Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

The incidence of post-transplant diabetes mellitus was evaluated retrospectively in 901 consecutive renal transplant recipients. Thirty-two (3.6%) patients developed diabetes mellitus requiring drug therapy. 18 of 32 became hyperglycaemic within 3 months of transplantation. Post-transplant diabetes mellitus occurred in 24 of 628 (3.8%) patients treated with conventional therapy consisting in azathioprine and prednisone, and in 8 of 273 (2.9%) patients receiving cyclosporin A (CsA) in addition (triple therapy). To identify predisposing factors 32 nondiabetic patients matched for age, sex, number of graft, immunosuppressive protocol, and graft function at onset of diabetes were used as case controls. Thirteen of 32 patients with diabetes mellitus and 5 of 32 control patients had abnormal glucose tolerance pretransplant (P<0.025). HLA-B8 was significantly more frequent in patients with post-transplant diabetes mellitus than in control patients (9 of 29 vs 2 of 31, (P<0.02). Twelve (38%) patients became diabetic during or immediately after anti-rejection therapy with intravenous pulse prednisone. Four diabetic patients experienced chronic pancreatitis pre-transplant. Family history of diabetes mellitus, bodyweight, number of rejection episodes, and immunosuppressive drug doses were similar in both groups. Actuarial patient and graft survival was not significantly different in diabetic patients and controls, although 10-year data tended to be better in controls. Thus, post-transplant diabetes mellitus was not a frequent complication in patients sometimes predisposed by an impaired glucose tolerance pre-transplant and was triggered by pulse prednisone therapy in 38

Post-Renal Transplant Diabetes Mellitus in Korean Subjects: Superimposition of Transplant-Related Immunosuppressant Factors on Genetic and Type 2 Diabetic Risk Factors

Postrenal transplantation diabetes mellitus (PTDM), or new-onset diabetes after organ transplantation, is an important chronic transplant-associated complication. Similar to type 2 diabetes, decreased insulin secretion and increased insulin resistance are important to the pathophysiologic mechanism behind the development of PTDM. However, β-cell dysfunction rather than insulin resistance seems to be a greater contributing factor in the development of PTDM. Increased age, family history of diabetes, ethnicity, genetic variation, obesity, and hepatitis C are partially accountable for an increased underlying risk of PTDM in renal allograft recipients. In addition, the use of and kinds of immunosuppressive agents are key transplant-associated risk factors. Recently, a number of genetic variants or polymorphisms susceptible to immunosuppressants have been reported to be associated with calcineurin inhibition-induced β-cell dysfunction. The identification of high risk factors of PTDM would help prevent PTDM and improve long-term patient outcomes by allowing for personalized immunosuppressant regimens and by managing cardiovascular risk factors

Symbol, myth and the demonic in the work of Jackson Pollock. In consideration of the reception of the Red Indian culture

Die Interpretation einiger Kunstwerke von Jackson Pollock aus den Jahren 1942 bis 1946 führt in die Glaubenswelt der Indianer. Die untersuchten mythologischen und religiösen Aspekte seines Schaffens, beispielhaft für den frühen Abstrakten Expressionismus, erklären die Rezeption des Totemismus sowie einen ethnologisch begründeten Primitivismus. Dabei stellt sich der existentielle Naturbezug als ein gravierendes Anliegen des Künstlers heraus. Die ikonographische Analyse der Bildmotive offeriert Vergleiche mit Künstlern wie Pablo Picasso, Max Ernst und André Masson und zeigt die Einflüsse des Surrealismus im Exil als auch der mexikanischen Kunst auf. Damit kann diese Dissertation einen Weg zu den tiefen Sinnschichten der späteren abstrakten Werke weisen.The interpretation of some pictures from Jackson Pollock, between 1942 until 1946, lead to the spiritual world of the Red Indian. The examination of the mythological and religious aspects of his work, an example for the beginning of the Abstract Expressionism, explain the reception of the totemism and the ethnological primitivism. So we come to the conclusion, that the existential underlaying of nature is very important for Pollock. The iconographical analysis of the motives out of the pictures offers comparisons with Pablo Picasso, Max Ernst and André Masson and shows the influences of the Surrealism in Exil and the Mexican art. Hereby is this dissertation a guide to the deeper sense of the abstract painting

Physiologische und biomechanische Untersuchungen zur Ermittlung der Beanspruchung beim repetitiven Heben von Lasten

TIB Hannover: DR 9222 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Productivity and belowground competition vectors of a temperate alley cropping system

