DR Group Research Articles

The effects of antidepressants on inflammatory factors of frontal lobe in depression model rats

Objective To investigate the effect of antidepressants on frontal lobe inflammatory factors in depressed model rats. Methods Thirty SD rats were randomly divided into 5 groups (n=6): contorl group(Cn), depression group(Dn), citalopram group(Dx), venlafaxine group(Dw) and reboxetine group(Dr) . The open field test and sugar consumption test were performed to observe the depression behavior and the changes of FGF-1, TNF-α, IL-1 and CRP were measured in frontal lobe of rats by ELISA. Pearson linear correlation analysis was used to evaluate the correlation between behavioral score and inflammatory factors level in rats. Results (1)Compared with the Cn group, the scores of Dn, Dr, Dw, Dx group were decreased on Open field test and sugar consumption test (P<0.05). Compared with the Dn group, the scores of the Dx, Dw, Dr group were increased in Open field test and sugar consumption test (P<0.05). (2)Compared with Cn group, the levels of TNF-α, IL-1 and CRP increased in Dn group and FGF-1 level decreased (P<0.01). Compared with Dn group, the levels of FGF-1 increased in Dx ((86.54±2.56)ng/L), Dw((79.82±4.89)ng/L) and Dr ((68.50±3.61)ng/L) group, however, the levels of TNF-α decreased in Dx ((150.21±5.65)ng/L), Dw ((161.28±8.80)ng/L), Dr ((175.78±9.67)ng/L) group, and the level of IL-1 also decreased in Dx ((30.87±4.48)ng/L), Dw ((36.65±3.33)ng/L), Dr ((40.14±2.81)ng/L) group, and the levels of CRP also decreased in Dx ((374.88±14.15)ng/L), Dw ((394.21±17.03)ng/L), Dr ((414.34±10.97)ng/L) (P<0.01). (3)The behavioral score of each group was positively correlated with of FGF-1 and negatively correlated with TNF-a, IL-1 and CRP (P<0.05). Conclusion Antidepressants can reduce the level of proinflammatory factors and increase the level of anti-inflammatory factors of frontal lobe in depression model rats, suggesting that antidepressants may play an antidepressant effect by regulating the concentration of inflammatory factors. Key words: Antidepressants; Depression model rats; FGF-1; TNF-a; IL-1; C-reaction protein

A study of diabetic retinopathy in type 2 diabetic patients and its relation with diabetic progression

The study aimed to investigate the diabetic retinopathy in type 2 diabetic patients and its relation with the glycemic control represented with the glycatedhaemoglobin (HbA1c). The study performed in the diabetic and endocrinology center at Al-Sader medical city in Al-Najaf Al-Ashraf. The study included 102 subjects, divided into a (10) healthy subjects ascontrol group and two groups of diabetic patients attended to the diabetic and endocrinology center at Al-Sader medical city and diagnosed as type 2 diabetic patients, divided into two groups with and without retinopathy. The type of retinopathy was determined by physicians, there are three retinopathy subtypes: diabetic retinopathy in early stages, proliferative retinopathy and macular edema.Most DR patients were in early stages of retinopathy 37.25%, proliferative diabetic retinopathy 11.76%, and macular edema 11.76%.The results shows a significant increase of diabetic retinopathy DR prevalence with increasing diabetic duration, the incidence of DR was highest in patients of 15-20 years of diabetes mellitus,and the highest were the proliferative , then macular edema 12.33 ± 18.6 and 14.16 ± 2.32 respectively. The level of fasting plasma glucose among control, DM and DR groups increased significantly (P &lt; 0.05), while there was no significant differences (P &lt; 0.05) in FPG levels between these subtypes of DR. The HbA1c was significantly highest (P&lt;0.05 )in DM and DR (6.65% ± 0.29 and 8.025 ± 0.19 respectively) when compared with 5.73% ± 0.18 in the control group. According to the successive HbA1c percentiles,the early stages of DR were found in all levels of HbA1c, but the highest incidence were in the highest levels. Also proliferative DR begin to appear at 7-7.5 % of HbA1c, andits highest incidence were at 7.5 – 8 %. Macular edema increased at 7-7.5% and at levels highest than 10.5 %.There was a significant decrease in body mass index BMI in DR patients when compared with other groups, and a significant decrease in BMI in proliferative DR and macular edema when compared with the control.The study concluded that there is a critical need to perform a periodical check to diabetic patients to diagnose the retinopathy in its early appearance, and to use the glycosylated haemoglobin as measurement periodically to detect any increase or fluctuation in this parameter to control the glycemic state in these patients.

