Background:Dysregulated inflammation is central to COVID-19 pathogenesis. Mast cells (MCs) and their protease tryptase are implicated in tissue injury and vascular dysfunction, but the prognostic value of circulating tryptase in COVID-19 remains uncertain. Methods:We conducted a prospective cohort study including 82 patients with laboratory-confirmed COVID-19 admitted between January and March 2021. On admission, serum tryptase, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and lymphocyte counts were measured. The objective of this study was to assess whether serum tryptase levels measured upon hospital admission are associated with COVID-19 severity and in-hospital mortality. Statistical analyses comprised t-tests, Mann-Whitney U tests, χ2 tests, receiver operating characteristic (ROC) curve analysis, and logistic regression. Results:Serum tryptase levels at admission did not differ significantly between patients requiring oxygen and those who did not (mean 5.45 vs. 4.97 μg/L; p = 0.2906) or between survivors and non-survivors (mean 5.24 vs. 5.60 μg/L; p = 0.6486). ROC analysis confirmed limited prognostic performance for tryptase regarding oxygen requirement (AUC = 0.580; p = 0.2972) and mortality (AUC = 0.538; p = 0.6103). By contrast, CRP, PCT, and LDH correlated strongly with disease severity. Elevated PCT (p = 0.0016) and LDH (p = 0.0360) were significantly associated with mortality. Logistic regression showed no independent association between tryptase and adverse outcomes. Conclusion:In this prospective cohort, serum tryptase measured at admission was not associated with COVID-19 severity or mortality, suggesting limited utility as a prognostic biomarker. Established markers, particularly PCT and LDH, outperformed tryptase in predicting adverse clinical outcomes. The negative findings are clinically relevant as they demonstrate that tryptase does not contribute to prognostic risk stratification in COVID-19, and its measurement does not provide added value beyond standard inflammatory biomarkers.

INTRODUCTION:Catheterisation of the right adrenal vein during adrenal venous sampling (AVS) is technically challenging and may fail. PURPOSE:We hypothesised that, in selected patients with primary aldosteronism who have a right adrenal gland adenoma on imaging, left-sided suppression on AVS could be sufficient to qualify the patient for successful surgical treatment. METHODS:We identified 77 patients referred to the Hypertension Inpatients Clinic at the Medical University of Gdańsk between 2015 and 2023 with suspected primary aldosteronism, subsequently confirmed by an intravenous saline suppression test. All patients underwent AVS, and management (surgical or pharmacological) was guided by the results. The effectiveness of surgical treatment was assessed by improvements in blood pressure control and reductions in serum aldosterone concentration. RESULTS:Of the 77 patients with confirmed primary aldosteronism, 13 (mean age 59.5 ± 10.1 years; 2 women) had a focal lesion in the right adrenal gland. In this subgroup, catheterisation of the right adrenal vein was unsuccessful in 4 patients (mean age 64.8 ± 6.5 years; 1 woman) due to anatomical factors; therefore, only the contralateral suppression index was calculated (mean 0.31). In view of their clinical histories and the right adrenal lesion on CT, all 4 patients were referred for adrenalectomy, and histology confirmed an aldosterone-producing adenoma. Following surgery, a significant decrease in serum aldosterone concentration (mean reduction 36.5 ± 18 ng/dL) and improved blood pressure control were observed. CONCLUSION:In selected patients with primary aldosteronism - those with a typical right adrenal adenoma on CT and left-sided suppression on AVS- the suppression index may be considered a sufficient criterion for proceeding to adrenalectomy.

