Background: Risk factors for post‐thrombotic syndrome (PTS) remain poorly understood.
Objectives: In this multinational multicenter study, we evaluated whether subtherapeutic warfarin ...anticoagulation was associated with the development of PTS.
Methods: Patients with a first unprovoked deep venous thrombosis (DVT) received standard anticoagulation for 5–7 months and were then assessed for PTS. The time in the therapeutic range was calculated from the international normalized ratio (INR) data. An INR below 2, more than 20% of the time, was considered as subtherapeutic anticoagulation.
Results: Of the 349 patients enrolled, 97 (28%) developed PTS. The overall frequency of PTS in patients with subtherapeutic anticoagulation was 33.5%, compared with 21.6% in those with an INR below two for ≤ 20% of the time (P = 0.01). During the first 3 months of therapy, the odds ratio (OR) for developing PTS if a patient had subtherapeutic anticoagulation was 1.78 (95% confidence interval CI 1.10–2.87). After adjusting for confounding variables, the OR was 1.84 (95% CI 1.13–3.01). Corresponding ORs for the full period of anticoagulation were 1.83 (95% CI 1.14–3.00) crude and 1.88 (95% CI 1.15–3.07) adjusted.
Conclusion: Subtherapeutic warfarin anticoagulation after a first unprovoked DVT was significantly associated with the development of PTS.
To identify recipient factors that may be related to risk of corneal graft failure.
Multicenter, prospective, double-masked, controlled clinical trial.
One thousand ninety subjects undergoing corneal ...transplantation for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic corneal edema).
Donor corneas were assigned using a random approach without respect to recipient factors, and surgeons were masked to information about the donor cornea, including donor age. Surgery and postoperative care were performed according to the surgeons' usual routines, and subjects were followed up for 5 years. Baseline factors were evaluated for their association with graft failure.
Graft failure, defined as a regraft or a cloudy cornea that was sufficiently opaque to compromise vision for a minimum of 3 consecutive months.
Preoperative diagnosis of pseudophakic or aphakic corneal edema increased graft failure risk approximately 4-fold compared with Fuchs' dystrophy (27% vs. 7%). Prior glaucoma surgery with preoperative glaucoma medication use substantially increased the graft failure rate. Factors not strongly associated with graft failure included age, gender, diabetes, smoking, and graft size.
The risk of graft failure is significantly increased in eyes with pseudophakic or aphakic corneal edema compared with Fuchs' dystrophy, independent of lens status, and in eyes with a history of glaucoma.
Proprietary or commercial disclosure may be found after the references.
To examine the long-term effect of donor diabetes history on graft failure and endothelial cell density (ECD) after penetrating keratoplasty (PK) in the Cornea Donor Study.
Multicenter, prospective, ...double-masked, controlled clinical trial.
One thousand ninety subjects undergoing PK for a moderate risk condition, principally Fuchs' dystrophy or pseudophakic or aphakic corneal edema, were enrolled by 105 surgeons from 80 clinical sites in the United States.
Corneas from donors 12 to 75 years of age were assigned by 43 eye banks to participants without respect to recipient factors. Donor and recipient diabetes status was determined from existing medical records. Images of the central endothelium were obtained before surgery (baseline) and at intervals for 10 years after surgery and were analyzed by a central image analysis reading center to determine ECD.
Time to graft failure (regraft or cloudy cornea for 3 consecutive months) and ECD.
There was no statistically significant association of donor diabetes history with 10-year graft failure, baseline ECD, 10-year ECD, or ECD values longitudinally over time in unadjusted analyses, nor after adjusting for donor age and other significant covariates. The 10-year graft failure rate was 23% in the 199 patients receiving a cornea from a donor with diabetes versus 26% in the 891 patients receiving a cornea from a donor without diabetes (95% confidence interval for the difference, -10% to 6%; unadjusted P=0.60). Baseline ECD (P=0.71), 10-year ECD (P>0.99), and changes in ECD over 10 years (P=0.86) were similar comparing donor groups with and without diabetes.
