whereas the duration of SR sounds increased. The dominant frequency of SR and the fundamental frequency of DR decreased and sound pressure level of SR increased with body size across species. The hypothesis that catfish produce more SR sounds in air and more DR sounds in water as a result of different predation pressure (birds versus fish) could not be confirmed. It is assumed that SR sounds serve as distress sounds in both media, whereas DR sounds might primarily be used as intraspecific communication signals in water in species possessing both mechanisms.

Risk of type 1 diabetes at 3 years is high for initially multiple and single Ab+ IT and multiple Ab+ NT. Genetic predisposition, age, and male sex are significant risk factors for development of Ab+ in twins.

Proper categorization of pediatric diabetes can be challenging, especially with comorbid obesity. Failure to ascertain type 1 diabetes mellitus in a timely manner in a pediatric population may increase the risk of substandard care and diabetes-related complications.

Pheochromocytoma and paraganglioma are rare in the pediatric population occurring in approximately 1 in 50,000 children. While some cases are sporadic, they have commonly been associated with syndromes such as von Hippel-Lindau, multiple endocrine neoplasia types IIa and IIb, neurofibromatosis type 1, and hereditary pheochromocytoma-paraganglioma syndromes. In children less than 18 years of age approximately 60% of pheochromocytomas and paragangliomas are associated with a germline mutation. We present an 11-year-old child with an abdominal paraganglioma related to a succinate dehydrogenase subunit B gene mutation whose father had a previously resected abdominal paraganglioma and was found to carry the same mutation. In addition, we review the etiology, genetics, diagnostic approach, and challenges of preoperative management of secretory pheochromocytomas and paragangliomas in children.

Children in rural settings are under‐represented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community‐based (nonclinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double‐screened at title/abstract and full‐text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for US‐based pediatric clinical studies conducted in rural or community‐based settings and were published in English through January 2021. Twenty‐seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting ( n = 23 articles; 85%); fewer ( n = 10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators ( n = 25 studies; 81%) and barriers ( n = 19; 61%) versus retention facilitators ( n = 15; 48%) and barriers ( n = 8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included contacts/reminders, community engagement, and relationship‐building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.

Comorbid hypertension, substance use disorders, and thyroid disorders deserve increased clinical surveillance in children and adolescents with ADHD because they may be associated with an increased risk of more than one musculoskeletal injury.

Background Dyslipidemia has been documented in youth with type 2 diabetes. There is a paucity of studies examining dyslipidemia over time in youth with type 2 diabetes and associated risk factors. Objective To evaluate lipids at baseline and follow‐up and associated risk factors in youth with type 2 diabetes. Methods We studied 212 youth with type 2 diabetes at baseline and after an average of 7 years of follow‐up in the SEARCH for Diabetes in Youth Study. Abnormal lipids were defined as high‐density lipoprotein cholesterol (HDL‐C) < 35, low‐density lipoprotein cholesterol (LDL‐C) > 100, or triglycerides >150 (all mg/dl). We evaluated participants for progression to abnormal lipids (normal lipids at baseline and abnormal at follow‐up), regression (abnormal lipids at baseline and normal at follow‐up), stable normal, and stable abnormal lipids over time for HDL‐C, LDL‐C, and triglycerides. Associations between hemoglobin A1c (HbA1c) and adiposity over time (area under the curve [AUC]) with progression and stable abnormal lipids were evaluated. Results HDL‐C progressed, regressed, was stable normal, and stable abnormal in 12.3%, 11.3%, 62.3%, and 14.2% of participants, respectively. Corresponding LDL‐C percentages were 15.6%, 12.7%, 42.9%, and 28.8% and triglycerides were 17.5%, 10.8%, 55.7%, and 16.0%. Each 1% increase in HbA1c AUC was associated with a 13% higher risk of progression and stable abnormal triglycerides and a 20% higher risk of progression and stable abnormal LDL‐C. Higher adiposity AUC was marginally (p = 0.049) associated with abnormal HDL‐C. Conclusions Progression and stable abnormal LDL‐C and triglycerides occur in youth with type 2 diabetes and are associated with higher HbA1c.