Strategy For Treatment Of Type Research Articles

False aneurysm of a hepatic artery branch complicating intrahepatic islet transplantation

Islet transplantation, an innovative treatment strategy for type 1 diabetes mellitus, is a relatively safe procedure, with less morbidity than pancreas transplantation. Vascular injuries have not been reported to date. We report a percutaneous transhepatic intraportal islet transplant infusion that was followed by bleeding from a false aneurysm of an intrahepatic branch of the hepatic artery. The bleeding was controlled by selective embolization. Despite the complication and its treatment, the patient gained insulin independence, which was sustained for 285 days. She is currently on a small dose of insulin with good glycemic control.

Effectiveness of interventions using empowerment concept for patients with chronic disease: a systematic review

Background Chronic disease patients may undergo long periods of treatment, experience changes in their lifestyle and attitude, as well as have to maintain self-care behaviors to prevent the chronic condition from worsening or to attempt to reduce potential complications. All of the above factors could negatively impact on their quality of life. Empowerment is a patient-centered, collaborative approach tailored to match the fundamental realities of chronic disease care. Empowerment is seen as a valuable approach in promoting patients' well-being, decision-making and self-management. Objectives The objective of this systematic review is to determine the effectiveness of interventions with empowerment concept for chronically ill patients. Search strategy The search strategy aimed to find both published and unpublished studies, in either the English or Chinese language published between 1937 to 2008. Reference lists of studies that met the inclusion criteria were searched for additional studies. Types of studies The review considered any randomized controlled trials (RCTs) and non-randomized controlled trials, quasi-experiential, and evaluation study that evaluate the effectiveness of empowerment interventions. Types of participant Patients with a chronic disease (such as chronic heart disease, chronic vascular disease, uremia, cancer and diabetes mellitus) were considered for inclusion. Types of intervention Strategies that utilized the concept of empowerment were included in the review. Interventions examined in this review included education, support group, dialogue and individual consultation. Types of outcome measures Health status outcomes as determined by physical symptoms, psychological symptoms and social aspects of the chronic disease were included. Health status was measured using disease-related laboratory data, scales of self-efficacy and psychological empowerment. Measures of disease management, such as patient knowledge and self-care were also assessed where reported. Quality of life measures were assessed when reported. Data extraction and analysis Meta-analysis was used to pool the data from included studies in order to determine the overall effectiveness of individual interventions. The Comprehensive Meta Analysis V2 was used to manage the data. Results This systematic review identified twenty-five studies that examined the effects of empowerment interventions. There were three broad categories of intervention: group-directed, individual-directed, and combined. The studies utilized bio-markers and quality of life (QoL) measures as indicators of effectiveness, however, only individual-directed interventions focused on psychological and disease management. All three categories of empowering interventions showed a significant effect on haemoglobin A1C (HbA1C) in diabetic patients. The effect size for group-directed, individual-directed, and the combined interventions were: 0.326, 0.434, and 0.367, respectively. The meta-analysis also showed that group-directed interventions (effect size=0.30) had more effect than individual-directed interventions (effect size=0.278) on blood pressure in diabetic patients. The review also found that some interventions took a long time to yield results. For example - one group-directed study reported that for their intervention to significantly reduce cholesterol in diabetic patients, the intervention period should last for at least 12 months. Both group-directed and individual-directed types of empowering interventions are able to improve patients' disease knowledge and ability to manage their illness. A meta-analysis of four individual-directed studies showed statistically significant effects. When examining the effectiveness of the three categories of intervention on quality of life, group-directed and the combined type appeared to be more effective than individual-directed type interventions. Conclusion This review has shown that interventions that aim to empower patients are able to improve the health status, psychological condition and quality of life of chronically ill patients. The length of time required to observe improvements in bio-markers such as: haemoglobin A1C, blood pressure, and cholesterol varied, with some interventions taking up to 12 months to be effective. Group-directed interventions were found to improve the quality of life of chronic disease patients in the short-term, with effects lasting up to one month. All of the three categories of empowerment interventions lead to an improvement in knowledge of the disease for chronic disease patients. Individual-directed type intervention lead to an increase in the level of self-care at four weeks, one month, and three months interventions, respectively. In summary, empowerment interventions are effective in chronic disease care.

