Background: Seronegative coeliac disease is poorly defined. Aims:To study clinical phenotypes and long-term outcomes of seronegative coeliac disease in a multicentre cohort over 20 years.Methods: Seronegative coeliac disease was diagnosed in HLA-DQ2/DQ8-positive patients with villous atrophy (VA), negative IgA endomysial (EmA), tissue transglutaminase (tTG) and deamidated-gliadin antibodies (DGP), clinical and histological response to a gluten-free diet (GFD), and no alternative causes for VA. In patients with IgA deficiency, coeliac disease was diagnosed through VA, positive IgG EmA/tTG/ DGP and clinical/histological response to a GFD (coeliac disease+IgAd). Patients with seropositive coeliac disease served as controls.Results: Of 227 patients previously diagnosed with seronegative coeliac disease, true seronegative coeliac disease was confirmed in 84, coeliac disease+IgAd in 48, and excluded in 55. Lack of follow-up duodenal biopsy precluded diagnosing seronegative coeliac disease in 40 patients. 2084 patients with seropositive coeliac disease served as controls. True seronegative coeliac disease had more severe symptoms at diagnosis and a higher risk of complications (HR 10.87,, P < 0.001) and mortality (HR 2.18, 95% CI 1.12-4.26, P < 0.01) than seropositive coeliac disease.There were no differences between true seronegative coeliac disease and coeliac disease+IgAd. On multivariate analysis, age at diagnosis, lack of clinical response to a GFD, true seronegative coeliac disease, coeliac disease+IgAd, and classical presentation predicted complications. Age at diagnosis, complications and absence of clinical response to a GFD predicted mortality. Conclusions:Seronegative coeliac disease has a more aggressive disease phenotype than seropositive coeliac disease. These data argue against over-reliance on serology for the diagnosis of coeliac disease and support a strict clinical and histologic followup in seronegative coeliac disease.
Profound sea ice loss is rapidly transforming coupled social-ecological Arctic marine systems. However, explicit impacts to harvesting of traditional resources for coastal Indigenous communities remain largely unquantified, particularly where the primary research questions are posed by the Indigenous community as a result of emerging approaches such as knowledge co-production. Here, we directly link reduced sea ice coverage to decreasing harvesting opportunities for ugruk (bearded seal, Erignathus barbatus) as a component of a partnership among a multidisciplinary team of scientists, Indigenous Elder Advisory Council, and sovereign Indigenous tribe in northwest Alaska, USA. We collaboratively established research questions, coordinated data collection, and interpreted results to understand the causes and consequences of changing ugruk harvests for the community of Qikiqtaġruk (Kotzebue). The duration of spring ugruk hunts by the Qikiqtaġruŋmiut declined significantly during 2003–2019 due to a shift (∼3 weeks earlier) in the timing of regional sea ice breakup. Harvests now cease ∼26 d earlier than in the past decade. Using historical sea ice records, we further demonstrate that ice coverage in May now resembles conditions that were common in July during the mid-20th century. Overall, we show that climate change is constraining hunting opportunities for this traditional marine resource, although Qikiqtaġruŋmiut hunters have so far been able to offset a shortened season with changes in effort. Notwithstanding recent hunting success in unprecedentedly sparse ice conditions, accessibility to traditional resources remains a prominent concern for many Arctic communities. Management and policy decisions related to Arctic marine mammal resources, such as ugruk, are therefore also interwoven with food security, well-being, and culture of Indigenous communities. Hence, research that originates with Indigenous sovereignty over the entire research process, such as demonstrated here, has the potential to also lead to more inclusive, sustainable, and equitable outcomes in the face of rapid and accelerating Arctic change.
The first year of life is typically the most critical to a pinniped’s survival, especially for Arctic phocids which are weaned at only a few weeks of age and left to locate and capture prey on their own. Their seasonal movements and habitat selection are therefore important factors in their survival. During a cooperative effort between scientists and subsistence hunters in October 2004, 2005, and 2006, 13 female and 13 male young (i.e., age <2) bearded seals (Erignathus barbatus) were tagged with satellite-linked dive recorders (SDRs) in Kotzebue Sound, Alaska. Shortly after being released, most seals moved south with the advancing sea-ice through the Bering Strait and into the Bering Sea where they spent the winter and early spring. The SDRs of 17 (8 female and 9 male) seals provided frequent high-quality positions in the Bering Sea; their data were used in our analysis. To investigate habitat selection, we simulated 20 tracks per seal by randomly selecting from the pooled distributions of the absolute bearings and swim speeds of the tagged seals. For each point in the observed and simulated tracks, we obtained the depth, sea-ice concentration, and the distances to sea-ice, open water, the shelf break and coastline. Using logistic regression with a stepwise model selection procedure, we compared the simulated tracks to those of the tagged seals and obtained a model for describing habitat selection. The regression coefficients indicated that the bearded seals in our study selected locations near the ice edge. In contrast, aerial surveys of the bearded seal population, predominantly composed of adults, indicated higher abundances in areas farther north and in heavier pack ice. We hypothesize that this discrepancy is the result of behavioral differences related to age. Ice concentration was also shown to be a statistically significant variable in our model. All else being equal, areas of higher ice concentration are selected for up to about 80%. The effects of sex and bathymetry were not statistically significant. The close association of young bearded seals to the ice edge in the Bering Sea is important given the likely effects of climate warming on the extent of sea-ice and subsequent changes in ice edge habitat.
Proteinuria is associated with DSA detection and is likely to be an important factor that determines rapid GFR decline and earlier graft failure in patients developing de novo HLA antibodies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.