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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1 January 1989 and 31 December 1990 568 consecutive patients were admitted to our unit for ischemic stroke (defined on clinical criteria and with CT or MR evidence of ischemic areas or exclusion of hemorrhage or tumor). The interval between onset of symptoms and arrival in hospital was under 6 h in 270 cases (47.5%). We classified our population according to the clinical criteria proposed by Bamford et al. by subgroup as follows: LACI (27.5%); PACI (24.5%); TACI (30.6%); POCI (17.4%). The mortality in our population was 10.9%. The distribution of the risk factors considered was: hypertension in 387 cases (67%), diabetes in 158 cases (27.8%), NVAF in 95 cases (16.7%). Our data show that about a half of all patients with ischemic stroke can expect to receive treatment at the acute stage.
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PMID:Before M.A.S.T.-I: analysis of the population of a participating center. 847 53

We assessed the combined role of epinephrine and glucagon in regulating gluconeogenic precursor metabolism during insulin-induced hypoglycemia in the overnight-fasted, adrenalectomized, conscious dog. In paired studies (n = 5), insulin was infused intraportally at 5 mU.kg-1.min-1 for 3 h. Epinephrine was infused at a basal rate (B-EPI) or variable rate to simulate the normal epinephrine response to hypoglycemia (H-EPI), whereas in both groups the hypoglycemia-induced rise in cortisol was simulated by cortisol infusion. Plasma glucose fell to approximately 42 mg/dl in both groups. Glucagon failed to rise in B-EPI, but increased normally in H-EPI. Hepatic glucose release fell in B-EPI but increased in H-EPI. In B-EPI, the normal rise in lactate levels and net hepatic lactate uptake was prevented. Alanine and glycerol metabolism were similar in both groups. Since glucagon plays little role in regulating gluconeogenic precursor metabolism during 3 h of insulin-induced hypoglycemia, epinephrine must be responsible for increasing lactate release from muscle, but is minimally involved in the lipolytic response. In conclusion, a normal rise in epinephrine appears to be required to elicit an increase in glucagon during insulin-induced hypoglycemia in the dog. During insulin-induced hypoglycemia, epinephrine plays a major role in maintaining an elevated rate of glucose production, probably via muscle lactate release and hepatic lactate uptake.
Diabetes Res Clin Pract 1996 Mar
PMID:Counterregulation by epinephrine and glucagon during insulin-induced hypoglycemia in the conscious dog. 879 1

Circadian (8/24 hours) variations in serum nitric oxide (NO), total tissue factor pathway inhibitor (T-TFPI). and E-selectin levels were studied in healthy adults and in subjects with type II diabetes. We postulated a possibility a functional relationship between them because vascular endothelium is the primary site of their synthesis and functions. NO is released by the action of eNO synthase isoform and modulates physiologic responses (e.g., vascular dilation, relaxation, increasing blood flow, inhibition of platelet and white blood cell adhesion); T-TFPI, a coagulation inhibitor, is also released from endothelial cells, and is bound to plasma lipoproteins and to glycosaminoglycans; E-selectin is expressed on endothelial cells after activation by inflammatory cytokines (interleukin-1beta and tumor necrosis factor-alpha) and elevated levels have been reported in a variety of pathologic conditions, including diabetes. We found that obese diabetic subjects had greater mean concentrations of NO and E-selectin than healthy men, 39.25 versus 12.71 microM and 81.51 versus 26.03 ng/mL, respectively. The T-TFPI levels were essentially similar in both groups of men, 47.10 versus 48.76 ng/mL. We observed that the time of peak concentrations of T-TFPI and E-selectin was similar to the timing of NO trough levels, suggesting a possible functional relationship. It may be hypothesized, therefore, that the higher concentrations of NO, unbalanced by increases in T-TFPI and E-selectin, may result in increased vascular wall uptake of lipoproteins in diabetic subjects, who are at greater risk than healthy men for developing diffuse atherosclerosis.
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PMID:Day-night variations in blood levels of nitric oxide, T-TFPI, and E-selectin. 1169 21

To obtain epidemiological data on the prevalence and risk factors for open angle glaucoma in hospital workers of African origin, and investigate appropriate methods of a rapid, cost-effective screening procedure for glaucoma. A cross-sectional study of workers in the University College Hospital (UCH) Ibadan, using a structured questionnaire for data collection. The variables available for data analysis include workers demographic characteristics, visual acuity, pupil status, intraocular pressure, cup-disc ratio, central visual fields, family history of glaucoma, chronic diseases such as hypertension and diabetes. The data was analysed with EPI-INFO version 6.02 for simple analysis, while the SPSS package was used for multivariate analysis. A total of two thousand, one hundred and nine (2,109) UCH workers participated in the screening exercise for glaucoma. A high majority of the workers 1794 (85.1%) were negative to the diagnosis of glaucoma, while the remaining 315 (14.9%) were suspected to have glaucoma out of which 57 (2.7%) were confirmed as definite glaucoma cases. The prevalence of glaucoma among UCH workers was 27 per 1000, 95%, confidence interval = 20 per 1000, 35 per 1000. Factors associated with glaucoma were relative afferent pupillary defect, cup-disc ratio greater than 0.7, intraocular pressure, family history of glaucoma and the presence of chronic diseases such as diabetes. The left eye appears to have a higher probability of ocular problems compared with the right eye. The prevalence of glaucoma among hospital workers was 2.7% The cup-disc ratio appears to be a better diagnostic tool for glaucoma since it gives the best positive predictive value (with a cut-off point of 0.7) than all other variables.
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PMID:The Ibadan glaucoma study. 1525 20

