المؤلفون: Ronald Klein, Malvin N. Janal, Monique S. Roy

المصدر: Archives of Ophthalmology. 129:8

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Proliferative vitreoretinopathy, Adolescent, Eye disease, Young Adult, chemistry.chemical_compound, Venules, Risk Factors, Ophthalmology, Diabetes mellitus, medicine, Humans, Child, Chromatography, High Pressure Liquid, Glycated Hemoglobin, Retina, Type 1 diabetes, Diabetic Retinopathy, New Jersey, business.industry, Incidence, Retinal Vessels, Retinal, Diabetic retinopathy, medicine.disease, Surgery, Black or African American, Arterioles, Diabetes Mellitus, Type 1, medicine.anatomical_structure, chemistry, Disease Progression, Female, business, Follow-Up Studies, Retinopathy

الوصف: To examine the relationship between retinal arteriolar and venular diameter and the 6-year progression of diabetic retinopathy (DR) in African Americans with type 1 insulin-dependent diabetes mellitus.Included were 468 African Americans with type 1 diabetes mellitus who participated in the New Jersey 725 and who had undergone a 6-year follow-up examination. Seven standard field retinal photographs were obtained at both examinations. Computer-assisted grading, from digitized images of field 1 of baseline retinal photographs, was accomplished to determine the average diameter of retinal arterioles (central retinal arteriolar equivalent [CRAE]) and venules (central retinal venular equivalent [CRVE]). Retinal vessel diameter was examined in relation to the 6-year incidence and/or progression of DR.For right and left eyes, mean (SD) CRAE was 168.8 (16.0) μm and mean CRVE was 254.2 (25.2) μm. Both CRAE and CRVE were correlated between eyes (P.001). Multivariate analysis with generalized estimating equations showed that larger CRVE in either the right or left eye was significantly associated with 6-year progression to either proliferative DR (PDR) or PDR with high-risk characteristics after adjusting for baseline clinical risk factors. Notably, a significant association between baseline CRVE and progression to PDR was present for eyes with no to moderate nonproliferative DR and also between baseline CRVE and progression to PDR with high-risk characteristics for eyes with no or nonproliferative DR.Larger retinal venular diameter is an independent and early indicator of progression to either PDR or PDR with high-risk characteristics in African Americans with type 1 diabetes mellitus.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d58f61729d6645e89751b3929ea3b3f2Test
https://doi.org/10.1001/archophthalmol.2010.340Test

المؤلفون: Stephen G.F. Ho, C. Bruce Verchere, Ziliang Ao, Tom Elliott, R. Jean Shapiro, Linnea Young, Michelle Fung, David M. Thompson, James D. Johnson, David P. Al-Adra, Yu-Huan Theresa Liao, Sharon E. Kozak, Peter T. W. Kim, Long-Jun Dai, R. Mark Meloche, Garth L. Warnock, Zehua He, Lorraine Blackburn

المصدر: Archives of Surgery. 140:735

مصطلحات موضوعية: Adult, Blood Glucose, Graft Rejection, Male, medicine.medical_specialty, medicine.medical_treatment, Islets of Langerhans Transplantation, Cold storage, Risk Assessment, Severity of Illness Index, Cohort Studies, Islets of Langerhans, chemistry.chemical_compound, Transplantation Immunology, Diabetes mellitus, medicine, Humans, Insulin, Prospective Studies, Prospective cohort study, Monitoring, Physiologic, Probability, Analysis of Variance, Type 1 diabetes, geography, geography.geographical_feature_category, C-peptide, business.industry, Graft Survival, Middle Aged, medicine.disease, Islet, Surgery, Transplantation, Diabetes Mellitus, Type 1, Treatment Outcome, chemistry, Tissue and Organ Harvesting, Female, business, Follow-Up Studies

