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Mooshage CM, Tsilingiris D, Schimpfle L, Kender Z, Aziz-Safaie T, Hohmann A, Szendroedi J, Nawroth P, Sturm V, Heiland S, Bendszus M, Kopf S, Kurz FT, Jende JME. Insulin Resistance Is Associated With Reduced Capillary Permeability of Thigh Muscles in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2023; 109:e137-e144. [PMID: 37579325 DOI: 10.1210/clinem/dgad481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
CONTEXT Insulin-mediated microvascular permeability and blood flow of skeletal muscle appears to be altered in the condition of insulin resistance. Previous studies on this effect used invasive procedures in humans or animals. OBJECTIVE The aim of this study was to demonstrate the feasibility of a noninvasive assessment of human muscle microcirculation via dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of skeletal muscle in patients with type 2 diabetes (T2D). METHODS A total of 56 participants (46 with T2D, 10 healthy controls [HC]) underwent DCE-MRI of the right thigh at 3 Tesla. The constant of the musculature's microvascular permeability (Ktrans), extravascular extracellular volume fraction (ve), and plasma volume fraction (vp) were calculated. RESULTS In T2D patients, skeletal muscle Ktrans was lower (HC 0.0677 ± 0.002 min-1, T2D 0.0664 ± 0.002 min-1; P = 0.042) while the homeostasis model assessment (HOMA) index was higher in patients with T2D compared to HC (HC 2.72 ± 2.2, T2D 6.11 ± 6.2; P = .011). In T2D, Ktrans correlated negatively with insulin (r = -0.39, P = .018) and HOMA index (r = -0.38, P = .020). CONCLUSION The results signify that skeletal muscle DCE-MRI can be employed as a noninvasive technique for the assessment of muscle microcirculation in T2D. Our findings suggest that microvascular permeability of skeletal muscle is lowered in patients with T2D and that a decrease in microvascular permeability is associated with insulin resistance. These results are of interest with regard to the impact of muscle perfusion on diabetic complications such as diabetic sarcopenia.
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Affiliation(s)
- Christoph M Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Dimitrios Tsilingiris
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, 85764 Neuherberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, 85764 Neuherberg, Germany
| | - Taraneh Aziz-Safaie
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Julia Szendroedi
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Volker Sturm
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, 85764 Neuherberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Yoshida K, Miura Y, Nakanishi S, Tanaka S, Kuniyasu K, Matsumoto S, Hanayama K. The impact of diabetic polyneuropathy on toe grip strength in patients with type 2 diabetes mellitus: a cross-sectional study. J Diabetes Metab Disord 2023; 22:1391-1397. [PMID: 37969917 PMCID: PMC10638331 DOI: 10.1007/s40200-023-01260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/01/2023] [Indexed: 11/17/2023]
Abstract
Purpose Type 2 diabetes mellitus (T2DM) and concomitant diabetic polyneuropathy (DPN) induce muscle weakness. Muscle weakness in the foot is associated with foot deformities and falls. However, factors affecting toe grip strength (TGS) are not well known. Therefore, the present study investigated factors related to TGS in patients with T2DM. Methods This was a cross-sectional study involving 100 patients with T2DM who were hospitalized for the treatment of T2DM and 50 healthy adults. The subjects were divided into three groups: a group of healthy subjects, a group of T2DM patients without DPN, and a group of T2DM patients with DPN. Hierarchical multiple regression analysis was performed with TGS and the TGS-to-weight ratio (TGS/Wt%) as dependent variables and with age, the presence of T2DM, and DPN as independent variables, and sex and BMI as confounders. Results There were no significant differences in age or sex among the three groups. In the final regression analysis, age and presence of T2DM and DPN were associated in both models with TGS and TGS/Wt% as dependent variables. Conclusion DPN, T2DM, and age were found to be related to TGS. The findings of this study could contribute to healthcare providers developing foot care and rehabilitation programs for diabetic patients. Trial registration This study was registered with UMIN-CTR (UMIN000034320) on 1 November 2018.
