PURPOSE:
The usefulness of laminin as a serum marker of diabetic retinopathy is a topic that generates conflicting views. The aim of the present study was to investigate the effect of diabetic ...retinopathy on serum laminin-P1, the larger pepsin resistant fragment of laminin, and to elucidate whether serum laminin-P1 could be an indicator of the risk for development of diabetic retinopathy.
METHODS:
In a prospective study, 97 consecutive diabetic patients (35 type 1 and 62 type 2) without diabetic retinopathy and a urinary albumin excretion rate lower than 20 μg per minute were enrolled in a 4-year follow-up study. Patients who developed microalbuminuria during the study were excluded in order to avoid the influence of diabetic nephropathy on serum laminin-P1. At the end of follow-up, data from ophthalmologic studies and serum laminin-P1 were evaluated in the 66 normoalbuminuric diabetic patients who completed the study.
RESULTS:
No statistical differences were observed in baseline laminin-P1 serum concentrations between patients who developed diabetic retinopathy (n = 15) and patients who remained without it during follow-up (n = 51). However, serum laminin-P1 levels obtained at the end of the study were significantly higher in patients who developed diabetic retinopathy (1.75 ± 0.33 U/ml versus 1.47 ± 0.27 U/ml;
P = .002). Furthermore, statistical difference was observed when initial and final values of serum laminin-P1 were compared in patients who developed diabetic retinopathy (1.56 ± 0.27 U/ml versus 1.75 ± 0.33 U/ml;
P = .001). Remarkably, an increase in serum laminin-P1 concentration was detected in all but two of the patients who developed diabetic retinopathy. The relative risk of development of diabetic retinopathy in patients who showed an increase in serum laminin-P1 during follow-up was 5.4 (95% confidence interval, 1.32 to 22.13).
CONCLUSIONS:
Serum laminin-P1 is a marker and a risk indicator of diabetic retinopathy but is not an early predictor of its development.
Abstract Type 2 diabetes and depressive disorder are 2 chronic diseases highly prevalent in developed countries and with a negative impact on quality of life and life expectancy. In recent years, ...both conditions have been shown to be strongly associated. Thus, diabetics have an increased risk of suffering depressive disorder, as well as impaired glucose homeostasis, if they experience depression. In diabetic patients, concurrent depression is associated to greater difficulties in disease management and metabolic control, increased risk of developing chronic complications, decreased quality of life, and higher healthcare expenses. As a result, the interest of diabetic scientific societies in this association has increased, and they recommend regular mood assessment in diabetic patients. However, the limited clinical experience available and the conflicting results reported to date make it difficult to draw conclusions.
Objective: To assess the influence of several variables on serum laminin-P1 (Lam-P1) and to evaluate its usefulness as a serum marker of diabetic microangiopathy.
Material and methods: We determined ...Lam-P1 by serum radioimmunoassay in 121 controls and 176 diabetic patients, 58 type 1 (insulin dependent) and 118 type (non-insulin dependent), grouped according to retinal status and urinary albumin excretion. The variables evaluated were: age, gender, body mass index, blood pressure, consumption of tobacco and alcohol, type of diabetes, duration of disease, fasting blood glucose, HbA
1, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins (A
1,B). Imprecision for laminin determination was: 3.6% intrassay; 5.8% interassay. Statistics: Student's
t-test, ANOVA, ANCOVA, and multiple regression analysis.
Results: In diabetic patients Lam-P1 was higher than in controls (X = 1.63 ± S.D. 0.36 vs. X = 1.40 ± S.D. 0.18 U ml
−1;
P < 0.001) and only correlated with age (
P = 0.002). Lam-P1 was higher in diabetics with proliferative retinopathy than in patients with non-proliferative retinopathy and without retinopathy (X = 2.17 ± S.D. 0.49 U ml
−1 vs. X = 1.71 ± S.D. 0.22 U ml
−1 vs. X = 1.47 ± S.D. 0.26 U ml
−1;
p < 0.001). Patients with macroalbuminuria presented higher serum Lam-P1 than patients with micro or normoalbuminuria (X = 2.39 ± S.D. 0.53 U ml
−1 vs. X = 1.78 ± S.D. 0.23 U ml
−1 vs. X = 1.51 ± S.D. 0.29 U ml
−1;
P < 0.001). These differences remained significative when patients were age-adjusted.
Conclusions: Lam-P1 could be useful as an index of diabetic microangiopathy but patient's age should be considered.
Cervical cord compression due to local extension of differentiated thyroid carcinoma (DTC) is an extremely rare condition and, to our knowledge, only one case has been reported in the literature. ...Among 256 patients with DTC treated at our hospital, we have observed 3 cases of spinal injury due to local extension of DTC. A Brown-Séquard syndrome was detected at physical examination in 2 cases. In both patients, cervical cord compression precipitated a fatal event. In the remaining patient, a radiculopathy C5-C7 was observed. Magnetic resonance imaging was very successful in outlining the mass, clearly differentiating the extrinsic invasion from a metastasis, and allowing the surgical possibilities to be evaluated. Poor cervical uptake of 131I was observed on scans performed in two cases, suggesting a certain degree of cell dedifferentiation. We suggest that cervical spinal injury due to local extension of DTC may be an underreported complication of DTC that seems to condition the patient's outcome. Careful neurological examination is warranted in patients with DTC at stages III-IV and magnetic resonance imaging must be performed when spinal injury is suspected.
