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Ravindranathan, Devi. "Photoplethysmography for the evaluation of diabetic autonomic neuropathy." Thesis, Cardiff University, 2009. http://orca.cf.ac.uk/54981/.
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The aim of this study was to determine if photoplethysmography (PPG) could be used to analyse the foot microvascular changes caused by diabetic autonomic neuropathy. The digital PPG signals were collected from 37 healthy volunteers (Group I), 35 diabetic patients (Group II), and 38 diabetic patients with sensory neuropathy (Group III) and analysed using MAT LAB. Prominent spectral peaks with sidebands were obtained at both the high frequency (HF) and the low frequency (LF) end of the Fourier spectrum of these PPG signals. Previous studies of microcirculation have shown that both are sympathetically and parasympathetically mediated and hence are a good measure of the autonomic activity. In the HF analysis, the heart rate (HR) response from 13 participants in Group III was severely reduced and significantly different from the responses obtained from the other two groups. However the responses from remaining 25 participants had similar characteristics to those of Group II. Hence the HF analyses failed to both statistically and objectively differentiate between the diabetics with and without neuropathy. The spectral density for the frequency bandwidth of 3-20 cpm was significantly reduced in the neuropathic group, compared to the other two groups. A Statistically significant difference was observed in the spectral densities calculated from Group II and III, though no difference could be established between Groups I and III. The LF analysis of this bandwidth differentiated between Groups II and III with a sensitivity of 84% and specificity of 61%. Activities at the LF end of the spectrum mostly represent the sympathetic control as opposed to the HR variability that is mostly a measure of the parasympathetic control. These results suggest that sympathetic dysfunction possibly precedes parasympathetic dysfunction and that PPG can assess the changes in the skin microcirculation due to sympathetic damage with moderate success.
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Wang, Siqi. "NONINVASIVE ASSESSMENT AND MODELING OF DIABETIC CARDIOVASCULAR AUTONOMIC NEUROPATHY." UKnowledge, 2012. http://uknowledge.uky.edu/cbme_etds/5.
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Noninvasive assessment of diabetic cardiovascular autonomic neuropathy (AN): Cardiac and vascular dysfunctions resulting from AN are complications of diabetes, often undiagnosed. Our objectives were to: 1) determine sympathetic and parasympathetic components of compromised blood pressure regulation in patients with polyneuropathy, and 2) rank noninvasive indexes for their sensitivity in diagnosing AN. Continuous 12-lead electrocardiography (ECG), blood pressure (BP), respiration, regional blood flow and bio-impedance were recorded from 12 able-bodied subjects (AB), 7 diabetics without (D0), 7 with possible (D1) and 8 with definite polyneuropathy (D2), during 10 minutes supine control, 30 minutes 70-degree head-up tilt and 5 minutes supine recovery. During the first 3 minutes of tilt, systolic BP decreased in D2 while increased in AB. Parasympathetic control of heart rate, baroreflex sensitivity, and baroreflex effectiveness and sympathetic control of heart rate and vasomotion were reduced in D2, compared with AB. Baroreflex effectiveness index was identified as the most sensitive index to discriminate diabetic AN.
Four-dimensional multiscale modeling of ECG indexes of diabetic autonomic neuropathy: QT interval prolongation which predicts long-term mortality in diabetics with AN, is well known. The mechanism of QT interval prolongation is still unknown, but correlation of regional sympathetic denervation of the heart (revealed by cardiac imaging) with QT interval in 12-lead ECG has been proposed. The goal of this study is to 1) reproduce QT interval prolongation seen in diabetics, and 2) develop a computer model to link QT interval prolongation to regional cardiac sympathetic denervation at the cellular level. From the 12-lead ECG acquired in the study above, heart rate-corrected QT interval (QTc) was computed and a reduced ionic whole heart mathematical model was constructed. Twelve-lead ECG was produced as a forward solution from an equivalent cardiac source. Different patterns of regional denervation in cardiac images of diabetic patients guided the simulation of pathological changes. Minimum QTc interval of lateral leads tended to be longer in D2 than in AB. Prolonging action potential duration in the basal septal region in the model produced ECG and QT interval similar to that of D2 subjects, suggesting sympathetic denervation in this region in patients with definite neuropathy.
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Gilmore, James Edward. "Autonomic neuropathy and blood flow abnormalities in the diabetic foot." Thesis, Queen's University Belfast, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335968.
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Clarke, Caroline Frances. "Autonomic neuropathy in children and adolescents with type 1 diabetes mellitus." Thesis, University of Southampton, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.359223.
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Gherghel, Doina. "Autonomic dysfunction and systemic oxidative stress associated with glaucomatous optic neuropathy." Thesis, Aston University, 2004. http://publications.aston.ac.uk/14543/.
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There were four principal sections to the work: 1. Investigation of ocular and systemic vascular risk factors in POAG. The principal findings of this work were: a). Glaucoma patients exhibit an anticipatory reaction to the physical stress, similar to subjects at risk for cardiovascular diseases; a blunted BP response and a reduction in ONH blood flow in response to cold provocation was also recorded. b). Silent myocardial ischaemic episodes occurred during peaks in systemic BP and HR. c). Independent of a positive history for cardiovascular diseases, patients suffering from POAG demonstrate a blunt circadian rhythm of the ANS. 2. Assessment of the relationship between vascular and systemic vascular risk factors in GON. The principal findings of this work were: a). POAG patients demonstrate a high sympathetic tonus over a 24-h period. b). POAG patients with lower OBF demonstrate both 24-h systemic BP and HRV abnormalities. c). OBF alterations observed in some glaucoma patients could be either primary or secondary to systemic haemodynamic disturbances and not a consequence of ONH damage. 3. Assessment of the level of systemic anti-oxidant defence in POAG patients. The principal finding of this work was: Patients suffering from POAG demonstrated significantly lower GSH and t-GSH levels than normal controls. 4. Investigation of the effect of treatment with latanoprost 0.005% on visual function and OBF. The findings of this work were: a). Treatment with latanoprost 0.005% resulted in a significant decrease in IOP and increase in OPP. VF damage progression has also been stopped. b). Treatment with latanoprost 0.005% resulted in a significant increase in the OBF parameters measured at the ONH and peripapillary retina levels. Finally, the importance of a clear protocol for managing new POAG cases is highlighted and a clinical conduit is proposed.
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Yang, Bufan. "Assessment of cardiac autonomic neuropathy (CAN) in Type I diabetic mice." Digital WPI, 2011. https://digitalcommons.wpi.edu/etd-dissertations/398.
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"Diabetic cardiovascular autonomic neuropathy (DCAN) is common in patients with diabetes mellitus, and causes abnormalities in heart rate control as well as central and peripheral nervous system dynamics. A good understanding of DCAN is not established yet. An effective way to detect diabetes mellitus at an early stage is still undiscovered, which method is highly desired by researchers and patients. One reason why the pathogenesis of DCAN is unclear is that non- invasive assessment of DCAN in humans and animals has been problematic. The non-stationary and non- linear natures of the interested physiological signals have placed great limitation on traditionally algorithms. To overcome this limitation, this work proposes a series of time- varying, nonlinear and non-invasive methods to assess cardiac autonomic dysregulation from ECG and PPG records. Including a non-stationary method called PDM, which is based on principal dynamic mode (PDM) analysis of heart rate variability (HRV), nonstationary power spectral density called TVOPS-VFCDM and also standard spectrum analysis method of HRV. We are also able to study and analyze a series of long term and short term ECG and PPG data. In a pilot study, ECG was measured via telemetry in conscious 4 month old C57/Bl6 controls and in Akita mice, a model of insulin- dependent type I diabetes, while PPG was measured via tail pulse oximetry system from 2 month old to 4 month old. The results indicate significant cardiac autonomic impairment in the diabetic mice in comparison to the controls at 4 month old and such impairment start to present at 3 month old. Further, both immunohistochemistry and Western blot analyses show a reduction in nerve density in Akita mice as compared to the control mice, thus, corroborating our data analysis records."
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Takahashi, A., S. Hakusui, N. Sakurai, et al. "Postprandial hypotension: hemodynamic differences between multiple system atrophy and peripheral autonomic neuropathy." Thesis, Elsevier, 1993. http://hdl.handle.net/2237/16641.
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Karachaliou, Fotini-Heleni. "The Avon Childhood Diabetes Project : evolution of microvascular disease and autonomic neuropathy." Thesis, University of Bristol, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389377.
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Mukkamala, Ramakrishna 1971. "Closed-loop system identification of cardiovascular control mechanisms in diabetic autonomic neuropathy." Thesis, Massachusetts Institute of Technology, 1995. http://hdl.handle.net/1721.1/36969.
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Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1995.<br>Includes bibliographical references (p. 92-95).<br>by Ramadrishna Mukkamala.<br>M.S.
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Kellogg, Aaron. "Effect of Cyclooxygenase (COX)-2 Activation on Diabetic Neuropathy." University of Toledo Health Science Campus / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=mco1211909697.
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Sardar, Asif Mohammed. "Autonomic nervous function in experimentally diabetic rats : the effects of aldose reductase inhibition, dietary myo-inositol and thyroid hormone replacement." Thesis, Loughborough University, 1992. https://dspace.lboro.ac.uk/2134/26818.
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Neuropathy, a common complication of human diabetes, is not prevented by current antidiabetic therapy. Several mechanisms, some reversible, have been proposed. Clinical assessment of drug efficacy in this condition is difficult because of its slow and unpredictable development and its possible irreversibility, once established. A reliable animal model of diabetic neuropathy would be very useful. Changes such as reduced nerve conduction velocity are used as models but their relationship to neuropathy is uncertain. The main purpose of this study was to examine autonomic changes in the experimentally diabetic rat with the aim of identifying more appropriate models. The effects of three treatments which correct specific biochemical abnormalities which may underlie diabetic complications, were also studied.
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Cardoso, KÃtia VirgÃnia Viana. "Autonomic neuropathy induced by cisplatin and vincristine in rats: functional study, electrophysiological and morphological." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=14202.
