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Background: Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported. Aims: To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM. Methods: A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge. Results: Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms. Discussion: Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery. Conclusions: Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) and Heart Failure (HF) are global diseases affecting millions worldwide. Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition that predisposes to adverse outcomes. There is limited scientific evidence of clinical outcomes of NAFLD in patients with DM who were hospitalized for Acute Decompensated Heart Failure (ADHF). Hence, we sought to investigate this population. We queried NIS between 2017-2020 for adult patients who were hospitalized with ADHF&DM and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant. There were 4,148,725 hospitalizations with ADHF&DM and 183,885 (4.4%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 67.8 vs. 70.5 yrs; males 56.6% vs 53%; Caucasians 63.7% vs 62.7%; systolic HF 58.4% vs 54.3%; diastolic HF 61% vs 64.8; STEMI 2.9% vs 1.3%, HTN 1.8% vs 2.2%; pulmonary hypertension (PH) 22.7% vs 19.3%; AF 44.6% vs 42.7%; AKI 57.9% vs 41.3%; DKA 1.8% vs 0.7%; obesity 68.6% vs 65.4%; anemia 24.6% vs 21.4%; history of MI 12.6% vs 16.2%; stroke 2.1% vs 1.5%, COPD 33.2% vs 37.1, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). ADHF&DM cohort demonstrated significantly higher mortality, worse clinical outcomes, and resource utilization. They were younger, predominantly Caucasian males, with more frequent systolic HF, STEMI, PH, AF, AKI, DKA, obesity, stroke, and anemia. NAFLD is associated with cardiac and renal impairment, complications during hospitalization and the need for ICU-level care. Awareness of NALFD and its early identification is important to improve health outcomes. Further research is necessary to describe long-term outcomes in this population. [ABSTRACT FROM AUTHOR]

Dysferlin (DYSF) has drawn much attention due to its involvement in dysferlinopathy and was reported to affect monocyte functions in recent studies. However, the role of DYSF in the pathogenesis of atherosclerotic cardiovascular diseases (ASCVD) and the regulation mechanism of DYSF expression have not been fully studied. In this study, Gene Expression Omnibus (GEO) database and epigenome-wide association study (EWAS) literatures were searched to find the DNA methylation-driven genes (including DYSF) of ASCVD. The hub genes related to DYSF were also identified through weighted correlation network analysis (WGCNA). Regulation of DYSF expression through its promoter methylation status was verified using peripheral blood leucocytes (PBLs) from ASCVD patients and normal controls, and experiments on THP1 cells and Apoe-/- mice. Similarly, the expressions of DYSF related hub genes, mainly contained SELL, STAT3 and TMX1, were also validated. DYSF functions were then evaluated by phagocytosis, transwell and adhesion assays in DYSF knock-down and overexpressed THP1 cells. The results showed that DYSF promoter hypermethylation up-regulated its expression in clinical samples, THP1 cells and Apoe-/- mice, confirming DYSF as a DNA methylation-driven gene. The combination of DYSF expression and methylation status in PBLs had a considerable prediction value for ASCVD. Besides, DYSF could enhance the phagocytosis, migration and adhesion ability of THP1 cells. Among DYSF related hub genes, SELL was proven to be the downstream target of DYSF by wet experiments. In conclusion, DYSF promoter hypermethylation upregulated its expression and promoted monocytes activation, which further participated in the pathogenesis of ASCVD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Syrian refugees in Zaatari Refugee Camp are in dire need of investigations of the control status of different chronic diseases. The current study aims to evaluate hypertension (HTN) and diabetes (DM) control among Syrian refugees in the Zaatari Refugee Camp. PATIENTS AND METHODS: This is a retrospective cross-sectional study. Patients' files were collected from the Zaatari camp database. Participants who had an HbA1c of less than 7 were considered to have controlled DM and a cut-off point of 130/80 was used for HTN. A p-value of <0.05 was considered statistically significant. RESULTS: A total of 418 patients (276 females) were included in the study. None of the patients-controlled blood pressure and only 25 controlled DM. Univariate analysis showed an association of smoking status with HbA1c and mean arterial pressure (MAP) (p-value=0.007 and <0.001 respectively), while taking insulin and Triglyceride (TyG) index had an association with HbA1c alone (p-value<0.001). Significant in the MANCOVA analysis were smoking status, taking insulin, and TyG index (p-value<0.001). CONCLUSIONS: This study demonstrates that refugees in Zaatari Refugee Camp have uncontrollable DM and HTN. More focus should be highlighted on controlling these diseases in order to prevent future complications. [ABSTRACT FROM AUTHOR]

