tbuckley/cabot-search huggingface dataset:
THU0221 Methotrexate Optimization (IE Introduction During the First 3 Months and with Dose Escalation at 6 Months at Least at 20Mg/W or 0.3Mg/Kg/W) is Associated with Better Clinical Outcomes in Daily Practice: Results from the Espoir Cohort
Authors: C. Gaujoux-Viala, S. Paternotte, B. Combe, M. Dougados, B. Fautrel
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Methotrexate(MTX) is recommended as the first DMARD in rheumatoid arthritis (RA) at a weekly dose of 20-25mg in combination with folic acid supplementation. Despite its widespread use and more than two decades of experience, considerable variations exist among rheumatologists in prescribing MTX. <h3>Objectives</h3> To describe symptomatic and structural impact of the MTX optimization in early arthritis (EA) in daily clinical practice over 2 years. <h3>Methods</h3> - <i>Patients</i>: from the French cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA), fulfilling the new ACR-EULAR criteria for RA at baseline, and treated by MTX as first DMARD. - <i>Treatment group:</i> optimized MTX was defined by at least 3 months of MTX during the first 6 months and dose of initiation at least 10 mg/week with escalation at 6 months at least at 20 mg/w or 0.3mg/kg/w if DAS28&gt;2.6 - <i>Outcomes</i>: remissions (Boolean, SDAI and DAS28), functional stability (HAQ≤0.5 and deltaHAQ≤0.25) and absence of radiographic progression (delta Sharp score&lt;1). - <i>Analyses:</i> evaluation of the symptomatic and structural efficacy has been performed by generalized linear regression after adjustement on propensity score (by modelling the optimization of MTX by disease specific- and demographic variables obtained at baseline, using logistic regression analysis) in the group of patients receiving optimized MTX versus the ones receiving MTX without optimization. <h3>Results</h3> Within the first year of follow-up of 600 RA patients, 352 received MTX as first DMARD. The mean dose of MTX was 13.1 +/- 3.9 mg/week. In all, 76.1% of patients received at least 3 months of MTX during the first 6 months and 25.3% were treated initially at least by 10 mg/week with escalation at 6 months at least at 20 mg/w or 0.3mg/kg/w if DAS28&gt;2.6; only 22.1% fulfilled the 2 criteria. MTX optimization was initiated in younger patients (45.2 years ± 12.6 vs 49.3 ± 11.3, p=0.009) with higher CRP (29.3±32.0 vs 24.4±36.7, p=0.006). After adjustment, optimized MTX was found to be more efficient in terms of remission and function than control (table). <h3>Conclusions</h3> Optimized MTX is more efficacious on remission and function than MTX without optimization in EA in daily practice but without impact on radiographic progression over 2 years. <h3>Disclosure of Interest</h3> C. Gaujoux-Viala Grant/research support from: Pfizer, Nordic Pharma, S. Paternotte: None Declared, B. Combe: None Declared, M. Dougados: None Declared, B. Fautrel Grant/research support from: Roche, Pfizer, Nordic Pharma, MSD
Clinical trials of new drugs for the treatment of rheumatoid arthritis: focus on early disease
Authors: Josef S Smolen, Sabine Collaud Basset, Maarten Boers, Ferdinand Breedveld, Christopher J Edwards, Tore K Kvien, Pierre Miossec, Tuulikki Sokka-Isler, Ronald F van Vollenhoven, Eric C Abadie, Olivier Bruyère, Cyrus Cooper, Heidi Mäkinen, Thierry Thomas, Peter Tugwell, Jean-Yves Reginster
Journal: Annals of the Rheumatic Diseases (2016)