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nÃo hÃ<br>Introduction: Chemotherapeutic agents are chemical compounds used for the treatment of cancer. The efficacy of chemotherapy is limited by its side effects such as nephro, neuro, hepato and ototoxicity. Cisplatin and vincristine are chemotherapy drugs and their use is limited by peripheral neuropathy with autonomic, sensory and/or motor involvement. Aims: We evaluated the effect of cisplatin and vincristine on the gastric emptying (GE), gastrointestinal (GI) transit of liquid, baroreflex function, thermal and mechanical withdrawal latencies, electrophysiological parameters of sympathetic neurons and morphology of nerve and muscle tissues in rats. Methods: Vincristine sulphate, cisplatin or saline were injected into the tail vein. Cisplatin was administered at doses of 0.5 mg/Kg (5 doses), 1 mg/kg (2-5 doses) or 2 mg/kg (1, 2 or 5 doses) daily and vincristine was administered at the doses of 50 Âg/kg (5 doses), 100Âg/kg (2-5 doses) or 150 Âg/kg (1, 2 or 5 doses) every other day, both drugs administered in male Wistar rats (200-250g). Next day, they were gavage-fed with a test meal (0.5 mg/ml of phenol red in 5% glucose solution) and were sacrificed 10 minutes later. The recovery of phenol red in the stomach and intestine was determined by spectrophotometry. Peak values of basal mean arterial pressure (MAP) and heart rate (HR) after i.v. phenylephrine 5 mg/kg and atropine 0.5 mg/kg were used to evaluate the baroreflex responses. Animals were subjected to hot plate testing to evaluate changes in the thermal pain threshold and for the assessment of mechanical threshold and allodynia, an dynamic plantar aesthesiometer based on the von Frey filament principle was used. Differences were evaluated by One-Way ANOVA with P<0.05. Results: Cisplatin increased the GE of liquid with doses ≥ 2 mg/Kg by 59.7-77.4% and this GE delay was not present two weeks after the treatment with 5 doses of cisplatin at 1 mg/kg. Vincristine increased the GE of liquid with doses ≥ 250 Âg/kg by 54.5 â 69.3% and this GE delay was not present one week after the treatment with 5 doses of vincristine at 150 Âg/kg. Cisplatin also enhanced baroreflex gain possibly by increasing sympathetic activity. Phenylephrine-induced bradycardia was enhanced suggesting sympathetic dysfunction and after infusion of atropine (0.5 mg/kg) heart rate changes related this drug infusion were still more prominent in cisplatin-treated rats than controls. Cisplatin changed the excitability of sympathetic neurons of the superior cervical ganglion and the morphology of autonomic and somatic ganglia and the vargus nerve in rats. Vincristine enhanced the HR reduction induced by phenylephrine and atropine (P<0.05). Conclusion: Our results demonstrated that cisplatin and vincristine induced autonomic neuropathy courses with delayed GE, altered baroreflex responses and increased colonic weight. Cisplatin altered mechanical threshold but not thermal, and autonomic neuropathy preceded this changes, in rats treated with vincristine sensory neuropathy preceded and outlasted the autonomic changes.<br>IntroduÃÃo: QuimioterÃpicos sÃo compostos quÃmicos utilizados para o tratamento de cÃncer. A eficÃcia destes compostos à limitada pelos efeitos colaterais como nefro, neuro, hepato e ototoxicidade. Cisplatina e vincristina sÃo quimioterÃpicos de uso limitado que causam neuropatia perifÃrica com alteraÃÃes autonÃmicas, sensitivas e/ou motoras. Objetivos: Avaliar os efeitos do tratamento com cisplatina e vincristina no esvaziamento gÃstrico, trÃnsito intestinal de lÃquidos, na funÃÃo barorreflexa, nas latÃncias tÃrmica e mecÃnica, nos parÃmetros eletrofisiolÃgicos de neurÃnios simpÃticos e na morfologia de tecidos nervosos e musculares em ratos. MÃtodos: Sulfato de vincristina, cisplatina ou salina foram injetados na veia da cauda. Cisplatina foi administrada nas doses de 0,5 mg/kg (5 doses), 1 mg/kg (2-5 doses) ou 2 mg/kg (1, 2 ou 5 doses) diariamente e vincristina administrada nas doses de 50 Âg/kg (5 doses), 100Âg/kg (2-5 doses) ou 150 Âg/kg (1, 2 ou 5 doses) em dias alternados, ambas as drogas administradas em ratos Wistar machos (200-250g). No dia seguinte, eles receberam gavagem com uma refeiÃÃo teste (0,5 mg/ml de vermelho fenol em 5% de soluÃÃo de glucose) e foram sacrificados apÃs 10 minutos. A recuperaÃÃo do vermelho fenol no estÃmago e intestino foi determinada por espectofotometria. Valores de pico da pressÃo arterial mÃdia basal (PAM) e freqÃÃncia cardÃaca (FC) apÃs fenilefrina 5 mg/kg e atropina 0,5 mg/kg i.v. foram utilizados para avaliar as respostas barorreflexas. Animais foram submetidos ao teste da placa quente para avaliar alteraÃÃes no limiar de dor induzido por calor e para a avaliaÃÃo do limiar mecÃnico e alodinia, um estesiÃmetro dinÃmico plantar baseado no princÃpio dos filamentos de Von Frey foi utilizado. DiferenÃas foram avaliadas com teste t ou One-Way ANOVA com P<0,05. Resultados: Cisplatina aumentou a retenÃÃo gÃstrica de lÃquidos com doses ≥ 2 mg/kg de 60-70% e este retarde do esvaziamento gÃstrico nÃo permaneceu apÃs duas semanas de interrupÃÃo do tratamento com 5 doses de 1 mg/kg de cisplatina. Vincristina aumentou a retenÃÃo gÃstrica de lÃquidos com doses > 250 Âg/kg de 54,5-69,3% e este retarde do esvaziamento gÃstrico nÃo permaneceu apÃs uma semana de interrupÃÃo do tratamento com 5 doses de 150 Âg/kg de vincristina. Cisplatina tambÃm aumentou o ganho do barorreflexo possivelmente pelo aumento da atividade simpÃtica. Bradicardia induzida por fenilefrina foi aumentada sugerindo disfunÃÃo simpÃtica e apÃs a infusÃo de atropina (0,5 mg/kg) as alteraÃÃes da freqÃÃncia cardÃaca relacionadas a infusÃo desta droga foram mais proeminentes nos ratos tratados com cisplatina que no grupo controle. Cisplatina tambÃm alterou a excitabilidade de neurÃnios do gÃnglio cervical superior e a morfologia de gÃnglios autonÃmicos, somÃticos e do nervo vago em ratos. Vincristina reforÃou a reduÃÃo da FC induzida pela fenilefrina e atropina. ConclusÃo: Nossos resultados demonstraram que cisplatina e vincristina induzem neuropatia autonÃmica com retarde do esvaziamento gÃstrico, alteraÃÃo das respostas barorreflexas e aumento do peso colÃnico. Cisplatina alterou a latÃncia mecÃnica, mas nÃo a tÃrmica e a neuropatia autonÃmica precedeu estas alteraÃÃes. Em ratos tratados com vincristina a neuropatia sensitiva precedeu as disfunÃÃes autonÃmicas.
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Dudley, Meagan Taryn. "HIV-associated Neuropathy and Autonomic Dysfunction in South Africans on established ART impacts daily living." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32600.
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Introduction A common complication of Human Immunodeficiency Virus (HIV) and anti-retroviral therapy (ART) is distal sensory polyneuropathy (DSP). Older age and previous TB are risk factors for DSP among HIVinfected Africans before and shortly after ART initiation. Little is known about autonomic dysfunction in Africans on long-term ART and the impact of DSP and autonomic impairment on their quality of life. Our aim was to describe the frequency, characteristics and functional consequences of DSP and autonomic dysfunction in a healthy HIV-infected community-based cohort after at least 5 years of ART. Methods HIV-infected South Africans on the government-sponsored ART program for at least 5 years were included in this cross-sectional analysis. Each consenting participant underwent a focussed neurological assessment using the Brief Peripheral Neuropathy Screen (BPNS) and a reduced version of the Total Neuropathy Score (rTNS). DSP was defined as the presence of at least 2 neuropathic signs in a distal and symmetrical distribution, and symptomatic DSP (SDSP) when accompanied by neuropathic symptoms. Heart rate variability and orthostatic hypotension were measured as described by the Ewing classic battery, and the Survey of Autonomic Symptoms (SAS) questionnaire assessed the presence and severity of autonomic symptoms. We used a modified version of the Lower Extremity Functional Scale (LEFS) to assess lower limb physical ability. Results The 67 participants had a median age of 41 years (interquartile range (IQR) 36-46) and 61 (91 %) were women. The median duration of ART was 7 years (IQR 6-10). DSP criteria were met in 54 (80.6%) and 24 (44.4%) had symptomatic DSP. Comparing participants with DSP to those without DSP, there was no difference in sex (P=0.39), age (P=0.79), current CD4 (P=0.69), viral suppression (P=0.34), ART duration (P=0.22) or previous tuberculosis (TB) (P=0.72) in those with DSP. Similar outcomes were obtained for SDSP. Abnormal autonomic tests were present in 60%. Those with SDSP had more severe autonomic symptoms than those with asymptomatic DSP (P=0.0008). We found that those with DSP and SDSP had significantly lower LEFS percentage scores than those without (P=0.039 and P=0.013 respectively). 5 Conclusion DSP remains a common complication of HIV in the modern era of ART and can lead to significant functional impairment. Autonomic dysfunction is prevalent in SDSP.
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Croaker, Geoffrey David Hain. "Clinical and Molecular Biological Studies in Hirschsprung's Disease." Thesis, The University of Sydney, 2002. http://hdl.handle.net/2123/520.
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HSCR has been felt to be a polygeneic disease on the basis of an incompletely penetrant sex modified transmission, which may be either autosomal dominant or recessive in different kindred. During the 1990's several of the genes involved in this transmission have come to light. Other genes remain to be discovered.
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Croaker, Geoffrey David Hain. "Clinical and Molecular Biological Studies in Hirschsprung's Disease." University of Sydney. Paediatrics and Child Health, 2002. http://hdl.handle.net/2123/520.
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HSCR has been felt to be a polygeneic disease on the basis of an incompletely penetrant sex modified transmission, which may be either autosomal dominant or recessive in different kindred. During the 1990's several of the genes involved in this transmission have come to light. Other genes remain to be discovered.
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Walkinshaw, Emma. "Exploring the relationship between impaired awareness of hypoglycaemia and autonomic neuropathy in type one diabetes mellitus." Thesis, University of Sheffield, 2018. http://etheses.whiterose.ac.uk/22423/.
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Takahashi, Naomi. "Correlates of autonomic nervous system function in a general population with special reference to HbA₁c: The Nagahama study." Kyoto University, 2021. http://hdl.handle.net/2433/261615.
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Winkler, Andrea-Sylvia. "Investigation of the pathogenesis of anaemia and symptomatic postural hypotension in diabetic autonomic neuropathy and multiple system atrophy." Thesis, King's College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246858.
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du, Plessis Ronél. "Effect of an exercise training programme on muscular strength, ankle mobility, balance and gait patterns in patients with diabetic peripheral neuropathy in the lower legs." University of the Western Cape, 2021. http://hdl.handle.net/11394/8049.