Yoga is an ancient system of wellness with Asana and Pranayama as its most popular and propagated modules for management of lifestyle disorders. The aim of the study was to characterise the liver abnormalities, biochemical changes, and stress levels after Yoga intervention in prediabetic females. 37 females were randomly divided into Yoga practising and non-practising control groups. The Yoga practising group performed Diabetic Yoga Protocol (DYP) for 3 months. Parameters including size of liver, fatty infiltration, and grade of severity were measured using ultrasonography along with biochemical parameters and stress levels at baseline and after Yoga practice. The glycosylated hemoglobin (HbA1c) and glucose levels were found significantly reduced in prediabetic (p = 0.015) women after practising DYP, although cholesterol levels increased in menopausal women. No escalation of fatty liver was noted among women practising DYP. DYP reduced the HbA1c and stress levels and therefore, could be a cost-effective tool for preventing prediabetes to diabetes progression. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, hyperinsulinaemia and hyperglycaemia. Increased glucose production through abnormally elevated hepatic gluconeogenesis is central to the manifestation of hyperglycaemia in T2DM. Metformin corrects hyperglycaemia mainly through inhibition of gluconeogenesis. Sirtuin 1 (SIRT1) has been identified as regulator of gluconeogenic gene expression. The present study aimed to evaluate the effect of metformin on SIRT1 level and activity in liver and pancreas of diabetic rats. Further, the possible role of SIRT1 on metabolic disorders associated with diabetes mellitus, including serum levels of glucose, insulin, triglyceride (TG) and high density lipoprotiens (HDL), will be explored. Thirty-two male albino rats were divided into control group (GpI), diabetic (DM) group (GpII), (metformin + DM) group (GpIII) administered 120 mg/kg metformin daily for 1 month before induction of diabetes, (DM + metformin) group (GpIV) administered 250 mg/kg metformin daily for 1 month after induction of diabetes. At the end of the study, BMI%, serum levels of glucose, insulin, TG and HDL, HOMA, SIRT1 level and activity in liver and pancreas and pancreatic DNA ladder were assessed. Our results showed significant decrease in serum glucose, insulin and TG levels and HOMA; significant increase in HDL level and SIRT1 level and activity in liver and pancreas beside the marked disappearance of pancreatic apoptosis in GpIII & IV relative to GpII. Regarding BMI%, it showed no significant changes in GpIV relative to GpII. No significant change was recorded between GpIII and GpIV regarding all studied parameters except on serum TG. Lowered SIRT1 in diabetes was improved by the administration of Metformin. Consequently, the pathophysiological disorders associated with T2DM were improved. [ABSTRACT FROM AUTHOR]

Diabetes-related vascular complication rates remain unacceptably high despite guideline-based medical therapies that are significantly more effective in individuals without diabetes. This critical gap represents an opportunity for researchers and clinicians to collaborate on targeting mechanisms and pathways that specifically contribute to vascular pathology in patients with diabetes mellitus. Dysfunctional mitochondria producing excessive mitochondrial reactive oxygen species (mtROS) play a proximal cell-signaling role in the development of vascular endothelial dysfunction in the setting of diabetes. Targeting the mechanisms of production of mtROS or mtROS themselves represents an attractive method to reduce the prevalence and severity of diabetic vascular disease. This review focuses on the role of mitochondria in the development of diabetic vascular disease and current developments in methods to improve mitochondrial health to improve vascular outcomes in patients with DM. [ABSTRACT FROM AUTHOR]