This study assessed markers of vascular endothelial cell dysfunction associated with early atherosclerosis in carotid arteries. We measured the plasma levels of free-form tissue factor pathway inhibitor (free TFPI), plasminogen activator inhibitor-1 (PAI-1), and von Willebrand factor (vWF) in 522 adults without cardiovascular disease enrolled in the Suita Study. For each sex, we analyzed the association of the degree of intimal-medial thickness (IMT) with hemostatic markers using logistic regression analysis considering potential confounding risk factors, including age, body mass index, lifestyle (current smoking and drinking), illness (diabetes mellitus and hyperlipidemia), systolic blood pressure, and antihypertensive drug use. The age-adjusted levels of free TFPI and PAI-1 were positively and independently associated with the degree of IMT for men. Even after adjustment for all confounding factors, the level of PAI-1 was positively associated with the degree of IMT. These results indicate that measurement of the levels of free TFPI and PAI-1 is a potentially useful tool for the detection of early atherosclerosis in men.
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PMID:Potential of free-form TFPI and PAI-1 to be useful markers of early atherosclerosis in a Japanese general population (the Suita Study): association with the intimal-medial thickness of carotid arteries. 1538 Apr 59

The aim of this study was to compare risk factors and concomitant potential cardioembolic sources detected by transthoracic (TTE) and transoesophageal echocardiography (TEE) in patients with lacunar and nonlacunar infarcts. Clinical data of 139 patients with a first episode of ischemic stroke who underwent both TTE and TEE were analysed. Patients were divided into two groups, lacunar (LACI=36), and nonlacunar infarcts (NLACI=103); then the latter group was divided into two subgroups, anterior (ACI=76) and posterior circulation infarct (POCI=27). Presence of hypertension and diabetes mellitus were not significantly different between LACI and NLACI groups. The rate of potential cardioembolic risk factors detected by echocardiography was similar in the NLACI groups. At least one potential cardiac source of embolism was identified in 44% (n=16) of LACI, 52.6% (n=40) of ACI and 55.5% (n=15) of POCI patients. Atrial fibrillation was significantly frequent in the ACI group. No significant differences were found between all groups regarding age, sex, hyperlipidemia, and smoking. Our findings demonstrate that hypertension and diabetes mellitus are equally important in the pathogenesis of both LACI and NLACI groups and there is a need for careful cardiac evaluation in cases even with lacunar infarct.
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PMID:Transoesophageal echocardiographic findings in patients with ischemic lacunar and nonlacunar stroke. 1820 76

Patients with neurologic symptoms who undergo carotid endarterectomy (CEA) have a higher incidence of stroke and death in the perioperative period than those with asymptomatic carotid disease. This study examines the outcomes of symptomatic and asymptomatic patients undergoing carotid stenting (CAS). From 2002 to 2006, 201 CAS procedures were performed in 193 patients (117 men, mean age 73 +/- 10 years), of whom 142 were for asymptomatic (AS) and 59 for symptomatic (S) disease. Preoperative neurologic symptoms included recent ipsilateral cerebrovascular accident (CVA, 29%), transient ischemic attack (50%), and amaurosis fugax (22%). There were 201 carotid stents placed (107 Acculink, 43 Wallstent, 23 Precise, 21 NexStent, 3 Exponent, 3 Xact, 1 Herculink) and 198 protection devices used (79 Accunet, 53 EPI Filterwire, 43 PercuSurge, 20 Angiogard, 3 EmboShield). Mean follow-up was 41 weeks. The groups were matched in terms of demographics and comorbidities (carotid artery disease, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, smoking, and chronic obstructive pulmonary disease; p = nonsignificant [NS]). There was no significant difference in anatomic risk factors (neck irradiation, S 3%, AS 6%; prior CEA, S 14%, AS 14%; bovine arch, S 22%, AS 16%; p = NS), and the types of embolic protection devices and stents used were similar between groups. The mean percentages of preintervention carotid stenosis were equal (S 88%, AS 88%), and the technical success rate was 99%. Incidence rates of CVA (S 3.4%, AS 1.4%), myocardial infarction (S 1.7%, AS 1.4%), and death (S 0, AS 0.7%) were equivalent between groups (p = NS). CAS with cerebral protection can be performed safely in both symptomatic and asymptomatic patients. The presence of preoperative neurologic symptoms does not significantly increase the risk of adverse events in the perioperative period in this study.
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PMID:Periprocedural complication rates are equivalent between symptomatic and asymptomatic patients undergoing carotid angioplasty and stenting. 1834 78

