Aldose reductase inhibition ameliorates pupillary light reflex and F-wave latency in patients with mild diabetic neuropathy

WSTĘP. Zbadanie wpływu inhibitora reduktazy aldozy, epalrestatu, na wczesną fazę neuropatii autonomicznej i somatycznej u chorych na cukrzycę typu 2 przez ocenę odruchu źrenicznego na światło oraz minimalnej latencji fali F. MATERIAŁ I METODY. Badanie objęło 30 chorych na cukrzycę z podkliniczną lub łagodną neuropatią cukrzycową, których losowo przydzielono do grupy kontrolnej (n = 15) lub do grupy leczonej epalrestatem (150 mg/d., n = 15). Po 24 tygodniach przeprowadzono badanie odruchu źrenicznego na światło, testy włókien autonomicznych układu sercowo-naczyniowego oraz badanie przewodzenia nerwowego. WYNIKI. Korzystny wpływ epalrestatu na odruch źreniczny na światło zaobserwowano w odniesieniu do minimalnej średnicy po bodźcu świetlnym (p = 0,044), wskaźnika zwężenia (p = 0,014) oraz maksymalnej szybkości zwężania (p = 0,008). Spośród testów autonomicznych układu sercowo-naczyniowego leczenie epalrestatem spowodowało poprawę wskaźnika najdłuższego odstępu RR podczas wydechu do najkrótszego odstępu RR w czasie wdechu obserwowanego podczas testu głębokiego oddychania (p = 0,037). Minimalna latencja fali F nerwów pośrodkowego oraz piszczelowego uległa istotnemu skróceniu w grupie chorych leczonych epalrestatem (odpowiednio p = 0,002 oraz p = 0,001); nie stwierdzono jednak istotnego wpływu na prędkość przewodzenia nerwowego w nerwach czuciowych oraz ruchowych. WNIOSKI. Powyższe obserwacje sugerują, że epalrestat może korzystnie działać we wczesnej fazie neuropatii cukrzycowej oraz że odruch źreniczny na światło i minimalna latencja fali F mogą stanowić przydatne wskaźniki neuropatii cukrzycowej.INTRODUCTION. The present study was conducted to investigate the effect of an aldose reductase inhibitor, epalrestat, on autonomic and somatic neuropathy at an early stage in type 2 diabetic patients by assessing the pupillary light reflex and minimum latency of the F-wave. MATERIAL AND METHODS. A total of 30 diabetic patients with subclinical or mild diabetic neuropathy were randomly allocated to a control group (n = 15) and epalrestat (150 mg/day) group (n = 15). After 24 weeks, the pupillary light reflex test, cardiovascular autonomic function tests, and nerve conduction study were performed. RESULTS. The beneficial effect of epalrestat on the pupillary light reflex was observed in the minimum diameter after light stimuli (P = 0.044), constriction ratio (P = 0.014), and maximum velocity of constriction (P = 0.008). Among cardiovascular autonomic nerve functions, the ratio of the longest expiratory R-R interval to the shortest inspiratory R-R interval during deep breathing was significantly improved by epalrestat (P = 0.037). Minimum latencies of F-wave of median and tibial motor nerves were significantly shortened by epalrestat (P = 0.002 and P = 0.001, respectively); however, no significant effects were observed in motor or sensory nerve conduction velocity. CONCLUSIONS. These observations suggest that epalrestat may have therapeutic value at the early stage of diabetic neuropathy and that the pupillary light reflex and minimum latency of F-wave may be useful indicators of diabetic neuropathy

MiR-33a is a therapeutic target in SPG4-related hereditary spastic paraplegia human neurons

Recent reports, including ours, have indicated that microRNA (miR)-33 located within the intron of sterol regulatory element binding protein (SREBP) 2 controls cholesterol homeostasis and can be a potential therapeutic target for the treatment of atherosclerosis. Here, we show that SPAST, which encodes a microtubule-severing protein called SPASTIN, was a novel target gene of miR-33 in human. Actually, the miR-33 binding site in the SPAST 3′-UTR is conserved not in mice but in mid to large mammals, and it is impossible to clarify the role of miR-33 on SPAST in mice. We demonstrated that inhibition of miR-33a, a major form of miR-33 in human neurons, via locked nucleic acid (LNA)-anti-miR ameliorated the pathological phenotype in hereditary spastic paraplegia (HSP)-SPG4 patient induced pluripotent stem cell (iPSC)-derived cortical neurons. Thus, miR-33a can be a potential therapeutic target for the treatment of HSP-SPG4

泌尿器科手術における術創の消毒の意義

著者らは泌尿器科手術の術創に対する頻回の消毒は不要であることを細菌学的に明らかにした.泌尿器科での手術を受けた症例(97例)を, 創部の消毒を行った群, 消毒を行わなかった群, 術直後のみ行った群で, 創処置別に3群に無作為に分けた.その結果, 1)3群間での創部感染に関する有意差はなかった. 2)創部の細菌数は術後の時間がたつごとに増加したが, 3群で同じ傾向であった. 3)分離菌では, 皮膚の常在菌の一種である表皮ブドウ球菌が最も多く, 3群間でもほぼ同様の頻度であった.以上, これらのことからも, 術後の創部の処置として, 汚染手術などの特殊な場合を除いて, 消毒しないで被覆しておくことは有効であり, 頻回の消毒は意味がないと考えられたThe objective of this study was to confirm that frequent disinfection by antiseptics is unnecessary on surgical wounds of urologic operations. Patients who received urologic operations were divided into 3 groups that had the same surgical dressings but different frequencies of disinfection and different antiseptics used. Surgical wounds were evaluated clinically and bacteriologically for the period until removal of sutures. Of the 97 patients randomly recruited for the study, 3 developed surgical-site infection (SSI). There was no significant difference in the incidence of SSI among the 3 groups. Bacterial counts of surgical wounds increased over time after operation, to similar extents in the 3 groups. The major isolate was Staphylococcus epidermidis, one of the normal florae on the skin. This strain was found at almost equal frequencies in all groups. In conclusion, our study suggested that covering with the surgical dressing without frequent disinfection by antiseptics was effective for prevention of SSI. Thus, traditional frequent disinfection should be abandoned

Effect of six years intensified multifactorial treatment on levels of hs-CRP and adiponectin in patients with screen detected type 2 diabetes: The ADDITION-Netherlands randomized trial

BackgroundLevels of high-sensitivity C-reactive protein (hs-CRP) and adiponectin, reflecting chronic inflammation, are associated with cardiovascular disease in type 2 diabetes. The long-term effects of multifactorial therapy in type 2 diabetes patients on CRP and adiponectin are unknown. MethodsThe ADDITION-NL study is a randomized clinical trial among screen-detected type 2 diabetes patients, randomized to intensive treatment (HbA(1c) ResultsA total of 424 patients were included (intensive care n=235; routine care n=189). Both groups were well matched. Body mass index, systolic blood pressure, total cholesterol and HbA(1c) improved significantly more in the intensive care group compared to routine care group. Levels of hs-CRP decreased significantly in both treatment groups over time. Mean hs-CRP in the routine care group was 24% higher (p=0.0027) than in the intensive treatment group during follow-up. After an initial increase the adiponectin values levelled off to nearly baseline values in both groups. The difference between the two groups after 6years was 0.44 mu g/mL (p=0.27). ConclusionsIntensified multifactorial treatment in type 2 diabetes results in an enhanced decrease in hs-CRP. Whether this is clinically meaningful remains uncertain. The link to adiponectin seems to be more complex. Copyright (c) 2015 John Wiley & Sons, Ltd