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Yuan Y, Yu Z, Tong F, Zhao S, Li Y, Shi Q, Zhou Y. A retrospective study of 29 fatal cases of insulin overdose. Forensic Sci Int 2024; 361:112126. [PMID: 38954875 DOI: 10.1016/j.forsciint.2024.112126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To summarize recent cases of fatal insulin poisoning both domestically and internationally, thereby offering valuable insights for the forensic identification of insulin overdose cases. METHODS Literature published since 2000 on fatal insulin overdose were systematically searched and screened. Data encompassing variables such as year, age, sex, cause of death, scene conditions, occupations, medical histories of victims and perpetrators, autopsy timing, dosage and administration methods, forensic pathology, and toxicological analysis, were compiled for rigorous statistical analysis. RESULTS Among the 29 fatal cases of insulin poisoning, suicides and homicides accounted for 55.2 % and 41.4 %, respectively. Precisely 34.5 % of victims or perpetrators were associated with the medical industry, 27.6 % had diabetes, and 24.1 % had mental illnesses such as depression. Intravenous injection resulted in quicker death than did subcutaneous injection. In some cases, immunohistochemical staining of insulin and protamine at injection sites yielded positive results. The average molar ratio of insulin to C-peptide in post-mortem blood was 13.76 ± 5.167, indicating a significant diagnostic value for insulin poisoning. CONCLUSION Assessment of cases of fatal insulin overdose should be thorough, incorporating case investigation, scene examination, medical records review, autopsy findings, pathological examinations, and laboratory tests, alongside considering the condition of the body and timing of death autopsy. Using mass spectrometry to detect insulin proves valuable, particularly in cases of poor body preservation.
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Affiliation(s)
- Yuhao Yuan
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Zhonghao Yu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Fang Tong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Yiling Li
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Qing Shi
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China.
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Dos Santos M, Yahya A, Kluding P, Pasnoor M, Wick J, Liu W. The effect of type 2 diabetes and diabetic peripheral neuropathy on predictive grip force control. Exp Brain Res 2023; 241:2605-2616. [PMID: 37730970 DOI: 10.1007/s00221-023-06705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
This study investigated the impact of type 2 diabetes and diabetic peripheral neuropathy on grip force control during object manipulation. The study included three age-matched groups: type 2 diabetes alone (n = 11), type 2 diabetes with neuropathy (n = 13), and healthy controls (n = 12). Grip force control variables derived from lifting and holding an experimental cup were the ratio between grip force and load forces during lifting (GFR), latency 1 and latency 2, which represented the time between the object's grip and its lift-off from the table, and the period between object's lift-off and the grip force peak, respectively; time lag, which denoted the time difference between the grip and load force peaks during the lifting phase, and finally static force, which was the grip force average during the holding phase. Grip force control variables were compared between groups using one-way ANOVA and Kruskal-Wallis test. Post-hoc analysis was used to compare differences between groups. GFR and latency 1 showed significant differences between groups; the type 2 diabetes with neuropathy group showed larger GFR than the type 2 diabetes alone and healthy control groups. The latency 1was longer for the group with neuropathy in comparison with the health control group. There were no significant differences between groups for latency 2, time lag, and static force. Our results showed impaired GFR and latency 1 in participants with type 2 diabetes with neuropathy while the time lag was preserved. People with type 2 diabetes alone might not have any deficits in grip force control. Higher grip forces might expose people with type 2 diabetes and diabetic peripheral neuropathy to the risk of fatigue and injuring their hands. Future studies should investigate strategies to help people with type 2 diabetes with neuropathy adjust grip forces during object manipulation.
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Affiliation(s)
- Marcio Dos Santos
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, Miami, 800 S. Douglas Road, Suite 149, Coral Gables, FL, 33134, USA.
| | - Abdalghani Yahya
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patricia Kluding
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Manetti AC, Visi G, Spina F, De Matteis A, Del Duca F, Turillazzi E, Maiese A. Insulin and Oral Hypoglycemic Drug Overdose in Post-Mortem Investigations: A Literature Review. Biomedicines 2022; 10:2823. [PMID: 36359343 PMCID: PMC9687110 DOI: 10.3390/biomedicines10112823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2023] Open
Abstract
Background and Objectives: Insulin and oral hypoglycemic agents are drugs widely used in the world population due to their therapeutic effects on diabetes mellitus. Despite these benefits, they can also cause accidental or voluntary drug overdose. This review aims to evaluate post-mortem investigations in cases of suspected hypoglycemic drug overdose. Materials and Methods: We performed a comprehensive search using the Preferred Reporting Items for Systematic Review (PRISMA) standards; we systematically searched the PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EM-BASE) databases from the point of database inception until August 2022. The following inclusion criteria were used: (1) original research articles, (2) reviews and mini-reviews, (3) case reports/series, (4) and only papers written in English. Results: Thirty-three scientific papers, including original research articles, case reports, and case series, fulfilled the inclusion criteria. A total of 109 cases of insulin or hypoglycemic drug overdose were found. There were 71 cases of suicide (65%), 25 cases of accidental poisoning (23%), and 13 cases of homicide (12%). The most commonly used drug was insulin (95.4%). Autopsy and post-mortem examinations were performed in 84 cases, while toxicological investigations were performed in 79 cases. The most common gross findings in the autopsy were pulmonary edema (55.7%) and congestion (41.8%), while the most common histological finding was neuronal depletion or necrosis (29.1%). Conclusions: In the suspicion of death from insulin or overdose from oral hypoglycemic agents, autopsy findings may be nonspecific, and the search for injection marks can be positive at the external examination. Significant post-mortal alterations can interest biological samples and an early autopsy investigation is recommended.
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Affiliation(s)
- Alice Chiara Manetti
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Giacomo Visi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Federica Spina
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Emanuela Turillazzi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
| | - Aniello Maiese
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, via Roma 55, 56126 Pisa, Italy
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Kaur V, Kalyani CV, Rohilla KK. Practices followed by type-II diabetes mellitus patients for prevention of foot ulcers. J Family Med Prim Care 2021; 10:3732-3737. [PMID: 34934673 PMCID: PMC8653434 DOI: 10.4103/jfmpc.jfmpc_486_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Type-II diabetes mellitus is a serious lifestyle-related health problem globally and its prevalence is rapidly increasing day by day. The main purpose of this study was to assess practices followed by Type-II diabetes mellitus patients regarding the prevention of foot ulcers. Method: This study was a cross-sectional study using a case series type of research design. Purposively, a total of 100 type-II diabetes mellitus patients were registered with AIIMS Rishikesh for their treatment. Data collection tools were a semi-structured questionnaire that included 20 items. By conducting an interview schedule, data was collected from each participant. Results: Majority of participants belong to age group of 51–60 years and were males. Practice score showed majority of Type-II DM patients were following moderate-level practices, followed by only few (15%) were following good practice for preventing foot ulcers. Conclusion: Health care professionals must empathize on educating type-II diabetes patients regarding preventive measures for foot ulcers. Educate patients regarding the importance of self-foot care practice and promoting them for proper follow-up as well to decrease incidence of diabetic foot ulcers.
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Affiliation(s)
- Vaneet Kaur
- Nursing Officer, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - C Vasantha Kalyani
- Principal, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kusum K Rohilla
- PhD Scholar, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Panigrahi DK, Chaudhury D. Spot Urine Albumin Creatinine Ratio can be a Predictor of Cognitive Function in Type 2 Diabetes Mellitus. Indian J Nephrol 2021; 31:377-382. [PMID: 34584354 PMCID: PMC8443093 DOI: 10.4103/ijn.ijn_286_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction In diabetes mellitus (DM), the underlying pathophysiology of albuminuria and cognitive dysfunction is similar. So, we hypothesized that urinary albumin excretion (UAE) could be linked to cognitive dysfunction in type 2 diabetes mellitus. Methods and Materials It was a hospital-based observational study. Patient aged 40-60 years with type 2 DM were included in this study. Complete assessment with detailed history, physical examination, and necessary biochemical investigations including spot urine albumin creatinine ratio (uACR) was done. Cognitive status was determined in all the individuals with the application of Hindi translated version of the mini-mental status examination (MMSE) questionnaire. Results In 80 patients, the mean MMSE score was 25.37 ± 3.34. Cognitive dysfunction (score <26) was present in 45% of individuals. Spot uACR, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), presence of retinopathy and dyslipidemia were significantly different between the normal and subnormal scoring groups. On multivariate analysis spot uACR was found to be independently predicting odds of developing cognitive dysfunction (OR 1.01, CI 1.004-1.022; P = 0.001). The mean MMSE scores in normo-albuminuric (n = 15), moderately increased albuminuric (n = 48) and severely albuminuric (n = 17) patients were 28.00 ± 1.60, 25.54 ± 3.33 and 22.58 ± 2.31, respectively, which were significantly different among the three groups (P < 0.001). Conclusions Spot uACR could be helpful in predicting cognitive decline in people with type 2 DM.
