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Neubauer-Geryk J, Myśliwiec M, Bieniaszewski L. Gender-Related Difference in Skin Oxygenation in Young Patients with Uncomplicated Type 1 Diabetes. Biomedicines 2024; 12:1413. [PMID: 39061987 PMCID: PMC11274177 DOI: 10.3390/biomedicines12071413] [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: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Gender, through genetic, epigenetic and hormonal regulation, is an important modifier of the physiological mechanisms and clinical course of diseases. In diabetes mellitus, there are gender differences in incidence, prevalence, morbidity, and mortality. This disease also has an impact on the microvascular function. Therefore, this cross-sectional study was designed to investigate how gender affects the cutaneous microcirculation. We hypothesized that gender should be an important factor in the interpretation of capillaroscopy and transcutaneous oxygen saturation results. The study group consisted of 42 boys and 55 girls, uncomplicated diabetic pediatric patients. Females (F) and males (M) did not differ in terms of age, age at onset of diabetes, or diabetes duration. Furthermore, they did not differ in metabolic parameters. The comparison showed that group F had lower BP, higher pulse, and higher HR than group M. Group F had significantly lower creatinine and hemoglobin levels than group M. In children and adolescents with type 1 diabetes without complications, there was a gender difference in microcirculatory parameters. The resting transcutaneous partial pressure of oxygen was significantly higher in females than in males. However, there were no gender-related differences in basal capillaroscopic parameters or vascular reactivity during the PORH test. Our results indicate that studies investigating the structure and function of the microcirculation should consider the role of gender in addition to known cofactors such as puberty, body mass index, physical activity, and cigarette smoking.
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Affiliation(s)
- Jolanta Neubauer-Geryk
- Clinical Physiology Unit, Medical Simulation Centre, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Leszek Bieniaszewski
- Clinical Physiology Unit, Medical Simulation Centre, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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2
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Moghaddaszadeh A, Roudier E, Edgell H, Vinet A, Belcastro AN. A 5-Week Guided Active Play Program Modulates Skin Microvascular Reactivity in Healthy Children. Pediatr Exerc Sci 2024:1-10. [PMID: 38684217 DOI: 10.1123/pes.2023-0138] [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: 09/17/2023] [Revised: 01/28/2024] [Accepted: 02/12/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Children's poor levels of physical activity (PA) participation and early-onset vascular aging are identified as global health challenges. Children's guided activity play (GAP)-based PA programs have emerged as effective strategies to improve cardiovascular risk factors and health-related fitness. This study proposes to investigate whether GAP improves children's cutaneous microvascular reactivity and health-related fitness. METHODS Children's (n = 18; 9.8 [1.5] y) PA during a 5-week (4 d/wk; 1 h/d) GAP program was assessed (accelerometry) with preassessments and postassessments for anthropometric, musculoskeletal fitness, blood pressure, estimated aerobic power, and cutaneous microvascular reactivity. RESULTS PA averaged 556 (132) kcal·week-1 at 34.7% (7.5%) time at moderate to vigorous intensity. Resting heart rate (-9.5%) and diastolic blood pressure (-7.8%) were reduced without changes in health-related fitness indices. Cutaneous microvascular reactivity to sodium nitroprusside iontophoresis increased the average perfusion (+36.8%), average cutaneous vascular conductance (+30%), the area under the curve (+28.8%), and a faster rise phase (+40%) of perfusion (quadratic modeling; P ≤ .05). Chi-square and crosstabulation analysis revealed significant association between children's PA levels and sodium nitroprusside average perfusion levels, where children with PA levels ≥205.1 kcal.55 minute-1 were overrepresented in the medium/high levels of sodium nitroprusside perfusion. CONCLUSION A 5-week GAP modified the microvascular reactivity in children without changes in body mass, musculoskeletal fitness, or estimated aerobic power.
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Affiliation(s)
- Asal Moghaddaszadeh
- Pediatric Exercise Physiology Laboratory, Faculty of Health, York University, Toronto, ON,Canada
| | - Emilie Roudier
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON,Canada
- Muscle Health Research Center, York University, Toronto, ON,Canada
| | - Heather Edgell
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON,Canada
- Muscle Health Research Center, York University, Toronto, ON,Canada
| | - Agnes Vinet
- Laboratoire de Physiologie Expérimentale Cardiovasculaire, Faculté des Sciences, Avignon Université, Avignon,France
| | - Angelo N Belcastro
- Pediatric Exercise Physiology Laboratory, Faculty of Health, York University, Toronto, ON,Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON,Canada
- Muscle Health Research Center, York University, Toronto, ON,Canada
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3
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Ratter-Rieck JM, Roden M, Herder C. Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia 2023; 66:1003-1015. [PMID: 36964771 PMCID: PMC10039694 DOI: 10.1007/s00125-023-05901-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/26/2023]
Abstract
Climate change will be a major challenge for the world's health systems in the coming decades. Elevated temperatures and increasing frequencies of heat waves, wildfires, heavy precipitation and other weather extremes can affect health in many ways, especially if chronic diseases are already present. Impaired responses to heat stress, including compromised vasodilation and sweating, diabetes-related comorbidities, insulin resistance and chronic low-grade inflammation make people with diabetes particularly vulnerable to environmental risk factors, such as extreme weather events and air pollution. Additionally, multiple pathogens show an increased rate of transmission under conditions of climate change and people with diabetes have an altered immune system, which increases the risk for a worse course of infectious diseases. In this review, we summarise recent studies on the impact of climate-change-associated risk for people with diabetes and discuss which individuals may be specifically prone to these risk conditions due to their clinical features. Knowledge of such high-risk groups will help to develop and implement tailored prevention and management strategies to mitigate the detrimental effect of climate change on the health of people with diabetes.