Background: This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates. Methods: A retrospective single-center study was conducted using electronic health records from 640 COVID-19 patients hospitalized at the University Clinical Centre in Gdansk, Poland, between November 2020 and May 2021. Patients were categorized based on disease severity into stable or ICU wards based on the disease severity. Data on demographics, comorbidities, complications, and treatments were collected and verified. Statistical analyses, including odds ratios (ORs) and confidence intervals (CIs), assessed mortality risk factors supported by python-based processing. Results: The mean patient age was 67 years (SD ± 15.89), comprising 39% females (n = 250) and 60.94% males (n = 390). Mortality risk was highest in patients aged 65 years and older (OR 3.00; 95% CI, 1.97–4.60). Among the pre-existing comorbidities, chronic kidney disease (OR 3.28; 95% CI, 2.12–5.09), atrial fibrillation (OR 2.43; CI 95%, 1.63–3.61), and heart failure (OR 2.89; 95% CI, 1.91–4.37) were significant predictors of mortality. In hospital complications, such as severe respiratory failure requiring ICU ventilation (OR 23.59; 95% CI, 2.81–197.87), myocardial infarction (OR 25.43; 95% CI, 3.16–204.97), acute kidney injury requiring renal replacement therapy (OR 19.15; 95% CI, 6.49–56.51), sepsis (OR 7.22, 95% CI, 3.77–13.84), stroke, further increased mortality risk. Conclusions: COVID-19 patients with pre-existing renal and cardiovascular conditions face a higher risk of fatal outcomes. Early diagnosis and intervention targeting these complications are vital to in reducing mortality. Further research is needed to reconcile disparities with existing literature.

Background: This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates. Methods: A retrospective single-center study was conducted using electronic health records from 640 COVID-19 patients hospitalized at the University Clinical Centre in Gdansk, Poland, between November 2020 and May 2021. Patients were categorized based on disease severity into stable or ICU wards based on the disease severity. Data on demographics, comorbidities, complications, and treatments were collected and verified. Statistical analyses, including odds ratios (ORs) and confidence intervals (CIs), assessed mortality risk factors supported by python-based processing. Results: The mean patient age was 67 years (SD +/- 15.89), comprising 39% females (n = 250) and 60.94% males (n = 390). Mortality risk was highest in patients aged 65 years and older (OR 3.00; 95% CI, 1.97-4.60). Among the pre-existing comorbidities, chronic kidney disease (OR 3.28; 95% CI, 2.12-5.09), atrial fibrillation (OR 2.43; CI 95%, 1.63-3.61), and heart failure (OR 2.89; 95% CI, 1.91-4.37) were significantpredictors of mortality. In hospital complications, such as severe respiratory failure requiring ICU ventilation (OR 23.59; 95% CI, 2.81-197.87), myocardial infarction (OR 25.43; 95% CI, 3.16-204.97), acute kidney injury requiring renal replacement therapy (OR 19.15; 95% CI, 6.49-56.51), sepsis (OR 7.22, 95% CI, 3.77-13.84), stroke, further increased mortality risk. Conclusions: COVID-19 patients with pre-existing renal and cardiovascular conditions face a higher risk of fatal outcomes. Early diagnosis and intervention targeting these complications are vital to in reducing mortality. Further research is needed to reconcile disparities with existing literature.

BACKGROUND:Arterial hypertension (AH) is the most important modifiable risk factor for cardiovascular diseases in Poland and around the world. Unfortunately, despite its potentially catastrophic consequences, more than 30% of hypertensive patients in Poland remain undiagnosed. Therefore, emergency department (ED) triage may play a role in screening of a significant proportion of the population. The present study aimed to assess the prevalence of hypertension in patients reporting to the ED by verifying ad hoc measurements with ambulatory blood pressure monitoring (ABPM). METHODS:The study included 78,274 patients admitted to the ED of the University Clinical Center in Gdansk from 01.01.2019 to 31.12.2020, with elevated blood pressure values (systolic blood pressure [SBP] > 140 mmHg and/or diastolic blood pressure [DBP] > 90 mmHg) during triage according to the inclusion and exclusion criteria. RESULTS:Out of 34,597 patients with SBP > 140 mmHg and/or DBP > 90 mmHg, 27,896 patients (80.6% of patients) had previously been diagnosed with AH. Finally, a group of 6701 patients with elevated values of arterial blood pressure in triage, who had not yet been diagnosed with AH, was identified. This accounted for 8.6% of patients admitted to the ED. Ultimately, 58 patients (26 women and 36 men) agreed to undergo ABPM. Based on the analysis, AH 32 patients were diagnosed with AH (55.2%). CONCLUSIONS:The ED plays an essential role in diagnosing hypertension among people reporting to the ED for various reasons. There is a high probability of a diagnosis of AH in a group of patients who have elevated blood pressure values during triage and have not yet been diagnosed with hypertension.