The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases convened a task force of experts in rheumatoid arthritis (RA) and clinical trial methodology to comment on the new draft 'Guideline on clinical investigation of medicinal products for the treatment of RA' released by the European Medicines Agency (EMA). Special emphasis was placed by the group on the development of new drugs for the treatment of early RA. In the absence of a clear definition of early RA, it was suggested that clinical investigations in this condition were conducted in disease-modifying antirheumatic drugs naïve patients with no more than 1 year disease duration. The expert group recommended using an appropriate improvement in disease activity (American College of Rheumatology (ACR) or Simplified/Clinical Disease Activity Index (SDAI/CDAI) response criteria) or low disease activity (by any score) as primary endpoints, with ACR/European League Against Rheumatism remission as a secondary endpoint. Finally, as compelling evidence showed that the Disease Acrivity Score using 28-joint counts (DAS28) might not provide a reliable definition of remission, or sometimes even low disease activity, the group suggested replacing DAS28 as a measurement instrument to evaluate disease activity in RA clinical trials. Proposed alternatives included SDAI, CDAI and Boolean criteria.
A1.12 Local experimental osteoarthritis induces systemic changes in monocyte populations regulated by S100A8/A9
Authors: NAJ Cremers, EJW Geven, AB Blom, A Sloetjes, I Di Ceglie, S van Dalen, G Ascone, W de Munter, M van den Bosch, PLEM van Lent
Journal: Annals of the Rheumatic Diseases (2016)

<h3></h3> Inflammation is increasingly recognised to be involved in osteoarthritis (OA) pathology. In response to pro-inflammatory cytokines, monocytes can be recruited from the bone marrow (BM) where monocyte chemoattractant protein-1 (MCP-1) is a key molecule that drives monocyte efflux via binding with the C-C chemokine receptor type 2 (CCR2). In mice, two functionally distinct monocyte populations are described: pro-inflammatory Ly6C-high monocytes (CCR2<sup>high)</sup> and patrolling Ly6C-low monocytes (CCR2<sup>low)</sup>. The objectives of our study are to investigate the systemic effects of locally induced OA on BM monocyte populations and their recruitment to the OA joint in collagenase induced OA (CiOA), and the role of the alarmins S100A8/A9 in that. CiOA was induced in C57BL/6 mice by unilateral-articular collagenase-injection and were sacrificed at day 7, 21 and 42, together with age-matched naive mice (n = 6/group), and synovial mRNA expression of several pro-inflammatory cytokines were measured. During CiOA, the absolute amount of cells in the BM per femur was measured and the mRNA expression of BM MCP-1 and CCR2 was determined. Cells from BM, blood and synovial tissue were isolated and analysed by FACS. Monocyte subsets were identified as (B220/CD90/CD49b/NK1.1/Ly6G)<sup>low</sup>CD11b<sup>high</sup>(F4/80/MHCII/CD11c)<sup>low</sup> and further distinguished by their Ly6C expression. In addition, we investigated synovitis in S100A9<sup>-/-</sup>mice during CiOA. Synovial expression of IL-1β, IL-6, TNF-α, S100A8 and S100A9 was increased at day 7, but only expression of S100A8 and S100A9 remained high until day 21. Local induction of CiOA resulted in systemic effects within the BM showing decreased cell numbers at day 7 and 21 (15% and 14% respectively). Concurrently, the expression of MCP1 at day7 in BM was increased 3.3-fold, suggesting increased BM-efflux. Relative number of BM-Ly6C-high monocytes was increased at day 7 (164%), being reflected by increased CCR2 expression (2.8-fold). This suggests a specific regulation of BM Ly6C-high monocytosis and recruitment during CiOA. During the course of CiOA increased number of Ly6C-high monocytes were observed in the synovium: 398% at day 7 and 510% at day 42, compared to naïve mice. These effects may be caused by the sustained S100A8/A9 levels, we therefore investigated synovitis in S100A9<sup>-/-</sup> mice during CiOA. The number of cell layers and cell influx in the synovium of S100A9<sup>-/-</sup> mice was decreased compared to C57BL/6 mice Local induction of OA induces systemic release of BM-derived cells and increased Ly6C-high monocyte populations systemically and locally in the synovium, a process that may be regulated by the sustained release of S100A8/A9 from the synovium. <h3>Disclosure of Interest</h3> None declared.
Abstract 4040: Goyazensolide, a sesquiterpene lactone from Piptocoma rufescens inhibits tumor development in hollow fiber
Authors: Qi Shen, Susan Matthew, Jennifer A. Wittwer, Yulin Ren, A. Douglas Kinghorn, Esperanza J. Carcache de Blanco, Steven M. Swanson
Journal: Cancer Research (2011)