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Affiliation(s)
- Jacqueline M Ratter-Rieck
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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4
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Zou W, Liu B, Wang Y, Shi F, Pang S. Metformin attenuates high glucose-induced injury in islet microvascular endothelial cells. Bioengineered 2022; 13:4385-4396. [PMID: 35139776 PMCID: PMC8973819 DOI: 10.1080/21655979.2022.2033411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
As one of the most frequently prescribed antidiabetic drugs, metformin can lower glucose levels, improve insulin resistance manage body weight. However, the effect of metformin on islet microcirculation remains unclear. In the present study, to explore the effect of metformin on islet endothelial cells and investigated the underlying mechanism, we assessed the effects of metformin on islet endothelial cell survival, proliferation, oxidative stress and apoptosis. Our results suggest that metformin stimulates the proliferation of pancreatic islet endothelial cells and inhibits the apoptosis and oxidative stress caused by high glucose levels. By activating farnesoid X receptor (FXR), metformin increases the expression of vascular endothelial growth factor-A (VEGF-A) and endothelial nitric oxide synthase (eNOS), improves the production of nitric oxide (NO) and decreases the production of ROS. After the inhibition of FXR or VEGF-A, all of the effects disappeared. Thus, metformin appears to regulate islet microvascular endothelial cell (IMEC) proliferation, apoptosis and oxidative stress by activating the FXR/VEGF-A/eNOS pathway. These findings provide a new mechanism underlying the islet-protective effect of metformin.
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Affiliation(s)
- Wenyu Zou
- Department of endocrinologyEndocrinology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bingkun Liu
- Department of Cardiology, Yidu Central Hospital of Weifang, Weifang, China
| | - Yulu Wang
- Department of Internal Medicine, Weifang Medical University, Weifang, China
| | - Fangbin Shi
- Department of endocrinologyEndocrinology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuguang Pang
- Department of endocrinologyEndocrinology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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5
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Wang B, Zhang X, Liu M, Li Y, Zhang J, Li A, Zhang H, Xiu R. Insulin protects against type 1 diabetes mellitus-induced ultrastructural abnormalities of pancreatic islet microcirculation. Microscopy (Oxf) 2021; 69:381-390. [PMID: 32648910 PMCID: PMC7711913 DOI: 10.1093/jmicro/dfaa036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/30/2022] Open
Abstract
Pancreatic islet microcirculation, consisting of pancreatic islet microvascular endothelial cells (IMECs) and pericytes (IMPCs), provides crucial support for the physiological function of pancreatic islet. Emerging evidence suggests that pancreatic islet microcirculation is impaired in type 1 diabetes mellitus (T1DM). Here, we investigated the potential ultrastructural protective effects of insulin against streptozotocin (STZ)-induced ultrastructural abnormalities of the pancreatic islet microcirculation in T1DM mouse model. For this purpose, pancreatic tissues were collected from control, STZ-induced T1DM and insulin-treated mice, and a pancreatic IMECs cell line (MS1) was cultured under control, 35 mM glucose with or without 10−8 M insulin conditions. Transmission and scanning electron microscopies were employed to evaluate the ultrastructure of the pancreatic islet microcirculation. We observed ultrastructural damage to IMECs and IMPCs in the type 1 diabetic group, as demonstrated by destruction of the cytoplasmic membrane and organelles (mainly mitochondria), and this damage was substantially reversed by insulin treatment. Furthermore, insulin inhibited collagenous fiber proliferation and alleviated edema of the widened pancreatic islet exocrine interface in T1DM mice. We conclude that insulin protects against T1DM-induced ultrastructural abnormalities of the pancreatic islet microcirculation.
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Affiliation(s)
- Bing Wang
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Xu Zhang
- Laboratory of Electron Microscopy, Pathology Center, Peking University First Hospital, Beijing, 100034, China
| | - Mingming Liu
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.,Diabetes Research Center, Chinese Academy of Medical Science, Beijing 100005, China
| | - Yuan Li
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Jian Zhang
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.,Diabetes Research Center, Chinese Academy of Medical Science, Beijing 100005, China
| | - Ailing Li
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Honggang Zhang
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Ruijuan Xiu
- Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
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6
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Profiling the endothelial function using both peripheral artery tonometry (EndoPAT) and Laser Doppler Flowmetry (LD) - Complementary studies or waste of time? Microvasc Res 2020; 130:104008. [PMID: 32330479 DOI: 10.1016/j.mvr.2020.104008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction (ED) plays a key role in developing of cardiovascular diseases and is an important predictor of future cardiovascular events. Nevertheless, there is no established method assessing endothelial function in general population. The most popular protocol includes the ultrasound-flow-mediated-dilation, but its repeatability is operator-dependent. We intended to compare the two other operator-independent methods assessing endothelial function - the EndoPAT and Laser Doppler flowmetry (LD), and we endeavored to place them on current individual profile of biochemical cardiovascular risk and endothelial function. A total of 61 clinically healthy subjects (aged 29 ± 1y) were investigated. The blood was collected for conventional cardiovascular risk markers, the NO-pathway metabolites (ADMA, L-arginine, SDMA), oxidative-stress-markers (MDA, thiol-index) as well as endothelial and platelet activation markers (sICAM1, sVCAM1, PAI-1, sE-selectin, sP-selectin, VEGF). Subsequently, all participants underwent examination by both EndoPAT and LD. There was a poor correlation between EndoPAT and LD results. No significant differences between participants with preserved and impaired endothelial function regarding endothelial activation nor cardiovascular risk markers were observed. Both methods assess endothelial function independently from the profile of endothelial pro/anti-inflammatory status and conventional risk factors, therefore further prospective studies are needed in order to verify their additional value in the cardiovascular risk stratification.
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7
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Madhloum N, Luyten LJ, Provost EB, De Boever P, Dockx Y, Sleurs H, Plusquin M, Roodt JO, Vrijens K, Nawrot TS. Establishing reference values for macro- and microvascular measurements in 4-to-5 year-old children of the ENVIRONAGE prospective birth cohort. Sci Rep 2020; 10:5107. [PMID: 32198402 PMCID: PMC7083909 DOI: 10.1038/s41598-020-61987-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular risk factors are usually better tolerated, and can therefore be perceived as less harmful, at a young age. However, over time the effects of these adverse factors may persist or accumulate and lead to excess morbidity and mortality from cardiovascular diseases later in life. Until now, reference values for the basic cardiovascular health characteristics of 4-to-6 year-old children are lacking. Within a follow-up study of the ENVIRONAGE (ENVIRonmental influence ON early AGE) birth cohort we assessed various cardiovascular measurements in 288 children aged 4–5 years. For the macrovasculature, we measured their blood pressure and examined the intima-media thickness of the carotid artery (CIMT), the arterial elasticity (including the pulse-wave velocity (PWV), carotid distensibility (DC) and compliance (CC) coefficients), the carotid β stiffness index (SIβ) and Young’s Elastic Modulus (YEM). Retinal microvascular traits included the Central Retinal Arteriolar Equivalent (CRAE) and Central Retinal Venular Equivalent (CRVE). Age of the study population averaged (±SD) 4.2 (±0.4 years. Mean systolic and diastolic blood pressure were 97.9 (±8.1) mmHg and 54.7(±7.6) mmHg, respectively. CIMT for the total population averaged 487.1 (±68.1) µm. The average stiffness values for DC, CC, SIβ, and PWV were 78.7 (±34.2) 10−³/kPa, 1.61 (±0.59) mm2/kPa and 4.4 (±2.4), and 3.7 m/s (±0.9) respectively. The mean determined for YEM was 163.2 kPa (±79.9). Concerning the microvasculature, the average CRAE was 180.9 (±14.2) µm and the corresponding value for CRVE was 251.0 (±19.7) µm. In contrast to the macrovasculature, a significant gender-related difference existed for the microvasculature: in boys, both the CRAE (178.8 µm vs 182.6 µm; p = 0.03) and CRVE (247.9 µm vs 254.0 µm; p = 0.01) were narrower than in girls. We have provided reference values for young children to understand changes in the early cardiovascular health trajectory. Establishing these reference values of cardiovascular phenotypes at this young age is necessary to develop targeted health promotion strategies as well as for better understanding of the life course changes of both small and large blood vessels.
