Introduction: Sudomotor impairment (SI) is common in people with diabetic peripheral neuropathy (DPN) and could potentially influence the effects of exercise. Exercise is known to improve outcomes ...such as physical fatigue (PF); however, the impact of SI on PF is not clear. Thus, our objective was to examine the impact of sudomotor function on PF change after 16-weeks of moderate intensity aerobic exercise (AEx).
Methods: People with DPN (n=17) who participated in 16-weeks of AEx were included in this secondary analysis. Sudomotor function was evaluated at baseline via a quantitative sudomotor axon reflex test and classified as normal (n=6), mild (n=6), moderate (n=3), or severe (n=2). Self-reported PF was assessed at baseline and post-intervention via a fatigue questionnaire. A Kruskal-Wallis test evaluated the impact of baseline sudomotor function on change in PF after exercise. Dunn’s tests were used to evaluate multiple comparisons. Association between sudomotor function and PF change was evaluated via a Spearman’s correlation. Alpha was set at 0.05.
Results: Changes in PF are reported as negative (↓in PF) and positive (↑in PF) values. Median PF changes of -29%, -30%, 0%, and 14% were observed for normal, mild, moderate, and severe groups, respectively with a significant between-group difference (p=0.039). Pairwise comparisons revealed significant differences between normal and moderate (p=0.025), normal and severe (p=0.047), and mild and moderate (p=0.04) groups. A moderate correlation between SI and PF change (r=0.630, p=0.007) was observed.
Conclusions: Our results indicate that change in PF following 16-weeks of AEx may be influenced by SI. SI can limit the body’s ability to dissipate heat during exercise, potentially exacerbating PF through disruptions in the thermoregulatory negative feedback loop. This could influence response to exercise, and future research should examine the effects of underlying mechanisms of SI on PF in this population.
Disclosure
C.M. Gray: None. A. Yahya: None. A.M. Alenazi: None. M. Alshehri: None. J.L. Rucker: None. M. Pasnoor: Advisory Panel; Self; Alexion Pharmaceuticals, Inc., Terumo BCT. Consultant; Self; Momenta Pharmaceuticals. P. Kluding: None.
Funding
National Center for Advancing Translation Sciences (UL1TR000001); Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD057850)
Objective: Type 2 diabetes (T2D) has been associated with osteoarthritis (OA). However, research related to the impact of T2D on pain severity is limited. The purpose of this study was to examine the ...association between T2D and pain severity in people with localized OA (LOA) (e.g., OA restricted to only one or two joints), and to explore the association between glycosylated hemoglobin (A1c) level and pain severity in people with LOA and T2D.
Methods: A retrospective review of data from a tertiary medical center was performed. Records were selected based on diagnoses codes for LOA using international classification of disease 9th and 10threvisions. Index date was set as the first diagnosis date. Pain severity, measured by a 0 to 10 numeric rating scale, was obtained and linked to the index date. T2D was defined as having two diagnostic codes for T2D or using insulin. A1c was obtained for patients with T2D within six months of the index date. Covariates of age, sex, depression, hypertension, dyslipidemia, and medications (+/- 90 days of the index date) were included in linear regression analysis. Alpha level was 0.05.
Results: Data from 819 patients (mean age = 65.08±9.77, 54.3% women) included 671 patients with LOA only (n=671) and 148 patients with LOA+T2D. T2D was significantly associated with increased pain severity (B=1.08, 95% CI 0.23 -1.93, p=0.013) after controlling for covariates. For patients with LOA+T2D with data for A1C (n=87), higher A1c was significantly associated with increased pain severity (B=0.33, 95% CI 0.01 -0.64, p=0.045) after controlling for medications.
Conclusion: This study found that T2D was associated with higher pain severity in people with LOA, and that poorer glycemic control was associated with higher pain severity in people with LOA+T2D. Only T2D was associated with pain that exceeded the clinically meaningful difference (>1 score). Clinicians should consider T2D as a factor in the management of pain in people with LOA.
