bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amputations and diabetes: a case‐control study
Authors: Trautner C. , Haastert B. , Giani G. , Berger M. 
Published: March 2003

AbstractAims Data concerning the relative risk of amputations in diabetic patients compared with the general population are scarce. Therefore, we carried out a case control study to quantify the relationship between diabetes and amputations.Methods In 20 hospitals in seven German cities and counties we obtained complete lists of non‐traumatic lower limb amputations performed in 1990 and 1991. Controls were selected from patients of the same surgical departments operated on in the same years. We drew a random sample of patients with procedures not likely to be associated with diabetes. Diabetic status was determined from patients’ records in both cases and controls. We calculated age‐ and sex‐specific and, using logistic regression, adjusted odds ratios (OR) and attributable risks.Results N = 2400, mean age 61.7 (sd 16.3) years. Cases: n = 729; 486 (66.7%) of them had diabetes. Controls: n = 1671; 127 (7.6%) of them had diabetes. Adjusted OR: 18.2 (confidence interval (CI) 14.2–23.6). Adjusted attributable risk among exposed (ARE): 0.95 (CI 0.93–0.96). Adjusted population attributable risk (PAR): 0.62 (CI 0.57–0.66).Conclusions This study has demonstrated a strong association between the risk of amputation and diabetes. The odds ratios and attributable risks for diabetic individuals are higher in the younger than in the older age groups. Population attributable risks are great. We conclude that the reduction of amputations in the general population will be achieved by improving foot care in people with diabetes.
Automated detection of diabetic retinopathy on digital fundus images
Authors: Sinthanayothin C. , Boyce J. F. , Williamson T. H. , Cook H. L. , Mensah E. , Lal S. , Usher D. 
Published: March 2003

AbstractAims The aim was to develop an automated screening system to analyse digital colour retinal images for important features of non‐proliferative diabetic retinopathy (NPDR).Methods High performance pre‐processing of the colour images was performed. Previously described automated image analysis systems were used to detect major landmarks of the retinal image (optic disc, blood vessels and fovea). Recursive region growing segmentation algorithms combined with the use of a new technique, termed a ‘Moat Operator’, were used to automatically detect features of NPDR. These features included haemorrhages and microaneurysms (HMA), which were treated as one group, and hard exudates as another group. Sensitivity and specificity data were calculated by comparison with an experienced fundoscopist.Results The algorithm for exudate recognition was applied to 30 retinal images of which 21 contained exudates and nine were without pathology. The sensitivity and specificity for exudate detection were 88.5% and 99.7%, respectively, when compared with the ophthalmologist. HMA were present in 14 retinal images. The algorithm achieved a sensitivity of 77.5% and specificity of 88.7% for detection of HMA.Conclusions Fully automated computer algorithms were able to detect hard exudates and HMA. This paper presents encouraging results in automatic identification of important features of NPDR.Diabet. Med. 19, 105–112 (2002)
A chaotic model for tight diabetes control
Authors: Holt T. A. 
Published: March 2003

AbstractThe principles of non‐linear dynamics (‘chaos’) theory may improve our understanding of the difficulties of blood glucose control in diabetes, may lead to alternative control strategies in selected individuals, and might even enlighten the issues involved in automated glucose control for the future. Possible experimental and mathematical methods of identifying chaotic behaviour in glucose profiles are briefly discussed. Advice based on this model is suggested for those aiming at tight blood glucose control.
Clinical characteristics, GAD antibody (GADA) and change of C‐peptide in Korean young age of onset diabetic patients
Authors: Ahn C. W. , Kim H. S. , Nam J. H. , Song Y. D. , Lim S. K. , Kim K. R. , Lee H. C. , Huh K. B. 
Published: March 2003