Editor's Choice – A Prospective Study to Evaluate Complete Wound Healing and Limb Salvage Rates After Angiosome Targeted Infrapopliteal Balloon Angioplasty in Patients with Critical Limb Ischaemia

To evaluate complete wound healing and limb salvage rates in patients with critical limb ischaemia (CLI) with concurrent foot ulceration/gangrene who underwent angiosome targeted infrapopliteal balloon angioplasty. This was a prospective observational study. In total, 212 patients who underwent successful infrapopliteal balloon angioplasty to assist wound healing and achieve limb salvage were included from June 2014 to March 2016. Propensity score matching was developed to compare complete wound healing, 1 year amputation free survival (AFS), and limb salvage rates between the two study groups (direct revascularisation [DR] and indirect revascularisation [IR]). Direct flow to the foot wounds based on the angiosome principle was achieved in 117 legs (55.2%) versus 95 legs (44.8%) that represented the IR group. Seventy-three matched pairs were obtained to minimise intergroup differences in baseline characteristics. Twelve months after angioplasty, the complete wound healing rates were 80.8% and 63.0% (p=.02), AFS rates were 72.6% and 61.6% (p=.164), and limb salvage rates were 90.4% and 82.2% (p=.148) in the DR and IR groups, respectively. This study suggests that the complete wound healing rate is better when the target foot lesion receives direct perfusion following the angiosome concept, whereas limb salvage and AFS rates were not significantly different among the DR and IR groups.

Neuroprotective Effect of Hydroxytyrosol in Experimental Diabetic Retinopathy: Relationship with Cardiovascular Biomarkers.

The aim of the study was to test the neuroprotective effect of hydroxytyrosol (HT) on experimental diabetic retinopathy. Animals were divided in four groups: (1) control nondiabetic rats, (2) streptozotocin-diabetic rats (DR), (3) DR treated with 1 mg/kg/day p.o. HT, and (4) DR treated with 5 mg/kg/day p.o. HT. Treatment with HT was started 7 days before inducing diabetes and was maintained for 2 months. In the DR group, total area occupied by extracellular matrix was increased, area occupied by retinal cells was decreased; both returned to near-control values in DR rats treated with HT. The number of retinal ganglion cells in DR was significantly lower (44%) than in the control group, and this decrease was smaller after HT treatment (34% and 9.1%). Linear regression analysis showed that prostacyclin, platelet aggregation, peroxynitrites, and the dose of 5 mg/kg/day HT significantly influenced retinal ganglion cell count. In conclusion, HT exerted a neuroprotective effect on diabetic retinopathy, and this effect correlated significantly with changes in some cardiovascular biomarkers.

Heart Protective Effects of Electroacupuncture in an Animal Experimental Study with Delayed Fluid Resuscitation after Hemorrhagic Shock.

Fluid resuscitation could hardly be performed immediately after fatal hemorrhagic shock in outpatients. We investigated whether electroacupuncture (EA) at Zusanli (ST36) could prevent fatal hemorrhagic shock induced heart failure with delayed fluid resuscitation and whether the protective role of EA is related to the autonomic nervous system. Sixty Sprague Dawley rats were randomly divided into five groups (n = 12 each): group of sham hemorrhagic shock (SHAM), group of EA, group of sham EA (SEA), group of delayed fluid resuscitation with EA (EA + DR), and group of delayed fluid resuscitation with SEA (SEA + DR). After blood loss for 6 hours, caspase-3 activity and positive rate of TUNEL in EA + DR group were significantly lower than in other hemorrhagic shock groups (e.g., versus SEA + DR: 0.156 ± 0.039 versus 0.301 ± 0.042; P < 0.05). Immediately EA treatment after the blood loss enhanced the protective effect of delayed resuscitation on the cardiac tissue of hemorrhagic shock rats. Considering the significant changes of epinephrine (137.8 ± 6.9 ng/L versus 98.6 ± 7.4 ng/L; P < 0.05) and acetylcholine (405 ± 8.6 pmol/L versus 341 ± 10.1 pmol/L; P < 0.05) after EA treatment (SEA + DR versus EA + DR), this cardiac protective effect may be related to regulation of the autonomic nervous system.

Oxidative damage of mitochondrial respiratory chain in different organs of a rat model of diet-induced obesity.