Abstract Goyazensolide (C19H20O7) is a rare sesquiterpene lactone isolated from Piptocoma rufescens Cass. (Asteraceae). Goyazensolide significantly inhibits NF-κB transcription factor and decreased the cell growth of HT-29 colon cancer cells in a dose-dependent manner. In the present study, we investigated the effects of goyazensolide in a hollow fiber assay using in vivo setting. We also examined the involvement of ROS-signaling components (ROS levels, NF-κB transcription factor, mitochondrial membrane potential) and demonstrated that the antiproliferative effect of cancer cells is partially mediated by induction of oxidative stress. It is our aim to further investigate the molecular mechanism through which goyazensolide exerts its cytotoxic effect in vitro and its antitumor effect in vivo. Our data therefore supports goyazensolide as an active anti-proliferative agent with great potential for further development. Acknowledgment This research was supported by Program Project Grant P01-CA125066 funded by the National Cancer Institute, NIH.We also wish to acknowledge the plant taxonomists who collected the plant material used in this investigation. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4040. doi:10.1158/1538-7445.AM2011-4040
THU0156 The Evaluation of Joint Damage Progression in Patients with Rheumatoid Arthritis with Long-Term and Short-Term Remission
Authors: G. Imametdinova, E. Igolkina, N. Chichasova, E. Nasonov, S. Glukhova
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Radiographic progression of joint damage in Rheumatoid Arthritis (RA) is associated with disease activity of RA. But the joint damage may progress in patients considered to be in clinical remission. It requires clarification whether the duration of remission of RA influence on joint damage progression. <h3>Objectives</h3> The aim of this study was to compare radiographic progression of joint damage in patients (pts) with RA who had remission ≥ 6 months, pts with low disease activity and pts who had moderate disease activity. <h3>Methods</h3> In the prospective study 127 pts with RA (according to ACR 1987) was performed analysis of development of new bone erosions in hands and feet in 2 years. All pts received controlled treatment with DMARDS according «treat-to-target» concept. The pts were divided into 3 groups: during 2 years 1 group - 31 pts were in remission ≥ 6 months, 2 group - 45 pts had low disease activity, 3 group - 51 pts had moderate disease activity. There were no differences in all baseline demographic and clinical characteristics (P&gt;0,05) between 3 groups. The mean age was 42,4±15,8; 43,1±16,9; 43,5± 14,3 years; the median [25<sup>th</sup> percentile-75<sup>th</sup> percentile] duration of RA was 5,5 [2,5-13,5]; 15 [2,5-30,5]; 6 [2-39], the mean DAS28 was 5,5±1,0; 6,2±0,8; 6,1±1,7 respectively. Clinical remission, disease activity were defined according DAS28. Radiographic progression was assessed by the modified Sharp's method. The statistical analysis was performed using parametric and nonparametric methods. <h3>Results</h3> After 2 years the development of new bone erosions was in 11 (35%) pts of 1 group, in 34 (75%) pts of 2 group and in 41 (80%) pts of 3 group. (1 group vs 2 group P&lt;0,01; 1 group vs 2 group P&lt;0,01; 2 group vs 3 group P&gt;0,05). The mean number of new erosions was: 0,7±1,2, median 0 [25<sup>th</sup> percentile -75<sup>th</sup> percentile] [0- 1] in pts of 1 group; 3,4±4,3 median 2 [0- 4] in pts of 2 group;13,3±12, median 10 [3,5-18,5] in pts of 3 group, P &lt;0,001 between each group. 11 pts of 3th group had short-term remission (&lt; 6 months), the mean number of new erosions was13,5±17,2, median 3,5 [2-24.5] and there was no difference from pts of 3th group without short-term remission (40 pts) - the mean number of new erosions was 13,2±11, median 10 [4,5-18] P&gt;0,05. <h3>Conclusions</h3> Thus, the remission ≥ 6 months is correlated with development significantly less numbers of new bone erosions, than persistent low and particularly, moderate activity of RA. Duration of remission &lt; 6 months not inhibit progression of joint damage. <h3>Disclosure of Interest</h3> None Declared
COMPARISON OF THREE REVASCULARIZATION STRATEGY IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS: SIMULTANEOUS, “ONE-WEEK” STAGED, AND DELAYED STAGED PERCUTANEOUS CORONARY INTERVENTION
Authors: Young Keun Ahn, Inna Kim, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Kiyuk Chang, Ki-Bae Seung
Journal: Journal of the American College of Cardiology (2016)
Oncogenic PI3K mutations are as common as<i>AKT1</i>and<i>SMO</i>mutations in meningioma
Authors: Malak Abedalthagafi, Wenya Linda Bi, Ayal A Aizer, Parker H Merrill, Ryan Brewster, Pankaj K Agarwalla, Marc L Listewnik, Dora Dias-Santagata, Aaron R Thorner, Paul Van Hummelen, Priscilla K Brastianos, David A Reardon, Patrick Y Wen, Ossama Al-Mefty, Shakti H Ramkissoon, Rebecca D Folkerth, Keith L Ligon, Azra H Ligon, Brian M Alexander, Ian F Dunn, Rameen Beroukhim, Sandro Santagata
Journal: Neuro-Oncology (2016)