High on-clopidogrel platelet reactivity (HCPR) and high on-aspirin platelet reactivity (HAPR) are independently associated with an increased risk of atherothrombotic events. However, despite this positive correlation, the definitions of both HCPR and HAPR vary largely throughout studies and between different platelet function assays. The aim of the present study was to explore clinical and laboratory parameters that are associated with HCPR and HAPR as measured with different platelet function tests. 530 clopidogrel and aspirin pre-treated patients undergoing elective PCI (percutaneous coronary intervention) were enrolled. Platelet function measurements were performed with: optical aggregometry, the VerifyNow device and PFA-100 cartridges (including the novel INNOVANCE P2Y assay). HCPR as measured with Adenosin-Di-Phospate-induced (ADP) aggregation based tests was associated with clinical factors such as older age, female gender and Diabetes mellitus (DM). The VerifyNow P2Y12 assay was significantly influenced by haemoglobin and haematocrit levels. HAPR as measured with aggregation based tests was significantly influenced by the presence of malignancy, BMI (Body-Mass Index), older age and increased levels of hsCRP (high sensitivity c-reactive proteine). The PFA-100 COL/EPI (collagen-epinephrine) and COL/ADP (collagen-ADP) cartridges were significantly influenced by monocyte count, hs-CRP, MPV (mean platelet volume), vWF-antigen (von Willebrand factor) and vWF-activity. HCPR as measured with the novel INNOVANCE P2Y cartridge was associated with clinical determinants such as BMI, female gender, impaired LVEF (left ventricular ejection fraction), renal failure and dosing of clopidogrel. Laboratory markers that were associated with HCPR as measured with INNOVANCE P2Y were platelet count, white blood cells (WBC), hsCRP and fibrinogen. Both HCPR and HAPR are highly dependent on the type of platelet function assay. Each platelet function assay, in turn, is significantly influenced by distinct clinical and laboratory variables.
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PMID:The influence of clinical characteristics, laboratory and inflammatory markers on 'high on-treatment platelet reactivity' as measured with different platelet function tests. 1988 10

TF (tissue factor) is the main trigger of the coagulation cascade; by binding Factor VIIa it activates Factor IX and Factor X, thereby resulting in fibrin formation. Various stimuli, such as cytokines, growth factors and biogenic amines, induce TF expression and activity in vascular cells. Downstream targets of these mediators include diverse signalling molecules such as MAPKs (mitogen-activated protein kinases), PI3K (phosphoinositide 3-kinase) and PKC (protein kinase C). In addition, TF can be detected in the bloodstream, known as circulating or blood-borne TF. Many cardiovascular risk factors, such as hypertension, diabetes, dyslipidaemia and smoking, are associated with increased expression of TF. Furthermore, in patients presenting with acute coronary syndromes, elevated levels of circulating TF are found. Apart from its role in thrombosis, TF has pro-atherogenic properties, as it is involved in neointima formation by inducing vascular smooth muscle cell migration. As inhibition of TF action appears to be an attractive target for the treatment of cardiovascular disease, therapeutic strategies are under investigation to specifically interfere with the action of TF or, alternatively, promote the effects of TFPI (TF pathway inhibitor).
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PMID:Tissue factor: beyond coagulation in the cardiovascular system. 1984 9

The value of neutrophil gelatinase-associated lipocalin (NGAL) as a novel marker for early detection of acute renal failure has been highlighted recently. The aim of this study was to assess whether serum NGAL correlated with kidney function in heart allograft recipients. We evaluated serum NGAL, creatinine, and estimated glomerular filtration rate (GFR) in 164 heart allograft recipients on triple therapy. Heart transplant recipients showed significantly higher NGAL values than the control group. Kidney function was estimated using CKD-EPI, Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault formula, 24-hour creatinine clearance, and serum creatinine. Kidney function was significantly impaired among heart transplant recipients compared with healthy volunteers. On univariate analysis serum NGAL strongly correlated with serum creatinine (r = .70, P < .001), estimated GFR (CKD-EPI, r = -.57, P < .001, MDRD r = .56, P < .001, Cockcroft-Gault, r = -.56, P < .001), 24-hour creatinine clearance (r = .43, P < .001), and cystatin C (r = .74, P < .001). In contrast, it was moderately correlated with red blood cell count (r = -.39, P < .01), hemoglobin level (r = -.42, P < .01), NT-proBNP (r = .25, P < .01), and only weakly with New York Heart Association class (r = .21, P < .05), time after transplantation (r = .21, P < .05), or age (r = .19, P < .05) upon multiple regression analysis, the best predictor of serum NGAL was estimated GFR (beta -0.87, P < .0001), explaining 89% of the NGAL concentrations. Even a successful heart transplantation is associated with kidney injury as reflected by elevated serum NGAL and reduced estimated GFR. Therefore, NGAL needs to be investigated as a potential early marker for impaired kidney function/injury, especially among patients with risk factors for renal damage, i.e., hypertension or diabetes, other than heart pathology.
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PMID:Serum neutrophil gelatinase-associated lipocalin correlates with kidney function in heart allograft recipients. 2062 May 26


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