Objective Comparative study between the effect of LSG and LMGB on patients with type 2 DM and BMI ≥ 35 kg/m 2 . Study design A prospective comparative study which included 40 obese patients with type 2 DM(20 patients were operated for laparoscopic sleeve gastrectomy (LSG) and 20 patients for laparoscopic mini-gastric bypass (LMGB)), with mean age at LSG group 42.95 ± 7.63 with range of 31–59 years, at LMGB group was 42.9 ± 6.17 with range of 34–58 years. Results In SG cases; complete remission occurred in 11 patients with percentage of 55% and failure of remission occurred in 9 patients with percentage of 45%. No cases developed partial remission in SG cases. In MGB cases; 15 developed diabetic remission with percentage of 75% (11 (55%) patients developed complete remission, 4 (20%) patients developed partial remission). Failure of remission occurs in 5 patients in MGB cases with percentage of 25%. Conclusion Based on our results, LSG and LMGB are efficient operations for reducing weight in morbidly obese patients and also in diabetic control in T2DM. LMGB might be superior to LSG in %EWL and T2DM remission after 1.5 year follow up. [ABSTRACT FROM AUTHOR]

Objective The study was performed to evaluate the technique of laproscopic minigastric bypass for metabolic syndrome patients. Study design The patients were enrolled in a combined prospective study and had a retrospectively gathered outcome analysis. Patient and methods The study includes thirty patients; 24 females and 6 males suffering from metabolic syndrome with a mean age of 33.15 ± 10.17 years (range, 20–59), who fulfilled the criteria for bariatric surgery with BMI >35 with associated co-morbidities, all patients underwent laparoscopic mini-gastric bypass. Results BMI and WC were significantly reduced post-operatively; also co-morbidities as DM, hypertension and dyslipidemia were resolved or controlled. The mean operative time was 90 ± 12.6 min (range, 80–120). No mortality was reported within 30 days of surgery. Conclusion Laparoscopic mini gastric bypass is an effective procedure for the treatment of obesity, HTN, type 2 DM and dyslipidemia, technically feasible, safe operation with a low rate of major postoperative complications. [ABSTRACT FROM AUTHOR]

Testicular dysfunction and infertility are serious complications of diabetes mellitus (DM). L -Arginine (L -Arg) is a semi essential amino acid with various biological and metabolic functions. The molecular mechanisms of L -Arg on testicular dysfunction caused by DM remain elusive. This study aimed to assess the potential protective effect of L -Arg in diabetic testis and its possible mechanisms. 24 adult male Wistar albino rats were randomly divided into four groups: CON, L -Arg that received 1 g/kg body weight of L -Arg orally for 4 weeks, DM that fed a high fat diet followed by an injection of 30 mg/kg streptozotocin intraperitoneally, and L -Arg-treated DM that were diabetic and administered L -Arg. DM decreased relative testicular weight, reduced serum testosterone, and impaired semen parameters. Reduced total antioxidant capacity (TAC), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px), in addition to increased transforming growth factor B1 (TGF-β1) and nitric oxide (NO) levels, were found in the testicular tissue. This was associated with severe degenerative changes in the seminiferous tubules and interstitial cells of Leydig, reduction of Johnsen's score, significantly increased expression of both inducible nitric oxide synthase (iNOS) and caspase-3, and reduced zonula occludens (ZO)− 1 expression. Ultrastructurally, disrupted intercellular junctions and degeneration of interstitial cells of Leydig were observed. In contrast, treatment of diabetic animals with L -Arg increased TAC, SOD and GSH-Px, decreased TGF-β1 and NO levels, downregulated iNOS and caspase-3 expression, upregulated ZO-1 expression, and maintained the integrity of the Sertoli cell junctions. Hence, L -Arg restored the normal testicular structure and function via its antioxidant, antiapoptotic, and antifibrotic effects. [Display omitted] • L -Arg exerted gonadoprotective effects on testicular dysfunction in diabetic rats. • L -Arg ameliorated the oxidative stress, apoptosis, and fibrosis in the testicular tissue. • L -Arg restored the normal testicular morphological structure and functions. • L -Arg maintained the integrity of the Sertoli cell junctions. [ABSTRACT FROM AUTHOR]