الوصف: Hypothesis A local multiorgan donor pancreas procurement program can provide a source for optimized isolation of purified viable islets for transplantation into patients with type 1 diabetes mellitus receiving best medical therapy. Design Prospective before-after cohort study. Setting Tertiary referral center. Patients Glycemic control was assessed in 10 patients with diabetes-induced renal dysfunction who were enrolled in a best medical therapy program and then crossed over to islet transplantation. Interventions Thirty human pancreata were retrieved from local multiorgan donors and consecutively processed with intraductal collagenase perfusion, continuous digestion, and density gradient purification (group 1, n = 9) or similarly processed but impure tissue fractions cultured in vitro and then repurified to retrieve additional islets (group 2, n = 21). Islets were implanted by percutaneous portal embolization, providing more than 10 000 islet equivalents (IE) per kilogram of body weight (infusions from 1-3 donors per patient) under cover of antithymocyte globulin, sirolimus, or mycophenolate mofetil and tacrolimus. Main Outcome Measures Islet yields, purity, and cell viability (caspase 3, terminal deoxynucleotidyl transferase–mediated biotin-deoxyuridine 5-triphosphate nick-end labeling stain, and insulin secretion in vitro) were compared. In patients, monitored metabolic parameters were C-peptide secretion, insulin requirements, glycemic excursion, and hemoglobin A 1c (HbA 1c ). Results For group 1 vs group 2, no differences were observed in pancreas age (43 vs 44 years), cold storage (5 vs 4 hours), or weight (73 vs 82 g). Group 2 yielded 453 690 IE vs 214 109 IE in group 1 ( P = .002). Grafts contained 50% or more endocrine cells in both groups. No difference occurred in cell viability or insulin secretion. Islets from 90% of group 2 pancreata met release criteria for transplantation. C-peptide secretion was detected in all recipients and persisted with a median follow-up to 12 months (range, 6-21 months) after full islet transplantation. Daily insulin dependence was reversed in all patients for at least 3 months. Five patients resumed small insulin doses. Compared with the best care program, all patients had improved metabolic stability. The mean ± SE HbA 1c level at entry into the study was 7.8% ± 0.5%, and this decreased to 6.9% ± 0.2% after best care ( P = .38) and further to 6.2% ± 0.2% at 6 months after transplantation ( P = .002 vs entry; P = .15 vs best care; analysis of variance). Conclusions Local pancreas donor retrieval with islet isolation and culture conditioning enabled an offer of islets for transplantation for 90% of consecutively processed pancreata. Isolated islets secreted insulin during prolonged follow-up after implantation into patients, yielding metabolic control comparable with that achieved by best medical therapy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bc0c62554e1c4248d5384b2a2c77932dTest
https://doi.org/10.1001/archsurg.140.8.735Test

المؤلفون: Griffiths Gd, Wieman Tj

المصدر: Archives of Surgery. 125:1567

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Renal function, Diabetic angiopathy, Kidney, Foot Diseases, chemistry.chemical_compound, Diabetic Neuropathies, Skin Ulcer, medicine, Humans, Diabetic Nephropathies, Aged, Retrospective Studies, Wound Healing, Creatinine, business.industry, Vascular disease, Middle Aged, Skin ulcer, medicine.disease, Diabetic foot, Surgery, Diabetes Mellitus, Type 1, Peripheral neuropathy, medicine.anatomical_structure, Diabetes Mellitus, Type 2, chemistry, Female, medicine.symptom, business, Diabetic Angiopathies, Follow-Up Studies

الوصف: • We examined the effect of renal function on the formation, severity, and outcome of diabetic foot lesions. Information was collected from a retrospective hospital chart survey and analyzed by univariate and multivariate linear regression analysis. Creatinine clearance, peripheral neuropathy, and peripheral vascular disease were all found to be independently associated with formation of foot lesions, indicating that each of these acts by distinct biologic mechanisms. Renal function had no bearing on the severity of lesions or on their eventual healing. We conclude that foot ulcers are more likely to develop in diabetic patients who also suffer from renal impairment, but they are no less likely to heal than are those in patients with normal renal function. We further conclude that attempts to preserve functional limbs in these patients are justified. ( Arch Surg . 1990;125:1567-1569)

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::640f324dc615c59a502baac24a393f4eTest
https://doi.org/10.1001/archsurg.1990.01410240045010Test