المؤلفون: Wisel, SA, Gardner, JM, Roll, GR, Harbell, J, Freise, CE, Feng, S, Kang, SM, Hirose, R, Kaufman, DB, Posselt, AM, Stock, PG

المصدر: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 17(9)

مصطلحات موضوعية: Humans, Diabetes Mellitus, Type 1, Insulin, Immunosuppressive Agents, Prognosis, Pancreas Transplantation, Islets of Langerhans Transplantation, Risk Factors, Follow-Up Studies, Graft Rejection, Graft Survival, Adult, Middle Aged, Female, Male, Young Adult, clinical research/practice, diabetes: type 1, immunosuppressive regimens, islet transplantation, pancreas/simultaneous pancreas-kidney transplantation, patient characteristics, protocol biopsy, Kidney Disease, Diabetes, Organ Transplantation, Transplantation, Autoimmune Disease, Development of treatments and therapeutic interventions, 5.4 Surgery, Renal and urogenital, Metabolic and endocrine, Medical and Health Sciences, Surgery

الوصف: Islet transplantation offers a minimally invasive approach for β cell replacement in diabetic patients with hypoglycemic unawareness. Attempts at insulin independence may require multiple islet reinfusions from distinct donors, increasing the risk of allogeneic sensitization. Currently, solid organ pancreas transplant is the only remaining surgical option following failed islet transplantation in the United States; however, the immunologic impact of repeated exposure to donor antigens on subsequent pancreas transplantation is unclear. We describe a case series of seven patients undergoing solid organ pancreas transplant following islet graft failure with long-term follow-up of pancreatic graft survival and renal function. Despite highly variable panel reactive antibody levels prior to pancreas transplant (mean 27 ± 35%), all seven patients achieved stable and durable insulin independence with a mean follow-up of 6.7 years. Mean hemoglobin A1c values improved significantly from postislet, prepancreas levels (mean 8.1 ± 1.5%) to postpancreas levels (mean 5.3 ± 0.1%; p = 0.0022). Three patients experienced acute rejection episodes that were successfully managed with thymoglobulin and methylprednisolone, and none of these preuremic type 1 diabetic recipients developed stage 4 or 5 chronic kidney disease postoperatively. These results support pancreas-after-islet transplantation with aggressive immunosuppression and protocol biopsies as a viable strategy to restore insulin independence after islet graft failure.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9gt3z474Test

المؤلفون: Moassesfar, S, Masharani, U, Frassetto, LA, Szot, GL, Tavakol, M, Stock, PG, Posselt, AM

المصدر: American Journal of Transplantation. 16(2)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Autoimmune Disease, Diabetes, Pediatric, Transplantation, Metabolic and endocrine, Adult, Cost-Benefit Analysis, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection, Graft Survival, Humans, Islets of Langerhans Transplantation, Kidney Function Tests, Length of Stay, Male, Middle Aged, Pancreas Transplantation, Prognosis, Risk Factors, Safety, clinical research, practice, islet transplantation, pancreas, simultaneous pancreas-kidney, type 1, islet isolation, insulin, C-peptide, islets of Langerhans, Medical and Health Sciences, Surgery, Clinical sciences, Immunology

الوصف: Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long-term insulin independence in selected patients with T1D.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6cn6f0x7Test

المؤلفون: Ivo Tzvetanov, Kelly Galen, Federico Gheza, Caterina Di Bella, Jose Oberholzer, Mario Spaggiari, Maya Campara, Enrico Benedetti, Pierpaolo Di Cocco

المصدر: Transplantation. 102:1732-1739

مصطلحات موضوعية: Adult, Graft Rejection, Male, medicine.medical_specialty, Glycated Hemoglobin A, Adolescent, medicine.medical_treatment, 030230 surgery, Pancreas transplantation, Age Factors, Body Weight, Child, Diabetes Mellitus, Type 1, Donor Selection, Female, Follow-Up Studies, Graft Survival, Humans, Middle Aged, Organ Size, Pancreas, Pancreas Transplantation, Retrospective Studies, Risk Factors, Tissue Donors, Young Adult, Single Center, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Young adult, Glycated Hemoglobin, Transplantation, geography, geography.geographical_feature_category, business.industry, Retrospective cohort study, medicine.disease, Islet, Surgery, Increased risk, 030211 gastroenterology & hepatology, business, Type 1