Mitochondrial dysfunction plays an important role in the development of obesity and obesity-associated metabolic diseases. In this study, we dynamically observed the characteristics of mitochondrial damage in a rat model of diet-induced obesity (DIO). From the 2nd to the 10th week, animals were killed every 2weeks and the heart, liver, kidney, and testicular tissues were harvested. Mitochondria were isolated and the activities of respiratory chain complexes I, II, III, and IV as well as the 8-Hydroxy-2-deoxy Guanosine content were determined. Reactive oxygen species and malondialdehyde were measured. Mitochondrial damages were observed in the heart and liver of DIO and DR rats, and the damages occurred later in DR group than that in DIO group. The mitochondrial membrane potential of heart and liver decreased in DIO and DR groups. The activity of the heart mitochondria complexes I, III, and IV (composing NADH oxidative respiratory) was higher in the early stage of DIO and lower in the end of week 10. The higher activity of the liver complexes I, III, and IV was found until the end of week 10 in DIO and DR groups, accompanied with enhanced oxidative stress. Besides, mitochondrial DNA damages were observed in all tissues. In DIO rats, the heart mitochondrial dysfunction occurred first and the liver presented the strongest compensatory ability against oxidative stress.

Caffeine to improve breathing effort of preterm infants at birth: a randomized controlled trial.

BackgroundCaffeine promotes spontaneous breathing by antagonizing adenosine. We assessed the direct effect of caffeine on respiratory effort in preterm infants at birth.MethodsThirty infants of 24-30 weeks of gestation were randomized for receiving caffeine directly after birth in the delivery room (caffeine DR group) or later in the neonatal intensive care unit (control group). Primary outcome was respiratory effort, expressed as minute volume, tidal volumes, respiratory rate, rate of rise to maximum tidal volume, and recruitment breaths at 7-9 min after birth.ResultsAfter correction for gestational age, minute volumes ((mean±SD; 189±74 vs. 162±70 ml/kg/min; P<0.05) and tidal volumes ((median (interquartile range (IQR)) 5.2 (3.9-6.4) vs. 4.4 (3.0-5.6) ml/kg) were significantly greater in the caffeine DR group. Although respiratory rates were similar ((mean±SD) 35±10 vs. 33±10), RoR increased significantly ((median (IQR) 14.3 (11.2-19.8) vs. 11.2 (7.9-15.2) ml/kg/s), and more recruitment breaths were observed (13 vs. 9%).ConclusionCaffeine increases respiratory effort in preterm infants at birth, but the effect on clinical outcomes needs further investigation.

Relationship between Diabetic Retinopathy and Methylenetetrahydrofolate Reductase Gene Polymorphism

Purpose: To assess MTHFR rs1801133 (C677T) gene polymorphism in diabetic patients as a risk factor for diabetic retinopathy and to establish the changes in Platelet indices & count in diabetic patient as compared to the healthy control group. Patients and Methods: The study included 40 patients with Type 2 Diabetes Mellitus. They were divided into 2 equal groups, 20 patients with Diabetic Retinopathy, 20 patients without Diabetic Retinopathy. Patients were selected from those attending the outpatient Ophthalmology Unit and Diabetes Clinic of Al-Zahraa University Hospital in the period from June 2014 to June 2015. Their ages ranged between 34 to 66 years old. They were 14 males and 26 females. Twenty cases apparently healthy individuals were selected as a control group. All cases were subjected to full history taking and complete ophthalmological examination. Also laboratory investigations were done including complete blood picture, kidney and liver function tests, coagulation profile, urine analysis, lipid profile, fasting and postprandial blood sugar and Genetic study for detection of MTHFR gene C677T mutation (rs 1801133)by real time PCR. Results: In all diabetic patients the mutant homozygous TT showed a highly statistically significant increase in FBS (p=0.000), PPBS (p=0.000), HbA1C (p=0.000) and cholesterol (p=0.001) as compared to wild type. Also in all diabetic patients the mutant homozygous TT showed a highly statistically significant increase in FBS (p=0.002), PPBS (p=0.001), HbA1C (p=0.019) and cholesterol (p=0.012) as compared to heterozygous mutant type. Conclusion: The homozygous mutant type (TT) of rs1801133 was detected in 10% of DR patients group while absent in DWR group and the control group. The heterozygous mutant type (CT) was increased in DR group (50%) as compared to DWR group (35%) and the control group (25%).