AbstractAims To investigate the association of clinical and immunological markers with diabetes classification in newly diagnosed young diabetic patients at disease onset.Methods Eighty‐two diabetic patients recruited within 1 year of onset (mean age 23.0 ± 7.1, M:F = 46:36) were divided into three groups, namely: a low fasting C‐peptide (FC) level at baseline group (the low FC group (n = 14, FC < 0.18 nmol/l)), an intermediate FC group (n = 29, 0.18 nmol/l ≤ FC < 0.37 nmol/l), and a high FC group (n = 39, 0.37 nmol/l ≤ FC). Patients were reclassified at follow‐up (mean follow‐up period 3.7 ± 1.4 years) in the same manner as described above into low FC group (n = 31), intermediate FC group (n = 20), and high FC group (n = 31). The clinical characteristics and prevalence of GADA were compared.Results Patients in the high FC group at baseline had a higher body mass index (BMI), a higher frequency of a family history of diabetes, a higher meal‐stimulated C‐peptide increment, a lower frequency of ketonuria, a lower frequency of history of diabetic ketoacidosis, and a lower frequency of insulin therapy at diagnosis than those in the low and intermediate FC groups at baseline. Insulin secretory capacity, which was represented by fasting C‐peptide, was affected by BMI at diagnosis and the presence of GADA. All the patients of the low FC group on follow‐up were finally classified as having Type 1 diabetes; moreover, the factors that determined the type of diabetes were lower BMI at onset, GADA positivity, insulin therapy, lower fasting C‐peptide level and lower meal‐stimulated C‐peptide increment at initial admission.Conclusions Our study suggests that follow‐up involving C‐peptide and GADA measurements in combination with clinical characteristics is useful for discriminating between the types of diabetes in these groups.Diabet. Med. 19, 227–233 (2002)
Heterogeneity in young adult onset diabetes: aetiology alters clinical characteristics
Authors: Owen K. R. , Shepherd M. , Stride A. , Ellard S. , Hattersley A. T. 
Published: March 2003

AbstractAims To describe the characteristics of hepatocyte nuclear factor (HNF) 1α mutation carriers diagnosed with diabetes after 25 years and compare them with young‐onset Type 2 diabetic patients (YT2D) diagnosed at the same age.Subjects and methods We studied 44 (21 male, 23 female) patients with HNF‐1α mutations diagnosed with diabetes at ages 25–45 years and 44 YT2D subjects matched for sex and age of diagnosis.Results Median age of onset of diabetes was 35 years in both groups. The HNF‐1α group demonstrated: lower body mass index (25.1 vs. 30.7 kg/m2; P < 0.001) and lower fasting triglycerides (1.37 vs. 2.96 mmol/l; P = 0.001) with similar fasting cholesterol level. They had lower glycated haemoglobin A1c (7.3 vs. 8.5%; P = 0.015) despite greater duration of diabetes (24 vs. 16 years; P = 0.02) and less frequent treatment with insulin (21% vs. 55%; P = 0.002). They were less likely to be treated for hypertension (13.3% vs. 56.3%; P = 0.009). Importantly, no difference was observed in reported parental history of diabetes between the two groups (65.9% vs. 63.6%; P = 0.92). Logistic regression showed that triglyceride levels and presence of anti‐hypertensive treatment were the most important independent variables.Conclusions Patients with HNF‐1α mutations may present with diabetes as young adults between the ages of 25–45 years. In this age range a wide differential diagnosis of diabetes is observed. Conventional criteria of age of onset and family history will not differentiate HNF‐1α mutation carriers from YT2D subjects in this age range, but features of the metabolic syndrome, in particular fasting triglycerides and hypertension, are helpful. In patients diagnosed before 45 years without features of insulin resistance the diagnosis of HNF‐1α should be considered.
Post‐mortem findings in familial partial lipodystrophy, Dunnigan variety
Authors: Haque W. A. , Vuitch F. , Garg A. 
Published: March 2003