الوصف: Pancreas allografts from pediatric donors are considered less suitable due to the increased risk of surgical complications and reduced islet cell mass that may compromise function.All pancreatic transplants, procured from donors younger than 18 years, between January 2007 and March 2017, were included in the analysis. The grafts were subdivided into 3 groups by donor's weight: less than 30 kg, 30 to 60 kg, greater than 60 kg. Analysis of patient and graft survival was done between the groups, and subsequently between the pediatric cohort and the adult-donor control group.Sixty-three pediatric-donor pancreas transplants were performed. The mean donor age and weight were of 12.10 ± 4.13 years and 47.8 ± 21.3 kg. Excellent metabolic control was achieved in 59 (93.65%) patients at the time of discharge and at a mean 5 year follow up, with the average hemoglobin A1c of 5.30 ± 0.61% and blood glucose level of 102.75 ± 20.70 mg/dL in those with a functioning graft. Nine graft losses were registered, of which one (1.6%) was due to arterial thrombosis. Eight (12.7%) patients experienced rejection. Overall graft survival and patient survival were of 85.7% and 92.1%, respectively, at a median follow-up of 37.07 months (minimum, 0.19 to maximum, 119.57). No differences among the 3 groups were identified. Long-term patient and allograft survival was comparable to that of the adult-donor pancreatic transplants.Pediatric-donor pancreas demonstrated excellent short-term outcomes with no surgical complications and promising long-term outcomes despite the smaller islet mass. Pancreata from pediatric donors should not be marginalized and can offset worsening organ shortage.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b351a6c67dbfe85056ec8062549feb1cTest
https://doi.org/10.1097/tp.0000000000002208Test

المؤلفون: Dixon B. Kaufman, Garrett R. Roll, Chris E. Freise, James M. Gardner, Peter G. Stock, Sang-Mo Kang, Jack Harbell, Andrew M. Posselt, R. Hirose, Steven A. Wisel, Sandy Feng

المصدر: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol 17, iss 9

مصطلحات موضوعية: Graft Rejection, Male, Kidney Disease, medicine.medical_treatment, Islets of Langerhans Transplantation, 030230 surgery, Medical and Health Sciences, 0302 clinical medicine, Risk Factors, Insulin, Immunology and Allergy, Pharmacology (medical), patient characteristics, geography.geographical_feature_category, Graft Survival, Diabetes, Immunosuppression, Middle Aged, Prognosis, Islet, medicine.anatomical_structure, type 1 [diabetes], Female, Pancreas Transplantation, Development of treatments and therapeutic interventions, Pancreas, Immunosuppressive Agents, Type 1, Adult, medicine.medical_specialty, Renal and urogenital, Urology, 030209 endocrinology & metabolism, Pancreas transplantation, clinical research/practice, Autoimmune Disease, Article, Young Adult, 03 medical and health sciences, Diabetes Mellitus, protocol biopsy, 5.4 Surgery, medicine, Humans, Metabolic and endocrine, Transplantation, geography, Type 1 diabetes, Thymoglobulin, business.industry, islet transplantation, Organ Transplantation, medicine.disease, Surgery, immunosuppressive regimens, Diabetes Mellitus, Type 1, pancreas/simultaneous pancreas-kidney transplantation, business, Follow-Up Studies, Kidney disease

الوصف: Islet transplantation offers a minimally-invasive approach for beta cell replacement in diabetic patients with hypoglycemic unawareness. Attempts at insulin independence may require multiple islet re-infusions from distinct donors, thus increasing the risk for allogeneic sensitization. Currently, solid organ pancreas transplant is the only remaining surgical option following failed islet transplantation in the US. However, the immunologic impact of repeated exposure to donor antigens on subsequent pancreas transplantation is unclear. Here we describe a case series of seven patients undergoing solid organ pancreas transplant following islet graft failure, with long-term follow-up of pancreatic graft survival and renal function. Despite highly variable panel-reactive antibody (PRA) levels prior to pancreas transplant (mean 27±35%), all seven patients achieved stable and durable insulin independence with a mean follow-up of 6.7 years. Mean hemoglobin A1c (HgbA1c) values improved significantly from post-islet, pre-pancreas levels (mean 8.1±1.5%) to post-pancreas levels (mean 5.3±0.1%; p=0.0022). Three patients experienced acute rejection episodes successfully managed with thymoglobulin and methylprednisolone, and none of these pre-uremic type 1 diabetic recipients developed Stage 4 or 5 chronic kidney disease postoperatively. These results support pancreas-after-islet (PAI) transplantation with aggressive immunosuppression and protocol biopsies as a viable strategy to restore insulin independence after islet graft failure. This article is protected by copyright. All rights reserved.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ac2f9eef4f8fb8d463e6cb67dbb11920Test
https://doi.org/10.1111/ajt.14344Test