Aqueous calyxes extract of Roselle or Hibiscus sabdariffa Linn supplementation improves liver morphology in streptozotocin induced diabetic rats

Background and study aimsThe complex series of deleterious events among diabetes patients leads to multiple organ failure. Therefore, a holistic approach of treatment is urgently required to prevent worsening of complications. The present investigation was carried out to study the possible protective effects of Roselle or Hibiscus sabdariffa Linn (HSL) calyxes aqueous extract, as an antidiabetic and antioxidant agent against oxidative liver injury in streptozotocin-induced diabetic rats. Material and methodsA single dose of streptozotocin (45mg/kg body weight, iv) was used to induced diabetes in male Sprague Dawley rats which were then divided into two groups: Diabetic control (DC) and HSL-treated diabetic (DR) group. Normal rats were divided into normal control (NC), HSL-treated control (NR). Aqueous calyxes extract of HSL (100mg/kg/day, orally) was given for 28 consecutive days in the treated group. Weight, biochemical and histopathological (light and electron microscopic) parameters were compared in all groups. ResultsSupplementation of HSL significantly lowered the level of fasting blood glucose and increased plasma insulin level in DR group compared to DC group (p<0.05). Alanine aminotransaminases and aspartate aminotransferase enzymes level were found to be significantly reduced in DR compared to DC. Microscopic examination demonstrated destruction of the liver architecture, cytoplasmic vacuolation of the hepatocytes and signs of necrosis in diabetic rats. Moreover, dilatation and congestion of blood vessels with leucocytes adherence were detected. Ultrastructural study using electron microscope showed homogeneous substance accumulation in nuclear chromatin, a decrease of organelles and mitochondrial degeneration in the diabetic rats. ConclusionAdministration of HSL in diabetic rats causes significant decrease in hepatocyte destruction and prevented the changes associated with the diabetic condition. Thus, our findings provide a scientific rationale for the use of HSL as promising agent in preventing liver injury in diabetes.

The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy: A retrospective trial.

Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1.0 μg kg−1 for 10 minutes, then adjusted to 0.5–0.7 μg kg−1 h−1; RF infusion at 1.0 μg kg−1 for 5 minutes, then adjusted to 0.05–0.2 μg kg−1 min−1), Group DP (n = 60, DEX infusion at 1.0 μg kg−1 for 10 minutes, then adjusted to 0.5–0.7 μg kg−1 h−1; propofol infusion at 10 μg kg−1 for 5 minutes, then adjusted to 0.05–0.1 μg kg−1 min−1). Ramsay sedation scale of the 2 groups was maintained at 3. Anesthesia onset time; total number of intraoperative patient movements; hemodynamics; total cumulative dose of DEX; amount of and time to first-dose rescue midazolam and lidocaine; postoperative recovery time; adverse events; and bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DP (8.22 ± 2.48 vs 12.25 ± 6.43 minutes, respectively, for DP, DR, P = 0.015). The perioperative hemodynamic profile was more stable in DR than DP group. More children moved during flexible bronchoscopy in DP group (P = 0.009). Total dose of rescue midazolam and lidocaine was significantly higher in DR than in DP (P < 0.001). Similarly, the time to first dose of rescue midazolam and lidocaine was significantly longer in DP than in DR (P < 0.001). Total cumulative dose of DEX was more in DR than DP group (P < 0.001). The time to recovery for discharge from the postanesthesia care unit (PACU) was significantly shorter in DP than in DR group (P < 0.001). The bronchoscopist-satisfaction scores were higher for DR than DP (P = 0.036). There were significant differences between the 2 groups in terms of the overall incidence of hypertension, tachycardia, and hypoxemia (P < 0.05).Although underwent longer recovery time and more incidence of rescue scheme, DEX-RF resulted in more stable hemodynamic profiles and bronchoscopist-satisfaction scores, lesser patient movements, and can hence be more effectively used in children undergoing flexible bronchoscopy than dexmedetomidine-propofol.