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Affiliation(s)
- Koji Yoshida
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
- Department of Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Yasushi Miura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| | - Shigeharu Tanaka
- School of Rehabilitation, Kanagawa University of Human Services, Yokosuka, Japan
| | - Katsushi Kuniyasu
- Department of Physical Therapist, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Shinsuke Matsumoto
- Department of Physical Therapist, Kawasaki Junior College of Rehabilitation, Kurashiki, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki, Japan
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Dvorak AV, Kumar D, Zhang J, Gilbert G, Balaji S, Wiley N, Laule C, Moore GW, MacKay AL, Kolind SH. The CALIPR framework for highly accelerated myelin water imaging with improved precision and sensitivity. SCIENCE ADVANCES 2023; 9:eadh9853. [PMID: 37910622 PMCID: PMC10619933 DOI: 10.1126/sciadv.adh9853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
Quantitative magnetic resonance imaging (MRI) techniques are powerful tools for the study of human tissue, but, in practice, their utility has been limited by lengthy acquisition times. Here, we introduce the Constrained, Adaptive, Low-dimensional, Intrinsically Precise Reconstruction (CALIPR) framework in the context of myelin water imaging (MWI); a quantitative MRI technique generally regarded as the most rigorous approach for noninvasive, in vivo measurement of myelin content. The CALIPR framework exploits data redundancy to recover high-quality images from a small fraction of an imaging dataset, which allowed MWI to be acquired with a previously unattainable sequence (fully sampled acquisition 2 hours:57 min:20 s) in 7 min:26 s (4.2% of the dataset, acceleration factor 23.9). CALIPR quantitative metrics had excellent precision (myelin water fraction mean coefficient of variation 3.2% for the brain and 3.0% for the spinal cord) and markedly increased sensitivity to demyelinating disease pathology compared to a current, widely used technique. The CALIPR framework facilitates drastically improved MWI and could be similarly transformative for other quantitative MRI applications.
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Affiliation(s)
- Adam V. Dvorak
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Dushyant Kumar
- Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Zhang
- Global MR Applications & Workflow, GE HealthCare Canada, Mississauga, ON, Canada
| | | | - Sharada Balaji
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Neale Wiley
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Radiology, University of British Columbia, Vancouver, BC, Canada
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - G.R. Wayne Moore
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alex L. MacKay
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- Radiology, University of British Columbia, Vancouver, BC, Canada
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shannon H. Kolind
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Radiology, University of British Columbia, Vancouver, BC, Canada
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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Chang WP, Peng YX. Differences Between Patients With Diabetes Mellitus and Obese Patients in Occurrence of Peri-Prosthetic Joint Infection: A Systemic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:671-683. [PMID: 37722014 DOI: 10.1089/sur.2023.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background: To understand the differences between patients with diabetes mellitus and obese patients with respect to the occurrence of peri-prosthetic joint infection (PJI) after lower-extremity joint arthroplasty as well as to identify differences in PJI occurrence at different time periods. Patients and Methods: The Cochrane Library, CINAHL, MEDLINE, and PubMed were searched for literature published between January 2000 and July 2022. Our targets were studies involving patients with PJI who had already been diagnosed as having diabetes mellitus or being obese before receiving lower-extremity joint arthroplasty. Analysis was performed using Comprehensive Meta-Analysis Software (CMA) Version 3 (Biostat, Inc., Englewood, NJ, USA). Results: A total of 53,522 patients with diabetes mellitus and 360,018 obese patients were included. The forest plot for patients with and without diabetes mellitus indicated that patients with diabetes mellitus were more likely to contract PJIs than were patients without diabetes mellitus (odds ratio, 1.84; 95% confidence interval [CI], 1.56-2.16) and that no differences existed among early, delayed, and late PJI occurrence in patients with diabetes mellitus. The forest plot for obese and non-obese patients indicated that obese patients were more likely to contract PJIs than were non-obese patients (odds ratio, 1.86; 95% CI, 1.53-2.14) and that among obese patients, early PJI occurrence was higher than was late PJI occurrence. In addition, the mixed model indicated that obese patients were more likely to develop early PJIs than were patients with diabetes mellitus. Conclusions: Patients with diabetes mellitus and obese patients were more likely to develop PJIs than were patients without diabetes mellitus and non-obese patients, and that obese patients were more likely to develop early PJIs than late PJIs. Also, obese patients were more likely to develop early PJIs than patients with diabetes mellitus.
