Mechanisms for the Increased Fatigability of the Lower Limb in People with Type 2 Diabetes

Fatiguing exercise is the basis of exercise training and a cornerstone of management of type 2 diabetes mellitus (T2D), however, little is known about the fatigability of limb muscles and the involved mechanisms in people with T2D. The purpose was to compare fatigability of knee extensor muscles between people with T2D and controls without diabetes and determine the neural and muscular mechanisms for a dynamic fatiguing task. Seventeen people with T2D (10 men, 7 women: 59.6{plus minus}9.0 years) and 21 age-, BMI- and physical activity-matched controls (11 men, 10 women: 59.5{plus minus}9.6 years) performed 120 high-velocity concentric contractions (1 contraction/3 s) with a load equivalent to 20% maximal voluntary isometric contraction (MVIC) torque with the knee extensors. Transcranial magnetic stimulation (TMS) and electrical stimulation of the quadriceps were used to assess voluntary activation and contractile properties. People with T2D had larger reductions than controls in power during the fatiguing task (39.9{plus minus}20.2% vs. 28.3{plus minus}16.7%, P2=0.364, P=0.002). Although neural mechanisms contributed to fatigability, contractile mechanisms were responsible for the greater knee extensor fatigability in men and women with T2D compared with healthy controls

SOME ABSTRACT PROPERTIES OF SEMIGROUPS APPEARING IN SUPERCONFORMAL THEORIES

A new type of semigroups which appears while dealing with $N=1$ superconformal symmetry in superstring theories is considered. The ideal series having unusual abstract properties is constructed. Various idealisers are introduced and studied. The ideal quasicharacter is defined. Green's relations are found and their connection with the ideal quasicharacter is established.Comment: 11 page

Koszt i jakość opieki diabetologicznej: Porównanie pomiędzy Rzeszowem, Podkarpacie, Polska i Waukesha, Wisconsin, Stany Zjednoczone

Background. The cost of diabetes care increases worldwide and is highest in the United States (US), while the quality of care remains unsatisfactory. The aim of this study was to compare the quality and cost of type 2 diabetes mellitus (DM) care between Waukesha, Wisconsin, US and Rzeszów, Poland.Methods. DM quality data for the Polish cohort were abstracted from the charts of 79 DM patients in Rzeszow, Podkarpacie from 1 January 2013 to 31 December 2014. Cost data were attained from the Polish National Health Fund. Seventy-nine DM patients, matched for age, body mass index, and sex, from Waukesha, Wisconsin were chosen as comparators. DM quality data was obtained from the medical record and cost data from health system decision support staff.Results. Average HbA1c (%, mean ± SD) in the Polish and US cohorts were 7.4 ± 1.4 and 8.0 ± 2.1, respectively (P = 0.03). Mean systolic/diastolic blood pressure (mm Hg) in the two cohorts was 150 ± 17/81 ± 12 and 132 ± 17/74 ± 11 (P < 0.001), respectively. The rates of statin usage were 90% and 86% (P = 0.45), respectively. Costs of direct medical care (hospitalizations, outpatient care, and medications) in the Polish and US cohorts were 1,263 US dollars (USD) and 10,121 USD, per annum, respectively.Conclusion. This study reports significant differences in cost with relatively small differences in quality and of DM care between Poland and the US. As the US continues to attempt healthcare reform in order to decrease cost and increase quality, this study suggests that gains in cost and quality may not be mutually exclusive.Wprowadzenie. Koszt opieki nad chorymi na cukrzycę wzrasta na całym świecie i jest najwyższy w Stanach Zjednoczonych (USA), podczas gdy jakość opieki pozostaje niezadowalająca. Cel. Celem pracy było porównanie jakości i kosztów leczenia cukrzycy typu 2 pomiędzy Waukesha, Wisconsin, USA i Rzeszowem. Pacjenci i metody. Dane dotyczące jakości leczenia cukrzycy dla polskiej kohorty zostały uzyskane z kart choroby 79 pacjentów w Rzeszowie na Podkarpaciu w okresie od 1 stycznia 2013 r. do 31 grudnia 2014 r. Dane kosztowe zostały uzyskane z Narodowego Funduszu Zdrowia. Jako grupę porównawczą wybrano 79 pacjentów z Waukesha, Wisconsin, dobranych pod względem wieku, wskaźnika masy ciała i płci. Dane dotyczące jakości terapii cukrzycy uzyskano z dokumentacji medycznej oraz danych kosztowych od pracowników wspomagających podejmowanie decyzji w systemie opieki zdrowotnej. Wyniki. Średnia HbA1c (%, średnia±SD) w kohortach polskiej i amerykańskiej wynosiła odpowiednio 7,4±1,4 i 8,0±2,1 (P=0,03). Średnie skurczowe/rozkurczowe ciśnienie krwi (mm Hg) w obu kohortach wynosiło odpowiednio 150±17/81±12 i 132±17/74±11 (

