bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal assessment of the development of diabetic polyneuropathy and associated risk factors
Authors: Van De Poll‐Franse L. V. , Valk G. D. , Renders C. M. , Heine R. J. , Van Eijk J. T. M. 
Published: March 2003

AbstractAims To longitudinally assess risk factors for diabetic polyneuropathy (DPN) severity, and to longitudinally assess risk factors for the change of DPN severity during 2–4 years of follow‐up.Methods From 1995 to 1999, 486 Type 2 diabetes patients in general practice were examined annually with regard to DPN severity and its possible risk factors. DPN severity was assessed with a clinical neurological examination (CNE) which included pinprick sense, light touch sense, vibration sense and ankle jerk. Longitudinal (multivariate) linear associations of (change of) CNE score and predicting variables were analysed using multilevel analyses.Results In this population, 50% of participants were men and had a mean age of 65.4 years, almost one‐third (31.7%) of the participants had a CNE score > 4 at baseline and were classified with DPN. CNE score significantly increased during follow‐up. Among participants not graded with DPN at baseline, 21.3% progressed towards a CNE score > 4 after 3 years of follow‐up. Longitudinal multivariate analyses showed that age, diabetes duration, HbA1c, height, body mass index and ankle‐arm index together best predicted CNE score during follow‐up. Change of CNE score during follow‐up was best predicted by age, diabetes duration and HbA1c, with the latter being the strongest predictor.Conclusions Although several factors are longitudinally associated with DPN, HbA1c, age and diabetes duration were the best predictors of CNE change during follow‐up. Therefore, improving glycaemia remains an important amenable factor in preventing worsening of diabetic polyneuropathy.
Does direct ophthalmoscopy improve retinal screening for diabetic eye disease by retinal photography?
Authors: Leese G. P. , Ellis J. D. , Morris A. D. , Ellingford A. 
Published: March 2003

AbstractAims To identify whether after performing retinal photography, direct ophthalmoscopy can improve the yield of screening for the detection of sight‐threatening diabetic eye disease (STDED).Methods Patients (n = 408) who had previously received both dilated direct ophthalmoscopy by a diabetologist and retinal photography graded by a diabetologist within 3 months of each other were included. The results of the other screening modality were not available to the grader/screener. The first 308 patients were consecutive attendees at the clinic who fulfilled the study criteria and 100 were selected because they were identified as having potential STDED by either one of these modalities. An ophthalmologist using slit lamp biomicroscopy then examined patients identified with potential STDED.Results In 357 (88%) patients there was agreement between the two modalities about whether referral to an ophthalmologist was required (κ 0.62). Retinal photography identified 38 patients for referral to ophthalmology which ophthalmoscopy missed. Of these, the ophthalmologist agreed that STDED was present in 32 (84%) and four patients required early laser. Ophthalmoscopy identified 13 patients for referral who were not identified by photography. Of these, the ophthalmologist agreed with the diabetologist that STDED was present in seven (54%) and one patient required early laser.Conclusion Ophthalmoscopy may identify the occasional patient with diabetes who has STDED which is missed by retinal photography. For a systematic retinal screening programme, adding ophthalmoscopy to retinal photography will increase false‐positive referrals and is likely to detect only a few extra patients requiring laser.
Metabolic and immunogenetic prediction of long‐term insulin remission in African patients with atypical diabetes
Authors: Sobngwi E. , Vexiau P. , Levy V. , Lepage V. , Mauvais‐Jarvis F. , Leblanc H. , Mbanya J. C. , Gautier J. F. 
Published: March 2003

