Failure of glycated hemoglobin drop after continuous subcutaneous insulin infusion initiation may indicate patients who discontinue: a 4-year follow-up study in children and adolescents with type 1 diabetes

Abstract Continuous subcutaneous insulin infusion (CSII) is effective and safe in children and adults with type 1 diabetes. Notwithstanding, some patients decide to discontinue using CSII. We evaluated the discontinuation rate, and its related factors, in a large group of children and adolescents with type 1 diabetes using CSII in Italy. Data on all patients with type 1 diabetes younger than 18 years were collected by 28 Pediatric Diabetologic referral Centers located throughout Italy. The primary endpoint was to measure the discontinuation rate using CSII. Among the study population (n = 6,644), 985 (14.8%) were using CSII. Sixty patients discontinued using CSII, representing the 6.1%. The discontinuation rate significantly increased (P = 0.002) with age: 0-6 years, 1/84 (1.2%), 7-11 years, 8/262 (3.1%), 12-18 years, 51/579 (8.8%). The average time to discontinuation was 1.8 ± 1.4 years. The average age of patients who discontinued using CSII was higher than in patients still on CSII (12.1 ± 3.2 vs. 10.3 ± 3.8, P = 0.0001), while their diabetes duration was significantly shorter (8.6 ± 2.7 vs. 10.2 ± 3.7, P = 0.0001). HbA1c decreased only in patients still on CSII (8.7 ± 1.3% vs. 7.8 ± 1.3%, P = 0.02), but not in patients who discontinued using CSII (8.5 ± 1.6% vs. 8.2 ± 1.3%, P = 0.213). HbA1c might be one important indicator helpful to identify patients at higher risk discontinuing using CSII.Continuous subcutaneous insulin infusion (CSII) is effective and safe in children and adults with type 1 diabetes. Notwithstanding, some patients decide to discontinue using CSII. We evaluated the discontinuation rate, and its related factors, in a large group of children and adolescents with type 1 diabetes using CSII in Italy. Data on all patients with type 1 diabetes younger than 18 years were collected by 28 Pediatric Diabetologic referral Centers located throughout Italy. The primary endpoint was to measure the discontinuation rate using CSII. Among the study population (n = 6,644), 985 (14.8%) were using CSII. Sixty patients discontinued using CSII, representing the 6.1%. The discontinuation rate significantly increased (P = 0.002) with age: 0-6 years, 1/84 (1.2%), 7-11 years, 8/262 (3.1%), 12-18 years, 51/579 (8.8%). The average time to discontinuation was 1.8 ± 1.4 years. The average age of patients who discontinued using CSII was higher than in patients still on CSII (12.1 ± 3.2 vs. 10.3 ± 3.8, P = 0.0001), while their diabetes duration was significantly shorter (8.6 ± 2.7 vs. 10.2 ± 3.7, P = 0.0001). HbA1c decreased only in patients still on CSII (8.7 ± 1.3% vs. 7.8 ± 1.3%, P = 0.02), but not in patients who discontinued using CSII (8.5 ± 1.6% vs. 8.2 ± 1.3%, P = 0.213). HbA1c might be one important indicator helpful to identify patients at higher risk discontinuing using CSII. © 2011 Springer-Verlag

Hyperhomocysteinemia and C677T MTHFR genotype in patients with retinal vein thrombosis.

Introduction: Elevated homocysteine (Hcy) is associated with the risk of deep vein thrombosis, pulmonary embolism, ischemic heart disease, and stroke. Several studies have suggested that hyperhomocysteinemia (HHcy) may predispose to retinal vein thrombosis (RVT) development. The aim of this study is to investigate the relationship between Hcy, C677T methylenetetrahydrofolate reductase (MTHFR) genotype, and RVT in patients compared with controls. Materials and Methods: We evaluated the Hcy plasma level of 3114 consecutive participants in 2 Italian centers during a 2-year period. Hyperhomocysteinemia was found in 99 patients and 136 healthy participants. Of the 99 patients, 20 had RVT with a high prevalence of HHcy in the RVT subgroup (20.2%). This result suggested a possible relationship between HHcy and RVT development. We investigated 105 consecutive patients with recent diagnosis of RVT, and we compared them with 226 healthy controls to evaluate whether HHcy may be a risk factor for RVT. Results: the prevalence of HHcy was higher in patients compared with controls (34.3% vs 14.2%; P < .001). The MTHFR C677T genotype was found in 69 of 105 (65.7%) patients with RVT (heterozygosity: 40 of 105 and homozygosity: 29 of 105). The control group showed the presence of MTHFR C677T genotype in 169 of 226 participants (74.8%; heterozygosity: 100 of 226 and homozygosity: 69 of 226) without difference between the 2 groups (P = .08). Conclusion: our study suggests that HHcy is a possible risk factor for RVT development, while no association was found between RVT and the C677T MTHFR genotype

