Neural and Local Regulation of Blood Flow and Synovial Fluid PO2 in the Rabbit Knee Joint

Synovial fluid, in addition to its lubricating action of moving structures, provides nutrients to avascular structures such as articular cartilage (McKibbin & Maroudas, 1979), and also to the knee ligaments (Renzoni et aL, 1984), within the joint. As synovial fluid formation is critically dependent on synovial blood flow (Levick, 1987), those factors which regulate flow in the synovial vascular bed are clearly important in this process. The first objective of this research was to measure knee joint blood flow quantitatively and also assess the effect of sympathetic nerves in the regulation of joint blood flow. Secondly, to investigate and characterize the type of adrenoceptors mediating the sympathetic control of joint blood flow, and other mediators involved in nerve mediated changes in articular blood flow. Thirdly, to assess the possible role of the endothelium in regulation of joint blood flow and modulation of sympathetic nerve-mediated changes in joint blood flow. Finally to perform all the mentioned procedures in an experimentally induced acutely inflamed knee joints to determine the effect of inflammation on these regulatory mechanisms and factors. The second objective of this study was to measure, in both normal and inflamed knee joints, the synovial PO2 directly in its place; and also assess the correlation between the joint blood flow and oxygen tension in the synovial fluid and the extent to which this correlation may be affected by the process of inflammation. Experiments were performed on rabbits. Acute inflammation was induced by intra-articular injection of carrageenan. Quantitative measurement of joint blood flow was conducted by the radiolabelled microsphere technique. Relative changes in blood flow were assessed by laser Doppler flowmetry, and a polarographic oxygen elecrode (and oxygen meter) was used to measure synovial PO2 and its changes during the course of experiments. The results of this investigation indicate that: 1). The microsphere technique and laser Doppler flowmetry are suitable methods for quantitative and continuous measurement of joint blood flow respectively, and the process of inflammation increases joint blood flow significantly. Despite this increase in blood flow, synovial PO2 which in normal joint is much lower than the arterial PO2, even decreases more in the inflamed joints. 2). Sympathetic nerves innervate the blood vessels of the posterior capsule of the knee joint and play an important role in regulation of joint blood flow. alpha2 adrenoceptors predominate in this vascular bed and mediate vasoconstrictor responses to nerve stimulation. No evidence of pimergic co-transmission was obtained. The process of inflammation reduced the effectiveness of sympathetic nervous system in regulation of joint blood flow. 3). Nerve-mediated vasodilator responses appeared to have two components, a beta-adrenoceptor component which is mediated by postjunctional beta1 adrenoceptors which found to predominate in this vascular bed, and a substance P mediated component which is produced by the release of neuropeptide, substance P, presumably from the unmyelinated sensory nerve endings. 4). Vascular endothelium keeps the joint blood vessels of both normal and inflamed joints in a state of active dilatation by release of nitric oxide (NO) and therefore plays a major role in local regulation of joint blood flow. NO also counteracts the sympathetic vasoconstrictor responses, but it showed no modulatory effect on nerve-mediated vasodilator responses. 5). Prostaglandins are important local factors in regulation of joint blood flow in both normal and inflamed joints. They seemed to have no modulatory effect on sympathetic regulation of blood flow to this vascular bed. PGE2 receptors are present on knee joint blood vessels but they down regulate during the process of inflammation. 6). A polarographic oxygen electrode provided a new and suitable method for quantitative and continuous measurement of oxygen partial pressure in the synovial fluid of both normal and inflamed knee joints. A high correlation between changes in joint blood flow and synovial PO2 was found in both joints

Inadequate control of diabetes and metabolic indices among diabetic patients: A population based study from the Kerman Coronary Artery Disease Risk Study (KERCADRS)

Background: The goal of diabetes control should be feasible in order to minimize the risk of its adverse events and to reduce its burden and cost on patients. The current study aimed to assess the status of glycemic control in male and female patients with Type 2 Diabetes Mellitus (T2DM) in Kerman, Iran. Methods: In the present study, 500 T2DM (300 women and 200 men) from the Kerman Coronary Artery Disease Risk Study (KERCADRS), a population-based study from 2009 to 2011, were selected. Patients were >18 years old, had Fasting Blood Sugar (FBS) higher than 126 mg/dl, and had been through treatment for their diagnosed disease. All participants underwent Glycosylated Hemoglobin (HbA1c) analysis. HbA1c less than 7% was considered as good glucose control. Other metabolic indices based on American Diabetes Association (ADA) target recommendations were considered. Results: The mean level of HbA1c in total subjects was 8.56 ± 4.72% that only 31.66% of men and 26.00% of women had controlled level of HbA1c. Total cholesterol less than 200 mg/dl was reported in 64.50% of men and 44.00% of women, High Density Lipoprotein (HDL) more than 40 mg/dl was revealed in 20.50% of men and 34.67% of women, and Low Density Lipoprotein (LDL) less than 100 mg/dl was reported in 41.50% of men and 25.33% of women. In multivariate logistic regression model, longer duration of disease and higher Waist Circumference (WC) were positively associated with uncontrolled diabetes status. Conclusion: The findings of the present study revealed that diabetes control in T2DM was inadequate. Changing the policy of treatment in individual patient and establishing better diabetes clinic to decrease the frequency of uncontrolled T2DM are crucial. Paying attention to other affecting metabolic components such as WC in the process of T2DM management is important