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Affiliation(s)
- Narjes Madhloum
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Leen J Luyten
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Unité de Recherche en Biologie Cellulaire (URBC) - Namur Research Institute for Life Sciences (Narilis), Namur University, Namur, Belgium
| | - Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Yinthe Dockx
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Jos Op't Roodt
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Karen Vrijens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium. .,Department of Public Health & Primary Care, Occupational and Environmental Medicine, Leuven University, Leuven, Belgium.
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8
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Abstract
OBJECTIVES Cardiopulmonary bypass-induced endothelial dysfunction has been inferred by changes in pulmonary vascular resistance, alterations in circulating biomarkers, and postoperative capillary leak. Endothelial-dependent vasomotor dysfunction of the systemic vasculature has never been quantified in this setting. The objective of the present study was to quantify acute effects of cardiopulmonary bypass on endothelial vasomotor control and attempt to correlate these effects with postoperative cytokines, tissue edema, and clinical outcomes in infants. DESIGN Single-center prospective observational cohort pilot study. SETTING Pediatric cardiac ICU at a tertiary children's hospital. PATIENTS Children less than 1 year old requiring cardiopulmonary bypass for repair of a congenital heart lesion. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Laser Doppler perfusion monitoring was coupled with local iontophoresis of acetylcholine (endothelium-dependent vasodilator) or sodium nitroprusside (endothelium-independent vasodilator) to quantify endothelial-dependent vasomotor function in the cutaneous microcirculation. Measurements were obtained preoperatively, 2-4 hours, and 24 hours after separation from cardiopulmonary bypass. Fifteen patients completed all laser Doppler perfusion monitor (Perimed, Järfälla, Sweden) measurements. Comparing prebypass with 2-4 hours postbypass responses, there was a decrease in both peak perfusion (p = 0.0006) and area under the dose-response curve (p = 0.005) following acetylcholine, but no change in responses to sodium nitroprusside. Twenty-four hours after bypass responsiveness to acetylcholine improved, but typically remained depressed from baseline. Conserved endothelial function was associated with higher urine output during the first 48 postoperative hours (R = 0.43; p = 0.008). CONCLUSIONS Cutaneous endothelial dysfunction is present in infants immediately following cardiopulmonary bypass and recovers significantly in some patients within 24 hours postoperatively. Confirmation of an association between persistent endothelial-dependent vasomotor dysfunction and decreased urine output could have important clinical implications. Ongoing research will explore the pattern of endothelial-dependent vasomotor dysfunction after cardiopulmonary bypass and its relationship with biochemical markers of inflammation and clinical outcomes.
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Trefz P, Obermeier J, Lehbrink R, Schubert JK, Miekisch W, Fischer DC. Exhaled volatile substances in children suffering from type 1 diabetes mellitus: results from a cross-sectional study. Sci Rep 2019; 9:15707. [PMID: 31673076 PMCID: PMC6823423 DOI: 10.1038/s41598-019-52165-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
Monitoring metabolic adaptation to type 1 diabetes mellitus in children is challenging. Analysis of volatile organic compounds (VOCs) in exhaled breath is non-invasive and appears as a promising tool. However, data on breath VOC profiles in pediatric patients are limited. We conducted a cross-sectional study and applied quantitative analysis of exhaled VOCs in children suffering from type 1 diabetes mellitus (T1DM) (n = 53) and healthy controls (n = 60). Both groups were matched for sex and age. For breath gas analysis, a very sensitive direct mass spectrometric technique (PTR-TOF) was applied. The duration of disease, the mode of insulin application (continuous subcutaneous insulin infusion vs. multiple daily insulin injection) and long-term metabolic control were considered as classifiers in patients. The concentration of exhaled VOCs differed between T1DM patients and healthy children. In particular, T1DM patients exhaled significantly higher amounts of ethanol, isopropanol, dimethylsulfid, isoprene and pentanal compared to healthy controls (171, 1223, 19.6, 112 and 13.5 ppbV vs. 82.4, 784, 11.3, 49.6, and 5.30 ppbV). The most remarkable differences in concentrations were found in patients with poor metabolic control, i.e. those with a mean HbA1c above 8%. In conclusion, non-invasive breath testing may support the discovery of basic metabolic mechanisms and adaptation early in the progress of T1DM.
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Affiliation(s)
- Phillip Trefz
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany.
| | - Juliane Obermeier
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Ruth Lehbrink
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Jochen K Schubert
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Wolfram Miekisch
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
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10
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Fei W, Xu S, Ma J, Zhai W, Cheng S, Chang Y, Wang X, Gao J, Tang H, Yang S, Zhang X. Fundamental supply of skin blood flow in the Chinese Han population: Measurements by a full-field laser perfusion imager. Skin Res Technol 2018; 24:656-662. [PMID: 29740880 DOI: 10.1111/srt.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin blood flow is believed to link with many diseases, and shows a significant heterogeneity. There are several papers on basal cutaneous microcirculation perfusion in different races, while the data in Chinese is vacant. OBJECTIVE The aim was to establish the database of absolute fundamental supply of skin blood flow in the Chinese Han population. METHODS With a full-field laser perfusion imager (FLPI), the skin blood flow can be quantified. Cutaneous perfusion values were determined in 17 selected skin areas in 406 healthy participants aged between 20 and 80 years (mean 35.05 ± 11.33). Essential parameters such as weight, height were also measured and values of BMI were calculated. The perfusion values were reported in Arbitrary Perfusion Units (APU). RESULTS The highest cutaneous perfusion value fell on eyelid (931.20 ± 242.59 in male and 967.83 ± 225.49 in female), and pretibial had the lowest value (89.09 ± 30.28 in male and 85.08 ± 33.59 in female). The values were higher in men than women on the bank of fingertips, nose, forehead, cheek, neck and earlobe (P < .05). Perfusion values on stretch and flexion side of forearm had negative correlation with age (P = .01 and P = 4.88 × 10-3 , respectively) in male. Abdomen was negatively correlated with BMI in both gender (P = .02, respectively). CONCLUSIONS Skin blood flow values vary with skin regions. There is a tendency to measure higher perfusion values in men than in women. And the values are irrelevant with age or BMI.