AbstractAims We aimed to characterize a cohort of ‘atypical’ diabetic patients of sub‐Saharan African origin and to analyse possible determinants of long‐term remission.Methods Over 6 years, we studied the clinical and therapeutic profile of 42 consecutive patients undiagnosed or untreated prior to inclusion presenting with cardinal features of diabetes mellitus. We measured insulin secretion and sensitivity at inclusion. Immunogenetic (anti‐GAD, anti‐ICA and HLA class II) markers of Type 1 diabetes were compared with a 90‐non‐diabetic unrelated adult African population.Results Twenty‐one ketonuric patients (age 42 ± 9 (sd) years; body mass index (BMI) 26
±
3 kg/m2) were initially insulin‐treated (IT), and 21 non‐ketonuric patients (age 38
±
8 years; BMI 26
±
5 kg/m2) had oral and/or diet therapy (NIT). Insulin could be discontinued in 47.6% (10/21) IT with adequate glycaemic control (HbA1c 6.7
±
1.3%), while insulin was secondarily started in 38.1% (8/21) NIT in expectation of better control. The initial basal (odds ratio (OR) 9.1, 95% confidence interval (CI) 1.3–64.4) and stimulated C‐peptide (OR 8.17, 95% CI 1.5–44.1) were independently associated with remission. Insulin resistance was present in all the groups, more marked in the insulin‐treated NIT. Anti‐GAD antibodies and ICA were rare, but 38.1% IT vs. 1.1% controls had Type 1 diabetes HLA susceptibility haplotypes (P < 0.001) without significant difference between the subgroups.Conclusion Prolonged discontinuation of insulin is frequent in African diabetic patients initially presenting with signs of insulinopenia. In our patients, long‐term insulin therapy was not associated with immunogenetic markers of Type 1 diabetes. The initial measure of insulin secretion seemed a good predictor of long‐term remission.
Tissue factor pathway inhibitor (TFPI) release after heparin stimulation is increased in Type 1 diabetic patients with albuminuria
Authors: Leurs P. B. , Van Oerle R. , Hamulyak K. , Wolffenbuttel B. H. R. 
Published: March 2003

AbstractAims To study heparin‐stimulated TFPI release in relation to complications in Type 1 diabetic patients.Subjects and methods Nineteen uncomplicated Type 1 diabetic patients (group I) were compared with 18 patients with retinopathy (group II), and nine patients with retinopathy and albuminuria (group III). Blood samples were taken before (basal) and till 30 min after 5000 IU of heparin i.v. (post‐heparin). TFPI activity was measured chromogenically. Von Willebrand factor, tissue plasminogen activator (t‐PA), plasminogen activator inhibitor‐1 (PAI‐1) and thrombomodulin were also measured.Results Basal TFPI activity was higher in group III (121 ± 10%) compared with group II (111 ± 8%) or group I (110 ± 13%) (P < 0.05), and strongly correlated with albuminuria (r = 0.66, P < 0.05). At all time points after heparin administration, TFPI activity in group III was significantly higher than in group I. TFPI activity was also higher in group III than in group II 5–30 min post‐heparin. The increase in post‐heparin TFPI activity, measured as the incremental area under the curve, was higher in group III compared with group I (65 ± 7 vs. 59 ± 4; P < 0.05). Of the other parameters, only thrombomodulin was higher in group III (44 ± 24 vs. 26 ± 7 (group II) and 28 ± 9 ng/ml (group I); P < 0.01).Conclusions We conclude that basal and post‐heparin TFPI activity is increased in albuminuric patients. The increase in heparin‐stimulated TFPI release in patients with albuminuria is higher than in patients with retinopathy or without complications. This could be the result of altered endothelial glycosaminoglycan characteristics.Diabet. Med. 20, 16–22 (2003)
Pregnancy outcome in Type 1 diabetes mellitus treated with insulin lispro (Humalog)
Authors: Masson E. A. , Patmore J. E. , Brash P. D. , Baxter M. , Caldwell G. , Gallen I. W. , Price P. A. , Vice P. A. , Walker J. D. , Lindow S. W. 
Published: March 2003