SIRT1 and Klotho expression in the heart and kidneys of rats with acute and chronic renovascular hypertension

Aim To evaluate Klotho and SIRT1 expression in the heart and kidneys of rats with acute and chronic renovascular hypertension. Methods Four and sixteen weeks after the induction of renovascular hypertension by clipping the left renal artery, systemic blood pressure, serum angiotensin II level, and the expression of Klotho and SIRT1 proteins and oxidative stress indices in the heart and kidneys were assessed. Results SIRT1 level was significantly reduced in the ischemic (left) kidney in acute and chronic phases of hypertension. In the heart, it decreased in the acute phase, but increased in the chronic phase. Klotho levels in the heart and kidneys did not change significantly in either hypertension phase. Superoxide dismutase (SOD) activity in the heart significantly decreased, and SOD, total antioxidant capacity, and malondialdehyde in the ischemic kidney significantly increased during the development of hypertension. Serum angiotensin II level significantly increased in the acute phase of hypertension. Conclusion Development of renovascular hypertension was associated with a reduction of SIRT1 expression in the heart and ischemic kidney. As angiotensin II and SIRT1 counteract each other’s expression, a SIRT1 reduction in the heart and kidney, along with the influence of systemic/ local angiotensin II, seems to be partly responsible for hypertension development. A combination of SIRT1 agonists and angiotensin II antagonists may be considered for use in the treatment of renovascular hypertension

Potential Effect of Opium Consumption on Controlling Diabetes and Some Cardiovascular Risk Factors in Diabetic Patients

Background: Due to this belief that opium may have beneficial effects on diabetes or cardiovascular risk factors, the present study aimed to assess the potential and possible effects of opium consumption on diabetes control and some cardiovascular risk factors in diabetic patients. Methods: This study enrolled 374 diabetic subjects from diabetes care centers in Kerman, Iran including opium user group (n = 179) and a non opium user group (n = 195). The data were collected through a questionnaire completed by interviewing, physical examination and laboratory assessment. Findings: Opium did not show any statistically significant effect on blood glucose, glycated hemoglobin (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL) and diastolic blood pressure. However, systolic blood pressure and prevalence of high systolic blood pressure were significantly higher in opium user group (P < 0.050). In addition, lower serum high-density lipoprotein (HDL) and frequency of lower HDL was significantly higher in opium user group (P < 0.001). Conclusion: According to this study, opium does not seem to have beneficial effects on diabetes control or cardiovascular risk factors. Therefore, it would not be advisable to consume opium as an anti-diabetes or cardioprotective agent

Oral Health Determinants among Opium Users in Kerman, Iran

Background: Promoting oral health is a complicated issue among drug abusers and opium is the most frequent drug abused in Iran. This study aims to find the oral health determinants of opium users in Kerman, Iran.Methods: This cross-sectional study was a part of the second phase of Kerman coronary artery disease risk factors study (KERCADRS, 2014-2018). In this survey, the data of 1140 opium users were analyzed. The information about using a toothbrush, dental floss, number of dental visits at last year, age of first use of opium, duration, and opium consumption frequency was recorded. The total number of decayed, missing, and filled teeth (DMFT) index and Community Periodontal Index (CPI) was recorded by an oral examination. Poisson and logistic regressions analyses were used for assessing the relationship among variables.Findings: The mean age of participants was 52 ± 12 years. 74.4% were men and 24.6% were women. The average DMFT index was 15.7 ± 7.6 and the prevalence of a healthy CPI score was 18.5%. Educational level (P < 0.001), brushing (P < 0.001), flossing (P < 0.001), dental visit (P < 0.001), first age of using opium (P < 0.001), frequency of consumption (P < 0.001), and age (P < 0.001) were associated with DMFT index. Only using floss (P < 0.001), dental visit [odds ratio (OR) = 1.80, P = 0.030], frequency of consumption (OR = 2.92, P < 0.001), and age (P = 0.001) were associated with CPI score.Conclusion: The frequency of opium consumption has the same effect on caries incidence as oral hygiene habits. Moreover, using dental floss has a more significant effect on the periodontal health of participants