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Affiliation(s)
- W Fei
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - S Xu
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - J Ma
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - W Zhai
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - S Cheng
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - Y Chang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - X Wang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - J Gao
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - H Tang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - S Yang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - X Zhang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
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11
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The corneal subbasal nerve plexus and thickness of the retinal layers in pediatric type 1 diabetes and matched controls. Sci Rep 2018; 8:14. [PMID: 29311586 PMCID: PMC5758564 DOI: 10.1038/s41598-017-18284-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/05/2017] [Indexed: 11/08/2022] Open
Abstract
Optical coherence tomography (OCT) of the retina and corneal confocal laser scanning microscopy (CLSM) of the subbasal nerve plexus (SBP) are noninvasive techniques for quantification of the ocular neurodegenerative changes in individuals with type 1 diabetes mellitus (T1DM). In adult T1DM patients these changes are hardly related to T1DM only. Instead, ageing and/or lifestyle associated comorbidities have to be considered as putative confounding variables. Therefore, we investigated pediatric T1DM patients (n = 28; 14.2 ± 2.51 y; duration of disease: 5.39 ± 4.16 y) without clinical signs of diabetic retina disease, neuropathy, vasculopathy or nephropathy and compared our findings with those obtained in healthy controls (n = 46; 14.8 ± 1.89 y). The SBP was characterized by the averaged length, thickness, and tortuosity of nerve fibers as well as the number of branching and connecting points. OCT was used to determine the total thickness of the retina (ALL) and the thickness of each retinal layer. Both methods revealed signs of early neurodegenerative changes, e.g. thinning of distinct retinal layers at the pericentral ring and shortening of corneal nerve fibers that are already present in pediatric T1DM patients. Standardization of instruments and algorithms are urgently required to enable uniform comparison between different groups and define normative values to introduce in the clinical setting.
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Allen A, Welch L, Kirkland K, Trout D, Baron S. Development of a Diabetes Mellitus Knowledge Resource for Clinical Decision Support Assisting Primary Care Physicians With Work-Related Issues. J Occup Environ Med 2017; 59:e236-e239. [PMID: 29116993 PMCID: PMC5884442 DOI: 10.1097/jom.0000000000001181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to describe the process by which a group of subject matter experts (SMEs) in the area of occupational health and primary care developed a clinical decision support (CDS) tool addressing work-related issues, which are important in the care of patients with diabetes mellitus (DM). The CDS is intended for primary care clinicians caring for employed adults with DM. METHODS The SME's selected guidelines for the management of DM in working adults, reviewed pertinent literature, and developed specific recommendations for action in the clinical setting. RESULTS Multiple factors at work may adversely affect DM management. Clinicians can support working patients through education and care strategies to improve control. CONCLUSION Improved recognition of factors at work that can have an impact on DM care provides opportunities for improved management of DM among working adults.
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Affiliation(s)
- Anna Allen
- West Virginia University, School of Public Health, Occupational Medicine Department, Morgantown, West Virginia (Dr Allen); Center for Construction Research and Training, Silver Spring, Maryland (Dr Welch); Association of Occupational and Environmental Health Clinics, Washington, DC (Dr Kirkland); National Institute for Occupational Safety and Health (NIOSH), DSHEFS, Centers for Disease Control and Prevention, Cincinnati, Ohio (Dr Trout); and Queens College, City University of New York, Queens, New York (Dr Baron)
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13
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Kulikov DA, Glazkov AA, Kovaleva YA, Balashova NV, Kulikov AV. Prospects of Laser Doppler flowmetry application in assessment of skin microcirculation in diabetes. DIABETES MELLITUS 2017. [DOI: 10.14341/dm8014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review includes results of scientific and clinical use of laser Doppler flowmetry (LDF) in patients with diabetes mellitus. LDF is a non-invasive method for the quantitative evaluation of microcirculation, which can assess microcirculatory rhythms and conduct functional tests with various impacts, allowing the exploration of regulatory mechanisms of microcirculation.
LDF reveals specific diabetes changes in the regulatory function of microcirculation. Microcirculation disturbances, which are traditionally associated with the pathogenesis of complications, also occur in patients with early disorders of carbohydrate metabolism and may precede the manifestation of diabetes. However, this method is still not applied in clinical practice. In this review, we analysed factors limiting the implementation of LDF in practical medicine and suggest ways to improve its clinical significance.
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14
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Liu M, Zhang X, Li A, Zhang X, Wang B, Li B, Liu S, Li H, Xiu R. Insulin treatment restores islet microvascular vasomotion function in diabetic mice. J Diabetes 2017; 9:958-971. [PMID: 27976498 DOI: 10.1111/1753-0407.12516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/26/2016] [Accepted: 11/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The microcirculation plays an important role in the pathogenesis of diabetes and its complications. We hypothesized that pancreatic islet microvascular (PIM) vasomotion, as a parameter of pancreatic islet microcirculation function, is abnormal in diabetic mice and that insulin treatment may reverse this dysfunction. METHODS Mice were randomly assigned to non-diabetic control, untreated diabetic, and insulin-treated diabetic groups (n = 6 in each group). Separate groups of streptozotocin (STZ)-induced diabetic and high-fat diet-fed mice were used as a model of hyperglycemia. Insulin-treated diabetic mice were treated with 1-1.5 IU/day insulin for 1 week. Laser Doppler monitors were used to evaluate PIM vasomotion. Morphological and ultrastructural changes in islet endothelial cells were determined by immunohistochemistry and transmission electron microscopy. Glucagon, insulin, vascular endothelial growth factor (VEGF)-A, and platelet endothelial cell adhesion molecule (PECAM-1) expression was determined by immunohistochemistry and Western blotting. RESULTS In both untreated diabetic groups, the pancreatic islet microcirculation was unable to regulate PIM vasomotion. The rhythm of vasomotion was irregular, and the average blood perfusion, amplitude, frequency, and relative velocity of vasomotion were significantly lower than in non-diabetic controls. Insulin treatment restored the functional status of PIM vasomotion. In islet endothelial cells from both untreated diabetic groups, the mitochondria were swollen with disarrangement of the cristae, and the distribution of PECAM-1 was discontinuous. Insulin treatment significantly increased the reduced expression of PECAM-1 in both untreated diabetic groups and VEGF-A expression in untreated STZ-diabetic mice. CONCLUSION The results suggest that the functional status of PIM vasomotion is impaired in diabetic mice but can be restored by insulin.