AbstractAims The use of insulin lispro in pregnancy has not been systematically investigated despite its increasing use. Pooled data from seven centres with experience in the use of insulin lispro were accumulated to evaluate pregnancy outcome in women with Type 1 diabetes.Methods Seven units with specialist obstetric diabetes services were recruited to describe their total experience with insulin lispro in pregnancy. Outcomes with respect to the rate of miscarriage, congenital abnormality, perinatal mortality and maternal parameters were recorded in a standardized format.Results Outcomes on 71 babies from 76 pregnancies were documented. There were six (7.8%) early miscarriages. All 71 babies were liveborn with a mean gestational age of 37.2 weeks, and median birthweight of 3230 g. Seven babies weighed > 4 kg. There were four congenital abnormalities (5.6%). There was a 72% increase in the mean insulin dose (0.75–1.29 IU/kg per day). Maternal glycaemic control improved throughout pregnancy. No women developed retinopathy de novo during pregnancy and six with established retinopathy required laser therapy during pregnancy.Conclusions The use of insulin lispro in Type 1 diabetes during pregnancy results in outcomes comparable to other large studies of diabetic pregnancy.
A protocol for improved glycaemic control following corticosteroid therapy in diabetic pregnancies
Authors: Kaushal K. , Gibson J. M. , Railton A. , Hounsome B. , New J. P. , Young R. J. 
Published: March 2003

AbstractAims Diabetic pregnancies have an increased risk of respiratory distress syndrome (RDS) and preterm delivery. Antenatal corticosteroids can prevent RDS but induce acute severe hyperglycaemia. We have developed a protocol which prevents hyperglycaemia and can be used easily by ward staff.Methods Intramuscular dexamethasone is given in two doses 12 h apart. Subcutaneous insulin and diet are continued but from the first dexamethasone dose until 12 h after the second, supplementary intravenous insulin is infused according to hourly blood glucose measurements. The protocol incorporates four graded sliding scales. The initial scale is selected according to the patient's current subcutaneous insulin dose and advanced if the blood glucose is ≥ 10.1 mmol/l for 2 consecutive hours.Results In a 10‐month period eight (three gestational, five pre‐gestational) women received antenatal corticosteroids from a total of 37 diabetic pregnancies. The median amount of supplementary intravenous insulin required was 74 U (range 32–88 U); the median glucose values achieved were 5.8–8.9 mmol/l. Seventy‐five percent of glucose measurements were within an acceptable range of 4–10 mmol/l. Only one baby developed RDS.Discussion Large amounts of supplementary intravenous insulin are needed to achieve even moderate glycaemic control. This protocol enables routine ward staff to manage this successfully.
Long‐term outcome after gastrectomy for intractable diabetic gastroparesis
Authors: Watkins P. J. , Buxton‐Thomas M. S. , Howard E. R. 
Published: March 2003

AbstractAims To examine the long‐term outlook for patients with intractable vomiting from diabetic gastroparesis who underwent major gastric surgery.Methods Of 18 patients with problems from vomiting referred to the King's Diabetes Centre during the years 1994–2000, seven were considered to suffer irreversible symptoms not alleviated by protracted periods of medical treatment. They were all Type 1 Caucasian diabetic women, mean age 32 years (range 28–37 years) with multiple symptoms of severe autonomic neuropathy. They underwent major gastric surgery comprising 70% gastric resection including pylorus and antrum, with a 60‐cm Roux‐en‐Y loop of jejunum to prevent reflux gastritis.Results The vomiting was relieved in six of the seven patients almost immediately after surgery and during review up to more than 6 years post‐operatively. There have been no serious relapses, resulting in considerable improvement in quality of life. Unfortunately, three of the patients developed renal failure, two of them needing renal support treatments 2 and 3 years after successful gastrectomy. One patient died suddenly 5 months after successful surgery and one 3 months after starting dialysis.Conclusions Major gastric surgery can, after careful patient selection, effectively relieve distressing vomiting from severe gastroparesis and give a greatly improved quality of life to a small group of seriously disadvantaged patients where risk of subsequent renal failure is high and where life expectancy is poor.
Factor analysis of the metabolic syndrome among elderly Koreans—the South‐west Seoul Study
Authors: Choi K. M. , Lee J. , Kim K. B. , Kim D. R. , Kim S. K. , Shin D. H. , Kim N. H. , Park I. B. , Choi D. S. , Baik S. H. 
Published: March 2003