المؤلفون: Rose A, Gubitosi-Klug, Barbara H, Braffett, Neil H, White, Robert S, Sherwin, F John, Service, John M, Lachin, William V, Tamborlane

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Male, Insulin pump, medicine.medical_specialty, Pediatrics, Adolescent, endocrine system diseases, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Hypoglycemia, Lower risk, Diabetes Therapy, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Internal Medicine, medicine, Humans, Insulin, Glycated Hemoglobin, Advanced and Specialized Nursing, Type 1 diabetes, Errata, business.industry, nutritional and metabolic diseases, medicine.disease, 3. Good health, Surgery, Diabetes Mellitus, Type 1, Relative risk, Cohort, Female, business, Follow-Up Studies

الوصف: OBJECTIVE During the Diabetes Control and Complications Trial (DCCT), intensive diabetes therapy achieving a mean HbA1c of ∼7% was associated with a threefold increase in the rate of severe hypoglycemia (defined as requiring assistance) compared with conventional diabetes therapy with a mean HbA1c of 9% (61.2 vs. 18.7 per 100 patient-years). After ∼30 years of follow-up, we investigated the rates of severe hypoglycemia in the DCCT/Epidemiology of Diabetes Inverventions and Complications (EDIC) cohort. RESEARCH DESIGN AND METHODS Rates of severe hypoglycemia were reported quarterly during DCCT and annually during EDIC (i.e., patient recall of episodes in the preceding 3 months). Risk factors influencing the rate of severe hypoglycemia over time were investigated. RESULTS One-half of the DCCT/EDIC cohort reported episodes of severe hypoglycemia. During EDIC, rates of severe hypoglycemia fell in the former DCCT intensive treatment group but rose in the former conventional treatment group, resulting in similar rates (40.8 vs. 36.6 episodes per 100 patient-years, respectively) with a relative risk of 1.12 (95% CI 0.91–1.37). A preceding episode of severe hypoglycemia was the most powerful predictor of subsequent episodes. Entry into the DCCT study as an adolescent was associated with an increased risk of severe hypoglycemia, whereas insulin pump use was associated with a lower risk. Severe hypoglycemia rates increased with lower HbA1c similarly among participants in both treatment groups. CONCLUSIONS Rates of severe hypoglycemia have equilibrated over time between the two DCCT/EDIC treatment groups in association with advancing duration of diabetes and similar HbA1c levels. Severe hypoglycemia persists and remains a challenge for patients with type 1 diabetes across their life span.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::23ee5a04747e3de35fc659e729c04ed3Test
https://doi.org/10.2337/dc16-2723Test

المؤلفون: Lachin, John M., Bebu, Ionut, Bergenstal, Richard M., Pop-Busui, Rodica, Service, F. John, Zinman, Bernard, Nathan, David M.

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Cardiovascular System, Nephropathy, law.invention, 03 medical and health sciences, 0302 clinical medicine, Diabetic Neuropathies, Randomized controlled trial, Risk Factors, law, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Albuminuria, Humans, Diabetic Nephropathies, Longitudinal Studies, Pathophysiology/Complications, Proportional Hazards Models, Glycemic, Glycated Hemoglobin, Advanced and Specialized Nursing, Type 1 diabetes, Diabetic Retinopathy, e-Letters: Comments and Responses, Proportional hazards model, business.industry, medicine.disease, 3. Good health, Surgery, Diabetes Mellitus, Type 1, Logistic Models, Disease Progression, Cardiology, Female, Microalbuminuria, medicine.symptom, business, Follow-Up Studies