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Diabetes Mellitus and the associated hyperglycemia trigger oxidative damage to tissues and organs. DM is obviously related to the salivary glands' dysfunction. Ascorbic acid is a powerful dietary antioxidant. In this study, we investigated the ascorbic acid's putative potential to conserve the structure and function of the major salivary glands in diabetic patients. Adult male albino rats (n = 24) were equally divided into four groups: Group I (control, only distilled water), Group II (ascorbic acid 200 mg/Kg/day), Group III (experimentally-induced diabetes by single intraperitoneal injection of streptozotocin 60 mg/kg), and Group IV (ascorbic acid after one week of diabetes induction). Blood glucose level was assessed. After eight weeks, samples from the salivary glands were processed for histopathological and immunohistochemical examination. Group III showed degenerative changes in the salivary glands and increased collagen deposition, whereas the glycoprotein content and antiapoptotic activity decreased. Group IV showed marked histologic and functional improvement. Although further research is required to fully understand its mode of action, ascorbic acid is advised as an adjuvant medication for diabetes to keep the integrity of major salivary glands. [ABSTRACT FROM AUTHOR]

Introduction Diabetes mellitus is a chronic condition with devastating cardiovascular complications. Earlier studies have reported a gender-based difference in major adverse cardiac events (MACEs) after index PCI procedures. In the drug eluting stent era, more recent studies have failed to show any differences in post-PCI outcomes between both genders. However, this finding has never been verified in Egyptian patients with diabetes. The aim of the study The aim of the study was to compare the impact of female gender on short- and long-term outcomes after elective PCI using drug-eluting stents (DES) in Egyptian diabetic patients. Patients and method The study included 100 diabetic males and 100 diabetic females, all of whom had DES deployed during elective PCI and followed up for 12 months. The clinical endpoints were death, myocardial infarction (MI), target vessel revascularization (TVR), or target lesion revascularization (TLR) at any time during 12 month follow-up period. Results Both diabetic females and males have a low and nearly equal incidence of adverse events following PCI using DES. Conclusion When all patients had DES implanted and after adjustment of demographic and risk factor/co morbidity profiles, there were no significant differences in the short- or long-term PCI outcomes of diabetic females treated with DES when compared to diabetic males. [ABSTRACT FROM AUTHOR]

To solve the problem of aware relationship-balance subgroup of context-acquisition of social computing, on the basis of the relationship-balance, and according to the characteristics of the 2-mode network environment, the relationship-balance gather subgroup and context entity of balance gather coefficient is put forward and used for group behavior analysis. The balance gather of threshold method is used to transform iterative optimization problem in the computing process and put forward the CABS-2mode algorithm used in the group clustering. The CABC-2mode algorithm is used in the acquisition of balance gather coefficient. Balance experiments show that by using the algorithm based on relationship-balance subgroup and the time-context and social-context fusion parameters, the aware relationship-balance of the entity in the context value is accessed, and the subgroup of balance to the intensity fluctuation process and the entity of behavior process are analyzed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of our study was to evaluate the diagnostic accuracy of multidetector computed tomography angiography (MDCTA) in comparison with digital subtraction angiography (DSA) in patients with long standing diabetes mellitus and chronic lower limb ischemia. Subjects and methods: One hundred patients with long standing DM and chronic limb ischemia underwent both CT angiography and DSA. The distal runoff of each lower limb was divided into 13 arterial segments. The status of each segment was graded as: 1, (normal or less than 10% stenosis); 2, (10–49% stenosis); 3, (50–99% stenosis); 4, occlusion. The effect of calcification on the diagnostic accuracy of CT angiography was evaluated. CTA findings were compared with DSA findings for each arterial segment. The sensitivity and specificity of CT angiography were determined using DSA as the gold standard. Results: A total of 100 patients were included (mean age, 58years; 70% men). The sensitivity and specificity of CT angiography were significantly affected by the degree of vessel wall calcification, and increase the need for additional imaging. Conclusion: Vessel wall calcifications decrease the diagnostic accuracy of CT angiography in patients with long standing DM and peripheral arterial disease. [Copyright &y& Elsevier]