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Affiliation(s)
- Deepak Kumar Panigrahi
- Department of Medicine, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Debasish Chaudhury
- Department of Medicine, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
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Diabetic Peripheral Neuropathy Affects Pinch Strength and Hand Dexterity in Elderly Patients. Neural Plast 2021; 2021:9959103. [PMID: 34335735 PMCID: PMC8318756 DOI: 10.1155/2021/9959103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, leading to disability and decreased quality of life. In past research and clinical studies, the lower limb function of DPN patients was often the principal subject of research, with little attention given to the upper limb and hand. Our goal was to assess and compare hand function between elderly diabetic patients with DPN and without DPN. Methods A total of 52 diabetic patients were registered and underwent hand function assessments and electrodiagnostic tests. Dynamometer, pinch meter, Semmes Weinstein monofilaments, and the Purdue Pegboard Test (PPT) were used to assess the patients' grip strength, pinch strength, tactile sensory threshold, and hand dexterity. Results Compared with the non-DPN group, the elderly DPN group showed worse thumb-middle fingertip pinch strength and thumb-little fingertip pinch strength in the dominant hand (3.50 (2.50, 4.25) vs. 4.50 (3.00, 5.00), p = 0.019; 1.50 (1.00, 2.00) vs. 2.50 (2.00, 3.00), p < 0.001); the elderly DPN group displayed worse thumb-middle fingertip pinch strength, thumb-ring fingertip pinch strength, and thumb-little fingertip pinch strength in the nondominant hand (3.50 (2.00, 4.50) vs. 4.00 (3.00, 5.00), p = 0.013; 2.50 (1.25, 3.00) vs. 3.00 (2.50, 3.50), p = 0.033; 1.00 (0.75, 2.25) vs. 2.50 (2.00, 2.50), p < 0.001). The elderly DPN group scored lower than the non-DPN group on the PPT test of assembly (13.96 ± 5.18 vs. 16.96 ± 4.61, t = 2.212, p = 0.032). Conclusion Motor function limitation is the principal hand dysfunction in elderly patients with DPN, which is mainly manifested as a decline in fingertip pinch strength and a decrease in hand dexterity. This trial is registered with Clinical Trial Registry no. ChiCTR1900025358.
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Zhang Y, Liu Y, Tang Y, Zhang D, He H, Wu J, Zheng J. Antimicrobial α-defensins as multi-target inhibitors against amyloid formation and microbial infection. Chem Sci 2021; 12:9124-9139. [PMID: 34276942 PMCID: PMC8261786 DOI: 10.1039/d1sc01133b] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/27/2021] [Indexed: 12/22/2022] Open
Abstract
Amyloid aggregation and microbial infection are considered as pathological risk factors for developing amyloid diseases, including Alzheimer's disease (AD), type II diabetes (T2D), Parkinson's disease (PD), and medullary thyroid carcinoma (MTC). Due to the multifactorial nature of amyloid diseases, single-target drugs and treatments have mostly failed to inhibit amyloid aggregation and microbial infection simultaneously, thus leading to marginal benefits for amyloid inhibition and medical treatments. Herein, we proposed and demonstrated a new "anti-amyloid and antimicrobial hypothesis" to discover two host-defense antimicrobial peptides of α-defensins containing β-rich structures (human neutrophil peptide of HNP-1 and rabbit neutrophil peptide of NP-3A), which have demonstrated multi-target, sequence-independent functions to (i) prevent the aggregation and misfolding of different amyloid proteins of amyloid-β (Aβ, associated with AD), human islet amyloid polypeptide (hIAPP, associated with T2D), and human calcitonin (hCT, associated with MTC) at sub-stoichiometric concentrations, (ii) reduce amyloid-induced cell toxicity, and (iii) retain their original antimicrobial activity upon the formation of complexes with amyloid peptides. Further structural analysis showed that the sequence-independent amyloid inhibition function of α-defensins mainly stems from their cross-interactions with amyloid proteins via β-structure interactions. The discovery of antimicrobial peptides containing β-structures to inhibit both microbial infection and amyloid aggregation greatly expands the new therapeutic potential of antimicrobial peptides as multi-target amyloid inhibitors for better understanding pathological causes and treatments of amyloid diseases.
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Affiliation(s)
- Yanxian Zhang
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron Ohio USA
| | - Yonglan Liu
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron Ohio USA
| | - Yijing Tang
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron Ohio USA
| | - Dong Zhang
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron Ohio USA
| | - Huacheng He
- College of Chemistry and Materials Engineering, Wenzhou University Zhejiang China
| | - Jiang Wu
- School of Pharmaceutical Sciences, Wenzhou Medical University Zhejiang China
| | - Jie Zheng
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron Ohio USA
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Lyerly MJ, Chow D. Neuroimaging Considerations in Patients with Chronic Kidney Disease. J Stroke Cerebrovasc Dis 2021; 30:105930. [PMID: 34176719 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic Kidney Disease is a common medical condition that frequently overlaps with neurologic disease. Neuroimaging can be a useful tool to aid in the diagnoses of neurologic illness, including those that result from renal impairment. Some neuroimaging studies also have the potential to lead to adverse effects on the kidneys necessitating a thoughtful approach to selection of imaging modalities. In particular, multimodal imaging is becoming increasingly common in patients presenting with symptoms of acute stroke, a population that may be at higher risk for renal complications. This article will summarize the neuroimaging manifestations of conditions with shared renal and neurologic involvement and highlight considerations regarding the use of contrast media, nephrogenic systemic fibrosis, and metformin-associated lactic acidosis.
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Affiliation(s)
- Michael J Lyerly
- Department of Neurology, University of Alabama at Birmingham USA; Birmingham VA Medical Center USA.
| | - Daniel Chow
- Department of Radiology, University of California-Irvine USA
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RAGE signaling is required for AMPA receptor dysfunction in the hippocampus of hyperglycemic mice. Physiol Behav 2020; 229:113255. [PMID: 33221393 DOI: 10.1016/j.physbeh.2020.113255] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 10/31/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Diabetes in humans has been associated for a long time with cognitive dysfunction. In rodent animal models, cognitive dysfunction can manifest as impaired hippocampal synaptic plasticity. Particular attention has been concentrated on the receptor for advanced glycation end products (RAGE), which is implicated in multiple diabetic complications involving the development of vascular and peripheral nerve abnormalities. In this study, we hypothesize that RAGE signaling alters glutamate receptor function and expression, impairing synaptic transmission in the hippocampus. Using preparations of hippocampal slices from male mice, we show a RAGE-dependent decrease in long-term potentiation (LTP) and an increase in paired-pulse facilitation (PPF) following streptozotocin (STZ)-induced diabetes. Consistently, in hippocampal cultures from male and female neonatal mice, high glucose caused a RAGE-dependent reduction of AMPA- but not NMDA-evoked currents, and an increase in cytosolic reactive oxygen species (ROS). Consistently, when cultures were co-treated with high glucose and the RAGE antagonist FPS-ZM1, AMPA-evoked currents were unchanged. Hippocampi from STZ-induced hyperglycemic wild type (WT) mice showed increased RAGE expression concomitant with a decrease of both expression and phosphorylation (Ser 831 and 845) of the AMPA GluA1 subunit. We found these changes correlated to activation of the MAPK pathway, consistent with decreased pJNK/JNK ratio and the JNK kinase, pMEK7. As no changes in expression or phosphorylation of regulatory proteins were observed in hippocampi from STZ-induced hyperglycemic RAGE-KO mice, we report a RAGE-dependent impairment in the hippocampi of hyperglycemic WT mice, with reduced AMPA receptor expression/function and LTP deficits.