Abandono do tratamento de tuberculose utilizando-se as estratégias tratamento auto-administrado ou tratamento supervisionado no Programa Municipal de Carapicuíba, São Paulo, Brasil

To determine treatment noncompliance rates among patients participating in a municipal tuberculosis control program and to identify the variables related to noncompliance depending on the type of treatment strategy used. A longitudinal non-concurrent cohort study was carried out involving two cohorts of patients participating in the Tuberculosis Control Program of the city of Carapicuíba, Brazil. The first cohort comprised 173 patients with tuberculosis treated from January 1, 2003 to December 31, 2003 using self administration of treatment, and the second comprised 187 patients with tuberculosis treated from July 1, 2004 to June 30, 2005 using the directly observed therapy, short-course strategy. Noncompliance rates decreased from 13.3% (self administration of treatment) to 5.9% (directly observed therapy, short-course), a significant difference (p < 0.05). For the self administration of treatment strategy, the variables significantly associated with treatment noncompliance were as follows: being an unregistered worker (relative risk [RR] = 3.06); retreatment (RR = 2.73); alcoholism (RR = 3.10); and no investigation of contacts (RR = 8.94). For the directly observed therapy, short-course strategy, no variables were significantly associated with noncompliance. The directly observed therapy, short-course strategy decreased noncompliance rates and produced better treatment outcomes, even when the risk factors for noncompliance were the same.

Investigation of the functional characteristics of antibodies to therapeutic anti-human tumor necrosis factor alpha monoclonal antibody

Humanized antibody-based treatment modalities represent an active area of investigation. Included in these strategies are passive administrations of monoclonal antibodies, which recognize tumor necrosis factor alpha (TNF-α). However, several problems associated with these types of treatment strategies have been reported in the literature. We attempted to address the issue related to unresponsiveness to infliximab that might be induced by anti-idiotype response to the passively administered humanized monoclonal antibody. The characteristics and functional importance of antibodies to infliximab (ATI) were investigated in human sera. We studied the binding characteristics of ATI to infliximab, TNF-α Receptor-I (RI, p55) and Receptor-II (RII, p75). In addition, cytotoxicity effect on L929 cells and blocking effects on the binding of TNF-α with infliximab and etanercept were also analyzed. On the basis of the results obtained from the experiments, it seems that the target epitope for ATI is related with somewhere else not residing in the region capable of generating “mirror image”. The results presented indicate that ATI does not mimic the functional characteristics of TNF-α. However, ATI inhibited the binding properties of infliximab to TNF-α.

Emerging Therapies for Type 2 Diabetes

Type 2 diabetes results from progressive β-cell dysfunction and insulin resistance, leading to progressive worsening of glycemic control, and increased risk of microvascular and macrovascular complications. Traditionally, treatment strategies for type 2 diabetes have concentrated on compensating for insulin deficiency and reducing insulin resistance. These approaches sequentially utilize diet and exercise, oral antidiabetic drug therapy, and ultimately, exogenous insulin. However, current therapies have little effect on the inexorable decline of β-cell dysfunction, and in a group of patients already overweight or obese, treatment often comes with further weight gain. Consequently, patients often experience deterioration of glycemic control as their disease progresses while battling obesity. Several new therapies including new insulin platforms and new classes of pharmaceutical agents with unique modes of action have recently been introduced or are in clinical development for use in patients with type 2 diabetes. These include amylinomimetics, incretin mimetics, DPP-IV inhibitors, and glucagon antagonists. These new agents improve glycemia and in some instances can reduce body weight. Furthermore, anti-obesity agents, either currently available or in development, are being investigated for their potential to treat diabetes. This review focuses primarily on these new therapeutic approaches, particularly those that improve glycemic control while improving control of body weight.

Traitements futurs de l'insulino-résistance

Present treatment strategies of type 2 diabetes are unsatisfactory. At diagnosis, most oral antidiabetic agents are effective on blood glucose control, but with time metabolic control deteriorates whatever therapeutic modality is used. The reasons for treatment failure are the natural history of the disease and the necessary implication of the patient in the management of blood glucose control on a constant basis. News treatments thus have to be developed acting on either insulin resistance or insulin secretion or both. We discuss here present and future developments which aim to decrease insulin resistance. In the last 10 years, multiple therapeutic targets have been identified in appetite control, such as the endocannabinoid system and glucagon-like-peptide 1, in insulin signalling and in the control of cellular energy balance such as AMP kinase. These developments should allow a better management of type 2 diabetes and its complications.