Unilaterally Selective Adrenal Vein Sampling for Identification of Surgically Curable Primary Aldosteronism

Background: Adrenal venous sampling is recommended for the identification of unilateral surgically curable primary aldosteronism but is often clinically useless, owing to failed bilateral adrenal vein cannulation. Objectives: To investigate if only unilaterally selective adrenal vein sampling studies can allow the identification of the responsible adrenal. Methods: Among 1625 patients consecutively submitted to adrenal vein sampling in tertiary referral centers, we selected those with selective adrenal vein sampling results in at least one side and surgically cured unilateral primary aldosteronism, used as gold reference. The accuracy of different values of the relative aldosterone secretion index (RASI), which estimates the amount of aldosterone produced in each adrenal gland corrected for catheterization selectivity, was examined. Results: We found prominent differences in RASI values distribution between patients with and without unilateral primary aldosteronism. The diagnostic accuracy of RASI values estimated by the area under receiver operating characteristic curves was 0.714 and 0.855, respectively, in the responsible and the contralateral side; RASI values >2.55 and ≤0.96 on the former and the latter side furnished the highest accuracy for detection of surgically cured unilateral primary aldosteronism. Moreover, in the patients without unilateral primary aldosteronism, only 20% and 16% had RASI values ≤0.96 and >2.55. Conclusions: With the strength of a large real-life data set and use of the gold reference entailing an unambiguous diagnosis of unilateral primary aldosteronism, these results indicate the feasibility of identifying unilateral primary aldosteronism using unilaterally selective adrenal vein sampling results. Registration: URL: https://www. Clinicaltrials: gov; Unique identifier: NCT01234220

Identification of Surgically Curable Primary Aldosteronism by Imaging in a Large Multiethnic International Study

Adrenal glands imaging is recommended by the current guidelines for the work-up of primary aldosteronism (PA). However, its diagnostic performance has not been established in large multi-ethnic cohorts of patients submitted to adrenal vein sampling (AVS) and adrenalectomy

Feasibility of imaging-guided adrenalectomy in young patients with primary aldosteronism

Many of the patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling. It has been suggested that adrenal vein sampling can be omitted in young patients with a unilateral adrenal nodule, who show a florid biochemical PA phenotype. As this suggestion was based on a very low quality of evidence, we tested the applicability and accuracy of imaging, performed by computed tomography and/or magnetic resonance, for identification of unilateral PA, as determined by biochemical and/or clinical cure after unilateral adrenalectomy. Among 1625 patients with PA submitted to adrenal vein sampling in a multicenter multiethnic international study, 473 were ≤45 years of age; 231 of them had exhaustive imaging and follow-up data. Fifty-three percentage had a unilateral adrenal nodule, 43% had no nodules, and 4% bilateral nodules. Fifty-six percentage (n=131) received adrenalectomy and 128 were unambiguously diagnosed as unilateral PA. A unilateral adrenal nodule on imaging and hypokalemia were the strongest predictors of unilateral PA at regression analysis. Accordingly, imaging allowed correct identification of the responsible adrenal in 95% of the adrenalectomized patients with a unilateral nodule. The rate raised to 100% in the patients with hypokalemia, who comprised 29% of the total, but fell to 88% in those without hypokalemia. Therefore, a unilateral nodule and hypokalemia could be used to identify unilateral PA in patients ≤45 years of age if adrenal vein sampling is not easily available. However, adrenal vein sampling remains indispensable in 71% of the young patients, who showed no nodules/bilateral nodules at imaging and/or no hypokalemia. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01234220