BACKGROUND: Cardiovascular risk factors distribution during the pandemic suggests worsening of the cardiovascular risk profile of hypertensive patients. At the same time, data on quality of hypertension control during the COVID-19 pandemic are scarce, in Poland. The aim of the study was to analyse the quality of blood pressure (BP) control in a group of patients who required regular control in tertiary care. MATERIAL AND METHODS: The study included patients regularly monitored in Gdańsk Hypertension Centre for at least 4 years with at least 2 visits a year prior the analysis. The size of the group was calculated based on the original data of first 50 consecutive records of patients (power of 90%). Records were retrospectively analysed with respect to office blood pressure (oBP) control. Additionally, within-visit BP variability was calculated (difference of maximum and minimum BP from 3 measurements); body weight, age, sex, duration of hypertension, number of visits per year, seasonal BP variability, use of telemedical services, comorbidities and BP-lowering treatment were recorded. RESULTS: The study enrolled 220 patients. The values of systolic BP (sBP) before and after the break in the whole group were 135.8 ± 17.1 mm Hg vs. 137.9 ±19.5 mm Hg; P=0.08, and a diastolic BP (dBP) of 80.3 ±11.4 mm Hg vs. 82.6 ±12.2 mm Hg; p = 0.001. After adjusting for seasonal variation of BP, the respective differences were: sBP: 134.8 ± 16.5 vs. 138.0 ± 19.4; p = 0.03, and dBP: 79.4 ±10.9 vs. 82.2 ± 11.9; p = 0.004. Before 2020, 61.4% of patients were controlled (BP < 140/90 mm Hg), whereas after the pandemic-driven break in regular visits the control rate decreased to 55.5% (p = 0.21). CONCLUSIONS: BP increased significantly and the rate of BP control decreased during the COVID-19 pandemic in a group of patients requiring tertiary care for hypertension.

Background:Inaccurate blood pressure (BP) classification results in inappropriate treatment. We tested whether machine learning (ML), using routine clinical data, can serve as a reliable alternative to ambulatory BP monitoring (ABPM) in classifying BP status. Methods:This study employed a multicentre approach involving 3 derivation cohorts from Glasgow, Gdańsk, and Birmingham, and a fourth independent evaluation cohort. ML models were trained using office BP, ABPM, and clinical, laboratory, and demographic data, collected from patients referred for hypertension assessment. Seven ML algorithms were trained to classify patients into 5 groups, named as follows: Normal/Target; Hypertension-Masked; Normal/Target-White-Coat (WC); Hypertension-WC; and Hypertension. The 10-year cardiovascular outcomes and 27-year all-cause mortality risks were calculated for the ML-derived groups using the Cox proportional hazards model. Results:Overall, extreme gradient boosting (using XGBoost open source software) showed the highest area under the receiver operating characteristic curve of 0.85-0.88 across derivation cohorts, Glasgow (n = 923; 43% female; age 50.7 ± 16.3 years), Gdańsk (n = 709; 46% female; age 54.4 ± 13 years), and Birmingham (n = 1222; 56% female; age 55.7 ± 14 years). But accuracy (0.57-0.72) and F1 (harmonic mean of precision and recall) scores (0.57-0.69) were low across the 3 patient cohorts. The evaluation cohort (n = 6213; 51% female; age 51.2 ± 10.8 years) indicated elevated 10-year risks of composite cardiovascular events in the Normal/Target-WC and the Hypertension-WC groups, with heightened 27-year all-cause mortality observed in all groups, except the Hypertension-Masked group, compared to the Normal/Target group. Conclusions:ML has limited potential in accurate BP classification when ABPM is unavailable. Larger studies including diverse patient groups and different resource settings are warranted.

