bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glycaemic control metrics and metabolic dysfunction–associated steatotic liver disease in children and adolescents with type 1 diabetes
Authors: Maffeis Claudio , Piona Claudia , Morandi Anita , Marigliano Marco , Morotti Elisa , Mancioppi Valentina , Caiazza Erika , Zusi Chiara , Emiliani Federica , Mantovani Alessandro , Colecchia Antonio , Targher Giovanni 
Published: September 2024

AbstractAimThe aim was to examine the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), a risk factor for atherosclerotic cardiovascular disease, and its association with glycaemic control metrics in children and adolescents with type 1 diabetes (T1D).Materials and MethodsWe enrolled 244 children and adolescents with T1D (115 girls, mean age: 16.2 ± 3.2 years). The diagnosis of MASLD was defined by the presence of hepatic steatosis on ultrasonography in combination with at least one of five common cardiometabolic risk factors. Metrics of short‐term and long‐term glycaemic control, blood pressure, lipids, anthropometric characteristics and three genetic variants strongly related to MASLD susceptibility (rs738409 [patatin‐like phospholipase domain‐containing 3], rs58542926 [transmembrane 6 superfamily member 2] and rs1260326 [glucokinase regulator]) were assessed. Characteristics of these subjects with and without MASLD were compared using the unpaired Student t test, Mann–Whitney test or χ2 test as appropriate. Logistic regression analyses were performed to determine the main independent predictors of MASLD.ResultsThe prevalence of MASLD was 27.5% in children and adolescents with T1D. Blood pressure, total cholesterol, low‐density lipoprotein (LDL) cholesterol, non‐high‐density lipoprotein cholesterol, HbA1c and time above range (TAR) were significantly higher in subjects with MASLD than in those without MASLD. Mean HbA1c values from diabetes onset (adjusted odds ratio [OR]: 1.703, 95% confidence interval [CI]: 1.040–2.787, p = 0.034), TAR (adjusted OR: 1.028, 95% CI: 1.009–1.047, p = 0.006) and plasma LDL cholesterol (adjusted OR: 1.045, 95% CI: 1.013–1.078, p = 0.004) were independently associated with the presence of MASLD.ConclusionsMASLD is a common condition in children and adolescents with T1D. The mean HbA1c values from diabetes onset, TAR and LDL cholesterol levels were the independent predictors of MASLD.
Risk of hypoglycaemia among people with type 2 diabetes not treated with insulin: A retrospective analysis of Medicare Advantage beneficiaries
Authors: Hannah Katia , Nemlekar Poorva , Bushman Jesse S. , Norman Gregory J. 
Published: September 2024

AbstractAimsIn 2022, the Centers for Medicare & Medicaid Services released proposed changes to Medicare's continuous glucose monitoring (CGM) coverage policy, making individuals with a history of problematic hypoglycaemia eligible for CGM coverage, irrespective of insulin use. This study estimated the burden of hypoglycaemia in Medicare Advantage beneficiaries with noninsulin‐treated type 2 diabetes (T2D).Materials and MethodsWe retrospectively analysed US healthcare claims data using Optum's deidentified Clinformatics® database. Noninsulin‐treated beneficiaries were identified in the 16 years from January 2007 to March 2023. Hypoglycaemia‐related encounters (HREs) were those accompanied by a hypoglycaemia‐specific ICD‐9/10 diagnosis code in any position on the claim or the first or second position. HREs following the first claim related to T2D were reported by setting (ambulatory or inpatient/emergency department [ED]).ResultsHREs were identified in 689,853 (21.4%) of 3,229,695 noninsulin‐treated Medicare Advantage beneficiaries, of whom 82.9% (n = 571,581) had ≥1 HRE in an ambulatory location and 26.8% (n = 184,833) in an ED/inpatient location. Use of sulfonylurea (odds ratio [OR]: 4.33 confidence interval [CI: 4.27–4.38]), evidence of end‐stage kidney disease (OR: 2.87 [CI: 2.79–2.94]), hypertension (OR: 3.09 [CI: 3.04–3.15]) and retinopathy (OR: 2.94 [CI: 2.82–3.07]) were the strongest predictors of an HRE (p < 0.001).ConclusionsThese findings show that HREs are prevalent in noninsulin‐treated diabetes and identify a large number of patients who may benefit from CGM. Because >80% of HREs occur in the ambulatory setting and >70% occur in patients not taking sulfonylureas, primary care providers should be aware of the latest eligibility criteria for Medicare's coverage of CGM and not restrict this technology to their sulfonylurea‐treated patients.
Improved diagnostic performance of high‐sensitivity cardiac troponins in muscle dystrophies using comprehensive definition criteria for cardiac involvement: A longitudinal study on 35 patients
Authors: Yildirim Mustafa , Salbach Christian , Reich Christoph , Pribe‐Wolferts Regina , Milles Barbara Ruth , Täger Tobias , Mueller‐Hennessen Matthias , Weiler Markus , Meder Benjamin , Frey Norbert , Giannitsis Evangelos 
Published: September 2024