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Palavicini JP, Chen J, Wang C, Wang J, Qin C, Baeuerle E, Wang X, Woo JA, Kang DE, Musi N, Dupree JL, Han X. Early disruption of nerve mitochondrial and myelin lipid homeostasis in obesity-induced diabetes. JCI Insight 2020; 5:137286. [PMID: 33148881 PMCID: PMC7710310 DOI: 10.1172/jci.insight.137286] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic neuropathy is a major complication of diabetes. Current treatment options alleviate pain but do not stop the progression of the disease. At present, there are no approved disease-modifying therapies. Thus, developing more effective therapies remains a major unmet medical need. Seeking to better understand the molecular mechanisms driving peripheral neuropathy, as well as other neurological complications associated with diabetes, we performed spatiotemporal lipidomics, biochemical, ultrastructural, and physiological studies on PNS and CNS tissue from multiple diabetic preclinical models. We unraveled potentially novel molecular fingerprints underlying nerve damage in obesity-induced diabetes, including an early loss of nerve mitochondrial (cardiolipin) and myelin signature (galactosylceramide, sulfatide, and plasmalogen phosphatidylethanolamine) lipids that preceded mitochondrial, myelin, and axonal structural/functional defects; started in the PNS; and progressed to the CNS at advanced diabetic stages. Mechanistically, we provided substantial evidence indicating that these nerve mitochondrial/myelin lipid abnormalities are (surprisingly) not driven by hyperglycemia, dysinsulinemia, or insulin resistance, but rather associate with obesity/hyperlipidemia. Importantly, our findings have major clinical implications as they open the door to novel lipid-based biomarkers to diagnose and distinguish different subtypes of diabetic neuropathy (obese vs. nonobese diabetics), as well as to lipid-lowering therapeutic strategies for treatment of obesity/diabetes-associated neurological complications and for glycemic control.
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Affiliation(s)
- Juan P. Palavicini
- Barshop Institute for Longevity and Aging Studies and
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Juan Chen
- Barshop Institute for Longevity and Aging Studies and
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chunyan Wang
- Barshop Institute for Longevity and Aging Studies and
| | - Jianing Wang
- Barshop Institute for Longevity and Aging Studies and
| | - Chao Qin
- Barshop Institute for Longevity and Aging Studies and
| | - Eric Baeuerle
- Barshop Institute for Longevity and Aging Studies and
| | - Xinming Wang
- Byrd Alzheimer’s Center and Research Institute, USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jung A. Woo
- Byrd Alzheimer’s Center and Research Institute, USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - David E. Kang
- Byrd Alzheimer’s Center and Research Institute, USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Nicolas Musi
- Barshop Institute for Longevity and Aging Studies and
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jeffrey L. Dupree
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Research Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
| | - Xianlin Han
- Barshop Institute for Longevity and Aging Studies and
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Nagarathna R, Madhava M, Patil SS, Singh A, Perumal K, Ningombam G, Nagendra AHR. Cost of Management of Diabetes Mellitus: A Pan India Study. Ann Neurosci 2020; 27:190-192. [PMID: 34556959 PMCID: PMC8455003 DOI: 10.1177/0972753121998496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Diabetes mellitus is a major noncommunicable disease. While mortality rates are increasing, the costs of managing the disease are also increasing. The all-India average monthly expenditure per person (pppm) is reported to be ₹ 1,098.25, which translates to an annual expenditure of ₹13,179 per person. Purpose: While a number of studies have gone into the aspect of the cost of disease management, we do not find any study which has pan-India reach. We also do not find studies that focus on differences (if any) between rural and urban areas, age or on the basis of gender. We planned to report the cost of illness (COI) in diabetes individuals as compared to others from the data of a pan-India trial. Methods: Government of India commissioned the Indian Yoga Association to study the prevalence of diabetes mellitus in India in 2017. As part of the questionnaire, the cost of treatment was also captured. Data collected from 25 states and union territories were analyzed using the analysis of covriance (ANCOVA) test on SPSS version 21. Results: There was a significant difference (P < .05) between the average expenses per person per month (pppm) of individuals with self-reported known diabetes (₹1,357.65 pppm) and others (unknown and/or nondiabetes individuals–₹ 999.91 pppm). Similarly, there was a significant difference between rural (₹2,893 pppm) and urban (₹4,162 pppm) participants and between those below (₹1,996 pppm) and above 40 years (₹5,059 pppm) of age. Conclusion: This preliminary report has shown that the COI because of diabetes is significantly higher than others pointing to an urgent need to promote disease-preventive measures.
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Affiliation(s)
- Raghuram Nagarathna
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - M Madhava
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - Suchitra S Patil
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, Karnataka, India
| | - Amit Singh
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, Karnataka, India
| | - K Perumal
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - Ganga Ningombam
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - And Hongasandra R Nagendra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, Karnataka, India
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Moscovici K, Wainstock T, Sheiner E, Pariente G. The association between family history of diabetes mellitus and offspring long-term neurological hospitalisation. Acta Paediatr 2020; 109:1236-1242. [PMID: 31677301 DOI: 10.1111/apa.15078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 01/27/2023]
Abstract
AIM The aim of the present study was to determine whether being born to non-diabetic mother with a family history of diabetes mellitus (DM) is associated with higher rates of long-term neurological hospitalisations of the offspring. METHODS A retrospective analysis of all live births and paediatric hospitalisations at Soroka University Medical Center between 1991 and 2014 was performed. Family history of DM was collected from prepartum women using anamnesis. During the study period, 208 728 deliveries met the inclusion criteria, and of them 8.2% (n = 17 040) were of non-diabetic mothers with family history of DM. Rates of neurological hospitalisation with or without family history were analysed. RESULTS Offspring born to non-diabetic mothers with family history of DM had higher rates of neurological hospitalisations. The cumulative incidence of long-term neurological hospitalisations was higher as compared with those without family history of DM (log-rank test P = .007). Neurological hospitalisations was higher by 13% in the study group, after controlling for confounders such as maternal age, maternal obesity, hypertensive disorders, birth weight and caesarean delivery. (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.23). CONCLUSION Being born to a non-diabetic mother with a family history of DM is independently associated with higher long-term neurological hospitalisations of the offspring.
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Affiliation(s)
- Khen Moscovici
- Department of Obstetrics and Gynecology Soroka University Medical Center Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Tamar Wainstock
- Department of Public Health Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology Soroka University Medical Center Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology Soroka University Medical Center Ben‐Gurion University of the Negev Beer‐Sheva Israel
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Mehteroğlu E, Çakmen AB, Aksoy B, Balcıoğlu S, Köytepe S, Ateş B, Yılmaz İ. Preparation of hybrid PU/PCL fibers from steviol glycosides via electrospinning as a potential wound dressing materials. J Appl Polym Sci 2020. [DOI: 10.1002/app.49217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ezgi Mehteroğlu
- Department of Molecular Biology and Genetics, Faculty of Arts and Scienceİnönü University Malatya Turkey
| | - Ayşe B. Çakmen
- Department of Chemistry, Faculty of Arts and Scienceİnönü University Malatya Turkey
| | - Büşra Aksoy
- Department of Chemistry, Faculty of Arts and Scienceİnönü University Malatya Turkey
| | | | - Süleyman Köytepe
- Department of Chemistry, Faculty of Arts and Scienceİnönü University Malatya Turkey
| | - Burhan Ateş
- Department of Chemistry, Faculty of Arts and Scienceİnönü University Malatya Turkey
| | - İsmet Yılmaz
- Department of Chemistry, Faculty of Arts and Scienceİnönü University Malatya Turkey
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Rahmani B, Gandhi J, Joshi G, Smith NL, Reid I, Khan SA. The Role of Diabetes Mellitus in Diseases of the Gallbladder and Biliary Tract. Curr Diabetes Rev 2020; 16:931-948. [PMID: 32133965 DOI: 10.2174/1573399816666200305094727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increasing prevalence of diabetes mellitus worldwide continues to pose a heavy burden. Though its gastrointestinal impact is appropriately recognized, the lesser known associations may be overlooked. OBJECTIVE We aim to review the negative implications of diabetes on the gallbladder and the biliary tract. METHODS A MEDLINE® database search of literature was conducted with emphasis on the previous five years, combining keywords such as "diabetes," "gallbladder," and "biliary". RESULTS The association of diabetes to the formation of gallstones, gallbladder cancer, and cancer of the biliary tract are discussed along with diagnosis and treatment. CONCLUSION Though we uncover the role of diabetic neuropathy in gallbladder and biliary complications, the specific individual diabetic risk factors behind these developments is unclear. Also, in addition to diabetes control and surgical gallbladder management, the treatment approach also requires further focus.