Focal loss volume of ganglion cell complex in diabetic neuropathy

BackgroundThe aim was to investigate the relationship between diabetic peripheral neuropathy (DPN) and abnormalities in ganglion cell complex (GCC); specifically, focal loss volume (FLV) and global loss volume (GLV).MethodsThe ganglion cell complex was evaluated using optical coherence tomography on 193 individuals (84 with type 1 diabetes, 67 with type 2 diabetes and 42 without diabetes). In those with diabetes, 88 had diabetes but no diabetic retinopathy (no DR group) and 63 had diabetes with diabetic retinopathy (DR group). Seventeen individuals in the no DR group and 27 in the DR group had diabetic peripheral neuropathy according to the neuropathy disability score (NDS). The probability of FLV and GLV being abnormal was determined. Forty four individuals had diabetic peripheral neuropathy (NDS of three or greater). Binary logistic regression analysis was performed, adjusting for the presence of diabetic retinopathy, age, sex, type of diabetes, duration of diabetes and HbA1c levels.ResultsTwenty‐five per cent of individuals with diabetic peripheral neuropathy had abnormal FLV compared to 11 per cent of those with diabetes but no diabetic peripheral neuropathy and five per cent in the control group (p = 0.011). Fourteen per cent of individuals with diabetic peripheral neuropathy, 10 per cent without diabetic peripheral neuropathy and two per cent in the control group had abnormal GLV (p = 0.185). For every unit increase in the neuropathy disability score, the odds of having an abnormal FLV increased by a factor of 1.25 (p = 0.007), after adjusting for potentially confounding factors. Abnormal GCC FLV is an independent predictor of diabetic neuropathy, (odds ratio = 2.94, 95 per cent CI [1.16, 7.40], p = 0.023).ConclusionDiabetic peripheral neuropathy is associated with abnormal GCC FLV at the macula, which is independent of diabetic retinopathy, age, sex, type of diabetes, duration of diabetes and HbA1c levels. An abnormality in GCC FLV is an independent predictor of diabetic peripheral neuropathy.

37P - Immunological markers of DC-based vaccine antitumor efficacy in patients with NSCLC

Aim/Background: One of the topical areas of cancer biotherapy is the development of new methods of specific active immunotherapy (IT), including dendritic cells (DC) based vaccines. The essential problem in achieving maximum therapeutic effect of antitumor vaccines is the lack of immunological criteria for evaluating their efficacy. The aim of this study was to analyze the immunological parameters in patients with non-small lung cancer (NSCLC) after DC-IT. Methods: DC were generated from monocytes of peripheral blood with the addition of growth factors (GM-CSF, IL-4) and loaded with autologous lyophilized tumor antigens. Adjuvant DC vaccine has been included in treatment of 60 patients with IIB-IIIA NSCLC stages after primary treatment. DC-vaccine was injected 4-times with intervals of 1 month. More than 25 immunological parameters that characterize the immune system of patients were analyzed with flow cytometry and real-time PCR at all stages of IT. Results: Depending on the clinical course of the disease, patients were divided into 2 subgroups: patients with disease stabilization (DS, n = 52) and with disease relapse (DR, n = 8). Before IT in DR group the number of T-reg lymphocytes significantly increased comparing to DS and was (10,21±2,44)% against (5,18±0,91)% in DS group (p < 0.05); TGF-β expression was 3 times lower than in DS (p < 0.05). Also, in DR group MIP-1α expression was 10 times higher than RANTES expression level, and during IT has increased more than 5 times. In DS group the level of chemokines expression was opposite. RANTES expression level was 5.9 times higher than MIP-1α. Increase of CD4 + cells number in DS patients was observed on the 3rd and 4th phases of DC-IT (p < 0.05) and was 2.2 times higher than in DR (p < 0.02). Conclusions: Assessment of immunological efficiency of DC-IT allowed to establish the most informative prognostic markers such as the number of T-reg cells, mRNA expression levels of TGF-β, MIP-1α, RANTES and the number of CD4 + -cells memory. Legal entity responsible for the study: National Cancer Institute of MPH of Ukraine Funding: National Cancer Institute of MPH of Ukraine Disclosure: All authors have declared no conflicts of interest.

PC200. Drain Placement Confers No Benefit Following Carotid Endarterectomy in the Vascular Quality Initiative