الوصف: OBJECTIVE The Diabetes Control and Complications Trial (DCCT) demonstrated the beneficial effects of intensive versus conventional therapy on the development and progression of microvascular complications of type 1 diabetes. These beneficial effects were almost completely explained by the difference between groups in the levels of HbA1c, which in turn were associated with the risk of these complications. We assessed the association of glucose variability within and between quarterly 7-point glucose profiles with the development and progression of retinopathy, nephropathy, and cardiovascular autonomic neuropathy during the DCCT. RESEARCH DESIGN AND METHODS Measures of variability included the within-day and updated mean (over time) of the SD, mean amplitude of glycemic excursions (MAGE), and M-value, and the longitudinal within-day, between-day, and total variances. Imputation methods filled in the 16.3% of expected glucose values that were missing. RESULTS Cox proportional hazards models assessed the association of each measure of glycemic variation, as a time-dependent covariate, with the risk of retinopathy and nephropathy, and a longitudinal logistic regression model did likewise for cardiovascular autonomic neuropathy. Adjusted for mean blood glucose, no measure of within-day variability was associated with any outcome. Only the longitudinal mean M-value (over time) was significantly associated with microalbuminuria when adjusted for the longitudinal mean blood glucose and corrected for multiple tests using the Holm procedure. CONCLUSIONS Overall, within-day glycemic variability, as determined from quarterly glucose profiles, does not play an apparent role in the development of microvascular complications beyond the influence of the mean glucose.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cd6155911c35bd65c395cb3b2d59ee41Test
https://doi.org/10.2337/dc16-2426Test

المؤلفون: Bernard Zinman, Ionut Bebu, John M. Lachin, Elsayed Z. Soliman, Jye-Yu C. Backlund, Trevor J. Orchard

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Male, Cardiovascular and Metabolic Risk, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Angina, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, Epidemiology, Prevalence, Internal Medicine, medicine, Humans, Longitudinal Studies, cardiovascular diseases, Myocardial infarction, Stroke, Proportional Hazards Models, Advanced and Specialized Nursing, Type 1 diabetes, business.industry, Proportional hazards model, Incidence, Hazard ratio, medicine.disease, 3. Good health, Surgery, Diabetes Mellitus, Type 1, Cardiovascular Diseases, Cardiology, Female, business, Follow-Up Studies

الوصف: OBJECTIVE We examined the association between the prevalence and incidence of electrocardiographic (ECG) abnormalities and the development of cardiovascular disease (CVD) in patients with type 1 diabetes, among whom these ECG abnormalities are common. RESEARCH DESIGN AND METHODS We conducted a longitudinal cohort study involving 1,306 patients with type 1 diabetes (mean age 35.5 ± 6.9 years; 47.7% female) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. ECG abnormalities were defined by the Minnesota Code ECG classification as major, minor, or no abnormality. CVD events were defined as the first occurrence of myocardial infarction, stroke, confirmed angina, coronary artery revascularization, congestive heart failure, or death from any CVD. RESULTS During a median follow-up of 19 years, 155 participants (11.9%) developed CVD events. In multivariable Cox proportional hazard models adjusted for demographics and potential confounders, the presence of any major ECG abnormalities as a time-varying covariate was associated with a more than twofold increased risk of CVD events (hazard ratio [HR] 2.10 [95% CI 1.26, 3.48] vs. no abnormality/normal ECG, and 2.19 [1.46, 3.29] vs. no major abnormality). Also, each visit (year) at which the diagnosis of major ECG abnormality was retained was associated with a 30% increased risk of CVD (HR 1.30 [95% CI 1.14, 1.48]). The presence of minor ECG abnormalities was not associated with a significant increase in CVD risk. CONCLUSIONS The presence of major ECG abnormalities is associated with an increased risk of CVD in patients with type 1 diabetes. This suggests a potential role for ECG screening in patients with type 1 diabetes to identify individuals at risk for CVD.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9f603fed61e5aed5809f803675d2873aTest
https://doi.org/10.2337/dc16-2050Test

المؤلفون: Ramon Sagarra-Alamo, Aida Valls-Mateu, Nuria Soler, Pedro Romero-Aroca, Antonio Moreno-Ribas, Raul Navarro-Gil