Disclosure
A.M. Alenazi: None. S.M. Obaidat: None. M. Alshehri: None. C.M. Gray: None. S. Alothman: None. J.L. Rucker: None. L.R. Waitman: None. P. Kluding: None.
Introduction: Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low (LABI) or ...high (HABI) are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of sleep apnea in people of Hispanic/Latino descent.
Methods: A cross sectional analysis from a multi-center epidemiologic study, HCHS/SOL, was utilized, including 8,378 participants (mean age 45.92?±?13.96, female = 49%, mean BMI=30.06?±?5.55). The sample was divided into 6 groups based on ADA guidelines (no-DM or DM) and ABI categories (LABI, normal ABI, or HABI). A linear regression was used to determine the strength of association between groups to predict the severity of sleep apnea, measured by the Apnea-Hypopnea Index (AHI). A Kruskal-Wallis H test was used for AHI comparisons between groups. Significance level was set at 0.01.
Results: There were significant differences between groups for mean AHI (P<0.001; no-DM+normal ABI= 19.28±16.57, DM+normal ABI = 26.85?±?21.87, no-DM+LABI = 17.63?±?18.22, DM?+LABI = 26.31?±?21.62, no-DM?+HABI = 27.12?±?19.82, and DM?+HABI = 33.0?±?22.01). Linear regression ?showed that DM and HABI was significantly associated with severe sleep apnea (β= 5.7, p=0.007) after controlling for age, waist-hip ratio, and Statin medication.
Conclusion: ?These data suggest that ?people with DM and HABI were more likely to have severe apnea compared to the other groups. People with DM, HABI, and severe sleep apnea might be at higher risk of cardiovascular complications. Thus, further research is required to elucidate the appropriate intervention to combat the high level of Peripheral artery disease.
Disclosure
M.M. Alshehri: None. A.S. Alqahtani: None. A.M. Alenazi: None. S. Alothman: None. M. Aldhahi: None. C.M. Gray: None. B. Alqahtani: None. P. Kluding: None.
Ascorbate (vitamin C) has been evaluated as a potential treatment for cancer as an independent agent and in combination with standard chemotherapies. This review assesses the evidence for safety and ...clinical effectiveness of intravenous (IV) ascorbate in treating various types of cancer.
Single arm and randomized Phase I/II trials were included in this review. The PubMed, MEDLINE, and Cochrane databases were searched. Results were screened by three of the authors (GN, RP, and CJP) to determine if they met inclusion criteria, and then summarized using a narrative approach.
A total of 23 trials involving 385 patients met the inclusion criteria. Only one trial, in ovarian cancer, randomized patients to receive vitamin C or standard of care (chemotherapy). That trial reported an 8.75 month increase in progression-free survival (PFS) and an improved trend in overall survival (OS) in the vitamin C treated arm.
Overall, vitamin C has been shown to be safe in nearly all patient populations, alone and in combination with chemotherapies. The promising results support the need for randomized placebo-controlled trials such as the ongoing placebo-controlled trials of vitamin C and chemotherapy in prostate cancer.
Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are ...signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden.
A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01.
There were significant differences between groups in the mean of apnea-hypopnea index (P < 0.001; no DM + normal ABI = 5.42 ± 9.66, no DM + abnormal ABI = 7.11 ± 11.63, DM + normal ABI = 10.99 ± 15.16, DM + abnormal ABI = 12.81 ± 17.80). Linear regression showed that DM and abnormal ABI were significantly associated with severe sleep apnea (β = 3.25, P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use.
These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.
Prostate specific membrane antigen targeted
F-DCFPyL positron emission tomography/computerized tomography may offer superior image quality and sensitivity for the detection of biochemically recurrent ...prostate cancer. We examined the association of Gleason sum, serum prostate specific antigen and prostate specific antigen doubling time with any detectable and pelvic confined disease in patients with biochemically recurrent prostate cancer.