Treatment of Diabetes: A Clinical Update on Insulin Trials

The prevalence of diabetes, along with its accompanying long-term microvascular and macrovascular complications, continues to increase. Landmark studies of both type 1 and type 2 diabetes have provided the foundations on which to investigate improved treatment strategies for type 2 diabetes. Recent evidence suggests a new paradigm for treating type 2 diabetes that adds insulin earlier in the treatment process to maintain tight glycemic control. The newer insulin analogues in combination with oral antidiabetic agents provide a viable option for improving glycemic control and preventing or delaying the occurrence of complications.

Rationale, Design, and Methods for Glycemic Control in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

A major therapeutic question in considering accelerated atherogenesis in patients with type 2 diabetes mellitus is whether reducing insulin resistance, as a proximal defect of a host of proatherogenic abnormalities including hyperglycemia, will be superior for decreasing mortality and coronary artery disease (CAD) risk compared with treating hyperglycemia to overcome insulin resistance with insulin-providing agents. This question is highly relevant, since earlier targeted glycemic control trials utilizing conventional glucose-lowering strategies that increase insulin levels have generally failed to reduce CAD risk despite markedly reducing microvascular risk. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial seeks to determine whether primarily using an insulin-sensitizing strategy for treatment of type 2 diabetes is superior when compared with primarily using an insulin-providing strategy with regard to cardiovascular outcomes. This article presents the rationale, design, and methods being used to test the glycemic control hypothesis in BARI 2D.

Combination therapy for rheumatoid arthritis in the era of biologicals.

Early, aggressive disease management is critical for halting disease progression and joint destruction in patients with rheumatoid arthritis. Combination therapy with at least two disease-modifying antirheumatic drugs, such as methotrexate (MTX), sulfasalazine, or hydroxychloroquine, is often more effective than monotherapy in reducing disease activity. Biologic therapies represent more effective and tolerable treatment options that, when combined with MTX, have been shown to dramatically reduce inflammation, inhibit radiographic progression, and induce remission. Although several types of treatment strategies are used in clinical practice, the most aggressive approaches that target early disease have shown the most promise in reversing disease progression and reducing disease-related costs.

PYY in the Expanding Pancreatic Epithelium

Gut peptide YY (PYY) plays an important role in regulating metabolism and is expressed during the ontogeny of the pancreas. However, its biological role during endocrine cell formation is not fully understood, and its role, if any, during pancreatic regeneration in the adult has not yet been explored. The knowledge of factors involved in beta cell renewal in adult animals is clearly relevant for the design of treatment strategies for type 1 diabetes. We therefore sought to determine if observations during fetal pancreas formation also apply to pancreatic growth in adult animals. Indeed, we have found marked expansion of the PYY-expressing population during pancreatic regeneration. In addition, we demonstrate the presence of cells co-expressing PYY and the critical pancreatic transcription factor pancreatic duodenal homeobox1 (PDX-1). Interestingly, these cells also co-expressed specific islet hormones during pancreatic development and re-growth, suggesting a developmental relationship. Furthermore, we have found that PYY can act in concert with IGF-1 to stimulate cellular responsiveness in pancreatic epithelial cells in vitro. Our data suggest that PYY may be a mediator of islet cell development, as well as a cofactor for growth factor responses, not only during fetal pancreas formation but also during regeneration in adult animals.

Modelling Lifetime Metabolic Progression and Cost Effectiveness of Treatment Strategies for Type 2 Diabetes

Modelling Lifetime Metabolic Progression and Cost Effectiveness of Treatment Strategies for Type 2 Diabetes

Phenotypic Correction of von Willebrand Disease Type 3 Blood-Derived Endothelial Cells with Lentiviral Vectors Expressing von Willebrand Factor.

Von Willebrand disease (VWD) is the most common inherited bleeding disorder, caused by quantitative (type 1 and 3 VWD) or qualitative (type 2 VWD) defects in von Willebrand factor (VWF). Gene therapy is an appealing strategy for treatment of type 3 VWD since it is caused by a single gene defect and since VWF is secreted into the circulation, obviating the need for targeting specific organs or tissues. However, development of gene therapy for VWD has been hampered by the considerable length of the VWF cDNA (8.4 kb) and the inherent complexicity of the VWF protein which requires extensive post-translational processing. The objective of this study consisted of developing a gene-based approach for VWD using lentiviral transduction of blood-outgrowth endothelial cells (BOECs) to express functional VWF. A lentiviral vector encoding the complete human VWF protein was used to transduce BOECs isolated from type 3 VWD dogs resulting in high transduction efficiencies (95.6 ± 2.2 %). These BOECs are completely deficient in VWF due to a point mutation in the VWF gene responsible for impaired VWF synthesis. Transduced VWD BOECs efficiently expressed fully functional vector-encoded VWF (4.6 ± 0.4 U/24hr per 106 cells, figure 1), with normal binding to GPIbα and collagen and normal multimeric pattern resulting in phenotypic correction of these cells, which had not been shown previously. These results indicate that BOECs are attractive target cells for gene therapy of type 3 VWD.

