Hypoglycemia is a common and potentially dangerous side effect of exercise in people with type 1 diabetes (T1D). [1][2][3] Although suspension of insulin delivery at the beginning of moderate aerobic exercise reduces the risk of exercise-associated hypoglycemia, the risk of hyperglycemia is increased. 4Glucose threshold-based insulin pump suspension has been shown to reduce the duration of exercise-induced hypoglycemia and can be performed in a user-independent manner. 5Our group previously augmented our predictive low glucose suspend (PLGS) algorithm to incorporate physical activity using a combined accelerometer/heart rate monitor.6 The activity-informed algorithm showed superior hypoglycemia mitigation compared to the PLGS algorithm alone using in silico testing. 7 The current study investigates the effectiveness of an accelerometer-augmented PLGS algorithm in the real-life setting of an outpatient exercise protocol. We hypothesized that Background: Exercise-associated hypoglycemia is a common adverse event in people with type 1 diabetes. Previous in silico testing by our group demonstrated superior exercise-associated hypoglycemia mitigation when a predictive low glucose suspend (PLGS) algorithm was augmented to incorporate activity data. The current study investigates the effectiveness of an accelerometer-augmented PLGS algorithm in an outpatient exercise protocol.
Context: Aromatase inhibitors are used off-label to treat short stature in peripubertal boys.Objective: To investigate short-and long-term hormonal and auxologic differences in short pubertal boys treated with letrozole (L) or anastrozole (A). Design:Patients are seen for laboratory evaluation and physical examination every 6 months, bone age yearly, DEXA and spine film every 2 years. They will be followed until they reach their final height. This is a preliminary report after 1 year of treatment.Setting: A single academic children's hospital outpatient clinic. Patients:Boys with age Ͼ10 years, bone age Յ14 years, clinical and hormonal evidence of central puberty, and either height Ͻ fifth percentile or predicted adult height (PAH) more than 10 cm below mid-parental height (MPH).Intervention: Letrozole (2.5 mg) or anastrozole (1 mg) was administered orally each day. Main Outcome Measures:Hormonal and clinical parameters, growth velocity, and change in bone age and PAH.Results: Thirty-nine boys have completed 1 year of treatment. Baseline means were age 14.1 years, PAH 166 cm, and testosterone 198 ng/dL. At 1 year, letrozole resulted in higher LH (L 6.1 Ϯ 2.5 vs A 3.2 Ϯ 1.7 IU/L) and testosterone (1038 Ϯ 348 vs 536 Ϯ 216 ng/dL) with lower estradiol (2.8 Ϯ 2.8 vs 5.6 Ϯ 2.9 pg/mL) and IGF-1 (237 Ϯ 51 vs 331 Ϯ 79 ng/mL). First year growth velocities were identical (7.2 cm/year), but an increase in PAH was greater in the anastrozole group (4.2 Ϯ 3.5 vs 1.4 Ϯ 4.4 cm, p ϭ 0.03) after 1 year. Conclusions:We present first-year data from a direct comparison of anastrozole and letrozole for height augmentation in short pubertal boys. Letrozole was more potent in hormonal manipulation than anastrozole. First-year growth velocities were comparable, but improvement in PAH was greater in the anastrozole group. It remains to be seen if positive PAH trends will translate to increase in final height in either group. A romatase is a cytochrome p450 enzyme that catalyzes the formation of C18 estrogens (estrone and estradiol) from C19 androgens (androstenedione and testosterone) (1). Two general types of pharmacologic aromatase inhibition have been developed to selectively inhibit estrogen synthesis: steroidal inhibitors compete with androstenedione for the substrate binding site, whereas nonsteroidal inhibitors bind to the heme group at the active site of the aromatase enzyme and block estrogen formation. Anastrozole and letrozole are the third generation
e12534 Background: Single-fraction, intraoperative radiation therapy (SF-IORT) can replace whole breast radiotherapy (WBT) in select patients after lumpectomy for breast cancer. By combining histology review with co-registration of breast MRI at diagnosis and following an in-breast tumor recurrence, we sought to characterize IBTR as: missed on initial MRI, treatment failure, or new primary tumor. This has important implications for both breast MRI and understanding the effectiveness of SF-IORT. Methods: We reviewed our IORT database for patients with IBTR. Three radiologists recorded findings on DCE-MRI, mammograms and ultrasound, pathology at initial diagnosis and IBTR, and time to IBTR. Results: 90 women received SF-IORT between 12/6/2002 - 4/10/2019. There were 6 IBTRs (average age at recurrence 63, range 49-71 years). For these 6 patients, initial diagnostic mammograms showed fatty (1), scattered (4) or extremely dense (1) breasts with suspicious masses (4), calcifications (1), or asymmetry (1), average size 1.4 cm: range 0.3 - 2.0 cm. On MRI, background parenchymal enhancement was minimal (2), mild (2), moderate (1), or marked (1), showing a mass (4), mass/distortion (1), or post-biopsy marker/no abnormal enhancement (1). Initial pathology showed 2 IDC, 3 IDC/DCIS, and 1 DCIS, (average size 1.7 cm, range 1.1 - 2.4 cm) with 6/6 ER +, 5/6 PR + and 6 HER2 negative. IDC Ki-67 ranged from 5-25%. 5/6 patients had sentinel lymph node biopsy (SLNB) with 1/5 having a positive SLN. 4/6 received endocrine therapy. One patient declined follow-up mammography. After IORT, IBTR (average size 1.4 cm, range 0.7 - 3.6 cm) was diagnosed by mammography (3), palpable breast lump (2), or palpable axillary lymph node (LN) (1) shown as mass (4), mass/calcifications (1), or abnormal LN (1). IBTR occurred post-SF-IORT an average of 141.7 months, range 88.3 to 195.8 months. 2/6 IBTR occurred near the biopsy cavity. Subsequent surgery included mastectomy (3), re-excision lumpectomy/RT (2), or axillary LN dissection/RT (1) showing 4 IDC, 1 IDC/DCIS, and 1 IDC /ILC (6/6 ER +; 3/6 PR positive; 2 PR weakly positive; and 5 HER2 negative, 1 HER2 equivocal). Ki-67 ranged from 1-70%. Conclusions: 6/90 (6.6%) patients had an IBTR an average of 141.7 months post SF-IORT with 2/6 near the biopsy cavity. Breast MRI reliably screens patients for SF-IORT. Co-registration of imaging can help distinguish true recurrences from new primary tumors.
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