While bleeding complications requiring a return to the operating room (OR) after carotid endarterectomy (CEA) are infrequent (1%), they are associated with an increased 30-day combined postoperative stroke or death rate. Drain placement (DR) after CEA varies among vascular surgeons, and there are limited data to support the practice. The goal of this study is to evaluate factors leading to DR and the effect of DR on postoperative outcomes, including return to OR for bleeding, stroke, and death. We identified 47,752 patients undergoing CEA using the VQI registry from 2011 to 2015. Demographic, preoperative and intraoperative factors between patients who underwent CEA with DR (n = 19,425) and without DR (n = 28,327) were compared. End points included return to the OR for bleeding, stroke, death, postoperative wound infection, and hospital length of stay. We then compared postoperative outcomes between groups using mixed-effect logistic regression models to control for correlation within center. Similar methods were used to show relationship between return to OR for bleeding and other variables. Subgroup analysis of patients with DR was compared among centers with high DR (>66.7% of cases), medium DR (33.3-66.7%), and low DR (<33.3%). Patients with DR were more likely to be on a preoperative P2Y12 antagonist (P2A; P < .001), have prior CEA/CAS (P < .001), use dextran (P < .001), have a concomitant procedure/CABG (P < .001), and less likely to use protamine (P < .001) compared to those without DR. DR did not prevent return to the OR for bleeding (P < .22). Re-exploration of the carotid artery after closure in the OR (P < .001), preoperative P2A (P < .001) and no protamine use (P < .001) were predictors for return to the OR for bleeding among those with DR. Of patients requiring return to the OR for bleeding, DR did not influence 30-day stroke (P = .82), 30-day mortality (P = .43), or 30-day combined stroke/mortality (P = .42) compared to those without DR. DR did not influence postoperative wound infection (P < .3). Hospital length of stay was increased in patients with DR (P < .001). Return to OR for bleeding (P = .24), wound infection (P = .16), and length of stay (P = .94) did not differ among the high, medium and low DR groups. DR after CEA does not reduce return to the OR for bleeding nor does it reduce perioperative stroke or death. Drain placement is associated with increased length of stay.

4-Nitrophenol exposure alters the AhR signaling pathway and related gene expression in the rat liver.

4-Nitrophenol (PNP) is well known as an environmental endocrine disruptor. The aim of this study was to clarify the mechanism of PNP-induced liver damage and determine the regulatory involvement of the aryl hydrocarbon receptor (AhR) signaling pathway and associated gene expression. Immature male Wistar-Imamichi rats (28 days old) were randomly divided into control and PNP groups, which consisted of 1- and 3-day exposure (1 DE and 3 DE, respectively) and 3-day exposure followed by 3-day recovery (3 DE + 3 DR), groups. Each group was administered the vehicle or PNP (200 mg kg-1 body weight). The body and liver weight were significantly decreased in the 3 DE group. The mRNA expression levels of estrogen receptor-α (ERα), glutathione S-transferase (GST) and AhR exhibited a significant increase in the 1 DE group whereas, in contrast, that of cytochrome P450 (CYP) 1A1 decreased significantly in the 3 DE +3 DR group. AhR and CYP1A1 proteins were detected in the cytoplasm of hepatocytes of the 1 DE and 3 DE +3 DR groups whereas the ERα protein was found in the hepatocyte nuclei of the 1 DE and 3 DE groups. The present study demonstrates that PNP activated the AhR signaling pathway and regulated related CYP1A1 and GST gene expression in the liver. Copyright © 2016 John Wiley & Sons, Ltd.

Retinal vessel diameter variation analysis in diabetic patients

To explore the influence factors of retinal vascular changes in diabetes patients. Case control study. One hundred and fifty-five type 2 diabetes patients were divided into NDR group (n=80) and DR group (n=70) according to the presence of diabetic retinopathy. Fundus photographs were taken after pupil dilated, the diameter of retinal arterioles and venules were measured between 1.0 PD and 1.5 PD. To analyze the relationship between retinal artery diameter, vein diameter and hypertension, diabetes duration, and DR stage. With retinal artery and vein diameter as the dependent variable, DR stage, hypertension, diabetes duration, insulin using time and age as independent variables, using step method, multiple linear regression was undergoing. The diameter of retinal vein in DR group and NDR group were (90.37+7.95) and (83.45±7.80) μm, the difference was statistically significant (t=5.446, P=0.000). Retinal vein diameter was positively correlated with DR stage and diabetes duration (r=0.377, 0.250; P=0.000, 0.002). DR stage (b=2.382, P=0.000) had a linear relationship with retinal vein diameter (R(2)=0.142, F=25.285). The regression equation was: retinal vein diameter =84.269+ 2.382 · DR stage. Retinal artery diameter was negatively correlated with DR stage, diabetes duration, and hypertension duration (r=-0.453, -0.343, -0.199. P=0.000, 0.000, 0.013). DR stage (b=-2.091, P=0.000) and age (b=-0.182, P=0.000) has a linear relationship with retinal artery diameter (R(2)=0.290, F=31.088). The regression equation was: retinal artery diameter =64.011-2.091·DR stage -0.182·age. With DR developed, retinal vein diameter increases, retinal artery diameter decreases in diabetic patients. The duration of diabetes mellitus and hypertension were not related to the diameter of retinal artery and vein.