AbstractAims Familial partial lipodystrophy, Dunnigan variety (FPLD), is an autosomal dominant disorder due to missense mutations in the lamin A/C gene and is characterized by gradual loss of subcutaneous fat from the extremities and trunk, fat accumulation in the head, neck and intra‐abdominal areas, insulin resistance and its metabolic complications. We studied autopsy findings in two patients with FPLD to determine fat distribution and organ involvement.Results Patient 1, a 66‐year‐old woman with the R482Q mutation, had diabetes mellitus, dyslipidaemia, and coronary artery disease and died suddenly. Autopsy confirmed the typical body fat distribution and further revealed excess fat deposition in the subpectoral regions extending to the axillae, in the axillary lymph nodes and in the retroperitoneum. Atherosclerotic vascular disease including old infarcts of the myocardium, temporal lobe and kidneys were noted. Severe amyloidosis of the pancreatic islets and grouped muscle atrophy of the quadriceps and diaphragmatic muscles were present. Patient 2, a 29‐year‐old woman belonging to a pedigree with the R62G mutation, died of hyperlipidaemia‐induced acute pancreatitis. Autopsy of patient 2 revealed extensive pancreatitis, hepatic steatosis and polycystic ovaries.Conclusions Our study confirms typical body fat distribution and describes new sites of excess fat deposition. Our data show predisposition to atherosclerosis and polycystic ovaries and suggest that pancreatic amyloidosis may underlie development of hyperglycaemia in FPLD patients.Diabet. Med. 19, 1022–1025 (2002)
Effect of hormone replacement therapy on inflammation‐sensitive proteins in post‐menopausal women with Type 2 diabetes
Authors: Manning P. J. , Sutherland W. H. F. , Allum A. R. , De Jong S. A. , Jones S. D. 
Published: March 2003

AbstractAims To test the effect of oral hormone replacement therapy (HRT) on plasma C‐reactive protein (CRP), soluble vascular cell adhesion molecule‐1 (VCAM‐1), soluble intercellular adhesion molecule‐1 (ICAM‐1) and IL‐6 concentrations and leucocyte count in post‐menopausal women with Type 2 diabetes.Methods Post‐menopausal women with Type 2 diabetes (n

=
61) were randomized in a double‐blind fashion to receive either continuous combined hormone replacement therapy (n

=
29) with conjugated equine oestrogen (0.625 mg/day) plus medroxyprogesterone acetate (2.5 mg/day) or placebo (n = 32) for 6 months. Study variables were measured at baseline and at the end of the study.Results Eight women randomized to hormone replacement therapy and four women assigned to placebo group dropped out of the study. Plasma CRP increased (2.2 mg/l, 95% confidence interval 0.3–4.1 mg/l) significantly (P

=
0.02) in women treated with HRT (n

=
21) compared with placebo (n = 29) taking baseline CRP, body mass index (BMI) and smoking status into account. Plasma levels of cell adhesion molecules, IL‐6 and leucocyte count did not change significantly during the study.Conclusions These findings indicate that oral HRT with conjugated equine oestrogen plus medroxyprogesterone acetate increases plasma CRP levels but not necessarily global inflammatory activity in post‐menopausal diabetic women. An increase in plasma CRP may potentially increase risk of a cardiovascular event.
The epidemiology of diabetic limb sepsis: an African perspective
Authors: Abbas Z. G. , Gill G. V. , Archibald L. K. 
Published: March 2003

AbstractWe review the epidemiology of foot and hand sepsis in adult diabetes patients in Africa. Limb sepsis in these patients is associated with significant morbidity and mortality. The pathogenesis of diabetic foot infections in these patient populations appears to be similar to that for patients in industrialized countries —ulcers and underlying peripheral neuropathy being the most important risk factors. Prevention of peripheral neuropathy through aggressive glycaemic control may be the most important primary control measure for foot infections. The tropical diabetic hand syndrome (TDHS) is being increasingly seen in diabetes patients in certain parts of Africa. The syndrome is acute, usually follows minor trauma to the hand, and is associated with a progressive synergistic form of gangrene. The major risk factors for TDHS are unknown but recent data suggest poor glycaemic control is associated with poor outcome. Treatment of TDHS requires aggressive surgery. Hence, preventive efforts for both foot and hand sepsis include aggressive glucose control, and education on hand and foot care and the importance of seeking medical attention promptly at the earliest onset of symptoms.Diabet. Med. 19, 895–899 (2002)
Preventing glycaemic excursions in diabetic patients requiring percutaneous endoscopic gastrostomy (PEG) feeding after a stroke
Authors: Kerr D. , Hamilton P. , Cavan D. A. 
Published: March 2003