Health promotion and disease prevention for older adults: Intervention themes and strategies used in Quebec local community health centres and seniors' day centres.

Despite the considerable potential of disease prevention and health promotion (DPHP) among older adults, extant data suggest that this field of intervention is still underdeveloped. To shed further light on this issue, this paper presents the results of an inventory of DPHP interventions for older adults conducted in local community health centres (CLSCs) and seniors' day centres in the province of Quebec. All CLSCs (N=147) and day centres (N=124) were invited to participate (response rates: 74% and 79%). Data were collected through telephone interviews. Interventions were coded according to type of intervention strategies and target themes. Awareness-raising and health education strategies emerged as the most frequently-cited type of intervention strategies, reported by 77% of CLSCs and 95% of day centres, respectively. The two themes reported by a majority of CLSCs were physical health (87%) and community issues (58%). Lifestyle habits (92%) and social issues (92%) were the two most frequently-cited themes in day centres. DPHP for older adults is substantially well developed in terms of intervention offerings in the two types of organizations under study. However, the range of available interventions requires expansion to increase the potential of DPHP programs to tackle the numerous challenges posed by the aging of the population.

Low-dose Metronomic Combined with Intermittent Bolus-dose Cyclophosphamide Is an Effective Long-term Chemotherapy Treatment Strategy

Metronomic chemotherapy refers to the close, regular administration of comparatively low doses of cytotoxic drugs, with minimal or no drug-free breaks, over prolonged periods. It is thought to have an antiangiogenic basis. However, whereas surprisingly durable and potent tumor responses have been observed in a number of preclinical tumor models, relapses usually eventually occur using this type of treatment strategy. We therefore decided to test modified metronomic chemotherapy regimens that might significantly delay such relapses, but still maintain modest and acceptable toxicity profiles. Here, we show that repeated administration of bolus doses (BDs) of cyclophosphamide every 3 or 6 weeks, combined with a daily oral low-dose metronomic (LDM) regimen (20 mg/kg/d cyclophosphamide), improves efficacy and significantly delays progression of transplanted PC-3 human prostate cancer xenografts, syngeneic transplanted EMT-6 breast tumors, and "spontaneous" murine erythroleukemia. Efficacy was superior whereas toxicity was mild and comparable to the LDM regimen, the latter assessed by body weight, neutrophil, lymphocyte, and total white blood counts. Antiangiogenic activity, measured by reduction in circulating endothelial precursor cells, revealed that the greatest degree of suppression occurred using the combination treatment. Overall, our results indicate that the administration of intermittent BD combined with chronic oral LDM cyclophosphamide is a potent treatment regimen for controlling tumor growth, which has a low toxicity profile, over prolonged periods of time.

A Comparison of Two Approaches for Facilitating Identity Exploration Processes in Emerging Adults

This article, using a controlled design, reports the results of an exploratory study to investigate the impact of two types of intervention strategies (cognitively vs. emotionally focused) on two types of identity processes (self-construction and self-discovery) in a culturally diverse sample of 90 emerging adult university students. A quasi experimental design was used to evaluate the relative impact of the cognitively focused self-construction and emotionally focused self-discovery strategies. Quantitative and qualitative results indicated that cognitively focused intervention strategies were most efficacious in affecting self-constructive identity processes, whereas emotionally focused intervention strategies were most efficacious in affecting self-discovery identity processes. This pattern of differential effects suggests that programs intended to broadly affect identity development should include both types of intervention strategies and should target both self-constructive and self-discovery processes.