Novel alley cropping systems in the humid temperate Midwestern USA are being developed as alternatives to the conventional practice of growing hardwood trees and agronomic crops in monocultures. There are several issues concerning management of the black walnut (Juglans nigra L.) alley cropping system, which include consideration of the sufficiency of belowground and aboveground plant resources and whether toxins exuded by the trees inhibit crop growth. Tree management activities were examined for their impacts on tree and maize (Zea mays L.) productivity in an alley cropping system located in southern Indiana. Tree root pruning in year 11 after system establishment (year 1 = 1985) improved crop access to nutrients and water resulting in little detectable difference in crop yield between mid alley and alley edge rows. This response dissipated by year 16 when crop production declined by up to 96% as trees continued to grow and light became limiting across the 8.5 m-wide alley. However, tree branch pruning in year 17 returned crop yields to up to 81% of the year 11 values in the mid alley, but only 30% at the alley edge. Root pruning was associated with reduced soil organic matter levels and organic nitrogen fertility as well as increased inorganic nitrogen concentrations in soil leachates below the effective rooting zone. Water appeared to limit maize productivity particularly during a late summer droughty period in year 12; however, more typically frequent summer rainfall in this humid region may provide sufficient water for resource demanding alley crops. Juglone (5-hydroxy-1,4-naphthoquinone) exudation by walnut tree root seedlings was confirmed in a pot study and soil pore-water concentrations estimated from extracts of surficial soil from beneath the alley cropping system were as high as 6.6 × 10−6 M, which is below levels known to inhibit crops considered for intercropping with black walnut. Further assessment of the likely persistence of juglone in soils indicated that juglone is both microbially and abiotically degraded, and that it will be particularly short-lived in soils supporting microbial activity. The potential increase in overall productivity and conservation of the landscape unit justifies efforts to overcome the challenges of managing mixed-cropping systems

Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

The incidence of post-transplant diabetes mellitus was evaluated retrospectively in 901 consecutive renal transplant recipients. Thirty-two (3.6%) patients developed diabetes mellitus requiring drug therapy. 18 of 32 became hyperglycaemic within 3 months of transplantation. Post-transplant diabetes mellitus occurred in 24 of 628 (3.8%) patients treated with conventional therapy consisting in azathioprine and prednisone, and in 8 of 273 (2.9%) patients receiving cyclosporin A (CsA) in addition (triple therapy). To identify predisposing factors 32 nondiabetic patients matched for age, sex, number of graft, immunosuppressive protocol, and graft function at onset of diabetes were used as case controls. Thirteen of 32 patients with diabetes mellitus and 5 of 32 control patients had abnormal glucose tolerance pretransplant (P<0.025). HLA-B8 was significantly more frequent in patients with post-transplant diabetes mellitus than in control patients (9 of 29 vs 2 of 31, (P<0.02). Twelve (38%) patients became diabetic during or immediately after anti-rejection therapy with intravenous pulse prednisone. Four diabetic patients experienced chronic pancreatitis pre-transplant. Family history of diabetes mellitus, bodyweight, number of rejection episodes, and immunosuppressive drug doses were similar in both groups. Actuarial patient and graft survival was not significantly different in diabetic patients and controls, although 10-year data tended to be better in controls. Thus, post-transplant diabetes mellitus was not a frequent complication in patients sometimes predisposed by an impaired glucose tolerance pre-transplant and was triggered by pulse prednisone therapy in 38

Predictors of new onset diabetes after renal transplantation

The development of new onset diabetes after transplantation (NODAT) is associated with increased cardiovascular morbidity and mortality. This study aimed at identifying risk factors for the development of NODAT. We performed a retrospective review of 787 renal transplants performed between 1994 and 2004 at a single centre. NODAT was diagnosed in patients who had two random plasma glucose concentrations >11.1 mmol/L after the first month post-transplant or patients who required treatment for hyperglycaemia within the first month and continued treatment thereafter. The incidence of NODAT was 7.7%. The incidence of NODAT requiring either insulin or oral hypoglycaemic agents was 4.5%. Risk factors for the development of NODAT were older age (HR 1.04, 95% CI: 1.01-1.07, p < 0.01), heavier weight at time of transplantation (HR 1.04, 95% CI: 1.02-1.07, p < 0.01), higher mean pre-transplant random plasma glucose concentrations (HR 1.54, 95% CI: 1.14-2.08, p < 0.01), higher plasma glucose within the first seven d post-transplant (HR 1.27, 95% CI: 1.09-1.47, p < 0.01) and use of tacrolimus (HR 3.70, 95% CI: 1.61-8.46, p < 0.01). Ten yr actuarial patient survival was 67.1% in patients with NODAT compared with 81.9% for those without diabetes and 65.3% in patients known to have diabetes pre-transplant. There was no difference in graft survival. We have identified a high-risk group in which attempts should be made to reduce the incidence of NODAT by tailoring immunosuppression, lifestyle modification and selecting non-diabetogenic medications. Improvements in management of patients at higher risk of NODAT may help reduce the incidence of deaths with a functioning graft

Post-transplant diabetes mellitus: a case-control analysis of the risk factors

Aim of the present study was to assess, in a pair-matched analysis design, risk factors for post-transplant diabetes mellitus (PTDM) in renal transplant recipients (KTx). The incidence of PTDM was evaluated in 538 consecutive KTx in relation to their baseline immunosuppression. PTDM was defined according to the 2003 American Diabetes Association and World Health Organization experts committee definition. As risk factors for PTDM development were considered: age, family history of diabetes, body mass index (BMI), baseline immunosuppression, doses and blood levels of the immunosuppressive agents used. Baseline immunosuppression consisted of CSA, TAC and SRL + CNI. Thirty-two pair-matched controls were identified among the 538 KTx and included in the risk analysis. Significant risk factors for the development of PTDM were identified in the family history of diabetes (P < 0.02) and BMI (P < 0.05). Higher BMI and positive family history for diabetes mellitus were significant risk factors for the development of PTDM, regardless of the immunosuppressive agent used