The study results do not suggest an association between donor diabetes and PK outcome. However, the assessment of donor diabetes was imprecise and based on historical data only. The increasing frequency of diabetes in the aging population in the United States affects the donor pool. Thus, the impact of donor diabetes on long-term endothelial health after PK or endothelial keratoplasty, or both, warrants further study with more precise measures of diabetes and its complications.
Aim
To compare the characteristics of children and adolescents with type 1 vs. type 2 diabetes in the Pediatric Diabetes Consortium (PDC) registries.
Methods
Participants were 10 to < 21 years of age ...at diagnosis; there were 484 with type 1 diabetes and 1236 with type 2 diabetes.
Results
Children and adolescents with type 2 diabetes were more likely to be female, overweight/obese, and from low‐income, minority ethnic families. Children and adolescents with type 1 diabetes were more likely to present with diabetic ketoacidosis and have higher mean HbA1c levels at diagnosis. More than 70% in both cohorts achieved target HbA1c levels < 58 mmol/mol (< 7.5%) within 6 months, but fewer participants with type 1 than type 2 diabetes were able to maintain target HbA1c levels after 6 months consistently throughout 3 years post diagnosis. Of the 401 participants with type 2 diabetes with ≥ 24 months diabetes duration on enrolment in the registry, 47% required no insulin treatment. Median C‐peptide levels were 1.43 mmol/l in the subset of participants with type 2 diabetes in whom it was measured, but only 0.06 mmol/l in the subset with type 1 diabetes.
Conclusions
Although families of children and adolescents with type 2 diabetes face greater socio‐economic obstacles and risk factors for poor diabetes outcomes, the greater retention of residual endogenous insulin secretion likely contributes to the increased ability of children and adolescents with type 2 diabetes to maintain target HbA1c during the first 3 years of diabetes diagnosis.
What's new?
Demographic and anthropometric characteristics differ between children and adolescents with type 1 and type 2 diabetes in the Pediatric Diabetes Consortium Registries.
Although a large percentage of older children and adolescents with type 1 and type 2 diabetes are able to achieve target HbA1c levels after 6 months of treatment, children and adolescents with type 2 diabetes are more likely to maintain glycaemic control than those with type 1 diabetes in the years after diagnosis, despite greater socio‐economic obstacles and risk factors.
More intensive treatment strategies are needed to maintain target HbA1c levels in older children and adolescents with type 1 diabetes after the initial 6‐month honeymoon period.
Background:
Managing glycemia during and after exercise events in type 1 diabetes (T1D) is challenging since these events can have wide-ranging effects on glycemia depending on the event timing, ...type, intensity. To this end, advanced physical activity-informed technologies can be beneficial for improving glucose control.
Methods:
We propose a real-time physical activity detection and classification framework, which builds upon random forest models. This module automatically detects exercise sessions and predicts the activity type and intensity from tri-axial accelerometer, heart rate, and continuous glucose monitoring records.
Results:
Data from 19 adults with T1D who performed structured sessions of either aerobic, resistance, or high-intensity interval exercise at varying times of day were used to train and test this framework. The exercise onset and completion were both predicted within 1 minute with an average accuracy of 81% and 78%, respectively. Activity type and intensity were identified within 2.38 minutes and from the exercise onset. On participants assigned to the test set, the average accuracy for activity type and intensity classification was 74% and 73%, respectively, if exercise was announced. For unannounced exercise events, the classification accuracy was 65% for the activity type and 70% for its intensity.
Conclusions:
The proposed module showed high performance in detection and classification of exercise in real-time within a minute of exercise onset. Integration of this module into insulin therapy decisions can help facilitate glucose management around physical activity.
Long-term exposure to infections can exert serious pressure on the host’s immune system and influence its capacity to react adequately when challenged by another parasite. Rather than reacting ...readily to the attack of a secondary pathogen the immune response might be weaker because of the costs imposed by resisting the primary infection.