AbstractBackground and purposeSparse information is available on the correct interpretation of elevated high‐sensitivity cardiac troponin (hs‐cTn) in confirmed muscular dystrophies.MethodsSerum concentrations of hs‐cTn T (hs‐cTnT) and hs‐cTn I (hs‐cTnI) were determined in 35 stable outpatients with confirmed skeletal muscle dystrophies. We calculated sensitivities, specificities, and positive and negative predictive values of hs‐cTnT and hs‐cTnI for identification of cardiac involvement using a comprehensive definition that included diastolic left ventricular and right ventricular function, strain analysis using two‐dimensional transthoracic echocardiogram and magnetic resonance imaging, myocardial biopsies, and consideration of a variety of triggers for cardiac injury, including arrhythmias, conduction disorders, and hypoxemia due to respiratory failure.ResultsCardiac involvement was diagnosed in 34 of 35 cases. Specificities of hs‐cTnT increased from 12.5% to 100% (p = 0.0006) applying the comprehensive definition compared to a definition based on electrocardiography and echocardiography alone. At the recommended 99th percentile upper limit of normal, sensitivities were significantly lower for hs‐cTnI than for hs‐cTnT (29.4% vs. 100%, p = 0.0164). Conversely, the specificities of hs‐cTnT and hs‐cTnI increased to 100% when using the comprehensive definition criteria for diagnosing cardiac involvement.ConclusionsElevated hs‐cTnT but not hs‐cTnI discriminates cardiac involvement in cases with confirmed skeletal muscle dystrophies with very high sensitivity and 100% specificity. Prior reports on worse performance may be explained by the use of less sensitive imaging methods or incomplete assessment of cardiac involvement.
Risk Management in the Public Sector: A Comparative Analysis of Central Government Settings in France, Germany, and Italy
Authors: Gourbier Léonard , Iacuzzi Silvia , Padovani Emanuele , Saliterer Iris 
Published: September 2024

ABSTRACTIn recent years, public organizations have come under increasing pressure to implement comprehensive risk management (RM) systems that are based on international frameworks and standards. However, little is known about whether different countries have addressed this issue in their regulatory strategies and how they have done so. To address this gap, this study conducts a cross‐country analysis and introduces and applies an analytical framework to compare the different RM approaches adopted by the central governments of France, Germany, and Italy. This comparison sheds light on the regulatory landscape in the three largest countries in the European Union and reveals the diverse RM frameworks with varying focuses, drivers, designs, and levels of integration. Although each country has unique nuances in its approaches, commonality is the primary perception of risk as a threat. This stance, although understandable in the context of financial risks, calls for a shift toward viewing risk as an opportunity, thus promoting a balanced approach that goes beyond mere compliance.
Forbs from seasonal managed wetlands boost plankton production more than emergent graminoids by supplying novel labile detritus
Authors: Phillips Kyle A. , Tung Alice M. , McConnell Rachel M. , O’Rear Teejay A. , Rejmánková Eliška , Lawler Sharon P. , Durand John R. 
Published: September 2024

Abstract

Opportunities to enhance ecosystem functions exist in human‐dominated working landscapes, but understanding of key drivers is often lacking in these novel environments. In Suisun Marsh, California, USA, impounded managed wetlands designed to promote waterfowl incidentally support higher plankton densities—a key resource for imperilled pelagic fishes—than adjacent tidal habitats. Managed wetland operations could produce plankton at critical periods for fish and the aquatic food‐web more broadly, but drivers of plankton production in managed wetlands are poorly understood.

We proposed that decaying vegetation resulting from controlled flooding in managed wetlands is important for stimulating plankton blooms, but that the effect varies by plant species and functional type. We conducted a mesocosm experiment to test the effects of different inundated plants on plankton production, including three forb species, three emergent graminoid species and a control treatment without added plant material.

