What factors are associated with success with insulin pumps?

What factors are associated with success with insulin pumps?Diabetes UK conference gran

Contemporary geomorphological activity throughout the proglacial area of an alpine catchment

Quantification of contemporary geomorphological activity is a fundamental prerequisite for predicting the effects of future earth surface process and landscape development changes. However, there is a lack of high-resolution spatial and temporal data on geomorphological activity within alpine catchments, which are especially sensitive to climate change, human impacts and which are amongst the most dynamic landscapes on Earth. This study used data from repeated laser scanning to identify and quantify the distribution of contemporary sediment sources and the intensity of geomorphological activity within the lower part of a glaciated alpine catchment; Ödenwinkelkees, central Austria. Spatially, geomorphological activity was discriminated by substrate class. Activity decreased in both areal extent and intensity with distance from the glacier, becoming progressively more restricted to the fluvially-dominated valley floor. Temporally, geomorphological activity was identified on annual, seasonal, weekly and daily timescales. Activity became more extensive with increasing study duration but more intense over shorter timescales, thereby demonstrating the importance of temporary storage of sediment within the catchment. The mean volume of material moved within the proglacial zone was 4400m.yr, which suggests a net surface lowering of 34mm.yr in this part of the catchment. We extrapolate a minimum of 4.8mm.yr net surface lowering across the whole catchment. These surface lowering values are approximately twice those calculated elsewhere from contemporary measurements of suspended sediment flux, and of rates calculated from the geological record, perhaps because we measure total geomorphological activity within the catchment rather than overall efflux of material. Repeated geomorphological surveying therefore appears to mitigate the problems of hydrological studies underestimating sediment fluxes on decadal-annual time-scales. Further development of the approach outlined in this study will enable the quantification of geomorphological activity, alpine terrain stability and persistence of landforms

Persistent Reductions in OCS Use in Patients With Severe, OCS-Dependent Asthma Treated With Dupilumab : LIBERTY ASTHMA TRAVERSE Study

Acknowledgments and funding sources Data first presented at the 118th International Conference of the American Thoracic Society (ATS 2022); San Francisco, CA, USA; May 13–18, 2022. Research sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. ClinicalTrials.gov Identifiers: NCT02528214 (VENTURE)/NCT02134028 (TRAVERSE). Medical writing/editorial assistance was provided by Anthony Aggidis, PhD, of Excerpta Medica, and was funded by Sanofi and Regeneron Pharmaceuticals, Inc., according to the Good Publication Practice guideline. Alternate presenters: Anne Atenhan and Mayank Thakur.Peer reviewe

The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance.

Pituitary dysfunction is a recognised, but potentially underdiagnosed complication of traumatic brain injury (TBI). Post-traumatic hypopituitarism (PTHP) can have major consequences for patients physically, psychologically, emotionally and socially, leading to reduced quality of life, depression and poor rehabilitation outcome. However, studies on the incidence of PTHP have yielded highly variable findings. The risk factors and pathophysiology of this condition are also not yet fully understood. There is currently no national consensus for the screening and detection of PTHP in patients with TBI, with practice likely varying significantly between centres. In view of this, a guidance development group consisting of expert clinicians involved in the care of patients with TBI, including neurosurgeons, neurologists, neurointensivists and endocrinologists, was convened to formulate national guidance with the aim of facilitating consistency and uniformity in the care of patients with TBI, and ensuring timely detection or exclusion of PTHP where appropriate. This article summarises the current literature on PTHP, and sets out guidance for the screening and management of pituitary dysfunction in adult patients with TBI. It is hoped that future research will lead to more definitive recommendations in the form of guidelines

Sustained Improvement in Clinical Efficacy, Asthma Control, and Quality of Life in Patients With Severe, Oral Corticosteroid (OCS)-Dependent Asthma Treated With Dupilumab : LIBERTY ASTHMA TRAVERSE Study

Acknowledgments and funding sources Research sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. ClinicalTrials.gov Identifiers: NCT02528214 (VENTURE)/NCT02134028 (TRAVERSE). Medical writing/editorial assistance was provided by Nevena Krstić, PhD, of Excerpta Medica, and was funded by Sanofi Genzyme and Regeneron Pharmaceuticals, Inc., according to the Good Publication Practice guideline.Peer reviewedPostprin

Dupilumab reduces OCS use and improves lung function in patients with severe OCS-dependent asthma

Peer reviewedPostprin

Rapid disease progression in a patient with mismatch repair-deficient and cortisol secreting adrenocortical carcinoma treated with pembrolizumab

Context: Metastatic adrenocortical carcinoma (ACC) is an aggressive malignancy with a poor prognosis and limited therapeutic options. A subset of ACC is due to Lynch syndrome, an inherited tumour syndrome resulting from germline mutations in mismatch repair (MMR) genes. It has been demonstrated that several cancers characterised by MMR-deficiency are sensitive to immune checkpoint inhibitors that target PD-1. Here, we provide the first report of PD-1 blockade by pembrolizumab in a patient with Lynch syndrome and progressive cortisol-secreting metastatic ACC. Case report: A 58-year old female with known Lynch syndrome who presented with severe Cushing’s syndrome was diagnosed with a cortisol-secreting ACC. Three months following surgical resection and adjuvant mitotane therapy the patient developed metastatic disease and persistent hypercortisolaemia. She commenced pembrolizumab, but her second cycle was delayed due to a transient transaminitis. Computed tomography performed after twelve weeks and 2 cycles of pembrolizumab administration revealed significant disease progression and treatment was discontinued. Seven weeks later, the patient became jaundiced and died rapidly with fulminant liver failure. Conclusion: Treatment of MMR-deficient cortisol-secreting ACC with pembrolizumab may be ineffective due to supra-physiological levels of circulating corticosteroids, which may in turn mask severe drug-induced organ damage