Meningiomas are the most common primary intracranial tumor in adults. Identification of SMO and AKT1 mutations in meningiomas has raised the possibility of targeted therapies for some patients. The frequency of such mutations in clinical cohorts and the presence of other actionable mutations in meningiomas are important to define.We used high-resolution array-comparative genomic hybridization to prospectively characterize copy-number changes in 150 meningiomas and then characterized these samples for mutations in AKT1, KLF4, NF2, PIK3CA, SMO, and TRAF7.Similar to prior reports, we identified AKT1 and SMO mutations in a subset of non-NF2-mutant meningiomas (ie, ∼9% and ∼6%, respectively). Notably, we detected oncogenic mutations in PIK3CA in ∼7% of non-NF2-mutant meningiomas. AKT1, SMO, and PIK3CA mutations were mutually exclusive. AKT1, KLF4, and PIK3CA mutations often co-occurred with mutations in TRAF7. PIK3CA-mutant meningiomas showed limited chromosomal instability and were enriched in the skull base.This work identifies PI3K signaling as an important target for precision medicine trials in meningioma patients.
Restrictive usage of monoclonal immunoglobulin λ light chain germline in POEMS syndrome
Authors: Daijiro Abe, Chiaki Nakaseko, Masahiro Takeuchi, Hiroaki Tanaka, Chikako Ohwada, Emiko Sakaida, Yusuke Takeda, Kayo Oda, Shinichi Ozawa, Naomi Shimizu, Shinichi Masuda, Ryuko Cho, Miki Nishimura, Sonoko Misawa, Satoshi Kuwabara, Yasushi Saito
Journal: Blood (2008)
Demonstration of Necrotizing Fasciitis on Ga-67 Scans in a Patient with Systemic Lupus Erythematosus
Authors: Guang-Uei Hung, Joung-Liang Lan, Wan-Yu Lin, Shyh-Jen Wang
Journal: Clinical Nuclear Medicine (2003)

HUNG, GUANG-UEI M.D.*; LAN, JOUNG-LIANG M.D.†; LIN, WAN-YU M.D.*; WANG, SHYH-JEN M.D.* Author Information
Endoscopic treatment of Zenker’s diverticulum by LigaSure scalpel
Authors: Nicolás González, Marcelo Viola, Ximena Costa, Alejandra Gamba
Journal: Endoscopy (2014)

Treatment of Zenker's diverticulum by flexible endoscopy is considered to be feasible, effective, and safe [1] [2]. Endoscopic treatment consists of the division of the septum between the diverticulum and the esophagus, within which the cricopharyngeus muscle is contained [1] [2].
Cisplatin, Radiation, and Adjuvant Hysterectomy Compared with Radiation and Adjuvant Hysterectomy for Bulky Stage IB Cervical Carcinoma
Authors: Henry M. Keys, Brian N. Bundy, Frederick B. Stehman, Laila I. Muderspach, Weldon E. Chafe, Charles L. Suggs, Joan L. Walker, Deborah Gersell
Journal: New England Journal of Medicine (1999)