المصدر: The British Journal of Ophthalmology

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, endocrine system diseases, Epidemiology, Population, Renal function, 030209 endocrinology & metabolism, Macular Edema, Retina, 03 medical and health sciences, Cellular and Molecular Neuroscience, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Internal medicine, medicine, Humans, Prospective Studies, education, Aged, Glycated Hemoglobin, education.field_of_study, Type 1 diabetes, Creatinine, Diabetic Retinopathy, business.industry, Incidence, Incidence (epidemiology), nutritional and metabolic diseases, Diabetic retinopathy, Middle Aged, Clinical Science, medicine.disease, Telemedicine, Sensory Systems, Surgery, Ophthalmology, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, chemistry, Multivariate Analysis, 030221 ophthalmology & optometry, Female, business, Follow-Up Studies

الوصف: Background/aims To determine the incidence of any diabetic retinopathy (any-DR), sight-threatening diabetic retinopathy (STDR) and diabetic macular oedema (DMO) and their risk factors in type 1 diabetes mellitus (T1DM) over a screening programme. Methods Nine-year follow-up, prospective population-based study of 366 patients with T1DM and 15 030 with T2DM. Epidemiological risk factors were as follows: current age, age at DM diagnosis, sex, type of DM, duration of DM, arterial hypertension, levels of glycosylated haemoglobin (HbA1c), triglycerides, cholesterol fractions, serum creatinine, estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR). Results Sum incidence of any-DR was 47.26% with annual incidence 15.16±2.19% in T1DM, and 26.49% with annual incidence 8.13% in T2DM. Sum incidence of STDR was 18.03% with annual incidence 5.77±1.21% in T1DM, and 7.59% with annual incidence 2.64±0.15% in T2DM. Sum incidence of DMO was 8.46% with annual incidence 2.68±038% in patients with T1DM and 6.36% with annual incidence 2.19±0.18% in T2DM. Cox's survival analysis showed that current age and age at diagnosis were risk factors at p

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a8a64239d5da08b4a69aa9d52299e1a9Test
https://doi.org/10.1136/bjophthalmol-2016-310063Test

المؤلفون: Ulrik Frydkjaer-Olsen, Malin Lundberg Rasmussen, Rebecca Broe, Birthe S. Olsen, Jakob Grauslund, Henrik B. Mortensen, Tunde Peto

المصدر: Europe PubMed Central
Rasmussen, M L, Broe, R, Frydkjaer-Olsen, U, Olsen, B S, Mortensen, H B, Peto, T & Grauslund, J 2017, ' Retinal vascular geometry and its association to microvascular complications in patients with type 1 diabetes : the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987) ', Graefe's Archive for Clinical and Experimental Ophthalmology, vol. 255, no. 2, pp. 293–299 . https://doi.org/10.1007/s00417-016-3454-3Test

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Time Factors, 030209 endocrinology & metabolism, Nephropathy, 03 medical and health sciences, Cellular and Molecular Neuroscience, Vibration perception, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Humans, Child, Retrospective Studies, Type 1 diabetes, Diabetic Retinopathy, business.industry, Microcirculation, Retinal Vessels, Retinal, Odds ratio, Diabetic retinopathy, medicine.disease, Sensory Systems, Surgery, Arterioles, Ophthalmology, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Peripheral neuropathy, chemistry, Disease Progression, 030221 ophthalmology & optometry, Cardiology, Female, business, Tomography, Optical Coherence, Follow-Up Studies

الوصف: PURPOSE: To examine associations between retinal vascular geometry (tortuosity, branching coefficient [BC] and length-diameter ratio [LDR]) and diabetic proliferative retinopathy (PDR), nephropathy, and peripheral neuropathy in patients with type 1 diabetes mellitus (T1DM).METHODS: A cohort of patients with T1DM participated in a clinical examination in 2011. Blood and urine analyses were done and retinal images taken. PDR was defined as Early Treatment Diabetic Retinopathy Study level 61 or above, nephropathy as albumin-creatinin ratio ≥300 mg/g, and neuropathy as vibration perception threshold >25 Volt. Retinal vessel parameters were measured using semi-automated software. Multiple logistic regressions were performed to investigate correlations between retinal vascular parameters and outcomes. Models were adjusted for other variables (sex, age, duration of diabetes, systolic and diastolic blood pressure, HbA1c, and presence of microvascular complications). Odds ratios were given per standard deviation in retinal vascular parameter.RESULTS: Retinal vascular analyses were performed in 181 patients. Mean age and duration of diabetes were 37.0 years and 29.4 years respectively, and 50.8% were male. Prevalence of PDR, nephropathy, and neuropathy were 26.5%, 6.8%, and 10.1% , respectively. Patients with increased arteriolar BC had a higher risk of nephropathy (OR: 3.10, 95% CI: [1.01-9.54]). Patients with increased venular BC had a higher risk of neuropathy (OR: 2.11, 95% CI: [1.11-4.03]). No associations were found in patients with PDR.CONCLUSIONS: By analyzing the retinal vascular tree in patients with T1DM, we found a higher risk of complications in kidneys and nerves when BC was increased. This might indicate a suboptimal construction of the vascular tree in these patients.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::48f58e9d6b8bf8fe091d746ebc643381Test
https://doi.org/10.1007/s00417-016-3454-3Test