AbstractAims and methods Enteral feeding for diabetic patients with a stroke is often associated with hyperglycaemia and/or hypoglycaemia, which can adversely influence neurological recovery. We have developed a structured enteral feeding programme aimed at establishing ‘normal’ feeding patterns and avoiding marked glycaemic excursions.Results Of 332 consecutive patients admitted to an acute stroke unit, 20 of 41 diabetic patients required PEG feeding. Over the initial 24–48 h, patients had 22‐ h feeds with continuous intravenous infusion of soluble insulin. Thereafter, they were established on three feeds per day. Soluble insulin was given prior to each feed with isophane insulin at 2200 h. Average duration of feed was 13 ± 8 days with an achieved glucose level of 8.7 ± 2.5 (mean ±sd) mmol/l associated with 0.8 episodes of biochemical hypoglycaemia (< 3 mmol/l) each week.Conclusions A structured enteral feeding programme for PEG‐fed diabetic patients can improve the quality of care with avoidance of marked glycaemic excursions.Diabet. Med. 19, 1006–1008 (2002)
Prevalence of diabetic eye disease in patients entering a systematic primary care‐based eye screening programme
Authors: Younis N. , Broadbent D. M. , Harding S. P. , Vora J. P. 
Published: March 2003

AbstractAims Large‐scale, baseline prevalence measurements in a population at the institution of systematic retinal screening are currently unavailable. We report the prevalence of all grades of retinopathy at entry into a systematic primary care‐based diabetic eye screening programme.Methods Primary care‐based photographic screening utilizing mydriasis and three‐field non‐stereoscopic photography for all patients with diabetes (except those under continuing care of an ophthalmologist) in Liverpool. Sight‐threatening diabetic eye disease (STED) was defined as any of: moderate preproliferative retinopathy or worse, circinate maculopathy or exudates within one disc diameter of the centre of fovea.Results Type 1 diabetes mellitus (DM) (n = 831): baseline prevalence (95% confidence interval (CI)) of any retinopathy, proliferative diabetic retinopathy (PDR) and STED was 45.7% (42.3–49.1), 3.7% (2.4–5.0) and 16.4% (13.9–18.9), respectively. Presence of STED was associated with increased disease duration (odds ratio (OR) 1.09 per year; P < 0.0001) and higher in men (OR 2.15; P = 0.001). Type 2 DM (n = 7231): baseline prevalence (95% CI) of any retinopathy, PDR and STED was 25.3% (24.3–26.3), 0.5% (0.3–0.7) and 6.0% (5.5–6.5), respectively. Presence of STED was associated with longer time since diagnosis of DM (OR 1.03; P < 0.0001) and insulin use (OR 2.46; P < 0.0001).Conclusion This study provides baseline information for health providers on prevalence of all grades of retinopathy and STED in a large population at the establishment of systematic screening. Baseline prevalence of STED was high and highest in patients with a longer disease duration in both Type 1 and Type 2 DM.Diabet. Med. 19, 1014–1021 (2002)
The relationship between range size and niche breadth: a test using five species ofGammarus(Amphipoda)
Authors: Gaston Kevin J. , Spicer John I. 
Published: March 2003

AbstractData for five closely related species of gammarid crustaceans are used to examine interspecific relationships between the breadth of fundamental tolerance or capacity and geographical range size.Gammarus duebeniis, almost without exception, the most tolerant species and that with the best physiological performance. Although there is some limited variation, the remaining species can be ranked broadly in the sequenceG. zaddachi >G. salinus > G. oceanicus > G. locusta. The wide tolerance and high performance ofG. duebeniis associated with the occupation of a wider range of environmental ‘types’ than any other of the species. In terms of geographical range size, the species can be ranked from most to least widespread in the sequenceG. oceanicus >G. duebeni > G. zaddachi > G. salinus > G. locusta. This provides little support for Brown’s hypothesis, or the argument that the more widely distributed species within a taxonomic assemblage also tend to have the widest fundamental niches. However, if marine (G. oceanicusandG. locusta) and estuarine (G. duebeni,G. zaddachi, G. salinus) species are considered separately, then in each case the species with the largest geographical range is also the most tolerant/best performer. In this sense, the jack‐of‐all‐trades is the master‐of‐all, rather than the master‐of‐none.
Small mammal diversity along elevational gradients in the Philippines: an assessment of patterns and hypotheses
Authors: Heaney Lawrence R. 
Published: March 2003