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>Magister Scientiae - MSc<br>Background: Patients who suffer from diabetic peripheral neuropathy in the leg experience a greater risk of developing gait deviations due to a decrease in strength of the lower extremities, especially the tibialis anterior and triceps surea muscle groups. Aim: The aim of the study was to determine the effect of an exercise training programme on blood pressure, fasting blood glucose, muscle strength, range of motion, balance and gait pattern deviations in patients with diabetic neuropathies. Methods: A total of fourteen participants, who had been diagnosed with diabetic peripheral neuropathy or nocturnal allodynia in either one or both extremities, were asked to participate in this study. Participants were purposively selected from two private Podiatry practices based on their signs and symptoms of diabetic neuropathy, age, gender and doctor’s clearance to participate in any form of physical activity. Dependent variables included isometric strength of the muscles surrounding the hip, knee and ankle, the range of motion of the ankle in plantarflexion and dorsiflexion using goniometry, an assessment of balance using the stork stand test, and a gait pattern analysis, using the modified Tinetti Gait pattern Assessment Scale. Study design: The study was a single-blinded, pre-test and post-test experimental study design using a quantitative approach. Intervention: The researcher (a registered biokineticist) developed a scientifically-based exercise intervention programme to specifically target the entire kinetic chain, and to reduce fall risks, improve quality of life and to assist in developing a standard protocol for patients with DPN. The intervention programme consisted of a combination of ankle, hip and knee rehabilitation, including gait pattern specific rehabilitation. The intervention took place 2-3 times a week for 45 minutes per session and was divided in four categories: Range of motion exercises, strengthening exercises, balance and proprioception and gait pattern training exercises. Results: The Mann-Whitney and Wilcoxon Sign Rank Tests were used to evaluate the differences in dependent variables from pre- to post-intervention. The level of significance was set at p<0.05. An increase in range of motion only in the left ankle dorsiflexion were observed and an increase in balance time for the left leg were observed in the intervention group after a 10-week follow up assessment. Clinical significance was observed in the intervention group, post-intervention, with a decrease in systolic (-9.09%) and diastolic blood pressure (-13.89%) and a decrease in blood glucose levels (-17.89%), however, an increase in these variables was observed in the control group post-intervention. An increase in plantarflexion, 8% (left) and 8% (right) and dorsiflexion 5.26% (left) and an 11.11% (right) increase in range of motion for both left and right ankles, and balance time for both legs, 200% (left) and 159% (right) was observed in the intervention group post-intervention. Although the muscular strength variables showed a mix of an increase and decrease in strength post-intervention in the intervention group, however a clinically significant decreased amount was observed in the control group post-intervention for the majority of muscular strength variables. Conclusions: Although not many findings of this study are statistically significant, clinical significance were observed with most of the variables of this study. The findings of this study can assist future researchers in the development of exercise interventions for patients who suffers from DPN.
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Saad, Mehdi. "Détection précoce et quantification objective par mesures chronoampérometriques de l’atteinte neurologique périphérique chez des patients recevant une chimiothérapie neurotoxique." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS060/document.
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Introduction : La chimiothérapie cytotoxique constitue une modalité thérapeutique de nombreux cancers. L’amélioration de la durée de survie des patients a fait apparaître des complications de ces traitements notamment sur le nerf périphérique. Il s’agit d’une complication fréquente et potentiellement sévère qui peut avoir un impact durable. Pourtant, bien que les chimiothérapies neurotoxiques soient connues, il n’existe pas de données précises permettant de prédire la tolérance individuelle. La détection précoce des polyneuropathies chimio-induites (PNCI) est donc capitale pour évaluer les facteurs favorisants. L’utilisation du TNSc (Total Neuropathy Score clinical version) et le Sudoscan® peut notamment permettre la détection de ces PNCI. En effet, le TNSc (Total Neuropathy Score clinical version), un score composite évaluant les petites et grosses fibres nerveuses. Celui-ci a été validé pour déterminer la sévérité de la PNCI. Selon le traitement, l’atteinte concerne les grosses fibres myélinisées ou les fibres fines amyéliniques (FFA). L’examen des grosses fibres est bien standardisé au moyen de l’EMG. Cependant il n’en est pas de même pour le diagnostic d’atteinte des FFA. Le Sudoscan® mesure la conductance cutanée (mesure chronoampérométrique) après une exposition à un courant continu inférieur à 100µA/6V permet d’apprécier la fonction sudomotrice. Des études dans le diabète ont montré que la fonction sudomotrice est directement liée à l’état des FFA, car ces fibres contrôlent les glandes sudoripares. Le Sudoscan® pourrait donc être utilisé pour la détection de PNCI.Objectifs i) Evaluer l’incidence des PNCI par le TNSc selon la dose et évaluer l’atteinte des FFA chez des patients au cours de traitement par Sels de platines ou Taxanes ou Alcaloïdes de pervenche; ii) étudier l’évolution dans le temps des PNCI par le TNSc et par Sudoscan® au cours de la chimiothérapie et à distance de son arrêt; iii) caractériser des facteurs de risque de PNCI; iv) comparer les TNSc et mesures chronoampérométriques selon les traitements reçus v) évaluer l’intérêt des conductances par rapport au TNSc.Résultats Une attention particulière a été portée aux patients sous Oxaliplatine (n=65) et Taxanes (n=28). Nous avons retrouvé une augmentation du TNSc chez tous les patients sous chimiothérapie neurotoxique. Pendant le suivi, 57% des patients sous Oxaliplatine et 58% des patients sous Taxanes atteignaient un TNSc correspondant à une neuropathie clinique. Aucune différence du TNSc entre les patients symptomatiques et asymptomatiques n’a été observée à distance de traitement par Oxaliplatine (≥4mois). De même, on ne retrouvait pas de différences du TNSc entre les patients symptomatiques et asymptomatiques à distance de traitement par Taxanes. D’autre part, l’étude des conductances n’a pas révélé d’évolution en fonction de la dose reçue pour les patients sous Oxaliplatine. En revanche, chez les patients sous Taxanes on retrouvait des différences significatives des conductances en fonction des doses reçues. La mesure la plus basse des pieds pendant le suivi est observée en moyenne 23 jours avant que le TNSc le plus élevé ne soit atteint (p=0,03). On ne retrouve pas de différences des conductances pendant le suivi entres les patients symptomatiques et asymptomatiques à distance de traitement par Oxaliplatine. Toutefois, les patients symptomatiques à distance de traitement par Taxanes avaient des conductances des pieds plus basses que les patients asymptomatiques à distance (p=0.004). Le TNSc est plus élevé selon la dose reçue chez les patients diabétiques que chez les patients non diabétiques. Les conductances des mains et des pieds des patients diabétiques étaient significativement plus basses (p=0.003) chez les patients diabétiques que chez les patients non diabétiques.Conclusion Ces résultats suggèrent que les mesures chronoampérométriques permettent de détecter et quantifier l’atteinte des FFA chez les patients recevant des Taxanes<br>Introduction : Cytotoxic chemotherapy is a treatment modality for many cancers. The improved survival time of patients showed some complications of these cytotoxic treatments including chemotherapy-induced peripheral neuropathy (CIPN). This is a common and potentially severe complication that can have a lasting impact on the quality of life. Although neurotoxic chemotherapies are known, there is no accurate data to predict individual tolerance. Early detection of CIPN is therefore essential to assess the contributing factors. To this end, the use of the TNSc (Total Neuropathy Score clinical view) and the Sudoscan® can improve the detection CIPN.Indeed, the TNSc (Total Neuropathy Score clinical view), a composite score assessing small and large nerve fibers, has been validated to evaluate the severity of CIPN. The nerve impairment concerns the large myelinated fibers or small fibers, depending on the treatment. The objective assessment of large fibers is standardized by means of the EMG (Electromyography), but it is not the same for the diagnosis of the small fibers impairment.On the other hand, the Sudoscan® measures skin conductance (chronoamperometric measurement) after exposure to a direct current of less than 100μA and 6V, and can assess the sudomotor function. Interestingly, studies in diabetes have shown that sudomotor function is directly related to the status of the small fibers that control the sweat glands. The Sudoscan® could thus be used for the detection of CIPN.Objectives: i) to evaluate the impact, depending on the dose received of chemotherapy, of CIPN by TNSc and assess the impairment of small fibers in patients during treatment with Platinum compounds or Taxanes or vinca alkaloids; ii) to study the evolution of the peripheral neurologic impairment by TNSC and skin conductance measurements during chemotherapy and after the end of the treatment; iii) to characterize risk factors for CIPN; iv) to assess the usefulness of conductance measurements compared to TNSc.Results: Particular attention has been given to patients treated with Oxaliplatin (n= 65) and Taxanes (n= 28), known to damage small fibers. We found an increased TNSc in all patients receiving neurotoxic chemotherapy. During follow-up, 57% of patients receiving Oxaliplatin and 58% of patients receiving Taxanes reach a TNSc corresponding to a clinical neuropathy. However, there was no difference of TNSc during the follow-up between symptomatic and asymptomatic patients, 4 months after the end of the treatment by Oxaliplatin. Similarly, we did not find differences of TNSc during the follow-up between symptomatic and asymptomatic patients, 4 months after the end of the treatment by Taxanes.Regarding conductance values, we didn’t observe changes depending on the dose received for patients treated by Oxaliplatin. However, in patients receiving Taxanes we found significant differences, based on the cumulative dose, for the hands and feet. Indeed, the lowest measure of the feet during the tracking is observed within an average of 23 days before the TNSc reached its highest value (p = 0.03). We didn’t find differences in conductance values during follow-up among symptomatic and asymptomatic patients 4 months after the end of their treatment. However, 4 months after the end of the chemotherapy, symptomatic patients treated with Taxanes had feet conductance values lower than asymptomatic patients (p= 0.004). The TNSc was higher in diabetic patients than in non-diabetic patients depending on the dose received during the follow-up. During the follow-up, the conductance values of the hands and feet were significantly lower (p= 0.003) for these patients than in nondiabetic ones.Conclusion: These results suggest that the chronoamperometric measurements can be useful in the detection and quantification of small fibers impairment in patients receiving Taxanes
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Zouari, Hela. "Neuropathie des petites fibres : phénotypage clinique de la douleur et caractérisation neurophysiologique de l'atteinte autonome." Thesis, Paris Est, 2017. http://www.theses.fr/2017PESC0021.
