Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes

WSTĘP. Celem pracy była ocena bezpieczeństwa skuteczności stosowania pompy insulinowej u dzieci młodzieży chorych na cukrzycę typu 1. MATERIAŁ I METODY. Do badania włączono 95 dzieci, które rozpoczęły stosowanie pompy insulinowej w Johns Hopkins Hospital w okresie od stycznia 1990 do grudnia 2000 roku. Średni wiek badanych wynosił 12,0 lat (przedział 4&#8211;18 lat); 29% badanych było poniżej 10 roku życia. Dane zebrano z dokumentacji medycznej, począwszy od okresu 6&#8211;12 miesięcy przed zastosowaniem terapii pompą insulinową. Średni czas obserwacji wynosił 28 miesięcy. WYNIKI. Zaobserwowano niewielkie, lecz znamienne statystycznie obniżenie stężenia HbA1c w 3.&#8211;6. miesiącu terapii (7,7% vs. 7,5%, p = 0,03). W czasie dalszej obserwacji stężenie to stopniowo zwiększało się i pozostało podwyższone po roku, jednak na to zjawisko wpływał wiek badanych i czas trwania cukrzycy. Obie wymienione zmienne wiązały się z wyższym stężeniem HbA1c. Po uwzględnieniu wieku i czasu trwania cukrzycy średnie stężenie HbA1c po rozpoczęciu terapii pompą insulinową było znamiennie niższe niż przed jej zastosowaniem (7,7% vs. 8,1%, p < 0,001). Częstość powikłań (kwasica ketonowa, interwencje w izbie przyjęć) była podobna przed i po rozpoczęciu leczenia. Zaobserwowano mniej incydentów hipoglikemii po rozpoczęciu terapii (12 vs. 17, współczynnik częstości = 0,46; 95% CI 0,21&#8211;1,01). WNIOSKI. Badanie to sugeruje, że stosowanie pompy insulinowej jest bezpieczną i skuteczną metodą leczenia u wybranych dzieci chorych na cukrzycę typu 1.INTRODUCTION. To evaluate the safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes. MATERIAL AND METHODS. All 95 patients who began insulin pump therapy at Johns Hopkins Hospital between January 1990 and December 2000 were included in the study. The mean age was 12.0 years (range 4&#8211;18), and 29% of the patients were < 10 years old. Data were obtained by chart review beginning 6&#8211;12 months before pump start. The median duration of follow-up was 28 months. RESULTS. There was a small but significant decrease in HbA1c at 3&#8211;6 months after pump start (7.7% vs. 7.5%; P = 0.03). HbA1c levels then gradually increased and remained elevated after 1 year of followup; however, this association was confounded by age and diabetes duration, both of which were associated with higher HbA1c levels. After adjusting for duration and age, mean HbA1c after pump start was significantly lower than before pump start (7.7% vs. 8.1%; P < 0.001). The number of medical complications (diabetic ketoacidosis, emergency department visits) was similar before and after pump start. There were fewer hypoglycemic events after pump start (12 vs. 17, rate ratio 0.46, 95% CI 0.21&#8211;1.01). CONCLUSIONS. This study suggests that pump therapy is safe and effective in selected children and adolescents with type 1 diabetes

Low birth weight and markers of inflammation and endothelial activation in adulthood: The ARIC study

To investigate the hypothesis that intrauterine growth restriction might produce a longstanding pro-inflammatory tendency, we investigated the association of low birth weight with blood levels of markers of inflammation and endothelial activation in middle-aged adults

Smoking Cessation and Cardiovascular Disease Risk Factors: Results from the Third National Health and Nutrition Examination Survey

BACKGROUND: Cigarette smoking is a major risk factor for the development and progression of cardiovascular disease. While smoking is associated with increased levels of inflammatory markers and accelerated atherosclerosis, few studies have examined the impact of smoking cessation on levels of inflammatory markers. The degree and rate at which inflammation subsides after smoking cessation are uncertain. It also remains unclear as to whether traditional risk factors can adequately explain the observed decline in cardiovascular risk following smoking cessation. METHODS AND FINDINGS: Using data from 15,489 individuals who participated in the Third National Health and Nutrition Examination Survey (NHANES III), we analyzed the association between smoking and smoking cessation on levels of inflammatory markers and traditional cardiovascular risk factors. In particular, we examined changes in C-reactive protein, white blood cell count, albumin, and fibrinogen. Inflammatory markers demonstrated a dose-dependent and temporal relationship to smoking and smoking cessation. Both inflammatory and traditional risk factors improved with decreased intensity of smoking. With increased time since smoking cessation, inflammatory markers resolved more slowly than traditional cardiovascular risk factors. CONCLUSION: Inflammatory markers may be more accurate indicators of atherosclerotic disease. Inflammatory markers returned to baseline levels 5 y after smoking cessation, consistent with the time frame associated with cardiovascular risk reduction observed in both the MONICA and Northwick Park Heart studies. Our results suggest that the inflammatory component of cardiovascular disease resulting from smoking is reversible with reduced tobacco exposure and smoking cessation