Forbs promoted larger phytoplankton blooms and higher zooplankton production—by an order of magnitude—than both emergent graminoids and the control treatment. Emergent graminoids supported larger phytoplankton blooms, but not higher zooplankton production, than the control treatment. Phytoplankton blooms exhibited pulse dynamics in all treatments, with densities increasing initially and crashing by the end of the experiment. Phytoplankton blooms in forb and emergent treatments lasted similar durations, counter to the expectation that emergent graminoids would support diminished production over a relatively prolonged period. Among zooplankton taxa, Daphnia magna and rotifers were strongly associated with all three forbs species while the nonnative cyclopoid copepod Limnothoina tetraspina were associated with cattails (Typha domingensis) and the control. Forbs temporarily depleted dissolved oxygen concentrations during the first week of the experiment, suggesting a tradeoff by which decaying forbs boost plankton production at risk of initial hypoxia.

Our results suggest that seasonal drying and flooding operations in managed wetlands are likely to enhance plankton production because dry periods promote forb growth and subsequent flooding introduces labile forb material to the aquatic food web. Results also suggest that seasonal managed‐wetlands act as novel floodplain‐analogues, by which flood pulses drive productivity. Further research is needed to quantify production benefits and tradeoffs to the aquatic ecosystem at the landscape scale and to identify optimal management regimes that will help conserve imperilled species.
An innovative benefit‐of‐the‐doubt approach for health system effectiveness: a global case study on amenable mortality
Authors: D'Inverno Giovanna , Santos João Vasco , Camanho Ana S. 
Published: September 2024

AbstractHealth system performance assessment (HSPA) is essential for health planning and to improve population health. One of the HSPA domains is related to effectiveness, which can be represented considering different dimensions. Composite indicators can be used to summarize complex constructs involving several indicators. One example of such efforts is the Healthcare Access and Quality Index from the Global Burden of Diseases Study, in which different causes of mortality amenable to health care are summarized in this index through principal component analysis and exploratory factor analysis. While these approaches use the variance of the indicators, marginal improvement is not considered, that is, the distance to the best practice frontier. In this study we propose an innovative benefit‐of‐the‐doubt approach to combine frontier analysis and composite indicators, using amenable mortality estimates for 188 countries. In particular, we include flexible aggregating weighting schemes and a robust and conditional approach. The dual formulation gives information on the peers and the potential mortality rate reduction targets considering the background conditions. In absolute terms, Andorra and high‐income countries are the most effective regarding healthcare access and quality, while sub‐Saharan African and South Asian countries are the least effective. North African and Middle Eastern countries benefit the most when epidemiological patterns, geographical proximity, and country development status are considered.
Simultaneous treatment of concurrent rejection and tissue invasive cytomegalovirus disease without detrimental effects upon patient or allograft survival
Authors: Dunn David L. , Mayoral Jaime L. , Gillingham Kristen J. , Sawyer Mark D. , Kramer Marie A. , Statz Catherine L. , McHugh Lois , Matas Arthur J. , Gores Paul F. , Payne William D. , Sutherland David L R. , Najarian John S. 
Published: September 2024