Prevalence of Carpal Tunnel Syndrome in Diabetic Patients with and without Metabolic Syndrome

Background and Objectives: Carpal tunnel syndrome (CTS) is defined as the impaction of the median nerve in the carpal tunnel of the wrist. Metabolic disorders are closely associated with CTS; and metabolic syndrome (MS) is found to be more in patients with CTS. Metabolic syndrome is highly prevalent in patients with type 2 diabetes. This study was conducted to determine the prevalence of CTS in diabetic patients with and without metabolic syndrome. Material and Methods: In this cross-sectional study, 439 diabetic patients that participated in the study of risk factors for coronary artery disease in Kerman (KERCADRS) were enrolled. People with positive clinical symptoms for CTS and a positive Boston questionnaire, were referred to a neurologist for further diagnosis. For the diagnosis of metabolic syndrome, three criteria (ATPIII, IDF and new criteria in Kerman) were used. Also, electro-diagnostic tests were used for the diagnosis of CTS. Data were analyzed by independent t-test and chi square test in SPSS20. Results: The prevalence of CTS in diabetic patients was 24.23%. The prevalence of the disorder in male and female patients was 16.21% and 30.65%, respectively. The results showed that there is no significant difference in the prevalence of CTS in diabetic people with and without metabolic syndrome, in overall as well as sex subgroups. Discussion and Conclusion: The higher prevalence of CTS in diabetic patients in this study compared to other studies shows the lack of prevention and case finding in diabetic patients. Therefore, screening, educating and informing at risk people about the disease is necessary

Obesity Mediates the Effect of Past and Current Mental Health on Diabetes Treatment Outcomes

Background: Anxiety and depression (A&D) are common among patients with diabetes (DM). We assessed the mediatory effect of obesity on the pathway between past and current mental health (as measured by A&D) on self-care DM treatment adherence and DM treatment failure. Methods: We used data collected in two rounds (2009-12, 2014-2018) of a population-based cohort study in Kerman, Iran (KERCADRS). By a random cluster sampling approach, 5900 residents of Kerman aged 15 to 75 yr were recruited to the study to measure demographic characteristics, body measures (to calculate BMI), adherence to DM treatment, and symptoms for A&D (Beck questionnaires). Fasting blood also collected for biochemical tests and glycemic control (as an indicator for treatment failure). We used path analysis and Structural Equation Modeling (SEM) for analysis. Results: We analyzed data for 264 patients with diabetes who attended in both study rounds. While only 5.7% reported not adherence to DM treatment, 67.9% had diabetes treatment failure. Past mental health had a significant positive association with HbA1c (standard beta coefficient for total effect =0.148, P=0.044), of which 42% was indirect effect through obesity. Current mental health had a positive association with current no adherence to diabetes treatment (standard beta coefficient for total effect=0.077, P=0.001). Conclusion: Our study showed an important indirect path from A&D to diabetes treatment failure outcome which mediated by obesity. Screening for A&D symptoms and treating those as well as obesity among patients with diabetes may improve glycemic control.

Prevalence of Active and Passive Smoking among Adult Population: Findings ‎of a Population-Based Survey in Kerman (KERCADR), Iran

Background: Smoking is one of the major modifiable non-communicable disease risk factors. Our aim was to report the pattern of active and passive smoking using the data collected through a population base household survey in Kerman, Iran. Methods: Given a cluster random sampling design, we recruited 5900 adult populations (15-75 years old) into a survey. After consenting, every participant was interviewed by a trained interviewer. The section for smoking had questions about daily (smoking at least one cigarette/day), non-daily, past and passive cigarette smoking as well as the time of exposure to cigarette’s smoke. We used Kerman population distribution (as the target population) to adjust our estimates using direct standardization method. Findings: Overall, 8.3% of study participants (15.5% in men vs. 0.8% in women, P = 0.010) reported themselves as daily smokers and 1.7% (2.9% in men vs. 0.4% in women, P = 0.010) as non-daily smokers. The passive smoking was common in total (27.5%), while women experienced more exposure than men (30.1% vs. 25.0%, P = 0.010). 3.2% of daily smokers smoked more than 20 cigarettes/day. Among passive smokers, 62.6% were exposed to cigarette smoke more than 6 days/week. Conclusion: Smoking is pretty common among adult populations, particularly men. A majority of tobacco-free young adult women are exposed to passive smoking. Age and gender oriented interventions are required to change this risk pattern in our community to prevent from further smoking related morbidities and mortalities