Purpose Primary aldosteronism is one of the most frequent causes of secondary arterial hypertension, and whether primary aldosteronism is associated with masked hypertension is unknown. Materials and methods We describe a 64-year-old man with a history of hypothyroidism, recurring hypokalaemia, and normal home and office blood pressure values. Ambulatory blood pressure monitoring revealed masked hypertension with strikingly high systolic blood pressure variability and typical hypertension-mediated organ damage. Results The patient required gradual escalation of antihypertensive medication to four drugs. During the diagnostic process we identified primary aldosteronism, cobalamin deficiency, severe obstructive sleep apnoea, and low baroreflex sensitivity (1.63 ms/mmHg). Following unilateral adrenalectomy, cobalamin supplementation and continuous positive airway pressure, we observed a spectacular improvement in the patient's blood pressure control, baroreflex sensitivity (4.82 ms/mmHg) and quality of life. Conclusions We report an unusual case of both masked arterial hypertension and primary aldosteronism. Elevated blood pressure values were masked in home and office measurements by coexisting hypotension which resulted most probably from deteriorated baroreflex sensitivity. Baroreflex sensitivity increased following treatment, including unilateral adrenalectomy. Hypertension can be masked by coexisting baroreceptor dysfunction which may derive from structural but also functional reversible changes.

Background: Hypertension is a global public health problem. Inaccurate blood pressure (BP) measurements result in unnecessary or insufficient treatment, which increases the risk of adverse drug effects and the cost of healthcare. Ambulatory BP monitoring (ABPM) is the gold standard for assessing hypertension, but costs and patient tolerability limit its use. Using routine clinical data, we aimed to demonstrate the clinical utility of ML-based classification of patients into BP risk groups that are as informative as classifying with an ABPM.Methods: Using office BP and ABPM as well as laboratory, clinical, and demographic data, seven machine learning (ML) algorithms were trained to classify patients referred for hypertension assessment from three cohorts into five groups: Normal/Target, Hypertension-Masked, Normal/Target-White-Coat, Hypertension-White-Coat, and Hypertension. In a fourth independent evaluation cohort, the Cox proportional hazards model was used to calculate the 10-year cardiovascular outcomes and 27-year all-cause mortality risk for the ML-inferred groups.Results: The three derivation cohorts were Glasgow (n=923; 43% females; age 50·7±16·3 years), Gdańsk (n=709; 46% females; age 54·4±13 years), and Birmingham (n=1,222; 56% females; age 55·7±14 years). The model that performed the best was XGBoost (AUROC 0.85-0.88). In the evaluation cohort (n=6213, 51% females; age 51·2±10·8 years), as compared to the referent Normal/Target group, Normal/Target-White-Coat and Hypertension-White-Coat groups had a higher 10-year risk of composite cardiovascular events and all the BP groups except Hypertension-Masked were associated with higher 27-year all-cause mortality.Conclusions: We demonstrate that ML inference of ABPM status from routine clinical data identifies high-risk patient groups for mortality and cardiovascular outcomes. This will improve clinical practice and decrease the burden of hypertension by targeting the use of ABPM where it will be most beneficial, minimizing the burden on patients, and lowering healthcare costs. This will be of particular value in settings with limited resources.

Abstract Objective: The risk of premature deaths in patients with epilepsy (approx. 50 mln. patients worldwide) is about 2–3 times higher as compared to general population. This phenomenon is mainly explained by cardiovascular causes as well as sudden unexpected deaths in epilepsy (SUDEP). Epilepsy is associated with sympathetic overdrive and renin-angiotensin-system abnormalities all of which may be implicated in organ damage (both directly and indirectly via high blood pressure; BP). In our study, we aimed at the evaluation of several cardiovascular risk factors and organ damage in patients with epilepsy; its’ relation to disease control and comorbid hypertension. Design and method: A total of 48 patients and matched controls were included in the study. Anthropometry, biochemical assessment, office and ambulatory blood pressure, structural and/ or functional vascular changes were recorded. One-way ANOVA and ANCOVA were employed (mean ± SE). Results: Patients were comparable in terms of age and BMI. Hypertensives were aware of high BP in 50% of cases. Study subgroups were comparable in terms of heart rate, serum uric acid, triglicerides, HDL, glucose, serum creatinine and eGFR, serum potassium (P = NS for all comparisons). Total cholesterol was the lowest in well-controlled epileptic patients which was followed by refractory disease and epilepsy with comorbid hypertension (167.6 ± 6.7 vs. 196.9 ± 7.4 vs. 223.5 ± 8.9; respectively). Patients with refractory epilepsy had comparable serum LDL and PWV to hypertensive well-controlled epileptics; both contrasted with values recorded in patients with well-controlled epilepsy who were free of hypertension (LDL: 121.7 ± 6.8 vs. 140.9 ± 8.2 vs. 99.2 ± 6.1; respectively, and PWV: 6.4 ± 0.24 vs. 6.8 ± 0.30 vs. 5.5 ± 0.22; respectively). Reported differences were valid after adjustment for age and BMI. Conclusions: Except for BP values, patients with refractory epilepsy who are free of hypertension have similar CV risk profile to patients with high BP. These findings along with underdiagnosed hypertension may explain higher CV mortality and morbidity documented in epilepsy.