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Affiliation(s)
- Benjamin Rahmani
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
- Medical Student Research Institute, St. George’s University School of Medicine, Grenada, West Indies
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | | | - Inefta Reid
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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15
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Naseri R, Farzaei F, Fakhri S, El-Senduny FF, Altouhamy M, Bahramsoltani R, Ebrahimi F, Rahimi R, Farzaei MH. Polyphenols for diabetes associated neuropathy: Pharmacological targets and clinical perspective. Daru 2019; 27:781-798. [PMID: 31352568 PMCID: PMC6895369 DOI: 10.1007/s40199-019-00289-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Diabetic neuropathy (DNP) is a widespread and debilitating complication with complex pathophysiology that is caused by neuronal dysfunction in diabetic patients. Conventional therapeutics for DNP are quite challenging due to their serious adverse effects. Hence, there is a need to investigate novel effective and safe options. The novelty of the present study was to provide available therapeutic approaches, emerging molecular mechanisms, signaling pathways and future directions of DNP as well as polyphenols' effect, which accordingly, give new insights for paving the way for novel treatments in DNP. EVIDENCE ACQUISITION A comprehensive review was done in electronic databases including Medline, PubMed, Web of Science, Scopus, national database (Irandoc and SID), and related articles regarding metabolic pathways on the pathogenesis of DNP as well as the polyphenols' effect. The keywords "diabetic neuropathy" and "diabetes mellitus" in the title/abstract and "polyphenol" in the whole text were used. Data were collected from inception until May 2019. RESULTS DNP complications is mostly related to a poor glycemic control and metabolic imbalances mainly inflammation and oxidative stress. Several signaling and molecular pathways play key roles in the pathogenesis and progression of DNP. Among natural entities, polyphenols are suggested as multi-target alternatives affecting most of these pathogenesis mechanisms in DNP. CONCLUSION The findings revealed novel pathogenicity signaling pathways of DNP and affirmed the auspicious role of polyphenols to tackle these destructive pathways in order to prevent, manage, and treat various diseases. Graphical Abstract .
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Affiliation(s)
- Rozita Naseri
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fardous F El-Senduny
- Biochemistry division, Chemistry Department, Faculty of Science, Mansoura University, Mansoura, 35516, Egypt
| | - Miram Altouhamy
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Roodabeh Bahramsoltani
- Department of Pharmacy in Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
- PhytoPharmacology Interest Group (PPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Farnaz Ebrahimi
- Pharmacy students` research committee, School of pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roja Rahimi
- Department of Pharmacy in Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
- PhytoPharmacology Interest Group (PPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Hinton T, Jelinek HF, Viengkhou V, Johnston GA, Matthews S. Effect of GABA-Fortified Oolong Tea on Reducing Stress in a University Student Cohort. Front Nutr 2019; 6:27. [PMID: 30972340 PMCID: PMC6443991 DOI: 10.3389/fnut.2019.00027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 02/22/2019] [Indexed: 02/06/2023] Open
Abstract
GABA-containing tea has gained popularity as an accessible intervention to reduce the impact of chronic stress-induced autonomic imbalance and increased risk for cardiovascular disease despite a lack of evidence concerning the γ-aminobutyric acid (GABA) content in a cup of the tea and its effects on physiological and psychological stress as measures of cognitive function. We aimed to measure the effects of GABA-fortified tea consumption on heart rate variability (HRV) and stress in 30 participants using a pre-post cohort study design. Ten minute lead II ECG recordings were analyzed with Kubios software. Frequency domain parameters including total power, high and low frequency power, along with heart rate, were determined. A control group that consumed a non-fortified tea was included in the research. Statistical analysis was by two-way ANOVA for two-group comparison with time as an interaction and a significance level of p < 0.05. Oolong tea consumption led to a significant decrease in the immediate stress score and a significant improvement in HRV. We conclude that autonomic imbalance and HRV in people with acute stress is significantly reduced following a cup of GABA fortified oolong tea and highlights the complex interaction between autonomic nervous system function and mood.
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Affiliation(s)
- Tina Hinton
- Pharmacology, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Herbert F. Jelinek
- Clinical Medicine, Macquarie University, Sydney, NSW, Australia
- School of Community Health, Charles Sturt University, Bathurst, NSW, Australia
| | - Vincent Viengkhou
- Pharmacology, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Graham A. Johnston
- Pharmacology, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Slade Matthews
- Pharmacology, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
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Lee HR, Kong SY, Sung SH, Kim HJ. DA-9801 and its saponins, dioscin and protodioscin, protect primary cortical neurons from hyperglycemia-induced neurotoxicity. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Lima KCDA, Borges LDS, Hatanaka E, Rolim LC, de Freitas PB. Grip force control and hand dexterity are impaired in individuals with diabetic peripheral neuropathy. Neurosci Lett 2017; 659:54-59. [PMID: 28867590 DOI: 10.1016/j.neulet.2017.08.071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
Diabetic peripheral neuropathy (DPN) affects the sensory function of the hands and, consequently, may negatively impact hand dexterity, maximum grip strength (GSMax), and hand grip force (GF) control during object manipulation. The aims of this study were to examine and compare the GF control during a simple holding task as well as GSMax and hand dexterity of individuals with DPN and healthy controls. Ten type 2 diabetic individuals diagnosed with DPN and ten age- and gender-matched healthy controls performed two traditional timed hand dexterity tests (i.e., nine-hole peg test and Jebsen-Taylor hand function test), a GSMax test, and a GF control test (i.e., hold a instrumented handle). The results indicated that individuals with DPN and controls produced similar GSMax. However, individuals with DPN took longer to perform the hand dexterity tests and set lower safety margin (exerted lower GF) than controls when holding the handle. The findings showed that mild to moderate DPN did not significantly affect maximum hand force generation, but does impair hand dexterity and hand GF control, which could impair the performance of daily living manipulation tasks and put them in risk of easily dropping handheld objects.
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Affiliation(s)
- Kauê Carvalho de Almeida Lima
- Institute of Physical Activity and Sports Sciences and Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Leandro da Silva Borges
- Institute of Physical Activity and Sports Sciences and Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Elaine Hatanaka
- Institute of Physical Activity and Sports Sciences and Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Luiz Clemente Rolim
- Endocrinology Division, Diabetes Center of Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, Brazil
| | - Paulo Barbosa de Freitas
- Institute of Physical Activity and Sports Sciences and Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil.
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19
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Barry J, McKay G, Fisher M. Propantheline. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Werring D, Howard R, Shorvon S. Systemic Conditions and Neurology. Neurology 2016. [DOI: 10.1002/9781118486160.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Popescu S, Timar B, Baderca F, Simu M, Diaconu L, Velea I, Timar R. Age as an independent factor for the development of neuropathy in diabetic patients. Clin Interv Aging 2016; 11:313-8. [PMID: 27042031 PMCID: PMC4801151 DOI: 10.2147/cia.s97295] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Population aging is unprecedented, without parallel in the history of humanity. As type 2 diabetes mellitus is predominantly more prevalent in aging populations, this creates a major public health burden. Older adults with diabetes have the highest rates of major lower-extremity amputation, myocardial infarction, visual impairment, and end-stage renal disease of any age group. The aims of our study were to assess whether age is an independent factor for the occurrence of diabetic neuropathy (DN), and to evaluate the relationship between the presence and the severity of DN and the diabetes duration and blood glucose level. In this study, we enrolled 198 patients, previously diagnosed with type 2 diabetes mellitus. For all patients, we measured hemoglobin A1c (HbA1c), lipid profile, and body mass index and we assessed the presence and severity of DN using the evaluation of clinical signs and symptoms. Patients had a median age of 62 years, with a median of diabetes duration of 7 years; 55.1% of the patients were men and the average HbA1c in the cohort was 8.2%. The prevalence of DN according to Michigan Neuropathy Screening Instrument was 28.8%, being significantly and positively correlated with higher age (65 vs 59 years; P=0.001) and HbA1c (8.6% vs 8.0%; P=0.027). No significant correlations were observed between the severity of DN and diabetes duration, body mass index (31.9 vs 29.9 kg/m(2)), or the number of centimeters exceeding the normal waist circumference (25.2 vs 17.3 cm; P=0.003). In conclusion, age influences the presence of DN, independent on other risk factors. This influence persists even after adjusting for other, very important risk factors, like blood glucose level or diabetes duration.
