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The article discusses a study that identified the factors related to more aggressive β-cell destruction in children with type 1 diabetes mellitus (T1D). Information on T1D is provided including its incidence among younger children. Classification of patients into early onset T1D (EOD) and later onset T1D (LOD) at Bambino Gesù Children's Hospital is cited. Laboratory methods are explained along with the statistical analysis employed. Results are discussed highlighting evidence that EOD children have more severe metabolic decompensation.

The aim was to estimate the prevalence of the serological markers of pancreatic autoimmunity in a cohort of Italian patients with type 1 diabetes mellitus occurring after 20 years of age in order to determine the prevalence of autoimmune diabetes and the most sensitive autoantibody combination to be employed for the diagnosis. We investigated 57 patients (31 males and 26 females) at clinical diagnosis of type 1 diabetes. 35 patients were 21–40 years and 22 were 41–72 years of age. Autoantibodies to islet-cells (ICA) were detected by indirect immunofluorescence, while those against glutamic acid decarboxylase (GADA), tyrosine-phosphatase (IA2A) and insulin (IAA) were detected by radiobinding assays. A positive test for at least one of the pancreatic autoantibodies was found in 45 of the 57 patients (78.9%). Coupling two antibody tests, GADA and/or IAA were found in 73.7%, ICA and/or GADA in 71.9%, while GADA and/or IA2A were found in 70.2% of the patients. The most frequently positive test was for GADA (66.7%). In general, the frequency of diabetes-related antibodies was higher in the 21–40-year-old group compared to the 41–72-year-old group and in females than males. Based on the detection of pancreatic autoantibodies determination, the great majority of the adult patients with recent onset type 1 diabetes were found to be autoimmune in nature. The best cost/benefit combination is provided by coupling the detection of GADA and ICA. [ABSTRACT FROM AUTHOR]

The optimal treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is still undefined. In the absence of randomised studies, we retrospectively analysed: (a) the effectiveness of two chemotherapy regimens (CHOP vs MACOP-B/VACOP-B) in complete remission (CR) achievement and event-free survival (EFS) and (b) the role of mediastinal involved-field radiotherapy (IF-RT) as consolidation. From 1982 to 1999, 138 consecutive patients affected by PMLBCL were treated in 13 Italian institutions with CHOP (43) or MACOP-B/VACOP-B (95). The two groups of patients were similar as regard to age, gender, presence of bulky mediastinal mass, pleural effusion, stage and international prognostic indexes category of risk. Overall, 75.5% of patients in CR received IF-RT as consolidation. Complete remission was 51.1% in the CHOP group and 80% in MACOP-B/VACOP-B (P<0.001). Relapse occurred in 22.7% of CHOP- and in 9.2% of MACOP-B/VACOP-B-treated patients (n.s.). Event-free patients were 39.5% in CHOP and 75.7% in the MACOP-B/VACOP-B group (P<0.001). The addition of IF-RT as consolidation improved the outcome, irrespectively of the type of chemotherapy (P=0.04). At a multivariate analysis, achievement of CR (P<0.0001) and type of CT (MACOP-B/VACOP-B) retained the significance for OS (P=0.008) and EFS (P=0.03). In our experience, MACOP-B/VACOP-B appears to positively influence OS and EFS in patients affected by PMLBCL, as compared to CHOP. Consolidation IF-RT on mediastinum further improves the outcome of CR patients.British Journal of Cancer (2004) 90, 372-376. doi:10.1038/sj.bjc.6601460 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Introduction: Les facteurs environnementaux impliqués dans la pathogénèse du diabète de type 1 (DT1) demeurent énigmatiques. Le Mycobacterium avium paratuberculosis (MAP) est transmis du bétail laitier à l’homme par contamination des aliments. Le MAP provoque une infection asymptomatique qui est très prévalente chez les patients DT1 par rapport aux sujets DT2 et sains de Sardaigne, une région qui affiche une incidence de DT1 parmi les plus hautes au monde. De plus, le MAP induit une réponse anticorpale contre plusieurs protéines mycobactériennes. Patients et méthodes: Une de ces protéines, nommée MAP3865c, montre une homologie de séquence avec la protéine β-cellulaire transporteur de zinc 8 (ZnT8). Nous avons donc recherché si les anticorps (Acs) dirigés contre MAP3865c pouvaient reconnaitre de façon croisée les épitopes peptidiques ZnT8 correspondants. À cette fin, les Acs anti-MAP386c ont été mesurés chez des sujets sardes DT1, DT2 et sains à l’aide d’un test Elisa. Résultats: Les Acs anti-MAP3865c reconnaissent deux épitopes immuno-dominants dans 52–65 % des patients DT1, mais seulement dans 5–7 % des DT2 et 3–5 % des sains. Il y a une corrélation linéaire entre les titres des Acs anti-MAP3865c et les titres des anti-ZnT8 qui ciblent les deux épitopes homologues. L’adsorption des sérums par les épitopes ZnT8 inhibe la liaison aux épitopes MAP3865c correspondants. Conclusion: Les Acs reconnaissant des épitopes MAP3865c présentent une réactivité croisée avec ZnT8. Cette réactivité croisée pourrait déclencher un mécanisme de mimétisme moléculaire accélérant le DT1 chez des individus infectés par le MAP [Copyright &y& Elsevier]