Abstract: Individuals with diabetes are at a significantly greater risk of developing cardioymyopathy and heart failure despite adjusting for concomitant risks such as coronary artery disease or hypertension. This has led to the increased recognition of a distinct disease process termed as “diabetic cardiomyopathy.” In this article, we perform an extensive review of the pathogenesis and treatment of this disease. From a clinical perspective, physicians should be aware of this entity, and early screening should be considered because physical evidence of early diabetic cardiomyopathy could be difficult to detect. Early detection of the disease should prompt intensification of glycemic control, concomitant risk factors, use of pharmacologic agents such as β-blockers and renin-angiotensin-aldosterone system antagosists. From a research perspective, more studies on myocardial tissue from diabetic patients are needed. Clinical trials to evaluate the development of diabetic cardiomyopathy and fibrosis in early stages of the disease, as well as clinical trials of pharmacologic intervention in patients specifically with diabetic cardiomyopathy, need to be conducted. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are so many factors contributing to the pathophysiology of type II DM, some of these factors are trace elements and Malondialdehyde (MDA). Their increase or decrease may affect control of diabetes and delay the complications. Aim: Zinc (Zn), copper (Cu), magnesium (Mg), chromium (Cr), selenium (Se) and MDA were studied in this work to clarify their role in the pathogenesis and complications of type II DM aiming at preventing or delaying its complications. Materials and methods: The present study was conducted on 50 patients with type II DM divided into 2 groups: group I (controlled diabetic patients), n =20 and group II which comprised 30 uncontrolled diabetic patients complicated with diabetic nephropathy, neuropathy and retinopathy. Their results were compared to 15 age and sex matched healthy group. Patients and controls were subjected to full history taking, complete clinical examination and laboratory investigations which included measuring fasting serum glucose, cholesterol, triglycerides, HDL-c and LDL-c. HbA1c was measured by column chromatography. MDA was assayed using colorimetric technique. The trace elements were measured in blood by means of atomic absorption spectrometer. Results: The mean levels of Zn, Mg, Se were significantly lower in the diabetic groups than the control group (P <0.001), while MDA was significantly higher in the diabetic groups (P <0.001). MDA showed significant positive correlation with HbA1c (r =0.301), cholesterol (r =0.394), triglycerides (0.315) and LDL-c (r =0.354) and negative correlation with HDL-c (r =−0.315). Significant negative correlation was found between each of Zn, Mg and Se and each of HbA1c and cholesterol. Copper positively correlated with HbA1c, cholesterol and LDL-c. MDA positively correlated with copper (r =0.307) and negatively correlated with Zn, Mg and Se (r =−0.356, −0.282, −0.513, respectively). Conclusion: Trace elements and MDA could have a role as cofactors in the pathogenesis of type II DM. They could be used as markers to evaluate the glycemic control as well as showing the lipid status of diabetic patients. Trace elements supplementations as zinc, magnesium and selenium might have utility in the treatment of the complex disorder in type II DM and may help in control of blood glucose and lipid levels, thus preventing or delaying serious clinical events in these patients. [Copyright &y& Elsevier]

Modern Real Time Operating Systems require reducing computational costs even though the microprocessors become more powerful each day. It is usual that Real Time Operating Systems for embedded systems have advance features to administrate the resources of the applications that they support. In order to guarantee either the schedulability of the system or the schedulability of a new task in a dynamic Real Time System, it is necessary to know the Worst Case Response Time of the Real Time tasks during runtime. In this paper a reduced computational cost algorithm is proposed to determine the Worst Case Response Time of Real Time tasks. [ABSTRACT FROM AUTHOR]

Abstract: Background: Diabetes is characterized by chronic hyperglycemia that produces dysregulation of cellular metabolism and result in excess free radical production and oxidative stress. Glutathione S-transferases (GSTs) are a family of multifunctional enzymes that work as antioxidants. Therefore, diminished expression of GSTs may result in a reduced body defense against oxidative stress, followed by development of diabetic complications. Objectives: To investigate the possible association between GSTM1 and GSTT1 polymorphism and the occurrence of complications in type 2 DM and to study the other risk factors for complications in DM. Methods: Twenty noncomplicated type 2 diabetic patients and 40 complicated type 2 diabetic patients were enrolled in the study. The GSTM1 and GSTT1 genotypes were identified by polymerase chain reaction of peripheral blood DNA samples. Analysis of data was done by using SPSS (SPSS, Chicago, Ill). Results: The frequencies of null GSTM1 and GSTT1 genotypes were 55% (11/20) and 40% (8/20), respectively, in noncomplicated DM group. The frequencies of null GSTM1 and GSTT1 genotype in complicated DM group were 57.5% (23/40) and 60% (24/40), respectively. The null GSTT1 genotype was more prevalent in the group of complicated DM with odds ratio (odds ratio, 2.3; 95% confidence interval, 0.75-6.7) when compared with noncomplicated DM. Conclusion: Our data provide evidence that diabetics with null GSTT1 genotypes are substantially at higher risk for developing complications. [Copyright &y& Elsevier]