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Les relations entre douleur, dysautonomie et atteinte des petites fibres nerveuses sont complexes. Notre travail a porté sur les relations entre le phénotypage clinique de la douleur d’une part, et sur la caractérisation neurophysiologique des atteintes autonomes d’autre part, dans le contexte d’atteinte des petites fibres nerveuses. Ceci a fait l’objet de 5 études. La première étude a montré que plusieurs variables cliniques permettaient de caractériser la douleur de façon différentielle entre des patients atteints de neuropathie des petites fibres idiopathique ou secondaire à un syndrome de Sjögren. La deuxième étude a montré que la lésion ou la perte de fonction des petites fibres entraînait plutôt une majoration de la sensibilisation centrale et des anomalies liées aux grosses fibres sensitives chez des patients ayant un syndrome de Sjögren douloureux associé à une neuropathie des petites fibres. La troisième étude a montré que, dans le syndrome du canal carpien, les troubles sensitifs, en dehors des sensations de brûlure, étaient aussi liés de façon prédominante aux grosses fibres, avec cependant une sensibilité diagnostique particulière de l’étude des fibres autonomes vasomotrices par le test à l'EMLA. La quatrième étude a porté sur l’intérêt de la mesure des conductances cutanées par Sudoscan ® dans le suivi des neuropathies amyloïdes et de leur traitement. Enfin, la cinquième étude a permis d’analyser la sensibilité diagnostique respective de deux tests sudoromoteurs (Sudoscan® et Neuropad®) dans le cadre de la détection précoce de la neuropathie amyloïde et aussi pour le suivi des patients, au moins en ce qui concerne le Sudoscan®. Avec tous ces aspects, ce travail a permis de mieux comprendre les relations entre troubles sensitifs et atteinte des petites fibres sensitives et autonomes dans des contextes neuropathiques cliniques, comme le syndrome de Sjögren, le syndrome du canal carpien et la neuropathie amyloïde<br>The relationships between pain, autonomic dysfunction and involvement of small nerve fibers are complex. Our work focused on the relationships between clinical phenotyping of pain on the one hand, and the neurophysiological characterization of autonomic disorders on the other hand, in the context of small nerve fiber involvement. This has been the subject of 5 studies. The first study showed that several clinical variables differentially characterize pain between patients with idiopathic small fiber neuropathy or secondary to Sjögren's syndrome. The second study showed that the lesion or loss of function of small fibers led to an increase in central sensitization and abnormalities related to large sensory fibers in patients with painful Sjögren's syndrome associated with small fiber neuropathy. The third study showed that, in carpal tunnel syndrome, sensory disturbances, apart from burning sensations, were also predominantly related to large fibers, with however a particular diagnostic sensitivity of the study of autonomic vasomotor fibers by the EMLA test. The fourth study focused on the interest of measuring electrochemical skin conductance with Sudoscan ® in the monitoring of amyloid neuropathies and their treatment. Finally, the fifth study analyzed the respective diagnostic sensitivity of two sudoromotor tests (Sudoscan® and Neuropad®) in the context of early detection of amyloid neuropathy and also for patient follow-up, at least with Sudoscan®. With all these aspects, this work has led to a better understanding of the relationships between sensory disturbances and small sensory and autonomic fibre disorders in clinical neuropathic contexts, such as Sjögren's syndrome, carpal tunnel syndrome and amyloid neuropathy
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Siepmann, Timo, Alexandra Pintér, Sylvia J. Buchmann, et al. "Cutaneous Autonomic Pilomotor Testing to Unveil the Role of Neuropathy Progression in Early Parkinson’s Disease (CAPTURE PD): Protocol for a Multicenter Study." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-230507.
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Background: In Parkinson’s disease (PD), alpha-synuclein accumulation in cutaneous autonomic pilomotor and sudomotor nerve fibers has been linked to autonomic nervous system disturbances even in the early stages of the disease. This study aims to assess the association between alpha-synuclein-mediated structural autonomic nerve fiber damage and function in PD, elucidate the role of neuropathy progression during the early disease stages, and test reproducibility and external validity of pilomotor function assessment using quantitative pilomotor axon-reflex test and sudomotor function via quantitative direct and indirect test of sudomotor function.
Methods/design: A prospective controlled study will be conducted at four study sites in Europe and the USA. Fifty-two male and female patients with idiopathic PD (Hoehn and Yahr 1–2) and 52 age- and sex-matched healthy controls will be recruited. Axon-reflex-mediated pilomotor erection will be induced by iontophoresis of phenylephrine on the dorsal forearm. Silicone impressions of the response will be obtained, scanned, and quantified for pilomotor muscle impressions by number, impression size, and area of axon-reflex spread. Axon-reflex-mediated sweating following acetylcholine iontophoresis will be quantified for number and size of droplets and axon-reflex spread. Sympathetic skin responses, autonomic and motor symptoms will be evaluated. Tests will be performed at baseline, after 2 weeks, 1, 2, and 3 years. Skin biopsies will be obtained at baseline and after 3 years and will be analyzed for nerve fiber density and alpha-synuclein accumulation.
Discussion: We anticipate that progression of autonomic nerve dysfunction assessed via pilomotor and sudomotor axon-reflex tests is related to progression of autonomic symptom severity and alpha-synuclein deposition. Potential applications of the techniques include interventional studies evaluating disease-modifying approaches and clinical assessment of autonomic dysfunction in patients with PD.
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Balbinot, Luciane Fachin. "Diagnóstico de neuropatia no diabetes mellitus tipo 2 e no pré-diabetes." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/79515.
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Segundo dados de 2012 da Sociedade Brasileira de Diabetes, se estima que cerca de 6% da população brasileira tenha diabetes e cerca de 7 a 8% tenha pré-diabetes. A neuropatia diabética é a complicação mais frequente dessa doença podendo já ocorrer no pré-diabetes. O início da neuropatia diabética é precoce e exibe grande variabilidade de manifestações clínicas, incluindo o comprometimento de diversas fibras nervosas somáticas e autonômicas. O diagnóstico tardio da neuropatia em diabéticos está associado à maior incidência de complicações como, por exemplo, ulcerações e amputações típicas do “pé diabético” e risco cardiovascular aumentado, incluindo a morte súbita. Dados como os citados acima motivaram a presente pesquisa, que se propõe a associar métodos diagnósticos não invasivos, disponíveis em nosso meio, a protocolos de investigação já recomendados pela comunidade científica internacional para neuropatia diabética. Aplicou-se um extenso protocolo de testes com finalidade de rastreamento da neuropatia somática e autonômica em três grupos de indivíduos: grupo DM (com diabetes melitus tipo 2), grupo Pré-DM, pré diabético e grupo C, de controles saudáveis. O teste em estudo foi a Termografia Computadorizada por Infravermelho, método sem contato que capta a emissão da radiação infravermelha pelo corpo humano e que, com auxílio de softwares, possibilita medições de temperatura em graus Celsius. A termografia foi testada na região plantar, utilizando-se de duas variáveis: Índice de Recuperação Térmica e presença ou não de Anisotermia Interdigital. O padrão de referência para a Termografia plantar foram os testes cardíacos de Variabilidade da Frequência Cardíaca. Pesquisas prévias demonstraram uma relação estreita entre a Neuropatia Autonômica Cardíaca (NAC) e neuropatia autonômica sistêmica. Quanto à reprodutibilidade das medidas termográficas, encontrou-se que as medidas relativas de diferenças de temperatura (Δt) são reprodutíveis nos diferentes grupos estudados e são preferíveis às medições de temperatura absoluta, confirmando a literatura. A presença de Anisotermia Interdigital parece ser o teste mais apropriado para identificar neuropatia em suas formas iniciais no grupo com diabetes e pré- diabetes, pela simplicidade de sua aplicação e pela sua boa sensibilidade e especificidade. Com a inclusão da termografia plantar em programas de rastreamento de neuropatia diabética pode-se prever um diagnóstico mais precoce e, assim, um controle mais efetivo de fatores de risco para esta patologia bem como tratamento mais precoce.<br>According to 2012 data from the Brazilian Society of Diabetes it is estimated that about 6% of the population have diabetes and about 7 to 8% have pre-diabetes. Diabetic neuropathy is the most common complication of this disease and may already occur in the pre-diabetes. The onset of diabetic neuropathy is early and shows great variability of clinical manifestations, including the commitment of various somatic and autonomic nerve fibers. Delayed diagnosis of diabetic neuropathy is associated with higher incidence of complications such as ulcerations and amputations, typical "diabetic foot" and increased of cardiovascular risk, including sudden death. Data such as those mentioned above have motivated this research, which aims to involve non-invasive diagnostic methods available in our area, the research protocols as recommended by the international scientific community for diabetic neuropathy. We applied an extensive testing protocol with the purpose of tracking somatic and autonomic neuropathy in three different groups: DM group, with type 2 diabetes, Pre-DM group, pre diabetic, and C, healthy controls. The test under study was Computerized Infrared Thermography, a no contact method that captures the emission of infrared radiation by the human body and, with the help of software, can make measurements of temperature in degrees Celsius. Thermography was tested in the plantar region, using two variables: Thermal Recovery Index and presence or absence of Interdigital Anisothermal. The reference standard for the plantar thermography tests were cardiac Heart Rate Variability. Previous studies have demonstrated a close relationship between Cardiac Autonomic Neuropathy (CAN) and systemic autonomic neuropathy. The reproducibility of the thermographic measurements was found that the relative measures of temperature differences (Δt) are reproducible in different groups, and are preferable to absolute temperature measurements, confirming the literature. The presence of Interdigital Anisothermal seems to be the most appropriate test to identify neuropathy in their initial forms in the group with diabetes and pre diabetes, because the simplicity of its application and its good sensitivity and specificity. With the addition of plantar thermography in the screening of diabetic neuropathy we may predict an earlier diagnosis and thus a more effective control of risk factors for this disease and earlier treatment.
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Tannus, Lucianne Righeti Monteiro. "Indicadores de neuropatia autonômica cardiovascular em pacientes com diabetes tipo 1." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=9321.
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A Neuropatia autonômica cardiovascular (NAC), apesar de ter sido apontada como fator de risco independente para doença cardiovascular (DCV) em pacientes com diabetes tipo 1 (DM1), permanece subdiagnosticada. Os objetivos do trababalho foram determinar a prevalência de NAC e seus indicadores clínicos e laboratoriais em pacientes com DM1 e a associação com outras complicações crônicas do diabetes, além de avaliar a concordância entre os critérios diagnósticos da NAC determinados pelos parâmetros da análise espectral e pelos testes reflexos cardiovasculares. Pacientes com DM1, duração da doença ≥ 5 anos e com idade ≥ 13 anos foram submetidos a um questionário clínico-epidemiológico, a coleta de sangue e de urina para determinação da concentração urinária de albumina, ao mapeamento de retina, e exame clínico para pesquisa de neuropatia diabética sensitivo motora além da realização de testes reflexos cardiovasculares. Cento e cinquenta e um pacientes com DM1, 53.6 % do sexo feminino, 45.7% brancos, com média de idade de 33.4 13 anos, idade ao diagnóstico de 17.2 9.8 anos, duração de DM1 de 16.3 9.5 anos, índice de massa corporal (IMC) de 23.4 (13.7-37.9) Kg/m2 e níveis de hemoglobina glicada de 9.1 2% foram avaliados. Após realização dos testes para rastreamento das complicações microvasculares, encontramos neuropatia diabética sensitivo motora, retinopatia diabética, nefropatia diabética e NAC em 44 (29.1%), 54 (38%), 35 (24.1%) e 46 (30.5%) dos pacientes avaliados, respectivamente. A presença de NAC foi associada com idade (p=0.01), duração do DM (p=0.036), HAS (p=0.001), frequência cardíaca em repouso (p=0.000), HbA1c (p=0.048), uréia (p=0.000), creatinina (p=0.008), taxa de filtração glomerular (p=0.000), concentração urinária de albumina (p=0.000), níveis séricos de LDL-colesterol (p=0.048), T4 livre (p=0.023) e hemoglobina (p=0.01) e a presença de retinopatia (p=0.000), nefropatia (p=0.000) e neuropatia diabética sensitivo motora (p=0.000), além dos seguintes sintomas; lipotimia (p=0.000), náuseas pós alimentares (p=0.042), saciedade precoce (p=0.031), disfunção sexual (p=0.049) e sudorese gustatória (p=0.018). No modelo de regressão logística binária, avaliando o diagnóstico de NAC como variável dependente, foi observado que apenas a FC em repouso, presença de neuropatia diabética sensitivo motora e retinopatia diabética foram consideradas variáveis independentes significativamente. A NAC é uma complicação crônica comum do DM1, atingindo cerca de 30% dos pacientes estudados e encontra-se associada à presença de outras complicações da doença. Indicadores da presença de NAC nos pacientes avaliados incluíram a idade, duração do diabetes, presença de HAS, frequência cardíaca de repouso e presença de sintomas sugestivos de neuropatia autonômica. O presente estudo ratifica a importância do rastreamento sistemático e precoce desta complicação.<br>The cardiovascular autonomic neuropathy (CAN), although considered as an independent risk factor for cardiovascular disease (CVD) in both patients with type 1 diabetes (T1D), remains underdiagnosed. The objective were to determine the prevalence, clinical and laboratorial indicators of CAN in patients with T1D and its association with other chronic complications of diabetes and evaluate the concordance between the diagnostic criteria for CAN diagnosis determined by the parameters of spectral analysis and the cardiovascular reflex tests. Patients with T1D aged ≥ 13 years and diabetes duration ≥ 5 years underwent a clinical-epidemiological survey, had blood samples collected, urinary samples for the determination of urinary albumin concentration, ophtalmoscopic exam, clinical neurological examination for diabetic neuropathy screeening and cardiovascular reflex tests. One hundred and fifty one patients with T1D, 53.6 % female, 45.7% Caucasian, mean age of 33.4 13 years, age at diagnosis of 17.2 9.8 years, diabetes duration of 16.3 9.5 years, body mass index (BMI) of 23.4 (13.7-37.9) kg/m2, glycated hemoglonin levels of 9.1 2% were evaluated. After performing the tests for screening for microvascular complications, we found diabetic sensory motor neuropathy, diabetic retinopathy, diabetic nephropathy and CAN in 44 (29.1%), 54 (38%), 35 (24.1%) and 46 (30.5%) of the patients, respectively. CAN was associated with age (p=0.01), diabetes duration (p=0.036), hypertension (p=0.001), resting heart rate (p=0.000), HbA1c (p=0.048), urea (p=0.000), creatinine (p=0.008), glomerular filtration rate (p=0.000), urinary albumin concentration (p=0.000), LDL-cholesterol (p=0.048), free T4 (p=0.023), hemoglobin (p=0.01) and presence of retinopathy (p=0.000), nephropathy (p=0.000) and diabetic neuropathy (p=0.000), the following symptons syncope (p=0.000), post prandial nausea (p=0.042), early saciety (p=0.031), sexual dysfunction (p=0.049) and gustatory sweating (p=0.018). In binary logistic regression model evaluating the diagnosis of CAN as a dependent variable, it was observed that only resting heart rate, presence of diabetic neuropathy and retinopathy were considered independent variables significantly. CAN is a common chronic complication of T1D affecting about 30% of the studied population and is associated with the presence of other chronic complications of T1D. Indicators of the presence of CAN included age, duration of diabetes, presence of hypertension, resting heart rate and symptoms suggestive of autonomic neuropathy. This study confirms the importance of systematic and early screening for this complication.