Posttransplant cytomegalovirus (CMV) infection has been directly and temporally correlated with decreased patient and allograft survival. Because of this association, prior dogma has dictated that immunosuppression be decreased or maintained, but not increased, and thus rejection episodes have not been treated during active CMV infection. Since 1987, we have treated a group of patients who developed concurrent (within 1–3 days) mild to moderate acute rejection and mild to moderate tissue invasive CMV disease (TI‐CMV) with antirejection and antiviral therapy simultaneously. 619 patients underwent renal transplantation between 5/7/87 and 12/13/90 [535 kidney (253 living related, 282 cadaver) and 84 kidney‐pancreas]. 18 patients presented with concurrent evidence of TI‐CMV plus acute kidney or pancreas allograft rejection. Treatment consisted of iv ganciclovir (DHPG, 5 mg/kg iv q 12 h, mean = 14.4 days) for TI‐CMV and initial oral or iv steroids (followed by ALG or OKT3 in 13 patients) for rejection. At 30 days, all 18 patients with concurrent TI‐CMV and rejection were successfully treated for CMV without DHPG toxicity, although 2 allografts were lost due to unrelenting rejection requiring nephrectomy. 4 patients developed recurrent TI‐CMV and 1 patient developed recurrent rejection >30 days after simultaneous therapy, all of which were successfully treated. A total of 4 deaths occurred due to the following causes: pulmonary embolus, cerebrovascular accident. Candida sepsis, and Aspergillus sepsis, the latter subsequent to treatment of recurrent rejection. We analyzed outcome in patients who developed TI‐CMV post‐rejection (> 14 days) or TI‐CMV without rejection and who received DHPG. and noted that patient and allograft survival was not statistically different compared to patients who received simultaneous therapy for both disease processes (p>0.05). Recipients with or without rejection who never developed TI‐CMV. however, did exhibit increased patient and allograft survival when compared to those who were treated for TI‐CMV alone or simultaneous TI‐CMV plus rejection (p<0.01). Based upon this analysis, we concluded that: 1) simultaneous treatment of concurrent TI‐CMV and acute rejection is feasible, and 2) this docs not magnify the adverse effects related to TI‐CMV alone, and recommended that: 1) antirejection therapy be instituted with simultaneous administration of DHPG in patient with proven rejection and suspected TI‐CMV. 2) the diagnostic work‐up for CMV and other pathogens should be vigorously pursued in this setting, and 3) if evidence of progression of CMV disease occurs (despite absence of this event in this series) that antirejection therapy be withdrawn.
Late reactions during initial OKT‐3 treatment
Authors: Turner Miriam C. , Holman John M. 
Published: September 2024

Three patients treated with an initial inductive course of OKT‐3 after cadaveric transplantation experienced reactions 9‐13 days after their first dose. The reactions were compatible with IgE‐mediated anaphylaxis, or resembled serum sickness. The cause of the reactions did not seem to be related to inadequate immunosuppression or to OKT‐3 IgG antibody formation.
Bile cytology versus serum sIL‐2R for monitoring of acute liver allograft rejections
Authors: Roberti Isabel , Lieberman Kenneth , Schwartz Myron , Reisman Lewis , Miller Charles 
Published: September 2024

Rejection is a major cause of allograft loss after liver transplantation and is often difficult to diagnose in its early stages. Various tests have been suggested to supplant or supplement liver biopsies in the differential diagnosis of acute rejection (AR) from other causes of impaired organ function. This study was undertaken to evaluate the usefulness of two non‐invasive tests for the monitoring of hepatic allograft recipients. We compared serial testing of serum sIL‐2R levels with results of bile cytology (BC) analysis in their ability to differentiate AR from other causes of graft damage. Bile (from an externally draining T‐tube) and blood samples from 12 liver transplant recipients were collected simultaneously at scheduled intervals during the first 3 months post‐operatively in a prospective study. The assignment of clinical diagnosis and the description of BC were performed by blinded investigators. A total of 42 paired samples randomly chosen from each of the established clinical categories were analyzed: 12 from stable grafts, 10 during the ischemic injury period, 13 during AR and 7 during systemic infections. Serum levels of sIL‐2R(U/ml) were significantly higher during AR (9847 ± 6958) and infections (18 437 ± 11 991) as compared to stable grafts (2457 ± 1852); p < 0.05. Cytological findings in stable grafts were unremarkable and consisted of occasional epithelial (ductal) cells. Inflammatory cells (ICs) were not seen in stable grafts. However, ICs (mostly PMNs) were noted in 70% (7/10) of infections and in 92% (12/13) of AR (p< 0.001 compared with stable grafts). Sensitivity and specificity for each test for the diagnosis of AR was calculated. In conclusion, BC analysis was found to be both more sensitive (92.3% vs 58.3%) and specific (73.7% vs 68.2%) than serum sIL‐2R levels in diagnosing AR after liver transplantation.
Successful revascularization of an orthotopic liver transplant (OLT) with the recipient right gastroepiploic artery
Authors: Radermecker M. A. , Honore P. , Dekoster G. , Dewandre J. M. , Thoorens P. , Jacquet N. , Meurisse M. 
Published: September 2024