Abstract: In the tourism market, it is destinations that compete, not individual firms [Ritchie, J. R. B., & Crouch, G. I. (2000). The competitive destination: A sustainable perspective. Tourism Management, 21(SI), 1–7]. Growing competition, both national and international, is making this more and more apparent. In fact, every destination (defined here as tourist district) has to position its products in such a way that gives them character and personality. The traditional fragmented structure of the European market has spurred the development of metamanagement organizations called destination management organizations (DMOs). Today, DMOs are called on to play a critical role: to help local firms build sustainable competitive advantage and to create competitive advantage for the entire district through positioning choices. This paper proposes a dynamic model of destination management (DDMM) which identifies typical metamanagement processes a DMO can use to shape district strategy. The usefulness of this work can be seen not only in the need to formulate a “good strategy”, which is often described in terms of positioning or criticality (strategy content), but also a method or a path that enables firms to build that positioning or acquire that criticality (strategy process). In fact, Kaplan and Norton [(2001). The strategy focused organization. How balanced scorecard companies thrive in the new business environment. HBS Press] note that the ability to implement a strategy is more important than the quality of the strategy itself. The model proposed here, consistent with the empirical evidence gathered in multiple longitudinal case studies, underscores the criticality of two different types of metamanagement processes: (i) a series of operative activies, here defined as primary processes, which can shape the resources of the district and serve to create, supply, and communicate local product systems, and (ii) a series of support processes, which can provide the “glue” between various players (public and private, profit and non-profit, entrepreneurs and community) that operate within the district. If these processes are effectively managed, they have a significant impact on the competitive advantage of the firms operating in the tourist district. [Copyright &y& Elsevier]

Autonomic Nervous System (ANS) operates to achieve the optimum physiological functioning and maintains homeostasis in a tonic and continuous manner. Evaluation of ANS profile is crucial in assessing autonomic dysfunction. Conventional ANS evaluation procedures fail to capture minute dynamic alterations of ANS activities. The ANS output pattern is appropriately reflected in the fine alteration of the resting heart rate (HR). HR is a non-stationary variable, results from the dynamic interplay between the multiple physiologic mechanisms. The control of cardiac rate or the chronotropic regulation of heart is considered as a coupled network of oscillators, each representing a specific facet of the cardiovascular reflex. The slower vasomotor oscillation via sympathetic system is combined with rapid respiratory oscillation by parasympathetic system to modulate the intrinsic oscillation pattern of the SA Node. Heart Rate Variability (HRV) is used to understand the autonomic influence on cardiovascular system in health and disease. Fourier decomposition of HRV offers us mainly two different frequency components. High frequency (HF) variation indicates parasympathetic variability due to respiration and Low frequency (LF) mainly implicates tonic sympathetic influence, due to slower vasomotor modulation of heart rate. However, different studies show conflicting results and direct recording of sympathetic nerve activity also failed to correlate with LF power in either healthy subjects or in patients with increased cardiac sympathetic drive. A scatter-plot where each R-R interval is plotted against the preceding R-R interval forms a distributed elliptic point cloud in two dimensional plane. The phase space realization of this plot with dimension two and delay one is referred to as Poincaré plot analysis, an emerging quantitative-visual technique where the shape of the plot is categorized into different functional classes. The plot provides summary as well as detailed beat-to-beat information of the heart. This plot can be extended to three dimensions and with multi-lag, offering more insight and information. A mathematical expression was developed by an interventional study by Toichi et al., using pharmacological blockers during different physiological variables that calculated the lengths of transverse and longitudinal axes of the Poincaré plot to derive two quantitative expressions of sympathetic and vagal influence on HRV: 'cardiac sympathetic index' (CSI)) and 'cardiac vagal index' (CVI). In the present study, we emulate Poincaré plot patterns seen in normal range of sympatho-vagal balances and also in Diabetes Mellitus (DM), known to cause autonomic dysfunction. The emerging pattern of R-R interval time series would provide valuable insight into the altered temporal dynamics and also extract crucial features embedded within. DM is a major public health crisis globally and particularly in Indian population. We hypothesize that, CSI and CVI will effectively segregate the two arms of ANS and can be utilized as an effective evaluation tool to explore the disease status in patients of Diabetes Mellitus. We also propose that, the dynamics of fluctuations in physiological rhythms that exhibit long-term correlation and memory, can also be explored and expressed quantitatively by incorporating various degrees of 'lag' in these recurrence plots. [ABSTRACT FROM AUTHOR]