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Harthmann, Ângela d'Avila. "Avaliação do efeito da administração de piridostigmina sobre a variabilidade da frequência cardíaca em pacientes portadores de diabetes mellitus tipo 2 com neuropatia autonômica cardiovascular." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2010. http://hdl.handle.net/10183/27789.
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Objetivos/Hipótese: A Piridostigmina bloqueia a acetilcolinesterase, promove estimulação colinérgica e aumenta a variabilidade da freqüência cardíaca (VFC) em indivíduos saudáveis e com insuficiência cardíaca. Os efeitos sobre a modulação autonômica no diabetes mellitus tipo 2 (DM2) são desconhecidos. Nós testamos a hipótese de que a administração de piridostigmina aumenta a VFC em pacientes com DM2 e neuropatia autonômica cardiovascular (NAC). Métodos: Estudamos 34 pacientes com DM2 e NAC com idade entre 30 e 70 anos. Dezessete receberam 30 mg de piridostigmina via oral, de 8/8h por 24h (PI) e 17 receberam placebo (PL). A VFC foi avaliada pela média (RRMed) e desvio padrão dos intervalos RR (SDNN), pela raiz quadrada da média das diferenças sucessivas entre intervalos RR (RMSSD) e pelos índices do Mapa de Retorno Tridimensional P1, P2, P3 e MN. Resultados: Não houve diferenças significativas entre os grupos PI e PL quanto às características clínicas basais e à VFC sob efeito de piridostigmina e PL (RRMed - 748 ± 99 vs 733 ± 111ms; SDNN - 107 ± 26 vs 108 ± 36ms; RRMSD - 20,7 ± 12,7 vs 20,3 ± 10ms; P1 - 63 ± 11 vs 69 ± 14; P2 - 66 ±13 vs 63 ± 15; P3 - 86 ± 34 vs 80 ± 24 e MN - 392 ± 241 vs 369 ± 185). Conclusão: A piridostigmina não modifica a VFC em pacientes com DM2 e NAC.<br>Aims/Hypothesis: Pyridostigmine blocks acetylcholinesterase, promotes cholinergic stimulation and increases heart rate variability (HRV) in healthy individuals and with cardiac heart failure. The effects on the autonomic modulation in diabetes mellitus type 2 (DM2) are unknown. We have tested the hypothesis that the administration of pyridostigmine increases HRV in DM2 and CAN patients (CAN). Methods: We have studied 34 DM2 and CAN patients aged between 30 and 70 years old. Seventeen received 30mg of pyridostigmine via oral administration, every 8 hours during 24 hours (PY) and 17 received placebo (PL). HRV was assessed by the mean of all normal R-R intervals RR (mean RR) and the standard deviation of all normal R-R intervals (SDNN), by the root-mean-square of successive differences (RMSSD) and by the three-dimensional return map indices P1, P2, P3 and MN. Results: There were no significant differences between the PY and PL groups as to the baseline clinical characteristics and to HRV under the effect of pyridostigmine and PL (mean RR - 748 ± 99 vs 733 ± 111ms; SDNN - 107 ± 26 vs 108 ± 36ms; RRMSD - 20,7 ± 12,7 vs 20,3 ± 10ms; P1 - 63 ± 11 vs 69 ± 14; P2 - 66 ±13 vs 63 ± 15; P3 - 86 ± 34 vs 80 ± 24 e MN - 392 ± 241 vs 369 ± 185). Conclusion: Pyridostigmine does not modify HRV in DM2 and CAN patients.
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Testa, Giovanna. "Understanding Pain Construction from Nociception through a Novel Mutation in Nerve Growth Factor." Doctoral thesis, Scuola Normale Superiore, 2019. http://hdl.handle.net/11384/85951.
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Pain is an important physiological function, whose primary role is to preserve an organism’s integrity. Disruption of the nociception transduction chain results in the inability to perceive pain. Among these “painlessness” pathologies, Hereditary Sensory and Autonomic Neuropathy type V (HSAN V) is caused by the 661C>T transition in the ngf gene, resulting in the R100W missense mutation in mature Nerve Growth Factor (NGF), in keeping with the key role of this neurotrophin in the development of nociceptors and in their function in the adult . Homozygous HSAN V patients display indifference to noxious stimuli but, no cognitive deficits. In contrast, heterozygous carriers do not show an overt clinical phenotype and have been identified only through pedigree and genetic screening. Considering the particular features of HSAN V patients, I hypothesized that the R100W mutation might cause a dissociation between the actions of NGF on the central and peripheral nervous systems. To test this hypothesis and understand the mechanisms underlying the HSAN V phenotype, I generated a transgenic mouse line harboring the human 661C>T mutation in the human ngf gene. Homozygous NGFR100W/R100W mice were born normal, but failed to reach the first month of age. This early lethality could be due to reduced NGF bioavailability and, indeed, was rescued by continuous treatment, during development and the early postnatal life, with wild type NGF. In contrast, heterozygous NGFR100W/m mice grew normally but displayed impaired nociception, despite Dorsal Root Ganglia (DRGs) neurons being morphologically normal. On the other hand, skin innervation was reduced. The NGFR100W protein showed reduced capability to activate pain-specific signalling, paralleling its reduced ability to induce mechanical allodynia. Surprisingly, NGFR100W/m mice, unlike heterozygous mNGF+/- mice, showed no learning nor memory deficits, despite a reduction in secretion and brain levels of NGF. These results prove the hypothesized dissociation between the peripheral and central actions of NGF, prompting me to investigate if the R100W mutation might affect brain elaboration of pain. To address this issue, I used the fear conditioning test and found that NGFR100W/m mice, despite normal nociceptive responses to a painful conditioning stimulus, showed a deficit in learned fear. Strikingly, their innate fear responses were normal. This was accompanied by a reduced activation of brain regions involved in pain processing and in the generation of task-related motor responses. I also found a decreased density of CGRP-positive fibers in the amygdala, which can provide a mechanistic explanation of the reduced fear response. On the other hand, the expression of endogenous analgesic peptides, namely β-endorphin and oxytocin, was decreased in NGFR100W/m mice, suggesting a different set point of the homeostatic pain/analgesia system, as a consequence of a prolonged reduction of afferent pain signals. Consistent with these findings in mice, data collected in humans showed that heterozygous R100W carriers, despite having a normal pain threshold, had a decreased urgency to react to a painful stimulus, along with impaired ability to integrate sensory information with behavioral task requirements. Functional magnetic resonance imaging (fMRI) revealed, in accordance with mouse data, an altered processing of painful stimuli in brain areas involved in pain processing. These findings demonstrate an uncoupling of nociceptive signals from their central elaboration, leading to altered interpretation and meaning attributed to painful stimuli in human HSAN V carriers and heterozygous NGFR100W/m mice.
In addition to clarify the role of NGF in transduction of nociceptive inputs, these data also demonstrate that NGF is at the center of a regulation system linking peripheral nociception to the brain processes responsible for constructing painful perceptions and pain-related memories. Moreover, the peculiar effects of NGFR100W could be exploited to open new avenues for treating conditions of chronic pain.
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Einarsdottir, Elisabet. "Mapping genetic diseases in northern Sweden." Doctoral thesis, Umeå universitet, Medicinsk biovetenskap, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-499.
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The population of northern Sweden has previously been shown to be well suited for the mapping of monogenic diseases. In this thesis we have tested the hypothesis that this population could also be used for efficient identification of risk genes for common diseases. In Paper I we have hypothesised that despite the admixture of Swedish, Finnish and Sami, the northern Swedish population consists of sub-populations geographically restricted by the main river valleys running through the region. This geographic isolation, in combination with founder effects and genetic drift, could represent a unique resource for genetic studies. On the other hand, it also underlines the importance of accounting for this e.g. in genetic association studies. To test this hypothesis, we studied the patterns of marriage within and between river valley regions and compared allelic frequencies of genetic markers between these regions. The tendency to find a spouse and live in the river valley where one was born is strong, and allelic frequencies of genetic markers vary significantly between adjacent regions. These data support our hypothesis that the river valleys are home to distinct sub-populations and that this is likely to affect mapping of genetic diseases in these populations. In Paper II, we tested the applicability of the population in mapping HSAN V, a monogenic disease. This disease was identified in only three consanguineous individuals suffering from a severe loss of deep pain perception and an impaired perception of heat. A genome-wide scan combined with sequencing of candidate genes resulted in the identification of a causative point mutation in the nerve growth factor beta (NGFB) gene. In Paper III, a large family with multiple members affected by familial forms of type 1 diabetes mellitus (T1DM) and autoimmune thyroiditis (AITD) was studied. This syndrome was mapped to the IDDM12 region on 2q33, giving positive lodscores when conditioning on HLA haplotype. The linkage to HLA and to the IDDM12 region thus confirmed previous reports of linkage and/or association of T1DM and AITD to these loci and provided evidence that the same genetic factors may be mediating these diseases. This also supported the feasibility of mapping complex diseases in northern Sweden by the use of familial forms of these diseases. In Paper IV, we applied the same approach to study type 2 diabetes mellitus (T2DM). A non-parametric genome-wide scan was carried out on a family material from northern Sweden, and linkage was found to the calpain-10 locus, a previously described T2DM-susceptibility gene on 2q37. Together, these findings demonstrate that selecting for familial forms of even complex diseases, and choosing families from the same geographical region can efficiently reduce the genetic heterogeneity of the disease and facilitate the identification of risk genes for the disease.