Abstract1 It is widely accepted that tropical lowland rain forest holds the greatest diversity of organisms, and it is often implied that this general pattern is also true for virtually all individual higher‐level taxa. Standardized elevational transect surveys of non‐flying small mammals (Insectivora and Rodentia) on geologically old, species‐rich islands in the Philippines consistently show maximum diversity and relative abundance in upper montane/lower mossy forest at 1500–2200 m, often exceeding lowland species richness and relative abundance by a factor of three or more.2 On mountains where maximum elevation exceeds 2000 m, there is a decline in species richness above about 1500–2000 m, yielding a curvilinear pattern of species richness along the elevational gradient. The peak in species richness occurs at the area of transition from montane to mossy forest, which is also the point at which rainfall probably peaks. In parallel with species richness, relative abundance of small mammals in the Philippines also increases from the lowlands to 1500–2200 m, increasing by a factor from two to 10.3 Twelve hypotheses concerning patterns of diversity along elevational gradients, plus the null hypothesis, are evaluated. The null hypothesis of no variation and the hypotheses that maximum diversity is in the lowlands, that diversity is highest in areas of least perturbation, and that diversity increases with increasing area, are rejected. There is weak or ambiguous support for the hypotheses that diversity is greatest in areas of community interdigitation, that diversity is highest in the area of highest productivity, that diversity is correlated with habitat complexity, and that diversity is correlated with habitat diversity. There is strongest support for the hypotheses that diversity is correlated with annual rainfall, with total abundance of individuals in the community, with food resource diversity, with areas of reduced competition from other organisms, and with areas characterized by high rates of speciation.4 Causality is difficult to evaluate because many hypotheses make non‐exclusive predictions, they probably represent non‐independent aspects of causal factors (in other words, there is much interaction among the processes highlighted by the various hypotheses), and they represent the range from proximate to ultimate and from descriptive to causal. All the hypotheses probably represent phenomena that exist in nature, but few (or none) represent phenomena found in all taxa. The primary challenge in the future will not be simply to accept or reject individual hypotheses, but rather to determine the circumstances under which the various causal factors are most important, how they interact, and how they can be combined into a more comprehensive and general multi‐factorial model.
Using simple environmental variables to estimate below‐ground productivity in grasslands
Authors: Gill R. A. , Kelly R. H. , Parton W. J. , Day K. A. , Jackson R. B. , Morgan J. A. , Scurlock J. M. O. , Tieszen L. L. , Castle J. V. , Ojima D. S. , Zhang X. S. 
Published: March 2003

AbstractIn many temperate and annual grasslands, above‐ground net primary productivity (NPP) can be estimated by measuring peak above‐ground biomass. Estimates of below‐ground net primary productivity and, consequently, total net primary productivity, are more difficult. We addressed one of the three main objectives of the Global Primary Productivity Data Initiative for grassland systems to develop simple models or algorithms to estimate missing components of total system NPP. Any estimate of below‐ground NPP (BNPP) requires an accounting of total root biomass, the percentage of living biomass and annual turnover of live roots. We derived a relationship using above‐ground peak biomass and mean annual temperature as predictors of below‐ground biomass (r2 = 0.54; P = 0.01). The percentage of live material was 0.6, based on published values. We used three different functions to describe root turnover: constant, a direct function of above‐ground biomass, or as a positive exponential relationship with mean annual temperature. We tested the various models against a large database of global grassland NPP and the constant turnover and direct function models were approximately equally descriptive (r2 = 0.31 and 0.37), while the exponential function had a stronger correlation with the measured values (r2 = 0.40) and had a better fit than the other two models at the productive end of the BNPP gradient. When applied to extensive data we assembled from two grassland sites with reliable estimates of total NPP, the direct function was most effective, especially at lower productivity sites. We provide some caveats for its use in systems that lie at the extremes of the grassland gradient and stress that there are large uncertainties associated with measured and modelled estimates of BNPP.