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Affiliation(s)
- Simona Popescu
- 2nd Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinic of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Bogdan Timar
- Clinic of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Flavia Baderca
- Department of Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Service of Pathology, Emergency City Hospital, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihaela Simu
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinic of Neurology, Emergency Clinical County Hospital, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Laura Diaconu
- 2nd Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinic of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Iulian Velea
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinic of Pediatrics, Emergency Clinical County Hospital, Timisoara, Romania
| | - Romulus Timar
- 2nd Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinic of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Greeley NR, Regner S, Willi S, Lynch DR. Cross-sectional analysis of glucose metabolism in Friedreich ataxia. J Neurol Sci 2014; 342:29-35. [PMID: 24819921 DOI: 10.1016/j.jns.2014.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/08/2014] [Accepted: 04/12/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the relationship between disease features in Friedreich ataxia and aberrant glucose metabolism. METHODS Fasting glucose, fasting insulin and random HbA1C were obtained in 158 patients with Friedreich ataxia. Regression analysis evaluated glucose, insulin, and homeostatic model assessment (HOMA) of insulin resistance (IR) and beta-cell function (ß) in relation to age, BMI, sex, and genetic severity. Categorical glucose values were analyzed in relation to other FRDA-associated disease characteristics. RESULTS In the FRDA cohort, age and GAA repeat length predicted fasting glucose and HbA1c levels (accounting for sex and BMI), while insulin and HOMA-IR were not predicted by these parameters. Within the cohort, average BMI was consistently lower than the national average by age and was marginally associated with insulin levels and HOMA-IR. Within juvenile subjects, insulin and HOMA-IR were predicted by age. Controlling for age and genetic severity, diabetes-related measures were not independent predictors of any quantitative measure of disease severity in FRDA. Glucose handling properties were also predicted by the presence of a point mutation, with 40% of individuals heterozygous for point mutations having diabetes, compared to 4.3% of subjects who carried two expanded GAA repeats. INTERPRETATION In FRDA, aberrant glucose metabolism is linked to increasing age, longer GAA repeat length on the shorter allele, frataxin point mutations, and increasing BMI. The effect of age to some degree may be mediated through changes in BMI, with increasing age associated with increases in BMI, and with HOMA-IR and insulin increases in children.
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Affiliation(s)
- Nathaniel R Greeley
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Sean Regner
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Steve Willi
- Division of Endocrinology and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - David R Lynch
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Neurology, University of Pennsylvania Medical School, Philadelphia, PA, United States; Department of Pediatrics, University of Pennsylvania Medical School, Philadelphia, PA, United States.
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de Freitas P, Lima K. Grip force control during simple manipulation tasks in non-neuropathic diabetic individuals. Clin Neurophysiol 2013; 124:1904-10. [DOI: 10.1016/j.clinph.2013.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 02/21/2013] [Accepted: 04/03/2013] [Indexed: 11/16/2022]
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Perceived effectiveness and barriers to physical therapy services for families and children with Friedreich ataxia. Pediatr Phys Ther 2013; 25:305-13. [PMID: 23685741 PMCID: PMC3696476 DOI: 10.1097/pep.0b013e31828ed7cb] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. METHOD Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. RESULTS Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. CONCLUSIONS Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.
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Lima KCDA, Freitas PBD. Avaliação da função manual e da força de preensão palmar máxima em indivíduos com diabetes mellitus. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000400014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O sucesso na realização de atividades manipulativas é crucial para um estilo independente. Como os diabéticos podem apresentar alterações sensoriais nas mãos, podem demonstrar alterações funcionais em tarefas manipulativas. Assim, o objetivo deste estudo foi comparar o desempenho de indivíduos diabéticos não neuropatas com o de não diabéticos em tarefas manipulativas e na capacidade de geração de força de preensão palmar máxima. Treze diabéticos sem diagnóstico de neuropatia (48,6±11,51 anos; 79,9±10,88 kg; 1,68 ±0,09 m) e 13 controles pareados por sexo e idade (48,5±10,09 anos; 76,44±11,79 kg; 1,69±0,1 m) participaram do estudo. A sensibilidade das mãos foi avaliada por meio do kit de monofilamentos Semmes-Weinstein e, em seguida, foram aplicados três testes comumente utilizados para avaliação da função manual na seguinte ordem: teste de função manual Jebsen Taylor (TFMJT), teste dos nove pinos nos buracos (9-PnB) e teste de força de preensão palmar máxima (FPmax). Os resultados do teste de sensibilidade cutânea indicaram que oito diabéticos apresentaram sensibilidade cutânea normal e cinco, alguma alteração sensorial detectável pelo monofilamento, a qual, no entanto, não os caracterizavam como neuropatas. Com relação aos testes funcionais, os resultados não indicaram qualquer diferença entre os grupos para os desempenhos nos três testes realizados (diabéticos e controles - TFMJT: 26,15±3,06 e 25,78±1,29 s; 9-PnB: 15,33±1,35 e 15,48±2,39 s; FPmax: 41,15±10,59 e 43,69±12,59 kgf). Assim, podemos concluir que indivíduos diabéticos sem neuropatia diabética periférica não apresentam qualquer alteração funcional nos membros superiores e na capacidade de gerar força de preensão palmar máxima.
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Louraki M, Karayianni C, Kanaka-Gantenbein C, Katsalouli M, Karavanaki K. Peripheral neuropathy in children with type 1 diabetes. DIABETES & METABOLISM 2012; 38:281-9. [DOI: 10.1016/j.diabet.2012.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/25/2012] [Accepted: 02/26/2012] [Indexed: 11/17/2022]
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Misra I, Temesgen FD, Soleiman N, Kalyanam J, Kurukumbi M. Myasthenia gravis presenting like guillain-barré syndrome. Case Rep Neurol 2012; 4:137-43. [PMID: 23271998 PMCID: PMC3529579 DOI: 10.1159/000342448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness in specific muscle groups, especially the ocular and bulbar muscles. Guillain-Barré syndrome (GBS) presents with ascending paralysis and areflexia, often secondary to an infection. Several theories have been proposed regarding the etiology behind GBS, with many studies pointing to a possible autoimmune cause. If this is in fact true, it is also possible that the two diseases may develop concurrently. While this is unusual, several recently published studies highlight such cases of concurrent MG and GBS. This co-occurrence could involve certain common proteins, as the two diseases can present somewhat similarly. This is an unusual case of a patient with no significant past medical history, presenting with generalized weakness and symptoms of new-onset diabetes, who developed bilateral ptosis, distal weakness, and areflexia while in the hospital, raising the possibility of concurrent MG and GBS. Although the diagnosis of MG was confirmed by the positive anticholinesterase antibodies and tensilon test, several features, including sudden onset of ascending paralysis and areflexia, were more common in GBS than MG. It is possible, albeit rare, that these two syndromes could have developed concurrently and that the untreated diabetes mellitus could have contributed to the neurological symptoms. This case is reported because of the rarity of its features, diagnostic and management challenges.
