Permanent diabetes mellitus in the first year of life

AIMS/HYPOTHESIS: The pathogenesis of permanent diabetes mellitus diagnosed early in life is heterogeneous and, in most cases, not known. We aimed at identifying markers differentiating between non-autoimmune and autoimmune diabetes. METHODS: The clinical, genetic and epidemiological features of 111 diabetic patients (62 males) who received insulin within 12 months of life were studied. RESULTS: The epidemic curve by age of diabetes onset revealed two subsets of patients at a cutoff of 180 days. In the group with diabetes onset before 180 days ("early onset" permanent diabetes) the analysis of HLA susceptibility heterodimers (available for 21 individuals) showed that 76% had a "protective" HLA genotype for Type I (insulin-dependent) diabetes mellitus as compared to 11.9% (5/42) of the later onset group. Accordingly, "early onset" children were less likely to have autoimmunity markers (4 out of 26 tested) than children with onset after 180 days (13 out 20 tested) (15.4% vs. 65.0%, p<0.01). Of note, 19 out of 20 (or the 95%) patients who were born on the island of Sardinia, an Italian region where the incidence of Type I diabetes is six times higher than continental Italy (33/100,000/year vs 5/100,000/year), were included in the later onset group (>180 days). Small-for-date birthweight, a possible sign of reduced foetal insulin secretion, was more common in the "early onset" group (OR=9.9, 95%-CI 2.6-38.6). CONCLUSION/INTERPRETATION: These results, obtained in the largest population-based cohort of diabetic infants hitherto reported, suggest that "early onset" permanent diabetes cases differ from later onset cases and that most of them do not have an autoimmune pathogenesis.     

Understanding eating choices among university students: A study using data from cafeteria cashiers’ transactions

ObjectiveTo illustrate the use of automatically collected data from cashier transactions to understand eating habits among university students using cafeteria and to identify individual characteristics associated with the diverse behaviors.MethodsThe study was carried out at a large university located in Pisa, central Italy, using data about meals automatically recorded from cashier transaction meals during the academic year 2015?16 as well as data from the administrative archive of the university. A model-based clustering relying on multivariate beta distribution was used to cluster eating choices while multivariate multinomial logistic regressions were applied to identify variables associated to diverse clusters identified.ResultsConsidering 4643 students and about 200,000 meals consumed, results suggest that healthy eaters represented a minority (11.2 %) of the study population while the large part of students composed their meals combining grains with processed food or proteins (32.7 %) and limiting the choice of fruit (42.9 %). Male gender and younger age were associated with eating behavior not in line with recommendations for a healthy diet.ConclusionsEating choice resulted to be “compromised” in most of students and specific characteristics associated with unhealthy choice were also identified that can help inform and target specific policy. The use of routinely collected data gives the opportunity to both cafeterias and university to take an active role in policy development.     

Percutaneous treatment of benign biliary stenosis: bilioplasty and stenting

We reviewed our personal experience in 46 patients with biliary strictures, who underwent percutaneous balloon dilatation between 1983 and 1988. The strictures were iatrogenic in 24% of the cases, anastomotic in 52%, inflammatory in 17%, and associated with sclerosing cholangitis in 7%. The treatment consisted in dilating the bile ducts with balloon catheters of different kinds and sizes ("bilioplasty") and placing an internal drainage catheter for a varying period of time ("stenting"). In 22 patients the catheter was removed after an average time of 7.7 months. The rate of stricture recurrence was 13.5% (average follow-up: 20 months). In the remaining 24 patients the stents are still in situ, waiting for removing. Major complication rate was 6.4% (2 pleural effusions and 1 hepatic artery bleeding). We also report our initial experience with metallic self-expanding stents which appear as a promising tool in the management of recurring strictures.