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Affiliation(s)
- Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yu-Xuan Peng
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
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Berli MC, Azaiez N, Götschi T, Pfirrmann CWA, Uçkay I, Sutter R, Waibel FWA, Rosskopf AB. Muscle atrophy in diabetic patients with Charcot foot: a case-control study. Skeletal Radiol 2023; 52:1661-1668. [PMID: 36997748 PMCID: PMC10348944 DOI: 10.1007/s00256-023-04328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/19/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To evaluate the distribution and severity of muscle atrophy in diabetic patients with active Charcot foot (CF) compared to diabetic patients without CF. Furthermore, to correlate the muscle atrophy with severity of CF disease. MATERIAL/METHODS In this retrospective study, MR images of 35 diabetic patients (21 male, median:62.1 years ± 9.9SD) with active CF were compared with an age- and gender-matched control group of diabetic patients without CF. Two readers evaluated fatty muscle infiltration (Goutallier-classification) in the mid- and hindfoot. Furthermore, muscle trophic (cross-sectional muscle area (CSA)), intramuscular edema (none/mild versus moderate/severe), and the severity of CF disease (Balgrist Score) were assessed. RESULTS Interreader correlation for fatty infiltration was substantial to almost perfect (kappa-values:0.73-1.0). Frequency of fatty muscle infiltration was high in both groups (CF:97.1-100%; control:77.1-91.4%), but severe infiltration was significantly more frequent in CF patients (p-values: < 0.001-0.043). Muscle edema was also frequently seen in both groups, but significantly more often in the CF group (p-values: < 0.001-0.003). CSAs of hindfoot muscles were significantly smaller in the CF group. For the flexor digitorum brevis muscle, a cutoff value of 139 mm2 (sensitivity:62.9%; specificity:82.9%) in the hindfoot was found to differentiate between CF disease and the control group. No correlation was seen between fatty muscle infiltration and the Balgrist Score. CONCLUSION Muscle atrophy and muscle edema are significantly more severe in diabetic patients with CF disease. Muscle atrophy does not correlate with the severity of active CF disease. A CSA < 139 mm2 of the flexor digitorum brevis muscle in the hindfoot may indicate CF disease.
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Affiliation(s)
- Martin C Berli
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicolas Azaiez
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tobias Götschi
- Unit for Clinical and Applied Research (UCAR), Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Ilker Uçkay
- Unit for Clinical and Applied Research (UCAR), Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Felix W A Waibel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrea B Rosskopf
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Rehmann R, Enax-Krumova E, Meyer-Frießem CH, Schlaffke L. Quantitative muscle MRI displays clinically relevant myostructural abnormalities in long-term ICU-survivors: a case-control study. BMC Med Imaging 2023; 23:38. [PMID: 36934222 PMCID: PMC10024415 DOI: 10.1186/s12880-023-00995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/08/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Long-term data on ICU-survivors reveal persisting sequalae and a reduced quality-of-life even after years. Major complaints are neuromuscular dysfunction due to Intensive care unit acquired weakness (ICUAW). Quantitative MRI (qMRI) protocols can quantify muscle alterations in contrast to standard qualitative MRI-protocols. METHODS Using qMRI, the aim of this study was to analyse persisting myostructural abnormalities in former ICU patients compared to controls and relate them to clinical assessments. The study was conducted as a cohort/case-control study. Nine former ICU-patients and matched controls were recruited (7 males; 54.8y ± 16.9; controls: 54.3y ± 11.1). MRI scans were performed on a 3T-MRI including a mDTI, T2 mapping and a mDixonquant sequence. Water T2 times, fat-fraction and mean values of the eigenvalue (λ1), mean diffusivity (MD), radial diffusivity (RD) and fractional anisotropy (FA) were obtained for six thigh and seven calf muscles bilaterally. Clinical assessment included strength testing, electrophysiologic studies and a questionnaire on quality-of-life (QoL). Study groups were compared using a multivariate general linear model. qMRI parameters were correlated to clinical assessments and QoL questionnaire using Pearson´s correlation. RESULTS qMRI parameters were significantly higher in the patients for fat-fraction (p < 0.001), water T2 time (p < 0.001), FA (p = 0.047), MD (p < 0.001) and RD (p < 0.001). Thighs and calves showed a different pattern with significantly higher water T2 times only in the calves. Correlation analysis showed a significant negative correlation of muscle strength (MRC sum score) with FA and T2-time. The results were related to impairment seen in QoL-questionnaires, clinical testing and electrophysiologic studies. CONCLUSION qMRI parameters show chronic next to active muscle degeneration in ICU survivors even years after ICU therapy with ongoing clinical relevance. Therefore, qMRI opens new doors to characterize and monitor muscle changes of patients with ICUAW. Further, better understanding on the underlying mechanisms of the persisting complaints could contribute the development of personalized rehabilitation programs.