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Affiliation(s)
- Isha Misra
- Department of Neurology, Howard University Hospital
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28
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Burnfield JM, Eberly VJ, Gronely JK, Perry J, Yule WJ, Mulroy SJ. Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees. Prosthet Orthot Int 2012; 36:95-104. [PMID: 22223685 DOI: 10.1177/0309364611431611] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Microprocessor controlled prosthetic knees (MPK) offer opportunities for improved walking stability and function, but some devices' swing phase features may exceed needs of users with invariable cadence. One MPK offers computerized control of only stance (C-Leg Compact). OBJECTIVE To assess Medicare Functional Classification Level K2 walkers' ramp negotiation performance, function and balance while using a non-MPK (NMPK) compared to the C-Leg Compact. STUDY DESIGN Crossover. METHODS Gait while ascending and descending a ramp (stride characteristics, kinematics, electromyography) and function were assessed in participant's existing NMPK and again in the C-Leg Compact following accommodation. RESULTS Ramp ascent and descent were markedly faster in the C-Leg Compact compared to the NMPK (p ≤ 0.006), owing to increases in stride length (p ≤ 0.020) and cadence (p ≤ 0.020). Residual limb peak knee flexion and ankle dorsiflexion were significantly greater (12.9° and 4.9° more, respectively) during single limb support while using the C-Leg Compact to descend ramps. Electromyography (mean, peak) did not differ significantly between prosthesis. Function improved in the C-Leg Compact as evidenced by a significantly faster Timed Up and Go and higher functional questionnaire scores. CONCLUSIONS Transfemoral K2 walkers exhibited significantly improved function and balance while using the stance-phase only MPK compared to their traditional NMPK.
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Park SH, Bahk JH, Oh AY, Gil NS, Huh J, Lee JH. Gender difference and change of α(1)-adrenoceptors in the distal mesenteric arteries of streptozotocin-induced diabetic rats. Korean J Anesthesiol 2011; 61:419-27. [PMID: 22148092 PMCID: PMC3229022 DOI: 10.4097/kjae.2011.61.5.419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 06/07/2011] [Accepted: 06/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the gender-related changes in the function and distribution of α(1)-adrenoceptors in the distal mesenteric artery of streptozotocin (STZ)-induced diabetic rats at the level of α(1)-adrenoceptor subtypes. METHODS Diabetes was induced by intravenous injection of STZ in a dose of 60 mg/kg through the tail vein in 8 week-old male or female Sprague-Dawley rats (n = 13/group). Age-matched normal rats (n = 15) were used as a control group. Four weeks after STZ injection, the change in mean arterial pressure caused by a 45° tilting was recorded. The α(1)-adrenoceptor subtypes mediating contractions of the distal mesenteric artery were investigated using the agonist, phenylephrine as well as subtype-selective antagonists including prazocin, 5-methylurapidil, and BMY 7378. The expression of α(1)-adrenoceptor subtypes of each artery was examined by immunofluorescence staining and western blotting using subtype selective antibodies. RESULTS Compared with normal male rats, the contractile response to phenylephrine was decreased in the distal mesenteric artery in normal female rats. Moreover, a decrease in contractile force was observed in STZ-induced diabetic rats compared with age-matched controls. Western blotting revealed that there was the difference between normal male and female rats in manifestation of the α(1D)-adrenoceptor. In STZ-induced male and female diabetic rats, all α(1)-adrenoceptor subtypes were decreased in distal mesenteric arteries, compared with normal rats. CONCLUSIONS There was the gender-related functional difference of α(1)-adrenoceptors in normal rats. In both male and female rats, diabetes decreased the contractile response in mesenteric arteries, which might be caused by the overall change in α(1)-adrenoceptor.
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Affiliation(s)
- Sang-Hyun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee JH, Bahk JH, Park SH, Huh J. The diabetes-induced functional and distributional changes of the alpha 1-adrenoceptor of the abdominal aorta and distal mesenteric artery from streptozotocin-induced diabetic rats. Korean J Anesthesiol 2011; 60:272-81. [PMID: 21602978 PMCID: PMC3092963 DOI: 10.4097/kjae.2011.60.4.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/16/2010] [Accepted: 11/16/2010] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to evaluate the effect of diabetes on the function and distribution of vascular α1-adrenoceptors in the abdominal aorta and distal mesenteric artery from streptozotocin (STZ)-induced diabetic rats at the level of the α1-adrenoceptor subtypes. Methods Diabetes was induced by a single intravenous injection of STZ (60 mg/kg) in 8 week-old male Sprague-Dawley rats (n = 11). Age-matched normal rats (n = 14) were used as a control group. Four weeks after STZ injection, the tilting-induced change of the mean arterial pressure was recorded. The α1-adrenoceptor subtypes mediating the contractions of the distal mesenteric artery and abdominal aorta were investigated using the agonist phenylephrine and subtype-selective antagonists that included prazocin, 5-methylurapidil and BMY 7378. The expressions of the α1-adrenoceptor subtypes of each artery were examined by immunofluorescence staining using the subtype selective antibodies. Results The recovery of the mean arterial pressure was delayed after positional change in the diabetic rats. Compared with that of the normal rats, the contractile response to phenylephrine was increased in the abdominal aortas and it was decreased in the distal mesenteric arteries in the diabetic rats. In addition, compared with the normal rats, the fluorescent intensity of all the α1-adrenoceptor subtypes was increased in the abdominal aortas and it was decreased in the mesenteric arteries of the diabetic rats. Conclusions Diabetes increased the contractility of the abdominal aorta in response to phenylephrine, yet diabetes decreased that of the mesenteric arteries in the STZ-induced diabetic rats. Those results are mainly based on the overall change of the α1-adrenoceptor, and not on the change of the specific α1-adrenoceptor subtypes.
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Affiliation(s)
- Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rolim LC, Sá JRD, Chacra AR, Dib SA. [Clinical heterogeneity and coexistence of diabetic neuropathies: difference and similarities between types 1 and 2 diabetes mellitus]. ACTA ACUST UNITED AC 2010; 53:818-24. [PMID: 19942983 DOI: 10.1590/s0004-27302009000700005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 07/14/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the heterogeneity and the coexistence of diabetic neuropathy (DNP) in type 1 (T1DM) and 2 (T2DM) diabetes mellitus. METHODS 74 T2DM and 20 T1DM patients were evaluated according to age (years), time from diagnosis of diabetes (TDD, years), body mass index (BMI, kg/m(2)), HbA1c and DNP type (American Diabetes Association criteria). RESULTS T1DM was younger (32.7 +/- 11.0 versus 56.9 +/- 10.3; p = 0.0001), leaner (BMI: 23.6 +/- 3.85 versus 28.4 +/- 5.3; p = 0.0005) and they had longer TDD (17.1 +/- 9.7 versus 10.4 +/- 6.8; p = 0.003). Cardiovascular autonomic neuropathy (CAN) (60% versus 32.4%; p = 0.02) and its coexistence with polyneuropathy (PN) (62.5% versus 33.3%; p = 0.03) were more common in T1DM. Chronic painful polyneuropathy (CPP) was more prevalent in T2DM (60.8% versus 30.0%; p = 0.009). Logistic regression showed HbA1c as an independent variable related to PN (p = 0.04) in both groups. TDD (p = 0.03) and CPP (p = 0.003) were related to CAN in T1DM. Age (p = 0.0004) was related to CPP in T2DM. CONCLUSIONS The DNP have shown a heterogeneity distribution in type 1 and type 2 diabetes mellitus. The related factors to different phenotypes of this complication, apart from hyperglycemia, may be variable between these two types of diabetes mellitus.
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Affiliation(s)
- Luiz Clemente Rolim
- Centro de Diabetes, Disciplinade Endocrinologia, Escola Paulistade Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol 2010; 4:175-81. [PMID: 18615140 DOI: 10.2174/157015906778019536] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 01/26/2023] Open
Abstract
Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain.
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Affiliation(s)
- P Marchettini
- Pain Medicine Center, Scientific Institute San Raffaele, Via Stamira D'Ancona 20, 20127 Milano, Italy.