المؤلفون: Carolina R.C. Pieterman, Jace P. Landry, Ioannis Christakis, Paul H. Graham, Samuel M. Hyde, Steven G. Waguespack, Yi Ju Chiang, Si Yuan Wu, Elizabeth G. Grubbs, Sarah B. Fisher, Nancy D. Perrier

المصدر: Surgery

مصطلحات موضوعية: Parathyroidectomy, Oncology, Adult, Male, medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, endocrine system, endocrine system diseases, Genotype, medicine.medical_treatment, Disease, Kaplan-Meier Estimate, 030230 surgery, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Proto-Oncogene Proteins, medicine, Multiple Endocrine Neoplasia Type 1, Endocrine system, Humans, MEN1, Pituitary Neoplasms, Genetic Testing, Multiple endocrine neoplasia, Watchful Waiting, Aged, Retrospective Studies, business.industry, Age Factors, Retrospective cohort study, Middle Aged, medicine.disease, Hyperparathyroidism, Primary, Penetrance, Pancreatic Neoplasms, Regimen, Neuroendocrine Tumors, 030220 oncology & carcinogenesis, Surgery, Female, business, Follow-Up Studies

الوصف: It is unclear whether genotype-negative clinical multiple endocrine neoplasia type 1 patients derive equal benefit from prospective surveillance as genotype-positive patients.In this retrospective cohort study, we compared genotype-negative patients with clinical multiple endocrine neoplasia type 1 with genotype-positive index cases. Primary outcome was age-related penetrance of manifestations; secondary outcomes were disease-specific survival and clinical course of endocrine tumors.We included 39 genotype-negative patients with clinical multiple endocrine neoplasia type 1 (Male: 33%) and 63 genotype-positive multiple endocrine neoplasia type 1 index cases (Male: 59%). Genotype-negative patients with clinical multiple endocrine neoplasia type 1 were 65 years old at last follow-up; genotype-positive multiple endocrine neoplasia type 1 index cases were 50 (P.001). Genotype-negative patients with clinical multiple endocrine neoplasia type 1 were significantly older at their first and second primary manifestation. Only 1 developed a third primary manifestation. No genotype-negative patients with clinical multiple endocrine neoplasia type 1 with primary hyperparathyroidism and a pituitary adenoma developed a duodenopancreatic neuroendocrine tumor. Disease-specific survival was significantly better in genotype-negative patients with clinical multiple endocrine neoplasia type 1. In genotype-negative patients with clinical multiple endocrine neoplasia type 1, primary hyperparathyroidism was single-gland disease in 47% of parathyroidectomies versus 0% in genotype-positive multiple endocrine neoplasia type 1 index cases. In genotype-negative patients with clinical multiple endocrine neoplasia type 1, 17% of duodenopancreatic neuroendocrine tumors were multifocal versus 68% in genotype-positive multiple endocrine neoplasia type 1 index cases. Genotype-negative patients with clinical multiple endocrine neoplasia type 1 had more pituitary macroadenomas, fewer prolactinomas, and more somatotroph adenomas.Genotype-negative patients with clinical multiple endocrine neoplasia type 1 have a different clinical course than genotype-positive multiple endocrine neoplasia type 1 index cases. This may support a separate classification and a tailored surveillance regimen. Of the genotype-negative patients with clinical multiple endocrine neoplasia type 1 who had parathyroidectomy, almost half had no evidence of multigland disease and may be potential candidates for a more targeted single-gland approach.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0a9070787da91375d2d4bebcad8c7ed7Test
https://pubmed.ncbi.nlm.nih.gov/32703679Test