Predictors of proliferative diabetic retinopathy among patients with type 2 diabetes mellitus in Malaysia as detected by fundus photography

Abstract Objectives Diabetic eye disease is the most common cause of visual loss in adults, and proliferative diabetic retinopathy (PDR) is the main cause of blindness. This study aimed to determine the predisposing factors for PDR that were identified by fundus photography among patients with type 2 diabetes mellitus (DM) at the Diabetic Clinic at Hospital Universiti Sains Malaysia. Methods In this retrospective study, fundus photo review was performed on patients with type 2 DM who had undergone diabetic retinopathy screening using a non-mydriatic fundus camera from January 2008 until December 2012. Fundus photos were classified into 2 groups, PDR and no apparent diabetic retinopathy (no DR). Socio-demographic data and clinical and metabolic profiles were obtained from the medical records. Logistic regression was used to determine the factors associated with PDR. Results A total of 120 patients were selected, with 30 patients in the PDR group and 90 patients in the no DR group. The mean age of patients with PDR was 52 (7.94) years and was 58 (12.31) years in the no DR group. Hypertension and hyperlipidaemia were the most common comorbidities identified in this study. The HbA1c level >6.5% and LDL level >2.6 mmol/L were higher in the PDR group. Age ( p = 0.032), duration of DM ( p = 0.022), nephropathy ( p = 0.002) and peripheral neuropathy ( p = 0.001) were significantly associated with PDR. Conclusion The significant predictors of PDR among patients with type 2 DM as detected by fundus photography were age, duration of DM, nephropathy and peripheral neuropathy.

High-Resolution Imaging of Parafoveal Cones in Different Stages of Diabetic Retinopathy Using Adaptive Optics Fundus Camera.

PurposeTo assess cone density as a marker of early signs of retinopathy in patients with type II diabetes mellitus.MethodsAn adaptive optics (AO) retinal camera (rtx1™; Imagine Eyes, Orsay, France) was used to acquire images of parafoveal cones from patients with type II diabetes mellitus with or without retinopathy and from healthy controls with no known systemic or ocular disease. Cone mosaic was captured at 0° and 2°eccentricities along the horizontal and vertical meridians. The density of the parafoveal cones was calculated within 100×100-μm squares located at 500-μm from the foveal center along the orthogonal meridians. Manual corrections of the automated counting were then performed by 2 masked graders. Cone density measurements were evaluated with ANOVA that consisted of one between-subjects factor, stage of retinopathy and the within-subject factors. The ANOVA model included a complex covariance structure to account for correlations between the levels of the within-subject factors.ResultsTen healthy participants (20 eyes) and 25 patients (29 eyes) with type II diabetes mellitus were recruited in the study. The mean (± standard deviation [SD]) age of the healthy participants (Control group), patients with diabetes without retinopathy (No DR group), and patients with diabetic retinopathy (DR group) was 55 ± 8, 53 ± 8, and 52 ± 9 years, respectively. The cone density was significantly lower in the moderate nonproliferative diabetic retinopathy (NPDR) and severe NPDR/proliferative DR groups compared to the Control, No DR, and mild NPDR groups (P < 0.05). No correlation was found between cone density and the level of hemoglobin A1c (HbA1c) or the duration of diabetes.ConclusionsThe extent of photoreceptor loss on AO imaging may correlate positively with severity of DR in patients with type II diabetes mellitus. Photoreceptor loss may be more pronounced among patients with advanced stages of DR due to higher risk of macular edema and its sequelae.

Clinical significance of the angiosome-based revascularization strategy for endovascular procedures in elderly patients with diabetic foot disease