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Affiliation(s)
- R Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany.
| | - E Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - C H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care and Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - L Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
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Chen SP, Ye TT, Hong J, Zhu H. Evaluation of Sciatic Nerve Stiffness Using Shear Wave Elastography in Patients with Unilateral Diabetic Foot Ulcers. Diagnostics (Basel) 2023; 13:diagnostics13030547. [PMID: 36766650 PMCID: PMC9914609 DOI: 10.3390/diagnostics13030547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the stiffness of the sciatic nerve by shear wave elastography (SWE) and to determine whether SWE can be used to predict diabetic foot ulcer (DFU) in a patient with diabetic peripheral neuropathy (DPN). METHODS Sixteen patients (thirty-two lower limbs) with unilateral DFU were studied retrospectively. The ultrasonographic parameters including cross-sectional area (CSA) of sciatic nerve, intraneural blood flow, peak systolic velocity (Vmax) and resistive index (RI) in the intraneural artery of the sciatic nerve, and the SWE stiffness value of the sciatic nerve were measured. The examinations of arteries of the lower limbs were also performed by ultrasound. According to the presence or absence of DFU, the 32 lower limbs were divided into two groups: the DFU group and the non-DFU group. The ultrasonographic parameters were compared between these two groups. RESULTS There was no significant difference (p > 0.05) between the two groups for CSA, intraneural blood flow, Vmax and RI in the intraneural artery of the sciatic nerve, and numbers of severe artery stenosis or full occlusion of the artery in the lower limbs. However, SWE stiffness values in the sciatic nerve in the DFU group are higher than the non-DFU group (p < 0.05). When the SWE stiffness values were used for prediction of DFU in patients with DPN, the area under the ROC curve (AUC) was 0.727 (95% CI: 0.541-0.868). When the best SWE stiffness value of 24.48 kPa was taken as a cutoff for prediction of DFU, the sensitivity was 62.50% (95% CI: 35.4-84.8%), and the specificity was 75% (95% CI: 47.6-92.7%). CONCLUSIONS Sciatic nerve stiffness is significantly higher in lower limbs with DFU. SWE is a noninvasive imaging method that may be used to evaluate sciatic nerve stiffness, then potentially predict DFU in patients with DPN.
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Affiliation(s)
- Shun-Ping Chen
- Department of Ultrasonography, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: (S.-P.C.); (H.Z.)
| | - Ting-Ting Ye
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jing Hong
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Hong Zhu
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: (S.-P.C.); (H.Z.)
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Rosen KA, Thodge A, Tang A, Franz BM, Klochko CL, Soliman SB. The sonographic quantitative assessment of the deltoid muscle to detect type 2 diabetes mellitus: a potential noninvasive and sensitive screening method? BMC Endocr Disord 2022; 22:193. [PMID: 35897066 PMCID: PMC9330649 DOI: 10.1186/s12902-022-01107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In our previous published study, we demonstrated that a qualitatively assessed elevation in deltoid muscle echogenicity on ultrasound was both sensitive for and a strong predictor of a type 2 diabetes (T2DM) diagnosis. This study aims to evaluate if a sonographic quantitative assessment of the deltoid muscle can be used to detect T2DM. METHODS Deltoid muscle ultrasound images from 124 patients were stored: 31 obese T2DM, 31 non-obese T2DM, 31 obese non-T2DM and 31 non-obese non-T2DM. Images were independently reviewed by 3 musculoskeletal radiologists, blinded to the patient's category. Each measured the grayscale pixel intensity of the deltoid muscle and humeral cortex to calculate a muscle/bone ratio for each patient. Following a 3-week delay, the 3 radiologists independently repeated measurements on a randomly selected 40 subjects. Ratios, age, gender, race, body mass index, insulin usage and hemoglobin A1c were analyzed. The difference among the 4 groups was compared using analysis of variance or chi-square tests. Both univariate and multivariate linear mixed models were performed. Multivariate mixed-effects regression models were used, adjusting for demographic and clinical variables. Post hoc comparisons were done with Bonferroni adjustments to identify any differences between groups. The sample size achieved 90% power. Sensitivity and specificity were calculated based on set threshold ratios. Both intra- and inter-radiologist variability or agreement were assessed. RESULTS A statistically significant difference in muscle/bone ratios between the groups was identified with the average ratios as follows: obese T2DM, 0.54 (P < 0.001); non-obese T2DM, 0.48 (P < 0.001); obese non-T2DM, 0.42 (P = 0.03); and non-obese non-T2DM, 0.35. There was excellent inter-observer agreement (intraclass correlation coefficient 0.87) and excellent intra-observer agreements (intraclass correlation coefficient 0.92, 0.95 and 0.94). Using threshold ratios, the sensitivity for detecting T2DM was 80% (95% CI 67% to 88%) with a specificity of 63% (95% CI 50% to 75%). CONCLUSIONS The sonographic quantitative assessment of the deltoid muscle by ultrasound is sensitive and accurate for the detection of T2DM. Following further studies, this process could translate into a dedicated, simple and noninvasive screening method to detect T2DM with the prospects of identifying even a fraction of the undiagnosed persons worldwide. This could prove especially beneficial in screening of underserved and underrepresented communities.