Epilepsy affects about 50 million people worldwide. Sudden unexpected death in epilepsy (SUDEP) is the main cause of death in epilepsy accounting for up to 17% of all deaths in epileptic patients, and therefore remains a major public health problem. SUDEP likely arises from a combination and interaction of multiple risk factors (such as being male, drug resistance, frequent generalized tonic-clonic seizures) making risk prediction and mitigation challenging. While there is a general understanding of the physiopathology of SUDEP, mechanistic hypotheses linking risk factors with a risk of SUDEP are still lacking. Identifying cross-talk between biological systems implicated in SUDEP may facilitate the development of improved models for SUDEP risk assessment, treatment and clinical management. In this review, the aim was to explore an overlap between the pathophysiology of hypertension, cardiovascular disease and epilepsy, and discuss its implication for SUDEP. Presented herein, evidence in literature in support of a cross-talk between the renin-angiotensin system (RAS) and sympathetic nervous system, both known to be involved in the development of hypertension and cardiovascular disease, and as one of the underlying mechanisms of SUDEP. This article also provides a brief description of local RAS in brain neuroinflammation and the role of centrally acting RAS inhibitors in epileptic seizure alleviation.

Here, we present a case that required a supplemental “old school” islet purification for a safe intraportal infusion. Following pancreas procurement from a brain-dead 26-year-old male donor (body mass index: 21.9), 24.6 ml of islet tissue was isolated after continuous density gradient centrifugation. The islet yield was 504,000 islet equivalent (IEQ), distributed among the following three fractions: 64,161 IEQ in 0.6 ml of pellet, 182,058 IEQ in 10 ml, and 258,010 IEQ in 14 ml with 95%, 20%, and 10% purity, respectively. After a 23-h culture, we applied supplemental islet purification, based on the separation of tissue subfractions during unit gravity sedimentation, a technique developed over 60 years ago (“old school”). This method enabled the reduction of the total pellet volume to 11.6 ml, while retaining 374,940 IEQ with a viability of over 90%. The final islet product was prepared in three infusion bags, containing 130,926 IEQ in 2.6 ml of pellet, 108,079 IEQ in 4 ml of pellet, and 135,935 IEQ in 5 ml of pellet with 65%, 40%, and 30% purity, respectively, and with the addition of unfractionated heparin (70 units/kg body weight). Upon the islet infusion from all three bags, portal pressure increased from 7 to 16 mmHg. Antithrombotic prophylaxis with heparin was continued for 48 h after the infusion, with target activated partial thromboplastin time 50–60 s, followed by fractionated heparin subcutaneous injections for 2 weeks. β-Cell graft function assessed on day 75 post-transplantation was good, according to Igls criteria, with complete elimination of severe hypoglycemic episodes and 50% reduction in insulin requirements. Time spent within the target glucose range (70–180 mg/dl) improved from 42% to 98% and HbA1c declined from 8.7% to 6.7%. Supplemental “old school” islet purification allowed for the safe and successful utilization of a robust and high-quality islet preparation, which otherwise would have been discarded.