Gluon condensation and deconfinement critical density in nuclear matter

An upper limit to the critical density for the transition to the deconfined phase, at zero temperature, has been evaluated by analyzing the behavior of the gluon condensate in nuclear matter. Due to the non linear baryon density effects, the upper limit to the critical density, \rho_c turns out about nine times the saturation density, rho_0 for the value of the gluon condensate in vacuum =0.012 GeV^4. For neutron matter \rho_c \simeq 8.5 \rho_0. The dependence of the critical density on the value of the gluon condensate in vacuum is studied.Comment: Published version, 11 pages, 2 eps figure

is 18f fluorodeoxyglucose uptake by the primary tumor a prognostic factor in breast cancer

Abstract Background We retrospectively investigated 18F-FDG uptake by the primary breast tumor as a predictor for relapse and survival. Patients and methods We studied 203 patients with cT1-T3N0 breast cancer. Standardized uptake value (SUVmax), was measured on the primary tumor. After a median follow-up of 68 months (range 22–80), the relation between SUVmax and tumor factors, disease free-survival (DFS) and overall survival (OS) was investigated. Results In the PET-positive patients, the median FDG uptake by the tumor was 4.7. FDG uptake was significantly related to tumor size, number of involved axillary nodes, grade, negative ER, high Ki-67 and HER2 overexpression. No distant metastases or deaths occurred in the PET-negative group. Five-year DFS was 97% and 83%, respectively in the PET-negative and PET-positive groups (P = 0.096). At univariate analysis, DFS was significantly lower in patients with SUVmax >4.7 compared to the patients with negative PET (P = 0.042), but not to the patients with SUVmax ≤4.7 (P = 0.106). At multivariable analysis, among PET-positive patients, SUVmax was not an independent prognostic factor for DFS (HR>4.7 vs ≤4.7: 1.02 (95% CI 0.45–2.31)). Five-year OS was 100% and 93%, respectively, in the PET-negative and PET-positive groups (P = 0.126). Conclusion FDG uptake by the primary lesion was significantly associated with several prognostic variables, but it was not an independent prognostic factor

Fluorescent redox-dependent labeling of lipid droplets in cultured cells by reduced phenazine methosulfate

Natural and synthetic phenazines are widely used in biomedical sciences. In dehydrogenase histochemistry, phenazine methosulfate (PMS) is applied as a redox reagent for coupling reduced coenzymes to the reduction of tetrazolium salts into colored formazans. PMS is also currently used for cytotoxicity and viability assays of cell cultures using sulfonated tetrazoliums. Under UV (340 nm) excitation, aqueous solutions of the cationic PMS show green fluorescence (λem: 526 nm), whereas the reduced hydrophobic derivative (methyl-phenazine, MPH) shows blue fluorescence (λem: 465 nm). Under UV (365 nm) excitation, cultured cells (LM2, IGROV-1, BGC-1, and 3T3-L1 adipocytes) treated with PMS (5 μg/mL, 30 min) showed cytoplasmic granules with bright blue fluorescence, which correspond to lipid droplets labeled by the lipophilic methyl-phenazine. After formaldehyde fixation blue-fluorescing droplets could be stained with oil red O. Interestingly, PMS-treated 3T3-L1 adipocytes observed under UV excitation 24 h after labeling showed large lipid droplets with a weak green emission within a diffuse pale blue-fluorescing cytoplasm, whereas a strong green emission was observed in small lipid droplets. This fluorescence change from blue to green indicates that reoxidation of methyl-phenazine to PMS can occur. Regarding cell uptake and labeling mechanisms, QSAR models predict that the hydrophilic PMS is not significantly membrane-permeant, so most PMS reduction is expected to be extracellular and associated with a plasma membrane NAD(P)H reductase. Once formed, the lipophilic and blue-fluorescing methyl-phenazine enters live cells and mainly accumulates in lipid droplets. Overall, the results reported here indicate that PMS is an excellent fluorescent probe to investigate labeling and redox dynamics of lipid droplets in cultured cells.Fil: Stockert, Juan C.. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Instituto de Investigación y Tecnología en Reproducción Animal; ArgentinaFil: Carou, María Clara. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Instituto de Investigación y Tecnología en Reproducción Animal; ArgentinaFil: Casas, Adriana Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Investigaciones sobre Porfirinas y Porfirias. Universidad de Buenos Aires. Centro de Investigaciones sobre Porfirinas y Porfirias; ArgentinaFil: Garcia Vior, María Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Orgánica; ArgentinaFil: Ezquerra Riega, Sergio Dario. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Orgánica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Blanco, María M.. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Orgánica; ArgentinaFil: Espada, Jesús. Universidad Bernardo O'Higgins; ChileFil: Blázquez Castro, Alfonso. Universidad Autónoma de Madrid. Facultad de Ciencias. Departamento de Biología; EspañaFil: Horobin, Richard W.. University of Glasgow; Reino UnidoFil: Lombardo, Daniel Marcelo. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Instituto de Investigación y Tecnología en Reproducción Animal; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study

AimsInsulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy.MethodsData were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013.ResultsData were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE, 9.4% Medtronic MiniMed 715/515, 34.3% Medtronic MiniMed VEO, 24.3% Accu-Check Spirit Combo and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE (22.1%) and Medtronic MiniMed VEO (17.7%) were the most replaced.ConclusionsIn a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models