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Affiliation(s)
- Mingming Liu
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Zhang
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ailing Li
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Zhang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, China
| | - Bing Wang
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingwei Li
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuying Liu
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Li
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruijuan Xiu
- Key Laboratory of Microcirculation, Institute of Microcirculation, Ministry of Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Houben AJHM, Martens RJH, Stehouwer CDA. Assessing Microvascular Function in Humans from a Chronic Disease Perspective. J Am Soc Nephrol 2017; 28:3461-3472. [PMID: 28904002 DOI: 10.1681/asn.2017020157] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Microvascular dysfunction (MVD) is considered a crucial pathway in the development and progression of cardiometabolic and renal disease and is associated with increased cardiovascular mortality. MVD often coexists with or even precedes macrovascular disease, possibly due to shared mechanisms of vascular damage, such as inflammatory processes and oxidative stress. One of the first events in MVD is endothelial dysfunction. With the use of different physiologic or pharmacologic stimuli, endothelium-dependent (micro)vascular reactivity can be studied. This reactivity depends on the balance between various mediators, including nitric oxide, endothelin, and prostanoids, among others. The measurement of microvascular (endothelial) function is important to understand the pathophysiologic mechanisms that contribute to MVD and the role of MVD in the development and progression of cardiometabolic/renal disease. Here, we review a selection of direct, noninvasive techniques for measuring human microcirculation, with a focus on methods, interpretation, and limitations from the perspective of chronic cardiometabolic and renal disease.
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Affiliation(s)
- Alfons J H M Houben
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; and .,CARIM School for Cardiovascular Diseases and
| | - Remy J H Martens
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; and.,School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; and.,CARIM School for Cardiovascular Diseases and
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Bastos da Cunha C, Sicuro F, Maranhão PA, Borges MA, Cyrino FZ, Gazolla FM, Madeira IR, Bordallo MAN, Bouskela E, Kraemer-Aguiar LG. Microcirculation, Adiposity, and Traditional and Emerging Cardiovascular Risk Factors in Prepubertal Children. J Endocr Soc 2017; 1:908-917. [PMID: 29264541 PMCID: PMC5686770 DOI: 10.1210/js.2017-00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/06/2017] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Previous studies have shown that microvascular dysfunction (MD) is associated with a number of cardiovascular risk factors, including obesity. Few studies have assessed microvascular reactivity in children, and in most of these, results were confounded by the effects of puberty. Our aim was to establish whether MD is already present in obese prepubertal children. METHODS This cross-sectional study included 52 obese, 18 overweight, and 28 eutrophic children, with a mean ± standard deviation age of 7.44 ± 1.22 years. We evaluated cardiovascular risk factors and nutritive microvascular function by using nailfold dynamic videocapillaroscopy and determined functional capillary density (FCD), red blood cell velocity at resting conditions (RBCV) and at peak (RBCVmax), and time to reach peak velocity during the post-occlusive reactive hyperemic response following 1 minute ischemia. RESULTS On univariate analysis, differences in microvascular reactivity were not observed among the groups. Obese and overweight children had significantly higher scores than eutrophic children for the following parameters: body mass index, waist circumference, waist-to-height ratio, mean arterial pressure, homeostasis model assessment for insulin resistance, levels of insulin, leptin, glucose, triglycerides, total cholesterol, uric acid, and C-reactive protein. Multivariate analysis demonstrated the association between metabolic, anthropometric, and microvascular variables, stratified according to the degree of adiposity and body fat distribution. CONCLUSIONS Univariate analysis did not show any difference in microvascular reactivity between groups but, by testing these variables by multivariate means, we noticed a common and direct variation between cardiovascular/metabolic risk factors and microvascular reactivity occurring early in life.
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Affiliation(s)
- Carolina Bastos da Cunha
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Fernando Sicuro
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
| | - Priscila Alves Maranhão
- Department of Information Sciences and Health Decision (CIDES) of the Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Marcos Antonio Borges
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Fátima Z. Cyrino
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
| | - Fernanda Mussi Gazolla
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Isabel Rey Madeira
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Maria Alice Neves Bordallo
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Eliete Bouskela
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
| | - Luiz Guilherme Kraemer-Aguiar
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
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Kreuzer M, Sollmann L, Ruben S, Leifheit-Nestler M, Fischer DC, Pape L, Haffner D. Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome. Pediatr Nephrol 2017; 32:1005-1011. [PMID: 28180952 DOI: 10.1007/s00467-016-3574-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shiga-toxin-producing Escherichia coli (STEC)-associated hemolytic-uremic syndrome (HUS) is a major cause of acute kidney injury (AKI), especially in children. Its long-term outcome with respect to endothelial damage remains largely elusive. METHODS This was a cross-sectional study in 26 children who had suffered from STEC-HUS in the past and achieved a complete recovery of renal function (eGFR >90 ml/min/1.73 m2). Skin microcirculation after local heating was assessed by laser Doppler fluximetry, carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), 24-h ambulatory blood pressure, and angiopoietin (Ang) 1 and 2 serum levels after a median follow-up period of 6.1 years. The results were compared to those of healthy controls. RESULTS All patients were normotensive, mean eGFR was 102 (range 91-154) ml/min/1.73 m2, and 13 of the 26 patients showed albuminuria. Endothelial dysfunction was present in 13 patients, and the mean serum Ang2/Ang1 ratio was increased compared to healthy children (each p < 0.05). In contrast, mean values for PWV and cIMT in the patients did not differ from those of the controls. Endothelial dysfunction was significantly associated with younger age at STEC-HUS manifestation, time after HUS, and presence of albuminuria. CONCLUSION The results of this study highlight the need for long-term follow-up of STEC-HUS patients even after complete recovery of eGFR and lack of hypertension with respect to microvascular damage.