AbstractAims  To examine the relationship between the components of the metabolic syndrome and to explore whether insulin resistance unifies the clustering of components of the metabolic syndrome among urban elderly Koreans using exploratory factor analysis.Methods  We included 1314 non‐diabetic subjects over the age of 60 years, selected from a cross‐sectional study, which was conducted in 1999 in Seoul, Korea. Factor analysis was carried out using the principle components analysis with Varimax orthogonal rotation of the components of the metabolic syndrome.Results  We found four major factors of cardiovascular disease risk variables in our study subjects. Impaired glucose tolerance, dyslipidaemia, hypertension and obesity aggregated as the major domain. Obesity and dyslipidaemia variables were closely related and loaded on the same factor. However, hypertension was not linked closely with other factors of the metabolic syndrome.Conclusions  Insulin resistance is not the only contributor to the metabolic syndrome among urban elderly Koreans. Although the components of the metabolic syndrome were closely related, the finding of more than one factor suggests that more than one pathophysiological mechanism underlies full expression of the metabolic syndrome among elderly Koreans.
Distribution, abundance and niche breadth of birds: scale matters
Authors: Brändle Martin , Brandl Roland 
Published: March 2003

AbstractWe used local habitat niche breadth, local abundance and body size of non‐passerine afrotropical birds in Tsavo East National Park (Kenya) to predict species distributional ranges in Kenya and across Africa. Univariate analysis revealed a significant positive correlation between local abundance and distribution only on the scale of Kenya. Performing a multiple regression analysis, local abundance, local habitat niche breadth and body size explained a significant part of the variance in bird distribution, again only on the Kenyan scale. From these results, we speculate that on continental scales distributions may be more influenced by macroclimatic conditions and historical factors, whereas distributions on regional scales are predominantly influenced by ecological factors.
Contrasting patterns of change in the distribution and abundance of farmland birds in relation to farming system in lowland Britain
Authors: Chamberlain D. E. , Fuller R. J. 
Published: March 2003

AbstractPatterns of change in distribution (presence/absence) and abundance since the late 1960s were examined in 20 species of farmland bird in southern Britain in predominantly arable (eastern), predominantly mixed (central) and predominantly grassland (western) regions. Comparisons were made between changes in distribution and in abundance to determine whether these measures show similar relationships to environmental change. Local extinctions of selected species and reductions in species richness were significantly greater in the predominantly grassland region. Decreases in abundance were greatest in seven species in the predominantly arable region, two in the mixed region and nine in the grassland region. Changes in distribution and abundance showed consistent patterns in three species, turtle dove Streptopelia turtur L., yellow wagtail Motacilla flava L. and reed bunting Emberiza schoeniclus L. In another four species, grey partridge Perdix perdix L., lapwing Vanellus vanellus L., tree sparrow Passer montanus L. and corn bunting Miliaria calandra L., decreases in abundance were greatest in the arable region, yet declines in distribution were lowest. For other individual species, changes in distribution were too small to draw any conclusions in relation to farm type. We suggest that modern grassland systems are suboptimal habitats compared to arable or mixed agricultural land for many farmland species that occur at relatively low density in the more western, grass‐dominated region. Declines in abundance are therefore more likely to lead to local extinction in these areas than in eastern areas where abundance is higher. However, the role of changes in grassland management on bird populations requires further research. It is suggested that conclusions drawn from changes in distribution alone, in the absence of supporting data on changes in abundance, may be misleading where the aim is to assess how large‐scale spatial dynamics of populations relate to environmental change.
Forest expansion and grassland contraction within a Eucalyptus savanna matrix between 1941 and 1994 at Litchfield National Park in the Australian monsoon tropics
Authors: Bowman D. M. J. S. , Walsh A. , Milne D. J. 
Published: March 2003