The Role of Bile in the Regulation of Exocrine Pancreatic Secretion

As early as 1926 Mellanby (1) was able to show that introduction of bile into the duodenum of anesthetized cats produces a copious flow of pancreatic juice. In conscious dogs, Ivy & Lueth (2) reported, bile is only a weak stimulant of pancreatic secretion. Diversion of bile from the duodenum, however, did not influence pancreatic volume secretion stimulated by a meal (3,4). Moreover, Thomas & Crider (5) observed that bile not only failed to stimulate the secretion of pancreatic juice but also abolished the pancreatic response to intraduodenally administered peptone or soap

Study protocol to investigate the effect of a lifestyle intervention on body weight, psychological health status and risk factors associated with disease recurrence in women recovering from breast cancer treatment

Background Breast cancer survivors often encounter physiological and psychological problems related to their diagnosis and treatment that can influence long-term prognosis. The aim of this research is to investigate the effects of a lifestyle intervention on body weight and psychological well-being in women recovering from breast cancer treatment, and to determine the relationship between changes in these variables and biomarkers associated with disease recurrence and survival. Methods/design Following ethical approval, a total of 100 patients will be randomly assigned to a lifestyle intervention (incorporating dietary energy restriction in conjunction with aerobic exercise training) or normal care control group. Patients randomised to the dietary and exercise intervention will be given individualised healthy eating dietary advice and written information and attend moderate intensity aerobic exercise sessions on three to five days per week for a period of 24 weeks. The aim of this strategy is to induce a steady weight loss of up to 0.5 Kg each week. In addition, the overall quality of the diet will be examined with a view to (i) reducing the dietary intake of fat to ~25% of the total calories, (ii) eating at least 5 portions of fruit and vegetables a day, (iii) increasing the intake of fibre and reducing refined carbohydrates, and (iv) taking moderate amounts of alcohol. Outcome measures will include body weight and body composition, psychological health status (stress and depression), cardiorespiratory fitness and quality of life. In addition, biomarkers associated with disease recurrence, including stress hormones, estrogen status, inflammatory markers and indices of innate and adaptive immune function will be monitored. Discussion This research will provide valuable information on the effectiveness of a practical, easily implemented lifestyle intervention for evoking positive effects on body weight and psychological well-being, two important factors that can influence long-term prognosis in breast cancer survivors. However, the added value of the study is that it will also evaluate the effects of the lifestyle intervention on a range of biomarkers associated with disease recurrence and survival. Considered together, the results should improve our understanding of the potential role that lifestyle-modifiable factors could play in saving or prolonging lives

Weight Loss During the Intensive Intervention Phase of the Weight-Loss Maintenance Trial

To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I)

Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines

This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Nutrition‐Related Cardiovascular Risk Factors in Older People: Results from the Third National Health and Nutrition Examination Survey

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144671/1/jgs200048111486.pd

Identification of sub-surface cracks in mechanical structures by nonlinear features of electro-mechanical impedance measurements

The present thesis deals with the identification of damages in mechanical structures using the electro-mechanical (E/M) impedance method. The E/M impedance method is a vibration based structural health monitoring (SHM) method. It uses for both the vibration excitation as well as for the measurement of the vibration response piezoelectric elements, so-called piezoelectric wafer active sensors (PWAS). In particular, damages of a mechanical structure are investigated, which produce a nonlinear response to a harmonic excitation. Examples therefore are delamination in laminates or face- layer debonding in sandwich panels, so-called sub-surface cracks. For a crack opening small enough, ideally equal to zero, the crack surfaces get for certain frequencies of the harmonic excitation into mechanical contact, and thus nonlinear response results. The effects of such a structural nonlinearity on the vibration response is initially investigated by means of a simplified two-dimensional model of a beam on a nonlinear elastic foundation. An analytical investigation and a numerical investigation based on the finite element method (FEM) are conducted. The harmonic excitation for this model is realized by a force excitation in the middle of the beam. The dynamic response is evaluated by the displacement at the position of the excitation. Further investigations are carried out on a second and more realistic model, an aluminum beam with rectangular cross-section and a sub-surface crack in the beams lengthwise center. In contrast to the first model, the vibration excitation and the sensing of the response are realized by piezoelectric wafer active sensors (PWAS). The focus for this investigation is mainly on the numerical and experimental investigation. Since experiments are conducted a part within this section deals with the manufacturing of the beam specimen, in particular with the manufacturing of the artificial sub-surface crack, since this crack should have an opening distance of ideally zero to produce a nonlinear response to a harmonic excitation. A manufacturing process of a sub-surface crack in metallic beams, capable to produce structural nonlinearity is presented. For both models the evaluation and assessment of the effects of the sub-surface crack is carried out on the one hand by comparing the dynamic responses of the pristine and damaged structure. On the other hand an evaluation of nonlinear features that occur in the dynamic response of the damaged structure is conducted. The discussed nonlinear features are sub- and higher harmonic oscillations with respect to the excitation frequency.submitted by Thomas Erlinger, BScUniversität Linz, Masterarbeit, 2018(VLID)275140