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Affiliation(s)
- Kelli A Rosen
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital/Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Anay Thodge
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital/Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
| | - Brendan M Franz
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital/Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Chad L Klochko
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital/Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital/Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
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Chu X, Du K, Tang Y, Zhao X, Yu M, Zheng Y, Deng J, Lv H, Zhang W, Wang Z, Yuan Y, Meng L. Skeletal Muscle Involvement Pattern of Hereditary Transthyretin Amyloidosis: A Study Based on Muscle MRI. Front Neurol 2022; 13:851190. [PMID: 35592471 PMCID: PMC9112281 DOI: 10.3389/fneur.2022.851190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Objects This study was intended to explore the characteristics of muscle magnetic resonance imaging (MRI) of patients with hereditary transthyretin amyloidosis (ATTRv amyloidosis) prospectively. Methods The clinical data of 20 patients with ATTRv amyloidosis at our hospital between July 2020 and August 2021 were analyzed. MRI of lower limbs including calf muscles was performed in all these 20 patients and MRI of thigh muscles was performed in 16 of them. Results The mean age of the 20 patients with ATTRv amyloidosis was 44.2 years (ranging from 26 to 60) whose mean duration of weakness was 23.3 ± 23.0 (ranging from 0 to 84) months. All the patients presented with polyneuropathy, and 18 of them with weakness in their lower limbs. Muscle involvement was selective in these patients with ATTRv amyloidosis. The posterior group of muscles was heavily fatty, and the soleus muscle was the most heavily involved. The proportion of fatty infiltration scores at the calf level was higher than at the thigh level with paired comparison for most patients. Three of these patients had more severely fatty infiltration of muscles at the thigh level. The fatty infiltration of posterior compartments at the calf level was highly consistent with neuropathy impairment scores of lower limbs (weakness), the strength of ankle plantar flexion muscles, and the amplitude of the compound muscle action potential of the tibial nerve. Conclusions It was found that the pattern of muscle fatty infiltration was consistent with a distal-to-proximal gradient on the whole and that proximal involvements in MRI of lower limbs in some patients could also be observed. Selective fatty infiltration of muscles of posterior compartments and fatty infiltration of the soleus muscle might be typical of ATTRv amyloidosis.
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Affiliation(s)
- Xujun Chu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Kang Du
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuwei Tang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xutong Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
- Yun Yuan
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
- *Correspondence: Lingchao Meng
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10
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Waterval NFJ, Meekes VL, Hooijmans MT, Froeling M, Jaspers RT, Oudeman J, Nederveen AJ, Brehm MA, Nollet F. The relationship between quantitative magnetic resonance imaging of the ankle plantar flexors, muscle function during walking and maximal strength in people with neuromuscular diseases. Clin Biomech (Bristol, Avon) 2022; 94:105609. [PMID: 35247697 DOI: 10.1016/j.clinbiomech.2022.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Progression of plantar flexor weakness in neuromuscular diseases is usually monitored by muscle strength measurements, although they poorly relate to muscle function during walking. Pathophysiological changes such as intramuscular adipose tissue affect dynamic muscle function independent from isometric strength. Diffusion tensor imaging and T2 imaging are quantitative MRI measures reflecting muscular pathophysiological changes, and are therefore potential biomarkers to monitor plantar flexor functioning during walking in people with neuromuscular diseases. METHODS In fourteen individuals with plantar flexor weakness diffusion tensor imaging and T2 scans of the plantar flexors were obtained, and the diffusion indices fractional anisotropy and mean diffusivity calculated. With a dynamometer, maximal isometric plantar flexor strength was measured. 3D gait analysis was used to assess maximal ankle moment and power during walking. FINDINGS Fractional anisotropy, mean diffusivity and T2 relaxation time all moderately correlated with maximal plantar flexor strength (r > 0.512). Fractional anisotropy and mean diffusivity were not related with ankle moment or power (r < 0.288). T2 relaxation time was strongly related to ankle moment (r = -0.789) and ankle power (r = -0.798), and moderately related to maximal plantar flexor strength (r < 0.600). INTERPRETATION In conclusion, T2 relaxation time, indicative of multiple pathophysiological changes, was strongly related to plantar flexor function during walking, while fractional anisotropy and mean diffusivity, indicative of fiber size, only related to maximal plantar flexor strength. This indicates that these measures may be suitable to monitor muscle function and gain insights into the pathophysiological changes underlying a poor plantar flexor functioning during gait in people with neuromuscular diseases.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - V L Meekes