Objective To investigate the clinical significance of compensatory angiogenesis and the angiosome-based revascularization strategy for endovascular procedures in treating infrapopliteal critical limb ischemia in elderly diabetic patients. Methods A retrospective study of 194 patients with diabetic feet (Fontaine IV) who had undergone endovascular procedures at our hospital from January 2005 to December 2014 was performed. Based on the angiosome concept, all subjects were classified into the direct revascularization group (DR group), the indirect revascularization through collaterals group (IR-tc group) and the indirect revascularization without collaterals group (IR-wc group). After one-year follow-up, the therapeutic effects were analyzed and compared between the three groups. Results During the one-year follow-up, the rate of unhealed ulcers, the re-intervention rate and the rate of major adverse limb events (MALE) were higher in the IR-wc group than in the DR and IR-tc groups (P=0.000 and 0.000, P=0.025 and 0.013, P=0.014 and 0.023, respectively). The IR-wc group presented a lower limb salvage rate as compared with those in the DR and IR-tc groups (P=0.011 and 0.027). Patients with a single recanalized branch had a higher rate of unhealed ulcers than those with multiple recanalized branches in the IR-wc group (93.9% vs. 71.0%, P=0.015). Conclusions The angiosome-based revascularization strategy has shown important value in guiding endovascular procedures for patients with diabetic foot disease and, in particular, the compensatory angiogenesis approach appears to be critical in generating favorable short-term clinical outcomes in the treatment of diabetic foot disease. Key words: Diabetic foot; Diabetic angiopathies; Angioplasty; Angiosome strategy

Automated detection of Diabetic Retinopathy in Three European Populations

Objective: Currently 1/12 of the world’s population has diabetes mellitus (DM), many are or will be screened by having retinal images taken. This current study aims to compare the DAPHNE software’s ability to detect DR in three different European populations compared to human grading carried out at the Moorfields Eye Hospital Reading Centre (MEHRC). Participants: Retinal images were taken from participants of the HAPIEE study (Lithuania, n=1014), the PAMDI study (Italy, n=882) and the MARS study (Germany, n=909). Methods: All anonymized images were graded by human graders at MEHRC for the presence of DR. Independently, and without any knowledge of the human grader’s results, the DAPHNE software analysed the images and divided the participants into DR and no-DR groups. Main outcome measures: The primary outcomes were sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the DAPHNE software with regards to the identification of DR or no-DR on retinal images as compared to the human grader as reference standard. Results: A total of 2805 participants were enrolled from the three study sites. The sensitivity of the DAPHNE software was above 93% in all three studies specificity was above 80%, the PPV was above 28% and the NPV was not below 98.8% in any of the studies. The DAPHNE software did not miss any vision-threatening DR. The areas under the curve (AUC) for all three studies were above 0.96. DAPHNE reduced manual human workload by 70% but had a total false positive rate of 63%. Conclusions: The DAPHNE software showed to be reliable to detect DR on three different European populations, using three different imaging settings. Further testing is required to see scalability, performance on live DR screening systems and on camera settings different to these studies.

Clinical significance of blood homocysteine and glycated hemoglobin in patients with diabetic retinopathy

Objective To investigate the clinical significance of homocysteine(Hcy) and glycated hemoglobin (HbA1c) in patients with diabetic retinopathy. Methods From March 2013 to February 2015, a total of 168 patients with diabetes from Beijing Jishuitern Hospital were divided into diabetic retinopathy group (76 cases, 32 male, 44 female, average age 62.97±12.46) and non-diabetic retinopathy group (92 cases, 46male, 46 female, average age 58.14±13.71), and 65 cases of healthy subjects(46male, 46 female, average age 60.24±10.85) were enrolled as normal control group as well. Hcy and HbA1c were detected in all groups. Multiple independent samples nonparametric tests were used to compare the difference between groups. The concentrations of Hcy and HbA1c between DR group and NDR group were analysised by ROC curve analysis. Result The Hcy levels in normal control group, NDR group and DR group were 7.00(4.55-10.50) μmol/L, 12.45(10.30-15.10) μmol/L, 20.10(16.63-25.68) μmol/L respectively.The HbA1c levels in normal control group, NDR group and DR group were 5.30(5.00-5.70)%, 6.80(5.83-8.03)%, 7.25(6.50-8.60)% respectively.There was no significant difference in Hay and HbA1c levels between groups (P<0.01); Compared with non-diabetic retinopathy group, levels of Hcy, HbA1c in diabetic retinopathy group were obviously higher; The optimal diagnostic cut-off values of Hcy was 14.35 μmol/L, at this cut-off value, the sensitivity was 96.05%, specificity was 68.48%; The optimal diagnostic cut-off values of HbA1c was 6.05%, at this cut-off value, the sensitivity was 98.68%, specificity was31.25%. Conclusion Patients with Diabetic retinopathy might have hyperhomocystinemia, and detection of Hcy may contribute to the early diagnosis of diabetic retinopathy.(Chin J Lab Med, 2015, 38: 818-821) Key words: Diabetic retinopathy; Homocysteine; Hemoglobin A, glycosylated