Data from 108 patients with biochemically recurrent prostate cancer after radical prostatectomy who underwent prostate specific membrane antigen targeted
F-DCFPyL positron emission tomography/computerized tomography were analyzed. Data were collected on positive positron emission tomography findings as well as pelvic confined disease. Associations between Gleason sum, prostate specific antigen and prostate specific antigen doubling time were retrospectively explored.
Serum prostate specific antigen was associated with positive prostate specific membrane antigen targeted imaging as continuous (OR 3.08, 95% CI 1.60-7.95, p=0.005) and categorical values (ie prostate specific antigen greater than 2.0 to 5.0 vs 0.5 ng/ml or less, OR 16.92, 95% CI 3.13-315.81, p=0.008). No relationship between Gleason sum or prostate specific antigen doubling time with overall positive imaging was observed. Patients with a prostate specific antigen greater than 2.0 to 5.0 ng/ml were significantly less likely to be diagnosed with pelvic confined disease compared with the 0.5 ng/ml or less subgroup (OR 0.21, 95% CI 0.06-0.69, p=0.013). A prostate specific antigen doubling time of 9 months or more (OR 4.20, 95% CI 1.57-11.89, p=0.005) or prostate specific antigen doubling time of 12 months or more (OR 3.03, 95% CI 1.12-8.76, p=0.033) was significantly associated with pelvic confined disease. No relationship between Gleason sum and pelvic confined disease was observed.
Absolute prostate specific antigen was positively associated with the presence of findings on prostate specific membrane antigen targeted imaging and negatively associated with pelvic confined disease. Prostate specific antigen doubling time did not predict for overall disease detection, but long prostate specific antigen doubling times were associated with pelvic confined prostate cancer.
In spite of concerted improvement efforts to improve curricula, many university-based principal preparation programmes in the United States do not explicitly attend to issues of equity or social ...justice in a thorough way. While curricular efforts are important, they are not enough on their own; a working theory in the field of educational leadership is that an equity-mindset is also needed and that social justice-oriented principal preparation programs should select individuals who already 'have a propensity, at a minimum, to critically question the inequities found in schools' for admission into programs. Generally speaking, however, there is a dearth of literature on both candidate selection for preparation programs and equity beliefs of current and pre-service school leaders. In this paper, we explore how potential candidates for a principal preparation program in an urban school district view equity and the vexing question of how to prepare socially just leaders
Figure 1-8
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Abstract
Objective
To examine the association between type 2 diabetes (T2D) and pain severity in people with localized osteoarthritis (OA) and to explore the association between glycemic control, ...measured by hemoglobin A1c (HbA1c) level, and pain severity in people with localized OA and T2D.
Design
Retrospective study.
Setting
A tertiary medical center.
Subjects
Data from 819 patients (mean age = 65.08±9.77 years, 54.3% women) were used.
Methods
Patients were grouped to localized OA only (N = 671) and localized OA+T2D (N = 148) based on diagnosis codes. An index date was set as the first diagnosis date of localized OA and linked to pain severity, measured by numeric rating scale from 0 to 10. HbA1c values were obtained for patients with T2D within six months of the index date. Multiple linear regression was used.
Results
After controlling for age, gender, body mass index (BMI); diagnoses of depression, hypertension, dyslipidemia; OA locations; and medication list (+/- 90 days of the index date), T2D was significantly associated with increased pain severity (B = 1.07, 95% confidence interval CI = 0.25 to 1.88, P = 0.014). For patients with T2D and localized OA with available data for HbA1c (N = 87), the results showed that an increased HbA1c value was significantly associated with higher pain severity (B = 0.36, 95% CI = 0.036 to 0.67, P = 0.029) after controlling for age, gender, BMI, medications, and OA locations.
Conclusion
T2D was associated with higher pain severity in people with localized OA, and poor glycemic control was associated with higher pain severity in people with localized OA+T2D. Clinicians should emphasize that better HbA1c control might help with pain management in people with T2D and OA.
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