Rickia wasmannii
is an ectoparasitic fungus, which attaches to the outer layer of
Myrmica
ants without killing the host, but causing different modifications on individual and social level. We examined the immune competence of
M. scabrinodis
workers of different age categories either coming from infected colonies or from healthy control colonies using encapsulation assays. Infection and age did not affect the encapsulation response separately, but their interaction had a considerable effect: the response was stronger in young, infected workers. Smaller individuals also had stronger responses. Encapsulation response was not influenced by fat content of workers. Immune facilitation might indeed work in infected colonies, although not for each worker category. This emphasizes the importance of within-colony diversity when considering colony level response to parasitic attacks.
Mieux comprendre l'origine de la ressource en eau afin d'en améliorer la gestion est aujourd'hui une nécessité. Les cours d'eau de l'amont cévenol du bassin versant des Gardons, présentent des ...différences dans leurs débits de basses eaux. Ces écarts entre débits s'expliquent, hors des différences liées aux précipitations (orages...), par des contributions particulières des réservoirs géologiques, dans la mesure où les basses eaux correspondent globalement à un régime hydraulique non influencé (tarissement).L'étude a été réalisée principalement durant les étés 2018 et 2019. Les débits et la minéralisation des eaux de surface et des eaux souterraines ont été suivis sur neuf sous-bassins versants. Un modèle de mélange, appliqué en complément du suivi géochimique, permet de quantifier la contribution des différentes formations aquifères et montre de fortes différences entre elles. À l'étiage, deux formations, les micaschistes noirs et les calcaires, se révèlent primordiales dans le soutien des débits : elles alimenteraient les cours d'eau étudiés à hauteur de 41 et 17 % respectivement, alors qu'elles ne couvrent que 13 et 8 % du secteur considéré. L'analyse de la contribution des différentes formations permet d'expliquer les différences de débit spécifique observées pour les cours d'eau du terrain d'étude. Ces contributions à l'étiage, couplées aux débits, permettent d'identifier les réservoirs les plus productifs, qui sont à protéger en priorité.
Many adolescents with type 2 diabetes (T2D) have rapid deterioration of glycemic control on metformin monotherapy within 2 years of diagnosis.
Enrollment data from the Pediatric Diabetes Consortium ...T2D Registry were used to categorize 276 youth with a T2D duration ≥2 years into two groups: (1) participants with HbA1c <7.5% on metformin monotherapy (group 1, n = 75) and (2) participants treated with insulin ± metformin (group 2, n = 201). The characteristics of the groups were compared.
At enrollment, groups 1 and 2 did not differ in age (16.2 vs. 16.8 years) or BMI percentile (99 vs. 98%); group 2 had higher HbA1c (9.9% 85 mmol/mol vs. 5.9% 41 mmol/mol, p < 0.001). Lower HbA1c and metformin monotherapy at diagnosis were associated with a greater likelihood of adequate control with metformin alone (p < 0.001). In multivariable analysis, HbA1c at diagnosis (p = 0.001) and diabetes duration (p = 0.009) were associated with adequate control on metformin. The HbA1c trajectory after diagnosis was worse in group 2.
Durable metabolic control of T2D with metformin monotherapy is most likely in youth presenting with lower HbA1c and with shorter diabetes duration, independent of age, race-ethnicity, and BMI. Elevated HbA1c levels in those on insulin therapy highlight the importance of early diagnosis and a better understanding of glycemic control barriers.
There are several types of super alloys: Titanium, Inconel. Titanium alloys are typical for aerospace products. They are attractive because of their low specific weight, and their resistance. Inconel ...alloys are corrosion and oxidation resistant materials, well suited for work in extreme environments who have a good resistance at high pressure and heat. Inconel alloys retain their properties in a wide temperature range and are attractive for high temperature applications where aluminum and steel parts will not resisted. But the processing of these super alloys is complex and requires dedicate cutting tools and special cutting tools parameters. In the paper will be present solutions at this requirements: new cutting tools and new solutions to manufacturing aerospace parts from Inconel.
The milling operation is widely used and the results are directly influenced by the milling strategies adopted. The paper presents two processing methods: one classical and one actual, both methods ...with wide industrial applications. Was made the comparison of these methods in manufacturing, are presented the results that were obtained on a real application. Knowing the milling processes, the new strategies developed by the CAM software, bring more substantial results and efficiency in manufacturing process.
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