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - M T Hooijmans
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - M Froeling
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, Utrecht, the Netherlands
| | - R T Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - J Oudeman
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, Utrecht, the Netherlands
| | - A J Nederveen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - M A Brehm
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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11
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Filgueiras JR, Sales CP, da Silva IG, Dos Santos CM, Neto EDCM, da Rocha RB, Cardoso VS. Morphological and functional changes in skeletal muscle in type 2 diabetes mellitus: A systematic review and meta-analysis. Physiother Theory Pract 2022:1-27. [PMID: 35345979 DOI: 10.1080/09593985.2022.2057375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Changes in the skeletal muscle are common in patients with type 2 diabetes mellitus (T2DM). These changes impair your motor skills. OBJECTIVE This systematic review aimed to investigate changes in skeletal muscle in patients with T2DM. METHODS The search was carried out in the PubMed, Scopus, and Web of Science databases until December 1, 2021. Observational studies that evaluated musculoskeletal changes in people with T2DM were included. The review was based on PRISMA recommendations. The primary parameters analyzed were muscle strength, muscle mass, muscle power, and muscle endurance. RESULTS Forty-eight studies were included, with a total of 26,042 participants. The results revealed that T2DM is associated with a reduction in handgrip [-2.64 (CI 95% = -3.33 to -1.95, Z = -7.50, p < .0001], and knee extension muscle strength [-0.56 (CI 95% = -0.76 to -0.36, Z = -5.64, p < .0001)], a higher percentage of type II fibers [11.74 (CI 95% = 6.24 to 17.25, Z = 4.18, p < .0001)], and a lower percentage of type I fibers [-15.69 (CI 95% = -18.22 to -13.16, Z = -12.16, p < .0001], in addition to a greater thickness of the calcaneus tendon (p < .0001). CONCLUSION Individuals with T2DM present skeletal muscle impairments, mainly reduced muscle strength, mass, and endurance; increase in the thickness of the calcaneus tendon, and alteration in the proportion of type I and II fibers, even in the initial stage of the disease.
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Affiliation(s)
- Jardeson Rocha Filgueiras
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | - Cleudiane Pereira Sales
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | - Ivanilson Gomes da Silva
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | - Cristiana Maria Dos Santos
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil.,Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | | | | | - Vinicius Saura Cardoso
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil.,Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil.,Center of Medical Specialties. Av. Capitão Claro, Parnaíba-Piauí, Brazil
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12
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Zhao Y, Guo L, Jiang Y, Wu H, Dai J, Cui Y, Mao H, Ju S, Wei Q, Peng XG. Assessment of Calf Skeletal Muscle in Male Type 2 Diabetes Mellitus Patients With Different Courses Using T1ρ Mapping. J Clin Endocrinol Metab 2022; 107:e1699-e1709. [PMID: 34747996 DOI: 10.1210/clinem/dgab817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The current clinical methods for detecting skeletal muscle complications of type 2 diabetes mellitus (T2DM) are invasive and insensitive. There is an urgent need for noninvasive assessment of skeletal muscle microstructure changes during the disease progression and treatment to assist the clinical management. OBJECTIVE This work aimed to investigate the T2DM caused changes in the fast-twitch tibialis anterior (TA) and slow-twitch soleus (SOL) skeletal muscles using T1ρ magnetic resonance imaging (MRI). METHODS This cross-sectional study took place from December 2014 to December 2020 at Zhongda Hospital Southeast University. A total of 26 new-onset and 15 long-term T2DM patients were enrolled, with the addition of 20 young and 13 older healthy volunteers as age-matched controls. T1ρ relaxation times of SOL and TA muscles in different groups were measured. Parametric and nonparametric tests were used to analyze the relationship between the T1ρ values in SOL and TA muscles and the length of illness, level of fasting blood glucose, and status of homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS T1ρ relaxation times of SOL and TA muscles both of new-onset and long-term T2DM patients were significantly higher than those of the young (P < .01, P < .05) and older healthy controls (P < .05, P < .01). Positive correlations were observed between the T1ρ relaxation times of the TA or SOL and the duration of T2DM (R2 = 0.420, R2 = 0.326), the level of fasting blood glucose (R2 = 0.253, R2 = 0.071) and HOMA-IR (R2 = 0.232, R2 = 0.414). CONCLUSION Quantitative MRI measurement of T1ρ provides a noninvasive tool to assess T2DM-induced changes in the skeletal muscles of T2DM patients.