Bulky stage IB cervical cancers have a poorer prognosis than smaller stage I cervical cancers. For the Gynecologic Oncology Group, we conducted a trial to determine whether weekly infusions of cisplatin during radiotherapy improve progression-free and overall survival among patients with bulky stage IB cervical cancer.
P43 THE SYNTHETIC FXR AGONIST PX20606 ATTENUATES BACTERIAL TRANSLOCATION, INTESTINAL INFLAMMATION, AND REDUCES SPLANCHNIC BLOOD FLOW IN PORTAL HYPERTENSIVE MICE
Authors: P. Schwabl, M. Wagner, L. Garnys, F. Riedl, T.-L. Schubert, D. Mitteregger, C. Kremoser, M. Trauner, M. Peck-Radosavljevic, T. Reiberger
Journal: Journal of Hepatology (2014)
Increased Resistance in the Pneumococcus
Authors: Maxwell Finland
Journal: New England Journal of Medicine (1971)

Microbiologists who are interested in antimicrobial agents and physicians who are called upon to treat patients with bacterial infections have become accustomed to expect resistance to develop or emerge against any newly introduced, highly active and useful antibiotic. Increasing numbers of resistant strains of Staphylococcus aureus, Mycobacterium tuberculosis and, more recently, gram-negative bacilli have been noted. Staphylococci resistant to penicillin (benzyl-penicillin or penicillin G) were noted early after this antibiotic first came into use, but the full extent of the problem created by this phenomenon became apparent only after a few years of intensive use of this agent. Likewise, although . . .
AB0801 Skin scores of patients with systemic sclerosis correlate with circulating thyrotropin levels
Authors: G. Bagnato, W.N. Roberts, D. Sangari, M. Atteritano, R. Talotta, G. Miceli, G. Bagnato
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Hypothyroidism has a higher prevalence in systemic sclerosis (SSc) patients<sup>1</sup> and thyrotropin (TSH) receptor is widely expressed in human tissues<sup>2</sup>, included the skin<sup>3</sup> and the aorta<sup>4</sup>. <h3>Objectives</h3> Our aim, therefore, was to measure skin scores across the clinical spectrum of limited and diffuse scleroderma and to correlate these scores with serum TSH levels. <h3>Methods</h3> In a cross-sectional study we compared skin severity modifiedRodnan total skin scores (TSS) to circulating TSH levels in 43 patients with scleroderma (18 with diffuse form, 25 with limited form). SSc patients with hypothyroidism necessitating thyroid hormonal replacement therapy and patients with positive TSH receptor antibodies were not enrolled. We also concurrently measured free triiodothyronine (FT3), free thyroxine (FT4), TSH receptor antibodies (TRAb), anti-thyroid peroxidise (TPOAb) and anti-thyroglobulin (TgAb), all by chemiluminescence immunoassay. <h3>Results</h3> Enrolled patients were all female with a mean age of patients was 50.04±13.07 years and a mean disease duration was 7.9±6 years. Skin scores for the entire group averaged 9.40±5.05, while the mean TSH was 2.05±1.14. Spearman's rank correlation between the TSS and TSH was statistically significant (r=0.75, p&lt;0.0001). Other thyroid hormonal measurements and anti-thyroid antibodies correlated poorly with skin scores. <h3>Conclusions</h3> TSH is higher for patients with more severe skin disease. Therefore TSH could play a role in the development of cutaneous fibrotic changes in SSc patients. Further confirmatory analyses are needed to establish the role of thyrotropin in systemic sclerosis pathogenesis. <h3>References</h3> Antonelli A, et al. Clinical and subclinical autoimmune thyroid disorders in systemic sclerosis. Eur J Endocrinol. 2007 Apr; 156(4)431-7. Klein, JR. Physiological relevance of thyroid stimulating hormone and thyroid stimulating hormone receptor in tissues other than the thyroid. Autoimmunity. 2003 Sept-Nov;36(6-7):417–421. Cianfarani F, et al. TSH receptor and thyroid-specific gene expression in human skin. J Invest Dermatol. 2010 Jan;130(1):93-101. Donnini D et al F. Thyrotropin stimulates production of procoagulant and vasodilative factors in human aortic endothelial cells. Thyroid. 2003 June;13(6): 517-21 <h3>Disclosure of Interest</h3> None Declared
AB0894 A Common VEGF -634G/C Polymorphism is Associated with Henoch-Schonlein Purpura Nephritis
Authors: H. Zeng, X. Xiong
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Objectives</h3> The purpose of this study was to evalulate the role of the single nucleotide polymorphism (SNP) –634 G/C at the 59-untranslated region (UTR) of the vascular endothelial growth factor (VEGF) in the susceptibility to children with Henoch-Schonlein Purpura nephritis (HSPN) in the south of China. <h3>Methods</h3> A case-control study was conducted in 100 children with Henoch-Schonlein Purpura (HSP) of Chinese Han population in the south of China. Patients were diagnosed according to proposed criteria. Patients (n=100) and ethnically matched controls (n=50) were genotyped for the VEGF -634G/C polymorphisms using PCR-RFLP technology. VEGF plasma levels were measured using an enzyme immunoassay. 100 patients included 50 patients with HSPN and 50 patients without HSPN. All patients were required to have had at least 6 month9 follow-up. <h3>Results</h3> No significant difference in the allele or genotype frequencies for the VEGF -634G/C polymorphism was observed between HSP patients without HSPN and controls. The VEGF -634 CC genotype and -634 C allele were increased in patients with HSPN compared with HSP patients without HSPN and healthy controls. The -634C allele was associated with susceptibility to HSPN. The -634G allele was a protective factor of HSPN. Furthermore, VEGF plasma levels were significantly higher in subjects with the CC genotype of the -634 G/C polymorphism than in those with the other genotypes. <h3>Conclusions</h3> These data suggest that the VEGF-634C allele in the 59UTR of the VEGF gene is a genetic risk factor in the development of nephritis in patients with HSP in the south of China. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.5553
Multiple Ectopic Calcification in Subcutaneous Tissues Detected by Bone Scintigraphy in a Patient With Chronic Renal Failure
Authors: Zeqing Xu, Caihua Tang, Linqi Zhang, Xinmin Gou, Yijie Fang
Journal: Clinical Nuclear Medicine (2015)