A technique for revascularizing the arterial supply to an orthotopic liver transplant (OLT) in a 55‐year‐old male afflicted with end‐stage alcoholic liver cirrhosis with portal hypertension is reported. The presence of well‐developed portosystemic collaterals and an unsuitable recipient common hepatic artery necessitated the dissection and liberation of the right gastroepiploic artery (RGEA) for its subsequent use as the recipient arterial source. Posttransplantation, save for an early biliary leak which was corrected promptly, the patient's evolution was uneventful. Two separate celiac angiographic series at 6 weeks and 20 months posttransplantation revealed an excellent flow through the recipient and donor arterial systems. Additionally, the RGEA demonstrated an adaptation in caliber when pre‐ and posttransplantation angiograms were compared. It was concluded that the RGEA is a suitable rescue option for revascularization of OLT's provided it satisfies elementary hemodynamic requirements.
Influence of chronic rejection on the occurrence of monoclonal gammapathies in renal transplant patients
Authors: Hestin D. , Petitpain N. , Mayeux D. , Renoult E. , Chanliau J. , Durand P. Y. , Huu T. Cao , Bertrand F. , Kessler M. 
Published: September 2024

To assess the frequency of monoclonal gammapathies (MG) and their origin in immunosuppressed renal transplant patients, a prospective study was conducted in 164 patients who underwent 165 consecutive renal transplantations (RT) from April 1986 to August 1991. Sera were tested by cellulose acetate electrophoresis before RT and every 3 months after RT, and those containing a monoclonal component were further investigated by immunoelectrophoresis and/or immunofixation. The immunosuppressive regimen in 69 cases (41.8%) consisted of the association cyclosporinc ‐ prednisone while 96 patients (58.2%) received azathioprine in combination. Sera were regularly monitored by serological assays to detect antibodies against cytomegalovirus (CMV), Epstein‐Barr virus (EBV) and hepatitis B virus. Renal function was evaluated every 6 months by measurement of serum creatinine and quantification of proteinuria. Mean duration of follow‐up was 31.2 months ±15.9 (range 4‐62.4). Thirty‐eight (23.03%) patients developed a MG during this period (26 men, 12 women, mean age: 43.4± 11 years). MG occurred early after RT (6.7 ±7 months) and were often transient (30/38 disappeared after a period of 8.4 ± 12 months). Twenty‐four of the 38 MG were of the gamma 2 ‐ kappa 2 immunologic type whereas 8 were of the biclonal or oligoclonal type. Only moderate quantities of monoclonal component were secreted (9.4 ±2 g/1). Clinical and laboratory examinations excluded the presence of lymphoproliferative disorders of multiple myeloma. No correlation was found for sex, age, underlying renal disease, immunosuppressive regimen, number of HLA matches, and viral infections. The number of acute rejection episodes was similar in the two groups. Conversely, MG were found with a higher frequency in the group of patients who had evidence of chronic rejection (13/27 vs 25/137, p<0.01). Serum creatinine was higher in MG patients from the 36th month after RT (p<0.05). No difference was noted for proteinuria. We conclude that MG are frequently encountered in RT, especially in patients with deteriorating renal function. Since MG results in the uncontrolled proliferation of a B‐cell clone, it can be assumed that chronic rejection favors the occurrence of MG by enhancing the imbalance between the T‐ and B‐cell immune system.
Large interindividual variability in bioavailability of azathioprine in renal transplant recipients
Authors: Ohlman S. , Lafolie P. , Lindholm A. , Liliemark J. , Tydén G. , Peterson C. 
Published: September 2024

Azathioprine (Aza), one of the first immunosuppressive agents that proved successful in clinical transplantation, is still widely used. The drug is given in standardized doses which are adjusted only when signs of myelotoxicity occur. It has only recently become possible to specifically determine the level of Aza in plasma. In this study the plasma concentrations of Aza and its primary metabolite 6‐mercaptopurine (6‐MP) were measured after an oral and an equally large intravenous dose of Aza had been administered to 6 recipients of cadaveric renal allografts. The bioavailability of Aza was low and highly variable (range 5.1‐23.7%). The maximum plasma peak concentration of 6‐MP after an i.v. dose of Aza was 17% of the maximum plasma Aza concentration, but after oral intake the peak concentrations of Aza and 6‐MP were in the same range (38±50 ng/ml and 38±45 ng/ml, respectively). The time to peak, peak concentrations, clearance and elimination half‐life varied widely between patients. It is concluded that the pharmacokinetics of Aza showed remarkably large interindividual variability. Therefore, it is possible that the immunosuppressive potency of Aza would be improved if the drug were dosed according to the individual pharmacokinetics rather than according to the standardized dosing schedules currently used in organ transplantation.