Efficacy of biphasic insulin aspart in patients with type 2 diabetes

Background: It is estimated that 39% of people withdiabetes worldwide who use insulin are prescribed premixes, largely because of the practical advantages of addressing both prandial and basal insulin needs with a single product. Rapid-acting premixed insulin analogues such as biphasic insulin aspart 30 (BIAsp 30 [30% soluble insulin aspart and 70% protamine-crystallized insulin aspart], NovoLog® Mix 70/30, Novo Nordisk, Bagsvaerd, Denmark) have been developed recently to overcome the pharmacokinetic limitations of regular human insulin used in the most commonly prescribed premix, biphasic human insulin 30 (BHI 30, 30% human insulin and 70% neutral protamine Hagedorn [NPH] insulin). It would be expected that these pharmacokinetic improvements would enhance clinical performance. However, the efficacy of BIAsp 30 compared with other common treatment regimens has not yet been systematically reviewed. Objective: The aim of this paper is to review currentdata on the efficacy of BIAsp 30 in comparison with other treatment strategies in type 2 diabetes, including oral antidiabetic drugs (eg, metformin, sulfonylureas, meglitinides, thiazolidinediones), conventional insulins (eg, BHI 30, NPH insulin), and other analogue insulins (eg, insulin glargine, biphasic insulin lispro 25 [Mix 25, 25% biphasic insulin lispro and 75% protaminated lispro]). The focus will be on comparative efficacy (le, postprandial glucose [PPG], blood glucose profiles, and glycosylated hemoglobin [HbA 1c]).). Methods: We identified human clinical studies publishedthrough February 2005 involving BIAsp 30 in patients with type 2 diabetes by performing a MEDLINE search (key words: biphasic insulin aspart, BIAsp 30, biphasic insulin, and premixed insulin). Additional papers were identified by assessing (1) the reference lists in these studies, (2) published conference proceedings, and (3) our reference files. A total of 21 relevant papers were retrieved: 13 were published as full manuscripts, 1 as a short communication, 5 as abstracts, and 1 as a poster. One paper is currently in press. Novo Nordisk supplied data from an unpublished trial (Study 1536, 2004), as well as data from a trial published in abstract form only (Study 1269, 2002). Results: A regimen of BIAsp 30 BID, at breakfast and dinner, provides improved PPG control compared with BHI 30 BID, NPH BID, and insulin glargine OD for patients with type 2 diabetes. Fasting plasma glucose (FPG) with BIAsp 30 was not significantly different from FPG with insulin glargine; however, FPG was higher with BIAsp 30 than with NPH. BIAsp 30 prevented excessive PPG excursions whether it was injected at the beginning of a meal or ≤15 minutes after starting a meal. BIAsp 30 was not associated with an increased risk of major hypoglycemia compared with other insulin regimens used in the studies reviewed. The incidence of minor hypoglycemic events with BIAsp 30 varied across studies but occurred with frequency or risk similar to BHI 30, Mix 25, or NPH. Treat-to-target trials reported that BIAsp 30 can be used to intensify insulin therapy and to reach the glycemic target recommended by the American Diabetes Association (ie, HbA 1c <7.0%). One study reported a greater lowering of postprandial triglyceride levels with BIAsp 30 than with BHI 30. Conclusions: BIAsp 30 BID can reduce PPG levelsto a greater extent than other common treatment regimens, including basal insulin OD. Using BIAsp 30, even once daily, may allow some patients to reach glycemic targets with a degree of convenience and tolerability that may not be achievable with other treatment regimens.

Short-term intermittent exposure to diazoxide improves functional performance of beta-cells in a high-glucose environment.

Prolonged periods of "beta-cell rest" exert beneficial effects on insulin secretion from pancreatic islets subjected to a high-glucose environment. Here, we tested for effects of short-term intermittent rest achieved by diazoxide. Rat islets were cultured for 48 h with 27 mmol/l glucose alone, with diazoxide present for 2 h every 12 h or with continuous 48-h presence of diazoxide. Both protocols with diazoxide enhanced the postculture insulin response to 27 mmol/l glucose, to 200 mumol/l tolbutamide, and to 20 mmol/l KCl. Intermittent diazoxide did not affect islet insulin content and enhanced only K(ATP)-dependent secretion, whereas continuous diazoxide increased islet insulin contents and enhanced both K(ATP)-dependent and -independent secretory effects of glucose. Intermittent and continuous diazoxide alike increased postculture ATP-to-ADP ratios, failed to affect [(14)C]glucose oxidation, but decreased oxidation of [(14)C]oleate. Neither of the two protocols affected gene expression of the ion channel-associated proteins Kir6.2, sulfonylurea receptor 1, voltage-dependent calcium channel-alpha1, or Kv2.1. Continuous, but not intermittent, diazoxide decreased significantly mRNA for uncoupling protein-2. A 2-h exposure to 20 mmol/l KCl or 10 mumol/l cycloheximide abrogated the postculture effects of intermittent, but not of continuous, diazoxide. Intermittent diazoxide decreased islet levels of the SNARE protein SNAP-25, and KCl antagonized this effect. Thus short-term intermittent diazoxide treatment has beneficial functional effects that encompass some but not all characteristics of continuous diazoxide treatment. The results support the soundness of intermittent beta-cell rest as a treatment strategy in type 2 diabetes.