Abstract

Analysis of digitized aerial photographs taken in 1941 and 1994, using image processing and geographical information system technology, enabled the quantification of change in the coverage of forest and grassland patches that occur within a Eucalyptus savanna matrix in a subcoastal region of the Australian monsoon tropics. The 3058 ha study area was orientated along a low escarpment that separated a sandstone plateau from lowlands that comprised 58% and 42% of the area, respectively.
In the 53‐year period, humans modified less than 1% of the study area, primarily for road building, and primarily in savanna areas. More than 85% of the study area at both sample times was covered by savanna. However, over the same period, the forest coverage increased from 5.03% to 9.91% of the study area and coverage of grassland decreased from 6.70% to 2.47%. The aerial photography also showed that tree density in the savanna had increased, although this was not assessed quantitatively.
There was an increase in the number of forest patches from 116 to 142. The number of grassland patches decreased (particularly those > 1 ha) from 87 to 59, although the size class distribution of forest and grassland patches was statistically similar for both sample times.
A 50‐m GIS buffer was used to distinguish creek‐lines environments from surrounding catchments. Using this criterion, 14% of the study area was classified as plateau creek‐lines and 9% lowland creek‐lines. Although the expansion of forest and loss of grassland varied significantly amongst catchment and creek‐lines on the plateau and lowlands, the 1941 rank order of coverage of each vegetation type was maintained in these four landscape categories in 1994. In both years the greatest extent of forest and grassland occurred on the lowland catchments, despite their accounting for only one‐third of the study area.
Transition matrices for vegetation change among the four landscape categories demonstrated that, unlike the other vegetation types, grasslands, particularly on the plateau, had a low probability of remaining unchanged during the study period.
The cause(s) of the overall increase of woody biomass across the topographic and edaphic gradient remains unclear but may be related to a period of increased rainfall since the 1970s, as well as to the cessation of Aboriginal landscape burning at the beginning of the study period.
Representation of vegetation dynamics in the modelling of terrestrial ecosystems: comparing two contrasting approaches within European climate space
Authors: Smith Benjamin , Prentice I. Colin , Sykes Martin T. 
Published: March 2003

Abstract

Advances in dynamic ecosystem modelling have made a number of different approaches to vegetation dynamics possible. Here we compare two models representing contrasting degrees of abstraction of the processes governing dynamics in real vegetation.
Model (a) (GUESS) simulates explicitly growth and competition among individual plants. Differences in crown structure (height, depth, area and LAI) influence relative light uptake by neighbours. Assimilated carbon is allocated individually by each plant to its leaf, fine root and sapwood tissues. Carbon allocation and turnover of sapwood to heartwood in turn govern height and diameter growth.
Model (b) (LPJ) incorporates a ‘dynamic global vegetation model’ (DGVM) architecture, simulating growth of populations of plant functional types (PFTs) over a grid cell, integrating individual‐level processes over the proportional area (foliar projective cover, FPC) occupied by each PFT. Individual plants are not simulated, but are replaced by explicit parameterizations of their growth and interactions.
The models are identical in their representation of core physiological and biogeochemical processes. Both also use the same set of PFTs, corresponding to the major woody plant groups in Europe, plus a grass type.
When applied at a range of locations, broadly spanning climatic variation within Europe, both models successfully predicted PFT composition and succession within modern natural vegetation. However, the individual‐based model performed better in areas where deciduous and evergreen types coincide, and in areas subject to pronounced seasonal water deficits, which would tend to favour grasses over drought‐intolerant trees.
Differences in model performance could be traced to their treatment of individual‐level processes, in particular light competition and stress‐induced mortality.
Our results suggest that an explicit individual‐based approach to vegetation dynamics may be an advantage in modelling of ecosystem structure and function at the resolution required for regional‐ to continental‐scale studies.
The importance of rapid, disturbance‐induced losses in carbon management and sequestration
Authors: Breshears David D. , Allen Craig D. 
Published: March 2003

AbstractManagement of terrestrial carbon fluxes is being proposed as a means of increasing the amount of carbon sequestered in the terrestrial biosphere. This approach is generally viewed only as an interim strategy for the coming decades while other longer‐term strategies are developed and implemented — the most important being the direct reduction of carbon emissions. We are concerned that the potential for rapid, disturbance‐induced losses may be much greater than is currently appreciated, especially by the decision‐making community. Here we wish to: (1) highlight the complex and threshold‐like nature of disturbances — such as fire and drought, as well as the erosion associated with each — that could lead to carbon losses; (2) note the global extent of ecosystems that are at risk of such disturbance‐induced carbon losses; and (3) call for increased consideration of and research on the mechanisms by which large, rapid disturbance‐induced losses of terrestrial carbon could occur.Our lack of ability as a scientific community to predict such ecosystem dynamics is precluding the effective consideration of these processes into strategies and policies related to carbon management and sequestration. Consequently, scientists need to do more to improve quantification of these potential losses and to integrate them into sound, sustainable policy options.