Background & Aims Acute hyperglycemia delays gastric emptying in patients with diabetes. However, it is not clear whether improved control of glycemia affects gastric emptying in these patients. We investigated whether overnight and short-term (6 mo) improvements in control of glycemia affect gastric emptying. Methods We studied 30 patients with poorly controlled type 2 diabetes (level of glycosylated hemoglobin, >9%). We measured gastric emptying using the [ 13 C]- Spirulina platensis breath test on the patients’ first visit (visit 1), after overnight administration of insulin or saline, 1 week later (visit 2), and 6 months after intensive therapy for diabetes. We also measured fasting and postprandial plasma levels of C-peptide, glucagon-like peptide 1, and amylin, as well as autonomic functions. Results At visit 1, gastric emptying was normal in 10 patients, delayed in 14, and accelerated in 6; 6 patients had gastrointestinal symptoms; vagal dysfunction was associated with delayed gastric emptying ( P < .05). Higher fasting blood levels of glucose were associated with shorter half-times of gastric emptying (t half ) at visits 1 (r = -0.46; P = .01) and 2 (r = -0.43; P = .02). Although blood levels of glucose were lower after administration of insulin (132 ± 7 mg/dL) than saline (211 ± 15 mg/dL; P = .0002), gastric emptying t half was not lower after administration of insulin, compared with saline. After 6 months of intensive therapy, levels of glycosylated hemoglobin decreased from 10.6% ± 0.3% to 9% ± 0.4% ( P = .0003), but gastric emptying t half did not change (92 ± 8 min before, 92 ± 7 min after). Gastric emptying did not correlate with plasma levels of glucagon-like peptide 1 and amylin. Conclusions Two-thirds of patients with poorly controlled type 2 diabetes have mostly asymptomatic yet abnormal gastric emptying. Higher fasting blood levels of glucose are associated with faster gastric emptying. Overnight and sustained (6 mo) improvements in glycemic control do not affect gastric emptying. [ABSTRACT FROM AUTHOR]

Abstract: Background: Diabetes mellitus (DM) is frequently associated with difficult-to-treat erectile dysfunction (ED). We performed two investigations about treatment for DM associated with ED in Japanese. The first investigation was to compare efficacy between Vardenafil 20 mg and 10 mg, whereas the second investigation was to observe whether Vardenafil allows successful intercourse initiated rapidly after dosing in Japanese patients with DM and ED. Methods: In the first investigation, 954 patients were recruited and randomly assigned into three groups, i.e., placebo group, valdenafil 10mg group and valdenafil 20mg group. Patients were instructed to take a single dose 1 h prior to sexual intercourse and not to take more than one dose per day with at least 24 h elapsing between doses. In the second investigation, a total of 778 patients were randomized to treatment, and 778 were included in the intent-to-treat analysis of efficacy. Patients received vardenafil 10 mg, 20 mg, or placebo, and were instructed to start sexual activity an hour after dosing. Results: First investigation revealed that Vardenafil 20 mg demonstrated superior efficacy to that of 10mg. The difference on efficacy between 10mg and 20mg was more evident in severe ED patients (base-line IIEF EF domain score <11). Second investigation revealed that Vardenafil allowed for successful completion of sexual activity irrespective of the time when men chose to initiate insertion after drug dosing, with treatment differences over placebo noted from as early as 15 min. Conclusions: Vardenafil 20mg demonstrated superior efficacy compared to 10mg, suggesting incremental clinical benefit in using the higher dose in this difficult-to-treat population in Japanese men with DM and ED. In addition, early onset of activity with vardenafil is also achievable in Japanese ED patients with DM. [Copyright &y& Elsevier]