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Affiliation(s)
- Yufei Zhao
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Li Guo
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing 210009, China
| | - Yang Jiang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Honghong Wu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Jingyue Dai
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Ying Cui
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia 30329, USA
| | - Shenghong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Qiong Wei
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing 210009, China
| | - Xin-Gui Peng
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
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13
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Chen X, Wang W, Huang J, Wu J, Chen L, Cai C, Cai S, Chen Z. Ultrafast water–fat separation using deep learning–based single‐shot MRI. Magn Reson Med 2022; 87:2811-2825. [DOI: 10.1002/mrm.29172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Xinran Chen
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
| | - Wei Wang
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
| | - Jianpan Huang
- Department of Biomedical Engineering City University of Hong Kong Hong Kong People’s Republic of China
| | - Jian Wu
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
| | - Lin Chen
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
| | - Congbo Cai
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
| | - Shuhui Cai
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
| | - Zhong Chen
- Department of Electronic Science Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance School of Electronic Science and Engineering National Model Microelectronics College Xiamen University Xiamen Fujian People’s Republic of China
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14
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Orlando G, Balducci S, Boulton AJM, Degens H, Reeves ND. Neuromuscular dysfunction and exercise training in people with diabetic peripheral neuropathy: A narrative review. Diabetes Res Clin Pract 2022; 183:109183. [PMID: 34929255 DOI: 10.1016/j.diabres.2021.109183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a common condition that is associated with neuromuscular dysfunction and peripheral sensory impairment. These deficits predispose patients to sensory and motor system limitations, foot ulcers and a high risk of falls. Exercise training has been proposed as an effective tool to alleviate neural deficits and improve whole-body function. Here we review the effects of DPN on neuromuscular function, the mechanisms underlying this impairment, and the neural and muscular adaptations to exercise training. Muscle dysfunction is an early hallmark of DPN. Deficits in muscle strength, power, mass and a greater fatigability are particularly severe in the lower extremity muscles. Non-enzymatic glycation of motor proteins, impaired excitation-contraction coupling and loss of motor units have been indicated as the main factors underlying muscular dysfunction. Among the exercise-based solutions, aerobic training improves neural structure and function and ameliorates neuropathic signs and symptoms. Resistance training induces marked improvement of muscle performance and may alleviate neuropathic pain. A combination of aerobic and resistance training (i.e., combined training) restores small sensory nerve damage, reduces symptoms, and improves muscle function. The evidence so far suggests that exercise training is highly beneficial and should be included in the standard care for DPN patients.
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Affiliation(s)
- Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
| | | | - Andrew J M Boulton
- Department of Medicine, Manchester Royal Infirmary, Manchester, UK; Diabetes Research Institute, University of Miami, Miami, FL, USA
| | - Hans Degens
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK; Lithuanian Sport University, Kaunas, Lithuania
| | - Neil D Reeves
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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15
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Brown R, Sharafi A, Slade JM, Convit A, Davis N, Baete S, Milton H, Mroczek KJ, Kluding PM, Regatte RR, Parasoglou P, Rao S. Lower extremity MRI following 10-week supervised exercise intervention in patients with diabetic peripheral neuropathy. BMJ Open Diabetes Res Care 2021; 9:9/1/e002312. [PMID: 34518157 PMCID: PMC8438733 DOI: 10.1136/bmjdrc-2021-002312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS Twenty participants with DPN completed a longitudinal trial consisting of a 30-day control period, during which subjects made no change to their lifestyle, followed by a 10-week intervention program that included three supervised aerobic and resistance exercise sessions per week targeting the upper and lower extremities. The participants' midcalves were scanned with multinuclear MRI two times prior to intervention (baseline1 and baseline2) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters. RESULTS There were no changes between baseline1 and baseline2 MRI metrics (p>0.2). Significant changes (p<0.05) between baseline2 and postintervention MRI metrics were: gastrocnemius medialis (GM) T1 -2.3%±3.0% and soleus T2 -3.2%±3.1%. Trends toward significant changes (0.05<p<0.1) between baseline2 and postintervention MRI metrics were: calf adipose infiltration -2.6%±6.4%, GM T1ρ -4.1%±7.7%, GM T2 -3.5%±6.4%, and gastrocnemius lateral T2 -4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4). CONCLUSIONS The 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity.
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Affiliation(s)
- Ryan Brown
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Azadeh Sharafi
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Antonio Convit
- Department of Psychiatry, New York University Grossman School of Medicine, New York City, New York, USA
- Department of Psychiatry, Nathan S Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Nathan Davis
- Department of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - Steven Baete
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Heather Milton
- Sports Performance Center, New York University Langone Health, New York City, New York, USA
| | - Kenneth J Mroczek
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York City, New York, USA
| | - Patricia M Kluding
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ravinder R Regatte
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Prodromos Parasoglou
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Smita Rao
- Department of Physical Therapy, New York University, New York City, New York, USA
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16
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Reeves ND, Orlando G, Brown SJ. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050457. [PMID: 34066681 PMCID: PMC8150714 DOI: 10.3390/medicina57050457] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.