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Saura V, Santos ALGD, Ortiz RT, Parisi MC, Fernandes TD, Nery M. Fatores preditivos da marcha em pacientes diabéticos neuropático e não neuropáticos. ACTA ORTOPEDICA BRASILEIRA 2010. [DOI: 10.1590/s1413-78522010000300006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo envolvidas na marcha de pacientes portadores de diabetes com e sem neuropatia periférica. CASUÍSTICA E MÉTODO: 36 indivíduos divididos em três grupos: Controle - GC: 10 indivíduos sem diabetes, Diabetes - GD: 10 indivíduos portadores de diabetes sem neuropatia periférica e Neuropatia - GDN: 16 indivíduos portadores de diabetes e neuropatia diabética periférica. Foi realizada análise da marcha - AMTI® OR6/6, e da amplitude de movimento articular tíbio-társica - Sistema Vicom 640® - de todos os participantes. RESULTADOS: O primeiro e segundo pico de força vertical de reação do solo são maiores no grupo Neuropatia e a amplitude de movimento articular do tornozelo é menor nos grupos Diabetes e Neuropatia. CONCLUSÃO: A amplitude de movimento da articulação tíbio-társica está diminuida nos diabetéticos, independente da presença ou ausência de neuropatia periférica, e os diabéticos com neuropatia periférica, apresentaram aumento no primeiro e no segundo pico da força de reação vertical do solo durante a marcha.
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Abstract
Postural orthostatic tachycardia syndrome (POTS) is characterised by the development of excessive tachycardia on standing with maintained blood pressure. We report a case of POTS in a 20-year-old girl with type 1 diabetes who presented with a 3-week history of lethargy, fatigue and orthostatic intolerance. Examination revealed a postural rise in heart rate of over 50 bpm with maintained blood pressure. This was associated with symptoms of light-headedness. Cardiac structure and function as assessed by ECG and ECHO were normal as was thyroid and adrenal function. POTS was confirmed with tilt table testing. Treatment was initiated with increased fluid intake, fludrocortisone and bisoprolol with improvement. POTS is a disabling condition which can significantly limit a patient's activities and working capacity and should be considered in a young, otherwise well patient who presents with orthostatic intolerance and a postural rise in heart rate.
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Affiliation(s)
- Una Graham
- Craigavon Area Hospital, 68 Lurgan Road, Portadown BT63 5QQ, UK
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Guney F, Demir O, Gonen MS. Blink reflex alterations in diabetic patients with or without polyneuropathy. Int J Neurosci 2009; 118:1287-98. [PMID: 18698511 DOI: 10.1080/00207450701870378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main aim of this study is to evaluate the role of blink reflex for early diagnosis of cranial neuropathy in diabetic patients with or without polyneuropathy. Ninety-five diabetic patients were included in the present study for the evaluation of blink reflex. The diabetic patients were divided into two groups according to having diabetic neuropathy or not. Both R1, R2i and R2c latencies in all diabetic patients with or without polyneuropathy were prolonged relative to controls and the differences were statistically significant (p < .001). R1 latencies in diabetic patients with polyneuropathy were prolonged relative to diabetic patients without polyneuropathy and the differences were statistically significant (p < .001). These findings presumably reflect that facial nerve is severly involved in diabetic polyneuropathy. Finally blink reflex is of value in detection of clinically silent intraaxial brainstem functional abnormalities or extraaxial lesions in diabetic patients before peripheral neuropathy.
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Affiliation(s)
- Figen Guney
- Department of Neurology, School of Medicine, Selcuk University, Konya, Turkey.
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Smyth S, Menkes DL. Coincident membranous glomerulonephritis and chronic inflammatory demyelinating polyradiculoneuropathy: Questioning the autoimmunity hypothesis. Muscle Nerve 2008; 37:130-5. [PMID: 17614320 DOI: 10.1002/mus.20841] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and membranous glomerulonephritis (MGN) are both autoimmune disorders that are rarely observed concurrently. We describe a patient who developed MGN nearly 20 years after the onset of CIDP, resulting in a secondary progression of his neuropathy. He responded dramatically to a novel regimen of plasma exchange and methotrexate. We propose a mechanism other than autoimmunity for the coincidence of these disorders and discuss the theoretical superiority of the treatment regimen that he received.
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Affiliation(s)
- Shane Smyth
- Department of Neurology, University of Tennessee Health Sciences Center at Memphis, 855 Monroe Avenue, Link 415, Memphis, Tennessee 38163, USA
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Archelos JJ. Therapieoptionen der schmerzhaften diabetischen Polyneuropathie. Wien Klin Wochenschr 2007; 119:205-16. [PMID: 17492346 DOI: 10.1007/s00508-007-0795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
Distal symmetrical polyneuropathy is the most frequent manifestation of diabetic neuropathy and crucially contributes to the development of diabetic foot and subsequent amputation in 70 to 80% of all cases. In 10 to 15% of affected patients considerable pain is present, in particular in early diabetic polyneuropathy. This review summarizes evidence based data on prevention, neuroregenerative, and symptomatic treatment of painful diabetic polyneuropathy. The most important clinical trials on treatment and prevention are presented. Conclusions from these clinical studies in particular detailed treatment recommendations including dosage and side effects are given. Combined treatments and escalating therapies for severe pain syndromes are discussed.
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Affiliation(s)
- Juan J Archelos
- Universitätsklinik für Neurologie, Abteilung für Allgemeine Neurologie, Medizinische Universität Graz, Graz, Osterreich.
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Sun PC, Lin HD, Jao SHE, Ku YC, Chan RC, Cheng CK. Relationship of skin temperature to sympathetic dysfunction in diabetic at-risk feet. Diabetes Res Clin Pract 2006; 73:41-6. [PMID: 16487615 DOI: 10.1016/j.diabres.2005.12.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 10/28/2005] [Accepted: 12/16/2005] [Indexed: 11/25/2022]
Abstract
The relationship of plantar skin temperature to diabetic neuropathy was studied using clinical, nerve conduction and autonomic evaluations. The sympathetic skin response (SSR) was found present in both feet of 25 control subjects and 29 (out of 69) diabetic patients (SSR+ group). For those diabetic patients absent with the SSR in both feet, 18 patients (at-risk group) had preulcerative skin lesions (dry and fissured skin) and 22 did not (SSR- group). The at-risk group showed significantly higher mean foot temperature (30.2+/-1.3 degrees Celsius) than the SSR- (27.9+/-1.7 degrees Celsius), the SSR+ (27.1+/-2.0 degrees Celsius) and the control group (26.8+/-1.8 degrees Celsius). The SSR- group had smaller temperature differences (7.2+/-1.7 degrees Celsius versus 8.6+/-1.6 degrees Celsius, p<0.05) and smaller normalized temperature (referencing to the forehead temperature) (0.19 versus 0.24, p<0.01) than the SSR+ group. Although the three diabetic groups had no significant differences in clinical and cardiovascular abnormalities, the at-risk group showed more nerve conduction abnormalities than the SSR- and SSR+ groups (55% versus 23% and 14%, p<0.02). This study indicated that the thermoregulatory sweating abnormality signified early sympathetic damage in diabetic feet. Assessing skin conditions and sudomotor activities should help identify small fiber neuropathy in diabetic patients with at-risk feet conditions.
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Affiliation(s)
- Pi-Chang Sun
- Orthopedic Biomechanics Laboratory, Institute of Rehabilitation Science and Technology, National Yang Ming University, No. 155, Sec. 2, Li-Nung St, Taipei 11221, Taiwan
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Kikkawa Y, Kuwabara S, Misawa S, Tamura N, Kitano Y, Ogawara K, Hattori T. The acute effects of glycemic control on nerve conduction in human diabetics. Clin Neurophysiol 2005; 116:270-4. [PMID: 15661104 DOI: 10.1016/j.clinph.2004.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate acute changes in nerve conduction associated with glycemic control. In diabetes, nerve dysfunction can result from reversible metabolic factors associated with hyperglycemia, as well as structural changes. METHODS Multiple nerve conduction parameters including F-wave latencies were measured in 47 diabetic patients with prominent hyperglycemia before and after intensive insulin treatment. RESULTS Four weeks after the start of treatment, there was a significant improvement in minimal F-wave latencies of the median (P<0.001) and tibial (P<0.001) nerves, and in distal latencies (P=0.01) and sensory nerve conduction velocities (P<0.001) of the median nerves. Amplitudes of motor and sensory responses did not change significantly. These findings were similar for patients with type 1 (n=8) and those with type 2 (n=39) diabetes. Patients with poorer glycemic control or milder neuropathy tended to show greater changes after treatment. CONCLUSIONS Glycemic control quickly alters the speed of nerve conduction. F-wave latencies and conduction times across the carpal tunnel are very sensitive parameters. SIGNIFICANCE Serial nerve conduction studies can detect reversible slowing of nerve conduction presumably caused by metabolic factors, such as decreased Na+/K+-ATPase activity, the altered polyol pathway, and tissue acidosis.
