Islet Transplantation for Brittle Type 1 Diabetes: The UIC Protocol

This prospective phase 1/2 trial investigated the safety and reproducibility of allogeneic islet transplantation (Tx) in type I diabetic (T1DM) patients and tested a strategy to achieve insulin-independence with lower islet mass. Ten C-peptide negative T1DM subjects with hypoglycemic unawareness received 1–3 intraportal allogeneic islet Tx and were followed for 15 months. Four subjects (Group 1) received the Edmonton immunosuppression regimen (daclizumab, sirolimus, tacrolimus). Six subjects (Group 2) received the University of Illinois protocol (etanercept, exenatide and the Edmonton regimen). All subjects became insulin- independent. Group 1 received a mean total number of islets (EIN) of 1460   080 ± 418   330 in 2 (n = 2) or 3 (n = 2) Tx, whereas Group 2 became insulin- independent after 1 Tx (537   495 ± 190   968 EIN, p = 0.028). All Group 1 subjects remained insulin free through the follow-up. Two Group 2 subjects resumed insulin: one after immunosuppression reduction during an infectious complication, the other with exenatide intolerance. HbA1c reached normal range in both groups (6.5 ± 0.6 at baseline to 5.6 ± 0.5 after 2–3 Tx in Group 1 vs. 7.8 ± 1.1 to 5.8 ± 0.3 after 1 Tx in Group 2). HYPO scores markedly decreased in both groups. Combined treatment of etanercept and exenatide improves islet graft function and facilitates achievement of insulin-independence with less islets .     

Post-traumatic stress disorder is not over-represented in a sample population of migraine patients

IntroductionExposure to extreme stress can result in a variety of clinical sequelae, in terms of severity and type, of which post-traumatic stress disorder (PTSD) is the prototype. PTSD was previously associated with chronic pain and primary pain disorders.ObjectiveTo evaluate the prevalence of PTSD among migraine patients and to assess its relation to migraine severity.MethodsWe evaluated 92 consecutive patients fulfilling the international headache society criteria for migraine with and without aura treated in the Headache Clinic of the Soroka University Medical Center in Beer-Sheva using the Clinician Administered PTSD Scale (CAPS), and headache severity scales (HIT-6 and MIDAS).ResultsThe prevalence of specific traumatic events in migraine patients was 16.3% (n = 15). Six patients (6.5%) of the 92 patients met the DSM-IV criteria for PTSD. Migraine patients with co-morbid PTSD had higher MIDAS scores than other migraine patients.ConclusionsMigraine patients do not suffer from PTSD more than the general population. When they do suffer from PTSD they report high levels of disability.