Przeszczepienie komorek beta jest obecnie jedyną metodą leczenia pozwalającą na przywrocenie fizjologicznego wydzielania endogennej insuliny w ilościach dostosowanych do aktualnych potrzeb organizmu. Dostepne formy przeszczepiania komorek beta obejmują przeszczepienie calej trzustki lub przeszczepienie izolowanych wysp trzustkowych. Zabiegi te oferowane są wyselekcjonowanym chorym na cukrzyce typu 1 o chwiejnym przebiegu. Przeszczepienie komorek beta moze byc proponowane zarowno pacjentom z dobrą funkcją nerek, jak i chorym z niewydolnością nerek. W przypadku postepującej niewydolności nerek przeszczepienie komorek beta moze byc wykonane jednocześnie z transplantacją nerki lub po niej. Mozliwa jest rowniez autotransplantacja wysp trzustkowych u chorych poddawanych calkowitej resekcji trzustki. U chorych na cukrzyce typu 1 o chwiejnym przebiegu, ktorzy doświadczają zagrazających zyciu epizodow ciezkiej hipoglikemii pomimo zoptymalizowanego leczenia insuliną, przeszczepienie komorek beta pomaga poprawic świadomośc hipoglikemii, tym samym redukując ryzyko wystąpienia epizodow ciezkiej hipoglikemii, ulatwia zapewnienie prawidlowej kontroli glikemii z normalizacją wartości odsetka hemoglobiny glikowanej (HbA1c) oraz spowalnia progresje powiklan mikronaczyniowych. W przypadku calkowitej resekcji trzustki podanie choremu wysp wyizolowanych z usunietej trzustki zapobiega chwiejnemu przebiegowi cukrzycy lub calkowicie chroni przed jej wystąpieniem. W niniejszej pracy omowiono aktualne wskazania i przeciwwskazania do przeszczepienia komorek beta, takze związane z nim spodziewane korzyści oraz mozliwe powiklania.

Abstract Background and Aims Hypertension (AH) is an early complication of autosomal dominant polycystic kidney disease (ADPKD), which significantly increases the risk of decline of kidney function and impacts cardiovascular risk. The diagnosis of AH is often delayed and the optimal control of blood pressure (BP) is difficult to achieve in this group of patients. Of note, the optimal treatment of AH in ADPKD is yet to be established. Aim of the study was to diagnose AH (including the prevalence of masked hypertension) and to evaluate the control of BP with the use of ABPM in a cohort of ADPKD patients. Method ABPMs were performed in 163 consecutive patients, with ADPKD according to Pei criteria, appointed for the first outpatient visit. Prior to the ABPM, the diagnosis based on office BP or current AH treatment was established as well as age, sex, medication intake, and eGFR (CKD-EPI formula) were recorded. The study had a cross-sectional design. Results Out of 163 performed ABPMs, 143 were eligible for further analysis. The study group consisted of 93 females and 50 males, median age was 40 (18-87) years and median eGFR was 79.5(13-90) ml/min/1.73m2. 68% of patients had CKD G1 or 2. Median systolic blood pressure (SBP) was 127 (101-157) mmHg with blood pressure variability (BPV) 12 (7.8-23); median diastolic blood pressure (DBP) was 79 (58-98) mmHg, BPV 10.8 (6.2-17.4). 35% of patients were non-dippers, 2.7% extreme dippers and 4.9% reverse-dippers. In 31 (55%), out of 56 patients without previous diagnosis of AH, masked hypertension was found. Among 87 diagnosed with AH before the measurement, 49% were treated with 1 drug, and 29% with 2, 13% with 3, and 2% with 4. The most prevalent medication was ACE-inhibitor. Among treated, only 5.5% had all ABPM values within the target. Conclusion 55% of patients previously not diagnosed with AH on the basis of office BP proved to suffer from masked hypertension. The night DBP was the most suboptimally controlled value in ADPKD patients. Whether this is a consequence of nonadherence or suboptimal treatment, needs further investigation. ABPM is an indispensable tool in managing patients inflicted with ADPKD.