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Affiliation(s)
- Martin Kreuzer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Laura Sollmann
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Stephan Ruben
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Maren Leifheit-Nestler
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | | | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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18
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Santesson P, Lins PE, Kalani M, Adamson U, Lelic I, von Wendt G, Fagrell B, Jörneskog G. Skin microvascular function in patients with type 1 diabetes: An observational study from the onset of diabetes. Diab Vasc Dis Res 2017; 14:191-199. [PMID: 28467200 DOI: 10.1177/1479164117694463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The development of disturbances in skin microcirculation in type 1 diabetes is not well characterised. We assessed skin microcirculation longitudinally from the onset of diabetes up to 29 years of duration to investigate when such disturbances start. MATERIAL AND METHODS Seventeen adult patients with type 1 diabetes participated. Skin microvascular function in digit IV of the left hand was investigated by laser Doppler fluxmetry (LDF, arbitrary units [AU]). LDF was carried out at rest and following one-min arterial occlusion. Time to peak LDF (s) and percentage increase of LDF (post-occlusive reactive hyperaemia, PRH%) were determined. Retinopathy was assessed from fundus photographs or ophthalmoscopic recordings. RESULTS Skin microvascular function remained normal during the first five years. Compared with baseline and a non-diabetic reference group, time to peak LDF was prolonged after 7-9 years of diabetes ( p < 0.01). PRH% was lower than in the reference group after 7-9 years ( p < 0.01), and lower than baseline after 24-29 years of diabetes ( p < 0.05). All but one patient developed retinopathy and the first signs were found after 10 years of diabetes. CONCLUSIONS Functional disturbances in total skin microcirculation were observed after seven years in patients with type 1 diabetes and preceded diabetic complications such as retinopathy.
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Affiliation(s)
- Pia Santesson
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Per-Eric Lins
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Majid Kalani
- 2 Division of Cardiovascular Medicine, Department of Clinical sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Ulf Adamson
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Isak Lelic
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gunvor von Wendt
- 3 Department of Medical Retina, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden
| | - Bengt Fagrell
- 4 Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Gun Jörneskog
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Marche P, Dubois S, Abraham P, Parot-Schinkel E, Gascoin L, Humeau-Heurtier A, Ducluzeau PH, Mahe G. Neurovascular microcirculatory vasodilation mediated by C-fibers and Transient receptor potential vanilloid-type-1 channels (TRPV 1) is impaired in type 1 diabetes. Sci Rep 2017; 7:44322. [PMID: 28287157 PMCID: PMC5347083 DOI: 10.1038/srep44322] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/06/2017] [Indexed: 01/20/2023] Open
Abstract
Microvascular dysfunction may have an early onset in type 1 diabetes (T1D) and can precede major complications. Our objectives were to assess the endothelial-dependent (acetylcholine, ACh; and post-occlusive hyperemia, PORH), non-endothelial-dependent (sodium nitroprusside, SNP) and neurovascular-dependent (local heating, LH and current induced vasodilation, CIV) microcirculatory vasodilation in T1D patients compared with matched control subjects using a laser speckle contrast imager. Seventeen T1D patients - matched with 17 subjects according to age, gender, Body-Mass-Index, and smoking status - underwent macro- and microvascular investigations. The LH early peak assessed the transient receptor potential vanilloid type 1 channels (TRPV1) mediated vasodilation, whereas the plateau assessed the Nitirc-Oxyde (NO) and endothelium-derived hyperpolarizing factor (EDHF) pathways. PORH explored sensory nerves and (EDHF), while CIV assessed sensory nerves (C-fibers) and prostaglandin-mediated vasodilation. Using neurological investigations, we observed that C-fiber and A-delta fiber functions in T1D patients were similar to control subjects. PORH, CIV, LH peak and plateau vasodilations were significantly decreased in T1D patients compared to controls, whereas there was no difference between the two groups for ACh and SNP vasodilations. Neurovascular microcirculatory vasodilations (C-fibers and TRPV 1-mediated vasodilations) are impaired in TD1 patients whereas no abnormalities were found using clinical neurological investigations. Clinicaltrials: No. NCT02538120.
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Affiliation(s)
- P Marche
- Endocrinology Department, University Hospital of Angers, Angers, France
| | - S Dubois
- Endocrinology Department, University Hospital of Angers, Angers, France
| | - P Abraham
- Laboratory of Vascular Investigations, University Hospital of Angers, UMR CNRS6214/INSERM1083, LUNAM Université, Angers, France
| | - E Parot-Schinkel
- Methodology and Biostatistics Unit, University Hospital of Angers, Angers, France
| | - L Gascoin
- Laboratory of Vascular Investigations, University Hospital of Angers, UMR CNRS6214/INSERM1083, LUNAM Université, Angers, France
| | - A Humeau-Heurtier
- University of Angers, LARIS - Laboratoire Angevin de Recherche en Ingénierie des Systèmes, Angers, France
| | - P H Ducluzeau
- Endocrinology Department, University Hospital of Tours, Tours, France
| | - G Mahe
- INSERM Clinical Investigation Center (CIC 14 14), Rennes, France, Université de Rennes 1 and LUNAM University, Inserm 1083/CNRS 6214, Faculty of Medicine, Angers, France
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Lenasi H, Klonizakis M. Assessing the evidence: Exploring the effects of exercise on diabetic microcirculation. Clin Hemorheol Microcirc 2017; 64:663-678. [PMID: 27767975 DOI: 10.3233/ch-168022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes mellitus (DM) is associated with cardiovascular complications. Impairment of glycemic control induces noxious glycations, an increase in oxydative stress and dearangement of various metabolic pathways. DM leads to dysfunction of micro- and macrovessels, connected to metabolic, endothelial and autonomic nervous system. Thus, assessing vascular reactivity might be one of the clinical tools to evaluate the impact of harmful effects of DM and potential benefit of treatment; skin and skeletal muscle microcirculation have usually been tested. Physical exercise improves vascular dysfunction through various mechanisms, and is regarded as an additional effective treatment strategy of DM as it positively impacts glycemic control, improves insulin sensitivity and glucose uptake in the target tissues, thus affecting glucose and lipid metabolism, and increases the endothelium dependent vasodilation. Yet, not all patients respond in the same way so titrating the exercise type individualy would be desirable. Resistance training has, apart from aerobic one, been shown to positively correlate to glycemic control, and improve vascular reactivity. It has been prescribed in various forms or in combination with aerobic training. This review would assess the impact of different modes of exercise, the mechanisms involved, and its potential positive and negative effects on treating patients with Type I and Type II DM, focusing on the recent literature.