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17
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Weidensteiner C, Madoerin P, Deligianni X, Haas T, Bieri O, Akinci D'Antonoli T, Bracht-Schweizer K, Romkes J, De Pieri E, Santini F, Rutz E, Brunner R, Garcia M. Quantification and Monitoring of the Effect of Botulinum Toxin A on Paretic Calf Muscles of Children With Cerebral Palsy With MRI: A Preliminary Study. Front Neurol 2021; 12:630435. [PMID: 33935939 PMCID: PMC8085320 DOI: 10.3389/fneur.2021.630435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Muscles from patients with cerebral palsy (CP) are often spastic and form contractures that limit the range of motion. Injections of botulinum toxin A (BTX) into the calf muscles are an important treatment for functional equinus; however, improvement in gait function is not always achieved. BTX is also used to test muscle weakening for risk evaluation of muscle lengthening surgery. Our aim was to assess the effect of BTX over time on calf muscle properties in pediatric CP patients with MRI. Material and Methods: Six toe-walking CP patients (mean age 11.6 years) with indication for lengthening surgery were prospectively enrolled and received BTX injections into the gastrocnemius and soleus muscles. MRI scans at 3T of the lower legs and clinical examinations were performed pre-BTX, 6 weeks (6w), and 12 weeks (12w) post-BTX. A fat-suppressed 2D multi-spin-echo sequence was used to acquire T2 maps and for segmentation. Fat fraction maps were calculated from 3D multi-echo Dixon images. Diffusion tensor imaging (DTI) with a 2D echo-planar imaging (EPI) sequence yielded maps of the mean apparent diffusion coefficient (ADC) and of the fractional anisotropy (FA). Hyperintense regions of interest (ROIs) on the T2-weighted (T2w) images at 6w were segmented in treated muscles. Mean values of T2, fat fraction, ADC, and FA were calculated in hyperintense ROIs and in reference ROIs in non-treated muscles. Results: Hyperintensity on T2w scans and increased T2 (group mean ± standard deviation: 35 ± 1 ms pre-BTX, 45 ± 2 ms at 6w, and 44 ± 2 ms at 12w) were observed in all patients at the injection sites. The T2 increase was spatially limited to parts of the injected muscles. FA increased (0.30 ± 0.03 pre-BTX, 0.34 ± 0.02 at 6w, and 0.36 ± 0.03 at 12w) while ADC did not change in hyperintense ROIs, indicating a BTX-induced increase in extracellular space and a simultaneous decrease of muscle fiber diameter. Fat fraction showed a trend for increase at 12w. Mean values in reference ROIs remained unchanged. Conclusion: MRI showed limited spatial distribution of the BTX-induced effects in pediatric CP patients. It could be a promising non-invasive tool for future studies to test BTX treatment protocols.
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Affiliation(s)
- Claudia Weidensteiner
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philipp Madoerin
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland
| | - Xeni Deligianni
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Tugba Akinci D'Antonoli
- Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Radiology, University Children's Hospital Basel, Basel, Switzerland
| | | | - Jacqueline Romkes
- Laboratory for Movement Analysis, University Children's Hospital Basel, Basel, Switzerland
| | - Enrico De Pieri
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Laboratory for Movement Analysis, University Children's Hospital Basel, Basel, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Erich Rutz
- Murdoch Children's Research Insitute, The University of Melbourne, Pediatric Orthopedic Department, The Royal Children's Hospital, Parkville, VIC, Australia.,Faculty of Medicine, The University of Basel, Basel, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University Children's Hospital Basel, Basel, Switzerland.,Department of Orthopedic Surgery, University Children's Hospital Basel, Basel, Switzerland
| | - Meritxell Garcia
- Department of Radiology, Division of Neuroradiology, University Hospital of Basel, Basel, Switzerland
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Sneag DB, Tan ET. Can Quantitative MRI Be Used to Differentiate Physiologic Changes Behind Muscle Weakness in Type 2 Diabetes Mellitus? Radiology 2020; 297:620-621. [PMID: 33064035 PMCID: PMC7706872 DOI: 10.1148/radiol.2020203768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Darryl B. Sneag
- From the MRI Laboratory, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Ek T. Tan
- From the MRI Laboratory, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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