Purpose:We have summarized key studies regarding the assessment of subclinical macroangiopathic target organ damage (TOD) in type 1 diabetes mellitus (T1DM). Results:Although chronic complications resulting from hyperglycemia, in particular macroangiopathies, are still the first cause of death in T1DM, there has been growing recognition of the role of hypoglycemia in cardiovascular morbidity and mortality. Subclinical TOD diagnosis ensures early implementation of the complex management aiming at either partial reversal of these complications or at least its downturn. To better identify patients with early TODs, several non-invasive diagnostic techniques are employed, including the ultrasonographic assessment of the intima-media thickness (IMT), computed tomography (CT) for coronary artery calcium (CAC) scores, and pulse wave velocity (PWV) measurement for arterial stiffness evaluation. Various studies reported that T1DM patients present an increased IMT. An increasing IMT fairly correlates with the cardiovascular (CV) events risk even after the adjustment to age, diabetes duration, quality of glucose control as well as the presence of hypertension, and chronic complications. Another, well established marker of the organ damage - CAC score is recommended by ACC/AHA guidelines to assess the overall CV risk in T1DM. Also, the arterial stiffness evaluation with PWV may further improve CV risk prediction, which has been reported in multiple studies including the Framingham Heart Study. Conclusions:There is shortage of data from prospective studies which could confirm the benefits of early treatment initiation based on the presence of the subclinical organ damage in T1DM. Most evidence comes from T2DM trials, where effective preventive measures were identified i.e.: smoking cessation, reasonable blood glucose control, efficacious hypertension treatment, and dyslipidemia management, as well as renoprotection. There is still a field for further research to see if routine assessment of asymptomatic vascular damage and early implementation of aggressive treatment would reduce mortality excess from CVD in T1DM.

Beta cell replacement therapy is currently the only treatment method that allows restoration of physiological endogenous insulin secretion in the amounts corresponding to the current body requirements. Beta cell replacement options available for highly selected patients with brittle type 1 diabetes include solid- -organ pancreas and islet transplantation. Beta cell replacement therapy may be offered to patients with both good kidney function and renal failure. In progressive renal failure, beta cell transplantation may be performed simultaneously with kidney transplantation or afterwards. Islet autotransplantation is offered to patients submitted to total pancreatectomy. In patients with brittle type 1 diabetes who continue to experience life threatening severe hypoglycaemia episodes despite optimized insulin therapy, beta cell replacement helps improve hypoglycaemia awareness, thus reducing the risk of severe hypoglycaemia episodes, facilitates blood glucose control with normalization of haemoglobin A1c (HbA1c) level, and reduces microvascular disease progression. In patients undergoing total pancreatectomy, infusion of the patient’s own islets isolated from the removed pancreas prevents blood glucose level excursions and reduces the risk of surgically- -induced diabetes. In this article, we review the current indications and contraindications to beta cell replacement, expected benefits, and possible complications of beta cell transplantation.

Beta cell replacement allows for adequate blood glucose control, reduced progression or even reversal of microvascular complications, and improves the quality of life. Simultaneous pancreas and kidney transplantation is the best therapeutic option for patients with type 1 diabetes and end-stage renal disease resulting from diabetic nephropathy. However, when pancreas transplantation is contraindicated or unavailable, pancreatic islet transplantation is an alternative minimally invasive procedure. We report a patient after earlier simultaneous kidney and pancreas transplantation with a failed pancreas graft, and no option for pancreas retransplantation. In this patient pancreatic islet transplantation was performed. The latter resulted in an improved blood glucose control, restoration of hypoglycaemia awareness, and improved quality of life with stable good function of the kidney allograft.

Arterial stiffening is a hallmark of early vascular aging (EVA) syndrome and an independent predictor of cardiovascular morbidity and mortality. In this case-control study we sought to identify plasma metabolites associated with EVA syndrome in the setting of hypertension. An untargeted metabolomic approach was used to identify plasma metabolites in an age-, BMI-, and sex-matched groups of EVA (n = 79) and non-EVA (n = 73) individuals with hypertension. After raw data processing and filtration, 497 putative compounds were characterized, out of which 4 were identified as lysophosphaditylcholines (LPCs) [LPC (18:2), LPC (16:0), LPC (18:0), and LPC (18:1)]. A main finding of this study shows that identified LPCs were independently associated with EVA status. Although LPCs have been shown previously to be positively associated with inflammation and atherosclerosis, we observed that hypertensive individuals characterized by 4 down-regulated LPCs had 3.8 times higher risk of EVA compared to those with higher LPC levels (OR = 3.8, 95% CI 1.7-8.5, P < 0.001). Our results provide new insights into a metabolomic phenotype of vascular aging and warrants further investigation of negative association of LPCs with EVA status. This study suggests that LPCs are potential candidates to be considered for further evaluation and validation as predictors of EVA in patients with hypertension.