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Affiliation(s)
- Helena Lenasi
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Markos Klonizakis
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
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21
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In situ eNOS/NO up-regulation-a simple and effective therapeutic strategy for diabetic skin ulcer. Sci Rep 2016; 6:30326. [PMID: 27453476 PMCID: PMC4958962 DOI: 10.1038/srep30326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/04/2016] [Indexed: 01/04/2023] Open
Abstract
Decreased nitric oxide (NO) synthesis and increased NO consumption in diabetes induces the inadequate blood flow to tissues that is primarily responsible for the pathogenesis and refractoriness of diabetic skin ulcers. The present study proposed a simple and effective therapeutic strategy for diabetic skin ulcers—in situ up-regulation of endothelial nitric oxide synthase (eNOS) expression and NO synthesis by statin-loaded tissue engineering scaffold (TES). In vitro experiments on human umbilical vein endothelial cells indicated that the statin-loaded TES relieved the high-glucose induced decrease in cell viability and promoted NO synthesis under high-glucose conditions. In a rat model of diabetes, the statin-loaded TES promoted eNOS expression and NO synthesis in/around the regenerated tissues. Subsequently, accelerated vascularization and elevated blood supply were observed, followed by rapid wound healing. These findings suggest that the in situ up-regulation of eNOS/NO by a statin-loaded TES may be a useful therapeutic method for intractable diabetic skin wounds.
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Wong BJ, Hollowed CG. Current concepts of active vasodilation in human skin. Temperature (Austin) 2016; 4:41-59. [PMID: 28349094 PMCID: PMC5356216 DOI: 10.1080/23328940.2016.1200203] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 10/30/2022] Open
Abstract
In humans, an increase in internal core temperature elicits large increases in skin blood flow and sweating. The increase in skin blood flow serves to transfer heat via convection from the body core to the skin surface while sweating results in evaporative cooling of the skin. Cutaneous vasodilation and sudomotor activity are controlled by a sympathetic cholinergic active vasodilator system that is hypothesized to operate through a co-transmission mechanism. To date, mechanisms of cutaneous active vasodilation remain equivocal despite many years of research by several productive laboratory groups. The purpose of this review is to highlight recent advancements in the field of cutaneous active vasodilation framed in the context of some of the historical findings that laid the groundwork for our current understanding of cutaneous active vasodilation.
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Affiliation(s)
- Brett J. Wong
- Department of Kinesiology & Health, Georgia State University, Atlanta, GA, USA
| | - Casey G. Hollowed
- Department of Kinesiology & Health, Georgia State University, Atlanta, GA, USA
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23
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Pourabbasi A, Tehrani-Doost M, Ebrahimi Qavam S, Larijani B. Evaluation of the correlation between type 1 diabetes and cognitive function in children and adolescents, and comparison of this correlation with structural changes in the central nervous system: a study protocol. BMJ Open 2016; 6:e007917. [PMID: 27126974 PMCID: PMC4853982 DOI: 10.1136/bmjopen-2015-007917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Diabetes mellitus type 1 (T1DM) affects nearly 15 million children worldwide and failure to achieve and maintain good glycaemic control in this group can lead to diabetes-related complications. Children with T1DM can experience impairment in cognitive function such as memory, attention and executive function. This study is designed to evaluate the correlation between diabetes and cognitive dysfunction as well as to clarify whether this correlation can be linked to neurological structural changes in 6-11-year-old children with diabetes. METHODS AND ANALYSIS 310 eligible children with diabetes will be divided into two groups based on glycaemic control according to their HbA1c index. The control group will include 150 children aged 6-11 without diabetes. The following parameters will be measured and investigated: duration of the disease since diagnosis, required daily insulin dose, frequency of insulin administration, hospital admissions due to diabetes, hypoglycaemic episodes during the last year, and episodes of diabetic ketoacidosis. The following components of cognitive function will be evaluated: memory, attention, executive function, decision-making and academic performance. Cognitive function and subsequent subtests will be assessed using Cambridge Neuropsychological Test Automated Battery (CANTAB) tools. Brain structural indices such as intracranial vault (ICV), as well as cerebrospinal fluid (CSF), ventricle, hippocampus, total intracranial, total brain, grey matter and white matter volume will be measured using MRI. ANOVA, correlational tests (Spearman) and regression models will be used to evaluate the hypothesis. ETHICS AND DISSEMINATION This study is approved by the ethics committee of the Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) under reference number 00300. Our findings are to be published in a peer-reviewed journal and disseminated both electronically and in print.
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Affiliation(s)
- Ata Pourabbasi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tehrani-Doost
- Department of Psychiatry, Rouzbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soqra Ebrahimi Qavam
- Faculty of Psychology and Education, Allameh Tabataba'ee University, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Astragulus polysaccharide-loaded fibrous mats promote the restoration of microcirculation in/around skin wounds to accelerate wound healing in a diabetic rat model. Colloids Surf B Biointerfaces 2015; 136:111-8. [PMID: 26370325 DOI: 10.1016/j.colsurfb.2015.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
Tissue engineering scaffolds (TES) can carry numerous biomacromolecules and cells, and they have been widely used in diabetic skin wound healing with positive effects. However, the bioactive retention of biomacromolecules and cells during fabrication and storage is still a factor restricting their use. Moreover, impaired blood supply in/around poorly healing diabetic skin wounds has not been considered. In the present study, a bioactive natural substance of Astragalus polysaccharide (APS), which has stable and confirmed effects on endothelial protection, was embedded into fibrous TES by electrospinning. The administration of APS-loaded TES on the skin wound in a diabetic rat model led to a dose-dependent promotion in skin blood flow around wounds and an increase in endoglin expression and microvessel density in regenerated skin tissues. Furthermore, the higher loading of APS in TES led to faster collagen synthesis, appendage and epidermal differentiation, and wound closure. In summary, the combination of APS with TES is a potentially novel therapeutic strategy for diabetic skin wound healing, as it not only mimics the ultrastructure of extracellular matrixes but also restores skin microcirculation.