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Ferreira, Maria Elvira Wagner. "Neuropatia autonomica do diabete melito : estudo do tempo do ciclo da pupila e do teste da ejaculacao retrograda; relacao com os testes cardiovasculares e sintomas de neuropatia autonomica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 1995. http://hdl.handle.net/10183/115309.
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Objetivando estudar um teste pupilar, o tempo do ciclo da pupila, e um teste para avaliar a possibilidade de ejaculação retrógrada, verificou-se a associação de cada desses testes com quatro testes cardiovasculares (resposta da pressão arterial ao ortostatismo,resposta da frequência cardíaca AE respiração profunda, ao ortostatismo e ao índice de Valsalva) e com sintomas de disautonomia. Foram submetidos, ao tempo do ciclo da pupila, 29 indivíduos normais, e 54 diabéticos dos quais 16 eram portadores de neuropatia autonômica e, ao teste da ejaculação retrógrada 25 indivíduos normais e 26 diabéticos dos quais 1 O apresentavam neuropatia autonômica. Observou-se diferença significativa entre as médias dos resultados do tempo do ciclo da pupila e as do teste da ejaculação retrógrada no grupo de indivíduos diabéticos com neuropatia autonômica em relação aos controles e em relação ao grupo de indivíduos diabéticos sem neuropatia. Os sintomas de disautonomia, que associaram-se ao tempo do ciclo da pupila alterado, foram tonturas ao levantar e sudorese gustatória; e os que se associaram ao teste da ejaculação retrógrada alterado foram tontura ao levantar e perda do controle do esfíncter anal. Os resultados do tempo do ciclo da pupila correlacionaram-se com as respostas da frequência cardíaca à respiração profunda, ao ortostatismo e ao índice de Valsalva. Os resultados do teste da ejaculação retrógrada correlacionaram-se com as respostas da pressão arterial ao ortostatismo e com as respostas da frequência cardíaca A:! respiração profunda, ao ortostatismo e ao índice de Valsalva. Em termos diagnósticos, foi observado que o tempo do ciclo da pupila possui ma sensibilidade baixa (58%) e uma especificidade um pouco melhor (85%), sugerindo que um resultado positivo possa ser útil para diagnóstico de neuropatia autonômica. O teste da ejaculação retrógrada possui ótima sensibilidade (100%) e especificidade ( 100%). Teoricamente é um excelente teste tanto para diagnosticar como para excluir a doença. Devido a inervação dos reflexos pupilares, do esfíncter vesical interno e a correlação dos testes cardiovasculares com os dois testes estudados, sugere-se que o tempo do ciclo da pupila altera-se, sobretudo, quando há comprometimento do parassimpático; e que o teste da ejaculação retrógrada altera-se quando há comprometimento do simpático e do parassimpático. Deste modo, são testes, que associados aos cardiovasculares, poderiam, talvez, classificar mais adequadamente os pacientes diabéticos quanto a presença de neuropatia autonômica.<br>The aim o f the study was to evaluate if two tests, the pupil cycle time and the presence of retrograde ejaculation, can be used as methods for definig the presence o f autonomic neuropathy. With this purpouse, the results of the two tests were compared with four cardiovascular tests (blood pressure and heart rate response to standing, heart rate response to deep breathing and Valsalva maneuver), and with symptoms usually related to autonomic neuropathy. Twenty nine normal and 54 diabetic subjects (16 with autonomic neuropathy) were submitted to the pupil cycle time test. Twenty five normal and 26 diabetic subjects (10 with autonomic neuropathy) were tested for retrograde ejaculation. There were significantly differences among the mean of the results of both tests in the group of diabetic subjets with autonomic neuropathy when compared against controls and diabetic subjects without autonomic neuropathy. Dizziness to standing and gustatory sweating were autonomic symptoms associated to the altered pupil cycle time test. Dizziness to standing and loss of the anal sphincter control were symptoms associated to the presence of the retrograde ejaculation test. A correlation between the pupil cycle time test with the heart rate response to deep breathing, standing and Valsalva maneuver was observed. On the other hand, the retrograde ejaculation test showed to be correlated with the blood pressure response to standing and with the heart rate response to deep breathing, Valsalva maneuver and standing. The results of the pupil cycle time test showed a low sensitivity (58%) and a reasonable specificity (85%). These results suggest that such test might be used to diagnose autonomic neuropathy. The retrograde ejaculation test showed a good sensitivity ( 100%) and specificity ( 100%). Theoretically, these results suggest that the test can be used to diagnose and exclude the disease. Due to the pupil innervation reflex, the vesical sphincter innervation and the correlation o f the cardiovascular tests with the results of the two tests evaluated in this work it is possible to make two suggestions: frrst, that the pupil cycle time changes specially when there is impairment of the parasympathetic nervous system; second, that retrograde ejaculation is related to abnormalities of both, sympathetic and parasympathetic system. In this way, these tests, if used as auxiliary to the cardiovascular tests, might classify more precisely whether a diabetic subject has autonomic neuropathy or not.
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Kreier, Felix. "Autonomic nervous control of white adipose tissue studies on the role of the brain in body fat distribution /." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2005. http://dare.uva.nl/document/77915.
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Görlach, Ivo. "Charakterisierung und Verlauf der autonomen Neuropathie HIV-infizierter Patienten mittels kardiovaskulärer Funktionstests." [S.l.] : [s.n.], 2001. http://deposit.ddb.de/cgi-bin/dokserv?idn=96440253X.
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Breitenbach, Clemens. "Die gesundheitsbezogene Lebensqualität und das kardiovaskuläre Regulationsverhalten eine Pilotstudie bei diabetischer autonomer Neuropathie /." [S.l.] : [s.n.], 2003. http://www.diss.fu-berlin.de/2003/198/index.html.
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Frankhof, Ute. "Diagnose, Häufigkeit und Charakteristika der autonomen Neuropathie bei Langzeitalkoholikern eine klinische und neurophysiologische Untersuchung /." [S.l.] : [s.n.], 2001. http://deposit.ddb.de/cgi-bin/dokserv?idn=962672939.
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Norman, Greg. "Psychosocial influences on physiological processes: A focus on health." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1280682539.
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Billé-Turc, Françoise. "Les fibres nerveuses de petit diametre (afferences sensitives et systeme autonome) dans les neuropathies peripheriques : correlations cliniques, electrophysiologiques et histologiques." Aix-Marseille 2, 1989. http://www.theses.fr/1989AIX20834.
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Wayhs, Cláudio. "Análise da variabilidade da frequência cardíaca em pacientes diabéticos com e sem nefropatia." reponame:Repositório Institucional da UFSC, 2014. https://repositorio.ufsc.br/xmlui/handle/123456789/128890.
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Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2014.<br>Made available in DSpace on 2015-02-05T20:27:28Z (GMT). No. of bitstreams: 1
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Previous issue date: 2014<br>INTRODUÇÃO: O número de indivíduos com Diabetes Mellitus (DM) vem aumentando de forma significativa no mundo inteiro nos últimos anos, bem como de suas complicações. As complicações microvasculares, como neuropatia autonômica e nefropatia, têm sido associadas a um desequilíbrio do sistema nervoso simpático e parassimpático e assim, a elevada morbimortalidade. OBJETIVO: Analisar a presença de neuropatia autonômica em pacientes diabéticos com e sem nefropatia e explorar o potencial da análise da variabilidade da frequência cardíaca como meio de detecção da disfunção autonômica. MATERIAIS E MÉTODOS: O estudo teve a participação de 65 indivíduos, divididos em 4 grupos. Grupo 1: 15 indivíduos saudáveis, não diabéticos; Grupo 2: 17 indivíduos portadores de DM Tipo 1 e 2 sem evidência de albuminúria; Grupo 3: 18 indivíduos com DM Tipo 1 e 2 com evidência de albuminúria ou nefropatia clínica; Grupo 4: 15 indivíduos com DM Tipo 1 e 2 com IRC Insuficiência Renal Crônica) em programa de Hemodiálise. Coletado exames laboratoriais e realizado registro eletrocardiográfico de todos os pacientes para obtenção de métricas da variabilidade de frequência cardíaca no domínio do tempo, frequência e não lineares. RESULTADOS: Os valores de variabilidade de frequência cardíaca tiveram uma redução nos Grupos 3 e 4 em comparação aos indivíduos saudáveis (p<0,05). O Grupo 3 teve piores resultados no RR, RMSSD (domínio tempo) e HF (domínio frequência), em comparação com os Grupos 1 e 2 (p<0,05). O Grupo 4 apresentou valores mais baixos no SDNN (domínio tempo), LF, VLF (domínio frequência) e CVI (métodos não lineares), com significância (p<0,05) quando comparados ao Grupo 1. DISCUSSÃO: Os indivíduos com disfunção renal, grupos 3 e 4 apresentaram um desequilíbrio maior do sistema nervoso autonômico simpático e parassimpático em relação ao grupo de diabéticos sem albuminúria e isto se comprova com a redução dos valores de VFC à medida que a lesão renal se torna mais evidente. O papel da hemodiálise ainda é bastante controverso na literatura, e neste estudo teve efeito benéfico em alguns dos parâmetros estudados, sobretudo naqueles que refletem o parassimpático. CONCLUSÃO: A análise da variabilidade da frequência cardíaca se mostrou útil no diagnóstico de neuropatia autonômica e no estudo de sua relação com a nefropatia. Ela pode ser usada como uma ferramenta que
ajude o clínico no diagnóstico precoce e frear o desenvolvimento das complicações microvasculares da DM. <br><br>Abstract: INTRODUCTION: The number of diabetic patients are growing up significantly in the last years, around the world, and so its complications. Microvasculars complications as autonomic neuropathyand nephropathy are associated to an imbalance of the sympathetic and parasympathetic nervous system and thus the high morbidity. OBJECTIVE: To analyse the presence of autonomic neuropathy in diabetic patients with and without nephropathy and to explore the potential of heart rate variability as a tool for detection of the autonomic dysfunction. MATERIALS AND METHODS: The study had 65 individuals divided in 4 groups. Group 1: 15 healthy individuals, non-diabetics; Group 2: 17 diabetic individuals (Type 1 or 2), without albuminúria; Group 3: 18 diabetic individuals (Type 1 or 2) with albuminúria or clinical nephropathy; Group 4: 15 diabetic individuals (Type 1 or 2) with end stage renal disease on Hemodialysis program. All patients were submitted to laboratory tests and electrocardiographic records in order to obtain heart rate variability in time domain, frequency and nonlinear. RESULTS: Values of heart rate variability had a decrease in groups 3 and 4 compared to healthy individuals (p<0.05). Group 3 had the worse values on RR, RMSSD (time domain) and HF (frequency domain) compared to groups 1 and 2 (p<0.05). Group 4 had the lowest values on SDNN (time domain), LF, VLF (frequency domain) and CVI (non linear methods) compared to group1 (p<0.05). DISCUSSION: Individuals with renal disease, Groups 3 and 4, presented an impairment of the sympathetic and parasympathetic utonomic nervous system compared to diabetics without albuminuria,and it is showed on the study by the decrease of the HRV values accordingly the renal damage became more evident. The role of the hemodialysis is still controversial in the literature, but in our study had a beneficial effect in some parameters, especially over those that reflect the parasympathetic. CONCLUSION: Analysis of the heart rate variability proved to be a useful tool to identify autonomic neuropathy and its relation to renal disease. It can be used as a method to help the physician in the early detection and block the development of the microvasculars complications of the Diabetes.