A 56-year-old man presented with swelling bilateral shoulders for 2 months. Plain radiograph and CT demonstrated symmetric masses with plaque calcification in bilateral shoulders. A 99mTc-MDP bone scintigraphy revealed intense radiotracer uptake not only in the masses of bilateral shoulders but also in the masses of the right buttock and the left thigh. The masses in bilateral shoulders were resected, and the pathological examination confirmed the ectopic calcification. This is a rare case of multiple ectopic calcification in subcutaneous tissues in a patient with chronic renal failure.
Protein-Losing Enteropathy Detected on Tc-99m HSA and Tc-99m MDP Scintigraphy
Authors: Ju Won Seok, Seong Kim, Sun Hee Lee, In Ju Kim, Yong Ki Kim
Journal: Clinical Nuclear Medicine (2002)

The authors describe a patient with protein-losing enteropathy in whom abnormal intestinal accumulation of tracer occurred during Tc-99m human serum albumin scintigraphy. Abnormal leakage of the radiotracer was observed in the left upper abdomen and was confirmed by Tc-99m MDP scintigraphy. Both Tc-99m HSA scintigraphy and Tc-99m MDP scintigraphy are useful in the detection of protein-losing enteropathy.
Case 21-2007
Authors: David M. Greer, Enrico Cagliero, Eric L. Krakauer, R. Gilberto Gonzalez, E. Tessa Hedley-Whyte
Journal: New England Journal of Medicine (2007)

A 58-year-old woman was admitted to this hospital because of a recent history of progressive fatigue and right-sided weakness, with headache and word-finding difficulty. Similar episodes had occurred over the previous 3 years, with increasing frequency and with residual right-sided weakness. She had a 30-year history of type 1 diabetes, complicated by retinopathy, neuropathy with gastroparesis, nephropathy, and cardiovascular disease. Symptoms of gastroparesis progressed; the patient refused further care and died. An autopsy was performed.