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Shah AS, Gao Z, Dolan LM, Dabelea D, D'Agostino RB, Urbina EM. Assessing endothelial dysfunction in adolescents and young adults with type 1 diabetes mellitus using a non-invasive heat stimulus. Pediatr Diabetes 2015; 16:434-40. [PMID: 25082568 PMCID: PMC4333115 DOI: 10.1111/pedi.12189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/09/2014] [Accepted: 06/16/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Microvascular dysfunction is a key event in the development of atherosclerosis, which predates the clinical manifestations of vascular disease including stroke and myocardial infarction. Dysfunction of the microvasculature can be measured as a decreased microperfusion in response to heat. OBJECTIVE We sought to evaluate the microvasculature using heat among adolescents and young adults with type 1 diabetes (T1D) compared to healthy non-diabetic controls. We hypothesized that youth with T1D would have impaired microvascular function measured as decreased perfusion. METHODS We studied 181 adolescents and young adults with T1D and 96 age-, race-, and sex-matched healthy controls (mean age 19 yr). Patients were seen at an in-person study visit where demographics, anthropometrics, and laboratory data was obtained. Skin microvascular perfusion was measured on the volvar surface of the right forearm using a standard laser flow Doppler. Measurements were taken at baseline and after heating to 44° C. RESULTS Youth with T1D had decreased microvascular perfusion as measured by lower percent change of perfusion units (1870 ± 945 vs. 2539 ± 1255, p < 0.01) and percent change in area under the curve (1870 ± 945 vs. 2539 ± 1255, p < 0.01) compared to controls. Glycosylated hemoglobin A1c (HbA1c) was found to be an independent determinant of microvascular function (p < 0.05). CONCLUSIONS Adolescents and young adults with T1D have evidence of microvascular dysfunction that can be detected using heat, a non-invasive physiologic stimulus. HbA1c appears to play an independent role in determining microvascular perfusion suggesting tight glycemic control is probably important for the development of vascular disease.
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Affiliation(s)
- Amy S. Shah
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology, Cincinnati, OH 45229, USA
| | - Zhiqian Gao
- Cincinnati Children's Hospital Medical Center, Division of Cardiology, Cincinnati, OH 45229, USA
| | - Lawrence M. Dolan
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology, Cincinnati, OH 45229, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80202, USA
| | - Ralph B. D'Agostino
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC 27103, USA
| | - Elaine M. Urbina
- Cincinnati Children's Hospital Medical Center, Division of Cardiology, Cincinnati, OH 45229, USA
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Dreno B, Araviiskaia E, Berardesca E, Bieber T, Hawk J, Sanchez-Viera M, Wolkenstein P. The science of dermocosmetics and its role in dermatology. J Eur Acad Dermatol Venereol 2014; 28:1409-17. [PMID: 24684296 DOI: 10.1111/jdv.12497] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/03/2014] [Indexed: 12/12/2022]
Abstract
Our increased knowledge of normal skin physiology has ushered in a subtle revolution in cosmetic science. Originally designed as preparations to enhance personal appearance by direct application on to the skin, cosmetics have now taken on a new role in dermatology, through the support of the management of many skin disorders. This evolving role of cosmetics in skin care is primarily due to scientific and technological advancements that have changed our understanding of normal skin physiology and how cosmetics modify its appearance both physically and biologically. The vast array of techniques currently available to investigate skin responsivity to multiple stimuli has brought about a new era in cosmetic and dermocosmetic development based on a robust understanding of skin physiology and its varied responses to commonly encountered environmental insults. Most cosmetic research is undertaken on reconstructed skin models crucial in dermatological research, given the strict ban imposed by the European Union on animal testing. In addition, the design and conduct of trials evaluating cosmetics now follow rules comparable to those used in the development and evaluation of pharmaceutical products. Cosmetic research should now aim to ensure all trials adhere to strictly reproducible and scientifically sound methodologies. The objective of this review is to provide an overview of the multidisciplinary scientific approach used in formulating dermocosmetics, and to examine the major advances in dermocosmetic development and assessment, the safety and regulatory guidelines governing their production and the exciting future outlook for these dermocosmetic processes following good practice rules.
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Affiliation(s)
- B Dreno
- Department of Dermato Cancerology, Nantes University, Nantes, France
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Holmquist P, Liuba P. Urine π-Glutathione S-transferase but not Tamm-Horsfall protein correlates with carotid artery intima media thickness in childhood type1 diabetes. BMC Cardiovasc Disord 2014; 14:39. [PMID: 24667016 PMCID: PMC3987063 DOI: 10.1186/1471-2261-14-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Renal disease remains a serious threat in patients with insulin-dependent (type1) diabetes. Hence its detection early in the life of patients with type1 diabetes is crucial. Several lines of evidence suggest similar mechanisms for the development of both renal and arterial disease. We sought to investigate in young patients with type1 diabetes whether π-Glutathione S-transferase to creatinine (π-GST:crea) and Tamm-Horsfall protein to creatinine (THP:crea) ratios, markers of distal tubular renal function, relate to subclinical markers of arterial disease, which appear to onset early and develop rapidly in type1 diabetes. Methods Seventy-one children and adolescents (median age and diabetes duration 14 and 6 years, respectively) with type1 diabetes for at least 6 months were assessed for timed urine levels of π-GST, THP, HbA1c, albumin, and plasma C-reactive protein (CRP). Carotid artery intima-media thickness (IMT), brachial artery flow-mediated dilatation (FMD), and cutaneous microvascular function were assessed by high-resolution ultrasound and laser Doppler, respectively. Results Two patients had microalbuminuria (> 20 μg/min), and were therefore removed from the study population. π-GST:crea ratio and THP:crea showed no relationship to the demographic, diabetes, or inflammatory indices. Lower π-GST:crea ratio was associated with greater IMT (p = 0.01, r = −0.29), particularly in female patients (p = 0.004, r = −0.49). The association of π-GST:crea ratio with IMT was stronger in patients with passive smoke exposure (p = 0.002, r = −0.43). Among post-pubertal patients, lower π-GST:crea ratio was also associated with lower microvascular response to Ach (acetylcholine; p = 0.03, r = 0.49). Conclusions In young patients with type1 diabetes, proximal tubular dysfunction as suggested by lower levels of π-GST:crea ratio seems to be paralleled by changes in arterial structure and microvascular function.
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Affiliation(s)
- Peter Holmquist
- Division of Endocrinology, Department of Paediatrics, Lund University Hospita, S-22185 Lund, Sweden.
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