A Strategy for Treatment of Type III and IV Thoracoabdominal Aortic Aneurysm

The aim of this study was to describe the results of resection and graft replacement for type III and IV thoracoabdominal aortic aneurysm repair. In this retrospective study, 27 patients underwent resection and graft replacement for type III (10) or type IV (17) thoracoabdominal aortic aneurysms. Nine patients had rupture, 12 were symptomatic, and 6 were operated on electively. The "clamp-and-sew" technique was applied in six cases. In 12 patients with type IV aneurysm the proximal part of the vascular graft was beveled, including the orifices of the celiac, superior mesenteric, and one or both renal arteries in the proximal anastomosis. Finally, eight patients underwent surgical application of a shunt for perfusion of the celiac and superior mesenteric arteries. One patient was treated with a combination of open and endovascular surgery. There were four early deaths (14.8%), all following operations for rupture, which represents a 45% mortality rate in this subgroup of patients. Two patients with type III aneurysm had postoperative paraparesis. One was symptomatic whereas the other was operated on electively. Excluding the patients with rupture, the accumulated 5-year survival rate was 65%. These results indicate that direct cross-clamping of the aorta gives limited time for performing the necessary anastomoses without inducing mesenteric ischemia. Inclusion of the orifices of the visceral arteries in the upper anastomosis is a feasible method during surgery for type IV aneurysms. Finally, shunting of the celiac and the superior mesenteric arteries seems to be useful, especially during surgery for type III aneurysms.

Anti-idiotype responses abrogate anti-CD4-induced tolerance to a tumor-specific antigen and promote systemic tumor immunity.

Immunologic-based cancer treatment modalities represent an active area of investigation. Included in these strategies are passive administration of monoclonal antibodies which recognize tumor-associated antigens and active vaccination with identified tumor antigens. However, several problems associated with these types of treatment strategies have been identified. In this report, we address certain issues by employing a murine model for experimental pulmonary metastasis and a tumor antigen vaccination strategy that induces complete tumor immunity in this system. Utilizing this model, we attempt to address issues related to unresponsiveness to tumor antigen immunization induced by passive administration of a rat monoclonal anti-CD4 and the induction of anti-idiotype responses to a passively administered monoclonal antibody and the effects on the induction of tumor immunity. The results presented indicate that passive administration of rat monoclonal anti-CD4 exhibits immunosuppressive effects that inhibit the production of antibodies to the tumor antigen immunization and abolishes tumor immunity. Repeated administration of the rat monoclonal anti-CD4 results in an anti-idiotype response that can abrogate unresponsiveness to tumor antigen immunization and promote systemic tumor immunity. The data examine a number of potential problems associated with immunologic-based treatments for cancer. These problems include the potential for tolerance to the tumor antigen and establishing an immunocompromised state where immunization with a tumor antigen failed to generate tumor immunity. Approaches to eliminate tolerant T cells by targeting anti-CD4 via anti-idiotype responses that could be generated in vivo without CD4+ T cells allowed for recovery of nontolerant T cells, and an antibody response to the tumor antigen that results in tumor immunity.

Pancreatic Islet Cell Transplantation: A Treatment Strategy for Type I Diabetes Mellitus

Type I diabetes mellitus continues to be a serious disease with long-term morbidity from complications of the disease, despite better knowledge of physiology and better patient care. Pancreatic islet cell transplantation, still experimental, is gaining acceptance as a treatment strategy for individuals with type 1 diabetes who have poor glucose control and frequent hypoglycemic episodes despite maximal care. The procedure can improve glucose control, avoiding further hypoglycemic episodes, and can achieve insulin-independence at the expense of immunosuppression treatment. Islet cell transplantation does not correct all the metabolic abnormalities seen in type 1 diabetes, and glucose tolerance can remain abnormal. The dietary management of the patients still needs to be defined. Further research is focused at improvement in islet isolation and the refinement of immunosuppression strategies aiming toward immune tolerance, bringing hope for a cure of diabetes.