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Dachauer, Stefan. "Kutane Mikrozirkulation bei Typ 1 diabetischen Patienten vor und nach Pankreas- und Nierentransplantation Kardiale autonome Neuropathie bei Typ 1 diabetischen Patienten vor und nach Pankreas- und Nierentransplantation." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-75962.
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Buchholz, Stefanie Annika [Verfasser], Dan [Gutachter] Ziegler, and Jörg [Gutachter] Felsberg. "Oxidativer Stress als Prädiktor für die Entwicklung und Progression der peripheren und kardialen autonomen diabetischen Neuropathie: Eine prospektive Studie über 6 Jahre / Stefanie Annika Buchholz ; Gutachter: Dan Ziegler, Jörg Felsberg." Düsseldorf : Universitäts- und Landesbibliothek der Heinrich-Heine-Universität Düsseldorf, 2016. http://d-nb.info/112117468X/34.
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Böckeler, Tobias Edwin [Verfasser], Patrick [Gutachter] Michl, Andreas [Gutachter] Berger, and Benjamin [Gutachter] Walter. "Wertigkeit des magnetischem Marker Imaging MMI zur Charakterisierung von migratorischen Motor-Komplexen des oberen Gastrointestinaltraktes bei Diabetes mellitus und diabetischer autonomer Neuropathie / Tobias Edwin Böckeler ; Gutachter: Patrick Michl, Andreas Berger, Benjamin Walter." Halle (Saale) : Universitäts- und Landesbibliothek Sachsen-Anhalt, 2020. http://d-nb.info/1210732130/34.
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Kuo, Yi-Chun, and 郭逸鈞. "Quantitative Assessment of Diabetics with Various Degrees of Autonomic Neuropathy." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/96626534960086665407.
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Liao, Ken Ying-Kai, and 廖英凱. "Classification of the Severity of Diabetic Autonomic Neuropathy Using SVM+." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/48490209181592798076.
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碩士<br>逢甲大學<br>生醫資訊暨生醫工程碩士學程<br>101<br>Diabetes mellitus is a common chronic disease. Type 2 diabetes, the more common type of diabetes, usually affects older people. However, in recent years, the number of young adults being diagnosed with type 2 diabetes is also increasing. Diabetes can lead to neuropathy, by the damage of small vessels leading to the nerves. The autonomic nervous system plays a large role in keeping our body balanced, through the sympathetic and parasympathetic nervous systems. If diabetes causes damage to the autonomic nervous system, it can lead to diabetic autonomic neuropathy. The severity of diabetic autonomic neuropathy can affect the quality of life of people, and needs to be diagnosed in order to be treated properly. This study recruited 39 patients with diabetes, with the severity of autonomic neuropathy ranging from mild neuropathy to severe neuropathy. 15 age and gender matched healthy controls were also recruited. The subjects’ cerebral blood flow velocity and blood pressure were measured with a transcranial Doppler ultrasound, and a Finapres continuous blood pressure measurement system. The data were stored and processed by a computer, and were analyzed with cross-correlation function and linear regression, which have been proven to be useful tools in assessing diabetic autonomic neuropathy. The results were processed by an SVM+ classifier to build a model to classify the varying degrees of autonomic neuropathy. The SVM+ classifier uses a new learning paradigm called “learning using hidden information”. This learning paradigm allows the SVM+ classifier to be efficient by only building the model with the hidden information, and thus patients may not have to go through many difficult tests to know the severity of their diabetic autonomic neuropathy. The program was written in the LabVIEW® environment, to be compatible with previous data collection methods. Normal controls and mild and severe diabetic autonomic neuropathy subjects have been successfully classified with a 92.59% classification accuracy based on leave-one-out cross validation using an SVM+ classifier with the modified composite autonomic scores as hidden information.
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"Noninvasive investigation of the postural circulatory homoestatic mechanisms and autonomic neuropathy." 2001. http://library.cuhk.edu.hk/record=b6073392.
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Zhang Ye.<br>"October 2001."<br>Thesis (Ph.D.)--Chinese University of Hong Kong, 2001.<br>Includes bibliographical references (p. 200-224).<br>Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Mode of access: World Wide Web.<br>Abstracts in English and Chinese.
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Chen, Kuan-nan, and 陳冠男. "Classification of Severity in Patients with Diabetic Autonomic Neuropathy Using Pulse Signal." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/56942266096035430137.
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Li, Tai-yu, and 李臺育. "Classification of Severity in Diabetic Autonomic Neuropathy Using Linear and Nonlinear Parameters." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/90376361853777134526.
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碩士<br>逢甲大學<br>生醫資訊暨生醫工程碩士學位學程<br>100<br>Diabetes has been one of the top ten death results in Taiwan in recent ten years, and it becomes one of the most common chronic diseases in modern society. Neuropathy is one of the most common chronic complication of diabetes, and it is related to the time of suffering from diabetes. For this reason, if we can distinguish between the severity of diabetic autonomic neuropathy, then we will retard the disease increased. In the past, the inspection of autonomic nervous system was quite cumbersome and required a longer time. Therefore, the aim of this study is to extract the parameters from arterial blood pressure and mean cerebral blood flow which are, expected to be helpful to distinguish the severity of autonomic neuropathy. In this study, the support vector machine is used to classify 14 cases of normal subjects and 58 patients with diabetes in which 15 patients with out neuropathy, 25 patients with mild neuropathy, and 18 patients with severe neuropathy. The mean arterial pressure and mean cerebral blood flow are first filtered into very low frequency, low frequency, and high frequency bands. The cross-correlation function of the maximum peak and the corresponding standard deviation and index are calculated. A total of nine parameters is applied to be the linear feature parameters. The classification result of the leave-one-out is 70.8%. The classification combined with the nonlinear feature parameter is 73.6%. These results indicate that the approach of this study can be helpful to improve the recognition results and can be used to classify the severity in diabetic autonomic neuropathy.
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Cheng, Cheng-Yang, and 鄭承洋. "The Development of Fuzzy Classification System for Recognition of Diabetics with Autonomic Neuropathy." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/64366693106444023885.
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碩士<br>逢甲大學<br>自動控制工程所<br>93<br>The autonomic nervous system of humans controls many essential physiological activities like heart beat, breath, blood pressure and mental response that cannot be changed as will. Although autonomic nervous system plays an important role in our daily life, its related diseases are usually ignored. The purpose of this research is to design a fuzzy recognition system for assessing and classifying the autonomic nervous signals from diabetic patients with and without autonomic neuropathy. The fuzzy recognition expert system is established based on the clinical diagnosis and the corresponding recorded signals using fuzzy logic and inference rules. Based on the clinical diagnosis, 30 subjects are classified into three groups: diabetic with autonomic neuropathy (10 subjects), diabetic without autonomic neuropathy (10 subjects) and the control group (10 subjects). The signals, arterial blood pressure and cerebral blood velocity, are acquired via noninvasive devices (i.e. Finaprès and TCD) in supine and tilting positions for assessing subjects’ physiological conditions. The results revealed that the accuracy of the proposed system is about 80% ~ 85% by using the fuzzy classification. According to the values of mean arterial blood pressure (MABP) and mean cerebral blood flow velocity (MCBFV), the range of estimated value are both –10~10 in normal subjects, –30~–50 and 30~50 in diabetics without neuropathy and –10~–30 and 10~30 in diabetics with neuropathy. Therefore, normal subjects and diabetics can be classified based on estimating the MABP and MCBFV. We expect the system can be applied in clinical practice.
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Tsai, Yu-Chou, and 蔡育周. "Using Nonlinear Analysis for Assessment of Dynamic Cerebral Autoregulation in Diabetes with Autonomic Neuropathy." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/x594mt.
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碩士<br>逢甲大學<br>自動控制工程所<br>91<br>The cerebral autoregulation (CA) mechanism refers to the cerebral blood flow (CBF) tendency to maintain relatively constant in the brain despite changes in mean arterial blood pressure (MABP). The main purpose of this study is to use chaotic analysis approaches to analyze the blood pressure and cerebral blood flow between 11 age-matched normal subjects and 19 diabetics with autonomic neuropathy. MABP in the finger via Finapres and mean cerebral blood flow velocity (MCBFV) of the middle cerebral artery via transcranial doppler (TCD) ultrasound were measured continuously during supine and tilt-up positions each for 5 minutes in both normals and patients. The results showed that the correlation dimension (CD) values of MABP in diabetics subjects (MABP supine: 3.688±2.289; MABP tilt-up: 2.145±1.239; p<0.01, paired t-test) decreased with statistical significance between supine and tilt-up positions. On the other hand, CD values of MABP between normals and patients in supine position (MABP in normals: 2.012±0.775; MABP in patients: 3.688±2.289; p<0.05) were significantly different. The CD of MCBFV remained no change. The Lyapunov exponent (LE) in MABP between normals and patinents in supine position (Normals: 1.704±0.995; Patients: 1.016±0.415; p<0.05) and MCBFV in patients between supine and tilt-up positions (Supine: 1.058±0.333; Tilt-up: 0.797±0.382; p<0.05) were different with statistical significance. The Kolmogorov entropy (K2) values in both the normal subjects and diabetics were not statistically significant. The only difference is that the K2 values of MCBFV between normals and diabetics in tilt-up positions were significantly different (Normals: 2.835±0.461, Patients: 3.323±0.568; p<0.05). It can be concluded that the CD, LE, and K2 nonlinear measures are suitable tools to explore the nonlinear analysis of dynamic CA.
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DEFEUDIS, GIUSEPPE. "Glicometabolic effects on bone metabolism: from new and different pathways to new diagnostic and therapeutic aspects." Doctoral thesis, 2018. http://hdl.handle.net/11573/1189499.