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Affiliation(s)
- Yuriko Kikkawa
- Department of Neurology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Stockdale RC, Biswas CK. Chronic Inflammatory Demyelinating Polyradiculoneuropathy with Ataxia. Med Chir Trans 2004; 97:338-9. [PMID: 15229265 PMCID: PMC1079532 DOI: 10.1177/014107680409700713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- R C Stockdale
- Department of Medicine for the Elderly, Dewsbury and District Hospital, Dewsbury WF13 4HS, UK.
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Abstract
In contrast to earlier views, new data indicate that proinsulin C-peptide exerts important physiological effects and shows the characteristics of an endogenous peptide hormone. C-peptide in nanomolar concentrations binds specifically to cell membranes, probably to a G-protein coupled receptor. Ca(2+)- and MAP-kinase dependent signalling pathways are activated, resulting in stimulation of Na(+), K(+)-ATPase and endothelial nitric oxide (NO) synthase, two enzyme systems known to be deficient in diabetes. C-peptide may also interact synergistically with insulin signal transduction. Studies in intact animals and in patients with type 1 diabetes have demonstrated multifaceted effects. Thus, C-peptide administration in streptozotocin-diabetic animals results in normalization of diabetes-induced glomerular hyperfiltration, reduction of urinary albumin excretion and diminished glomerular expansion. The former two effects have also been observed in type 1 diabetes patients given C-peptide in replacement dose for up to 3 months. Peripheral nerve function and structure are likewise influenced by C-peptide administration; sensory and motor nerve conduction velocities increase and nerve structural changes are diminished or reversed in diabetic rats. In patients with type 1 diabetes, beneficial effects have been demonstrated on sensory nerve conduction velocity, vibration perception and autonomic nerve function. C-peptide also augments blood flow in several tissues in type 1 diabetes via its stimulation of endothelial NO release, emphasizing a role for C-peptide in maintaining vascular homeostasis. Continued research is needed to establish whether, among the hormones from the islets of Langerhans, C-peptide is the ugly duckling that--nearly 40 years after its discovery--may prove to be an endogenous peptide hormone of importance in the treatment of diabetic long-term complications.
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Affiliation(s)
- John Wahren
- Section of Clinical Physiology, Department of Surgical Sciences, Karolinska Institute, N1:05, SE-171 76 Stockholm, Sweden.
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Trujillo-Hernández B, Huerta M, Pérez-Vargas D, Trujillo X, Vásquez C. Blink reflex alterations in recently diagnosed diabetic patients. J Clin Neurosci 2003; 10:306-9. [PMID: 12763333 DOI: 10.1016/s0967-5868(02)00306-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the present study was to determine the frequency of blink reflex alterations and to examine the influence of hyperglycemia in inducing the alterations in recently diagnosed Type 2 diabetes mellitus patients. METHODS A cross-sectional study was carried out on patients having asymptomatic diabetes with a period of evolution under 10 years. In all 47 patients (26 women and 21 men), serum glycemia levels were determined and the latency onset of the blink reflex components were measured. RESULTS The average patient age was 44.5+/-11.0 (mean+/-SD) years with a diabetes evolution period of 4.3+/-2.9 (mean+/-SD) years. After a fasting serum glucose test, the diabetic patients were catalogued as normoglycemic (< or =126 mg/dl) or as hyperglycemic (> 26 mg/dl) and subjected to a blink reflex test. The results obtained from the diabetic patients were compared with those from a non-diabetic control group. 14.8-31.9% of the diabetic patients showed alterations in blink reflex component latencies. The differences compared with the control group were significant (p<0.05). CONCLUSIONS Diabetes, as is well-known, can affect the central and peripheral nervous system and there does not appear to be a link between glycemic levels and blink reflex components. However, blink reflex alterations were present even in diabetic patients with a relatively short period of disease evolution.
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Affiliation(s)
- Benjamin Trujillo-Hernández
- Unit of Clinical Epidemiology Research, Hospital General de Zona y Medicina Familiar No. 1, Col., Colima, Mexico.
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Cheng X, Leung SWS, Lim SL, Pang CCY. Attenuated arterial and venous constriction in conscious rats with streptozotocin-induced diabetes. Eur J Pharmacol 2003; 458:299-304. [PMID: 12504786 DOI: 10.1016/s0014-2999(02)02762-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We examined if arterial or venous constriction is impaired in early diabetes. Dose-pressor and mean circulatory filling pressure (index of venous tone) response curves to noradrenaline and angiotensin II were constructed in four groups of conscious, instrumented, Wistar rats pretreated with streptozotocin (60 mg/kg i.v.) or vehicle at 2 weeks prior to the study. Rats with diabetes, relative to controls, had increased ED(50) (reduced potency) for the pressor (2.5-fold of control) and mean circulatory filling pressure (4.3-fold of control) response to noradrenaline, as well as reduced maximum pressor response (efficacy) to noradrenaline (diabetic, 74+/-8 mm Hg; control, 96+/-5 mm Hg). Diabetic rats also had reduced potency (ED(50), 5-fold of control) of the pressor response to angiotensin II; however, maximum pressor response and dose-mean circulatory filling pressure curve to angiotensin II were similar in both groups. Therefore, arterial and venous constrictions are impaired at an early phase of type I diabetes.
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Affiliation(s)
- Xing Cheng
- Department of Pharmacology and Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Abstract
Friedreich's ataxia is commonly associated with depression. Treatment of the depression can be difficult due to numerous morbid medical conditions. ECT is a safe and effective treatment option.
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Affiliation(s)
- G Singh
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
This article reviews the most recent epidemiologic evidence supporting topics such as hypertension, diabetes, tobacco, and lipids as risks for stroke. Where available, American Stroke Association (ASA) and National Stroke Association (NSA) consensus statement guidelines for the treatment of these risk factors are given.
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Affiliation(s)
- R T Benson
- Clinical and Research Stroke Fellow, Neurological Institute, Columbia University, New York, NY 10032, USA
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Schramm E, Wagner M, Nellessen U, Inselmann G. Ultrastructural changes of human cardiac atrial nerve endings in diabetes mellitus. Eur J Clin Invest 2000; 30:311-6. [PMID: 10759879 DOI: 10.1046/j.1365-2362.2000.00631.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Autonomic neuropathy resulting from long-term diabetes mellitus may affect heart innervation. However, so far diabetes induced morphological changes of cardiac nerves are not well-known. In this study human cardiac atrial tissue from diabetic patients was analysed by electron microscopy for structural alterations as a result of diabetic neuropathy. METHODS In coronary bypass surgery, an edge of the right auricle was routinely resected for reason of extracorporal circulation. Thin cardiac tissue sections of 100 nm were studied by electron microscopy. Atrial tissue samples were collected from 5 patients with long-standing diabetes (for at least 8 years) and compared to atrial tissue samples from 5 patients without diabetes, equally undergoing coronary bypass surgery. RESULTS In all atria-free nerve endings with unmyelinized, axons were observed. Cross sections of 479 axons from diabetic patients were compared to 419 axons of nondiabetic patients. The number of altered axons was significantly higher in cardiac tissue of diabetic patients (32%) in comparison to normal subjects (17%). In diabetic patients, 20% of the intra-axonal mitochondria were condensed or hydropic, whereas in nondiabetic patients only 4% of the mitochondria were altered. Membrane fragments were present in 21% of the axons in atria of diabetic patients compared to 10% in nondiabetic subjects. Only in cardiac axons from diabetic patients there were lamellar bodies, dissolved axoplasma and junctions between neighbouring axons in a minor number. Few vacuoles were present in axons of both groups. CONCLUSION In myocardial atrial-free nerve fibre bundles of diabetic patients, the amount of degenerative changes was higher in comparison to atrial cardiac tissue from nondiabetic subjects. These morphological alterations may indicate manifestation of diabetic neuropathy and might contribute to the impairment of autonomic neural control affecting the heart in long-standing diabetes mellitus.
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Affiliation(s)
- E Schramm
- Universität Würzburg, Würzburg; Johanniter-Krankenhaus Stendal, Stendal, Germany
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