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Background
Diabetes and bone fragility are rapidly growing diseases, as osteoporosis could be defined as a complication of type 2 diabetes (T2D) (Epstein et al. 2016). Aging of populations worldwide will be responsible for an increased risk in the incidence of these two diseases. There is a pathophysiological link between the high fracture incidence and diabetes if compared with the non-diabetic state, has recently been recognized but not totally clear and understood. In fact, several mechanisms are involved in bone homeostasis by impairing the function of bone cells as osteocytes, as osteoblasts and osteoclasts, and/or modifying the structural characteristics of the bone tissue (Jiang and Xia 2018; Epstein et al. 2016). Furthermore, as osteoblasts and adipocytes both derived from the mesenchymal stem cell (MSC), their physiological differentiation could be modulated by several interacting pathways on which diabetes may shows its influence and disruption. Finally, is well known the alteration of different organs and systems during diabetic disease, involved in bone metabolism, as kidney, gut or vitamin D pathway. In fact, In the last few years, studies are focusing not only to clarify old pathways but also to discover new pathways among diabetes, obesity and bone metabolism, as Wnt signaling and the role of sclerostin, as irisin, as different formulations of vitamin D like calcidiol. Moreover, some complications derived from diabetes, as cardiac neuropathy, were not yet fully evaluated on their link to the axis diabetes-bone, leading a gap of knowledge to fill (Epstein et al. 2016; Napoli, Strollo, et al. 2014).
So, many questions remain regarding the underlying mechanisms for greater bone fragility in diabetic patients and the best approach to risk assessment and treatment to prevent fractures.
Specific aims
1) to evaluate the role of sclerostin in patients with type 2 diabetes and patients with LADA.
2) to investigate the relationship between irisin and body composition in subjects with osteoporosis and the impact of irisin levels on fragility vertebral fractures.
3) to evaluate the role of calcidiol on metabolic parameters and ß-cell function in subjects with impaired glycaemic control and insufficient vitamin D levels.
4) to evaluate the relationship between cardiac autonomic neuropathy and BMD in patients with diabetes.
Materials and Methods
1) This cross-sectional study included 98 T2D and 89 LADA patients from the Action LADA and NIRAD cohorts. Patients were further divided according to MetS status. Non-diabetic subjects (n=53) were used as controls. Serum sclerostin, bone formation (P1NP) and bone resorption (CTX) were analyzed.
2) In this cross-sectional study, 36 overweight subjects affected by at least one vertebral osteoporotic fracture confirmed by a X-ray vertebral morphometry and 36 overweight non-osteoporotic subjects were enrolled. Serum irisin levels were measured using an irisin competitive ELISA. We evaluated lumbar spine and hip BMD and body composition using dual energy X-ray absorptiometry. To measure and monitor daily physical activity, each subject wore an armband for approximately 72 hours.
3) It is a double-blind placebo-controlled clinical trial enrolling subjects with IGT, IFG and T2D (20) and 25(OH)D <20 ng/ml. In this study were enrolled a total of 150 subjects and followed up for 6 months. Subjects were either assigned (50 per group) to 1) daily supplementation of 50 mcg of calcidiol (Arm A); 2) 25 mcg of calcidiol (arm B); 3) placebo (Arm C). Fasting blood glucose and Oral Glucose Tolerance Test (OGTT), HbA1c, 25 (OH) D, calcium, phosphorus, PTH, calciuria, phosphaturia, total cholesterol, HDL cholesterol and triglycerides were measured with laboratory kits used in clinical settings. Measurements of Ox-LDL, Hs-CRP, TNF-α, IL-6, esRAGE, sRAGE were performed at the laboratory. To evaluate insulin resistance were used the ISOGTT index and the evaluation of the model of insulin-resistance homeostasis (HOMA-IR). Beta-cell function was evaluated using the insulin secretion sensitivity index-2 (ISSI-2)
4) Fourty-nine people with T2D were enrolled. Tests to determine heart rate response to deep-breathing (expiratory-to-inspiratory ratio), heart rate response to lying-to-stand test (30:15 ratio) and blood pressure response to standing were performed to detect cardiac autonomic neuropathy, and dual energy X-ray absorptiometry scan of both the lumbar spine and femoral neck were performed to evaluate bone mineral density.
Results
1) T2D subjects had higher sclerostin than LADA (p=0.0008, adjusted for sex and BMI), even when analysis was restricted to MetS subjects (adjusted p=0.03). Analyzing T2D and LADA separately, sclerostin was similar between subjects with and without MetS. However, a positive trend between sclerostin and number of MetS features was seen in T2D (p for trend=0.001) but not in LADA. Subjects with either T2D or LADA had lower CTX than controls (p=0.0003), and not significantly reduced P1NP. Sclerostin was unrelated to age or HbA1c but correlated with BMI (ρ=0.29; p=0.0001), HDL (ρ=-0.23; p=0.003), triglycerides (ρ=0.19; p=0.002) and time since diagnosis (ρ=0.32, p<0.0001).
2) No significant correlations were found between irisin and BMD at any site and between irisin with either lean or fat mass. Serum levels of irisin were not correlated with the daily physical activity. Serum irisin levels were lower in subjects with previous osteoporotic fractures than in controls (p= 0.032) and the difference in irisin levels remained significant after adjustment for creatinine (p=0.037), vitamin D (p=0.046), lean mass (p=0.02), lumbar BMD (p=0.023) and femoral BMD (p=0.032).
3) At baseline, subjects were (mean±SD) 63.8± 2.1 y.o., BMI was 27.4±1.2 kg/m2; serum glucose 115.1±8.4 mg/dL, HbA1c 6.4±0.6%, 25OHD 16.3±2.5 ng/mL. There were significant associations of 25OHD with ISOGTT (β=0.35; 95% CI, 0.14, 0.46) and β-cell function (ISSI-2; β = 0.15; 95% CI, 0.02, 0.28). At six months, 25OHD increased up to 48±3 ng/mL in Arm A (P<0.01) and to 36±5 ng/mL in Arm B (P<0.01); no significant changes in the Arm C. Subjects in Arm A had a lower risk of dysglycemia (HR= 0.85, 95% CI, 0.75-0.97 per SD increase) while no significant effects were observed in the Arms B or C. Both ISOGTT and ISSI-2 were improved in Arm A (P<0.05) while no significant changes were observed in Arm B or placebo. Serum levels of sRAGE decreased in Arm A [median 1354 (1069-1680) pg/ml (P<0.01), as compared with levels at study entry, but not in Arms B or C. No significant differences were observed for hsCRP, IL6, TNFα or lipid panel.
4) We analyzed preliminary results among two evaluations of BMD and CAN, not finding any significative difference. In fact, subjects with no CAN showed a normal BMD in 35,7% while the remaining part had osteopenia or osteoporosis (64,3%: osteopenia: 60,7%; osteoporosis: 3,6%). Evaluating BMD in subjects with CAN, 48,1 had a normal BMD while 51,9 had osteopenia (37%) or osteoporosis (14,8%).
Conclusions
1) LADA patients present lower bone resorption compared to controls, similarly to T2D. Sclerostin is increased in T2D but not in LADA suggesting possible roles on bone metabolism in T2D only.
2) The data confirm an inverse correlation between irisin levels and vertebral fragility fractures, but no significant correlation was found with BMD or lean mass. Irisin may play a protective role on bone health independent of BMD.
3) Our findings indicate that high doses of calcidiol improved indices of glucose homeostasis in prediabetic subjects and decreased circulating sRAGE levels, suggesting a positive effect also on oxidative stress.
4) No significant correlations were found evaluating BMD in subjects with T2D and CAN.
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Hung, Hsiang Lin, and 洪祥齡. "Fractal Character in Point Process：Distinguishing the Pulse of Serious Diabetic Autonomic Neuropathy and Healthy Men." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/53968407532137970233.
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碩士<br>東海大學<br>統計學系<br>89<br>According to fractal character, we take several analyses to calculate the indexes which attempt to check a particular patient suffers from autonomic neuropathy or not and also compare those indexes for different analyses.
This research takes the pulse for serious diabetic autonomic neuropathy and healthy men as our empirical data. These analyses are based on interval and count measures. Interval measures consist of interveent-interval histogram and interval-based periodogram. And count measures consist of event-number histogram, variance-time-curve, Fano factor and generalized-rate-based peiodogram. Obeying the measures which is mentioned above, we can compute several indexes and use statistical test to verify these two different samples. Finally, we will review the conclusion and some suitable indexes will be chosen.
The analysis we have conducted suggests the use of the conveniently indexes, unless the ratio of LF/HF for IBP and RBP, indicates whether a particular patient does or does not suffer from autonomic neuropathy.
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Thomas, Tina. "A Québec mystery unveiled : the quest to understand hereditary sensory and autonomic neuropathy type 2." Thèse, 2007. http://hdl.handle.net/1866/15782.
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Meng-Shu, Tsai, and 蔡孟書. "Effects of physical training on heart rate variability and exercise capacity in diabetes with autonomic neuropathy." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/50625592530764550075.
Full textAbstract:
碩士<br>國立臺灣大學<br>物理治療學研究所<br>90<br>Background: Heart rate variability (HRV) was commonly used in studies of autonomic neuropathy. Decreased HRV was noted in diabetes mellitus. Exercise training can improve their exercise capacity and HRV. However, few studies have been reported the effects in diabetic patient with autonomic neuropathy, nor did the changes in HRV, especially during exercise and post-exercise. The purpose of this study was to investigate effects of physical training on exercise capacity and HRV in diabeteic patient with autonomic neuropathy (DAN).
Methods and Subjects: Thirty-one Type 2 diabetic patients with decreased HR response in deep breathing maneuver were recruited from National Taiwan University Hospital, and assigned to exercise group (n=16, average aged 57.0 ± 4.6 years) and control group (n=15, average aged 53.1 ± 7.5 years). Exercise group took a supervised aerobic training twice a week at the hospital and home exercise three times a week totallly for 8 weeks. The training intensity was set at 70% VO2peak. All the subjects were asked to keep their dietary intake, daily activity and medication during 8-week period. Measurements of blood glucose, body composition, VO2peak, and evaluation of HRV at rest, during exercise at 50% VO2peak, and peak workload that could be completed 3 mins, cool-down, and recovery phase were taken before and after 8 weeks for each subject. In addition, inquiries of daily physical activity and dietary intake were taken every 4 weeks. Nonparametric Mann-Whitney U test was used to make comparisions between groups, including the baseline data and the changes after 8 weeks. Wilcoxon Signed Ranks Test was used to make the comparsion within the groups.
Results: As compared with the control group, subjects in exercise group had significant increase in peak oxygen consumption and decreases in resting heart rate and percentage body fat (P < 0.05). In power spectral analysis of HRV, exercise group had (1) increase of TP (total power) in supine resting; (2) increase of HF (high frequency) and decreased LF/HF（lower frequency/ high frequency） at 50% VO2peak exercise intensity; and (3) increase of TP in cool down period (P < 0.05).
Conclusion: Eight-weeks exercise training can decrease percentage of body fat, increase exercise capacity, and decrease RHR (resting heart rate) in diabetic patients with autonomic neuropathy. The favorable changes HRV appeared in supine-resting, during 50% VO2peak exercise, and cool-down period.
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Lin, Yun-Hui, and 林筠惠. "Time series analysis and comparison of human heart rate variability–distinguishing between healthy and autonomic neuropathy subjects." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/59187168492973151658.
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