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Nong H, Pang X, Jing J, Cen Y, Qin S, Jiang H. Alterations in intra- and inter-network connectivity associated with cognition impairment in insulinoma patients. Front Endocrinol (Lausanne) 2023; 14:1234921. [PMID: 37818091 PMCID: PMC10561291 DOI: 10.3389/fendo.2023.1234921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
Objective Cognitive dysfunction is common in insulinoma patients, but the underlying neural mechanisms are less well understood. This study aimed to explore the alterations of intra- and inter-network connectivity patterns associated with patients with insulinoma. Methods Resting-state fMRI were acquired from 13 insulinoma patients and 13 matched healthy controls (HCs). Group Independent component analysis (ICA) was employed to capture the resting-state networks (RSNs), then the intra- and inter-network connectivity patterns, were calculated and compared. Montreal Cognitive Assessment (MoCA) was used to assess the cognitive function. The relationship between connectivity patterns and MoCA scores was also examined. Results Insulinoma patients performed significantly worse on MoCA compared to HCs. The intra-network connectivity analysis revealed that patients with insulinoma showed decreased connectivity in the left medial superior frontal gyrus within anterior default mode network (aDMN), and decreased connectivity in right lingual gyrus within the visual network (VN). The intra-network connectivity analysis showed that patients with insulinoma had an increased connectivity between the inferior-posterior default mode network (ipDMN) and right frontoparietal network (rFPN) and decreased connectivity between the ipDMN and auditory network (AUN). There was a significant negative correlation between the ipDMN-rFPN connectivity and MoCA score. Conclusion This study demonstrated significant abnormalities in the intra- and inter-network connectivity in patients with insulinoma, which may represent the neural mechanisms underlying the cognitive impairment in insulinoma patients.
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Affiliation(s)
- Hui Nong
- Department of Gastroenterology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Xiaomin Pang
- Department of Neurology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Jie Jing
- Department of Gastroenterology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Yu Cen
- Department of Gastroenterology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Shanyu Qin
- Department of Gastroenterology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Haixing Jiang
- Department of Gastroenterology, Guangxi Medical University First Affiliated Hospital, Nanning, China
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Khan MI, Barlow RB, Weinstock RS. Acute hypoglycemia decreases central retinal function in the human eye. Vision Res 2011; 51:1623-6. [PMID: 21601590 DOI: 10.1016/j.visres.2011.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/29/2011] [Accepted: 05/04/2011] [Indexed: 11/26/2022]
Abstract
The goal of this pilot study was to assess the effects of acute hypoglycemia on retinal function and contrast sensitivity in individuals with and without diabetes. Hyperinsulinemic hypoglycemic and euglycemic clamp procedures were performed in subjects without diabetes (n=7) and with controlled type 1 diabetes (n=5). Mean age was 28 years, and none had retinal disease. During euglycemia (glucose 95-110 mg/dl) and acute hypoglycemia (glucose 50-55 mg/dl), contrast sensitivity was measured and spatial retinal responses were recorded with multifocal electroretinograms (mfERG), a rapid technique for mapping sensitivity from the foveal, macular and peripheral areas of the retina. During hypoglycemia, retinal responses (mfERG P1 wave) were decreased in both type 1 diabetes subjects and subjects without diabetes. The dominant effect was in the amplitude of the responses in the central macular retina, not in their temporal properties. Responses from the central region, central 10(0), were on average 1.8-fold lower than those from the periphery for both groups. All diabetes subjects and 3/7 without diabetes reported central scotoma. Decreases in mfERG amplitude were accompanied by decreases in contrast sensitivity. These changes were immediately reversed with the restoration of euglycemia. Overall, this study demonstrates that the acute effects of hypoglycemia in the human eye predominantly involve central vision, and these visual effects originate, at least in part, in the retina. The association between low blood glucose levels and impaired central vision underscores the importance of avoiding when possible and promptly treating hypoglycemia, particularly in individuals with diabetes.
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Affiliation(s)
- Mukhtar I Khan
- SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
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Bie-Olsen LG, Kjaer TW, Pedersen-Bjergaard U, Lonsdale MN, Holst JJ, Law I, Thorsteinsson B. Changes of cognition and regional cerebral activity during acute hypoglycemia in normal subjects: A H215O positron emission tomographic study. J Neurosci Res 2009; 87:1922-8. [DOI: 10.1002/jnr.22002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Umino Y, Everhart D, Solessio E, Cusato K, Pan JC, Nguyen TH, Brown ET, Hafler R, Frio BA, Knox BE, Engbretson GA, Haeri M, Cui L, Glenn AS, Charron MJ, Barlow RB. Hypoglycemia leads to age-related loss of vision. Proc Natl Acad Sci U S A 2006; 103:19541-5. [PMID: 17159157 PMCID: PMC1697832 DOI: 10.1073/pnas.0604478104] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The retina is among the most metabolically active tissues in the body, requiring a constant supply of blood glucose to sustain function. We assessed the impact of low blood glucose on the vision of C57BL/6J mice rendered hypoglycemic by a null mutation of the glucagon receptor gene, Gcgr. Metabolic stress from moderate hypoglycemia led to late-onset loss of retinal function in Gcgr(-/-) mice, loss of visual acuity, and eventual death of retinal cells. Retinal function measured by the electroretinogram b-wave threshold declined >100-fold from age 9 to 13 months, whereas decreases in photoreceptor function measured by the ERG a-wave were delayed by 3 months. At 10 months of age Gcgr(-/-) mice began to lose visual acuity and exhibit changes in retinal anatomy, including an increase in cell death that was initially more pronounced in the inner retina. Decreases in retinal function and visual acuity correlated directly with the degree of hypoglycemia. This work demonstrates a metabolic-stress-induced loss of vision in mammals, which has not been described previously. Linkage between low blood glucose and loss of vision in mice may highlight the importance for glycemic control in diabetics and retinal diseases related to metabolic stress as macular degeneration.
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Affiliation(s)
- Y. Umino
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - D. Everhart
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - E. Solessio
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - K. Cusato
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY 13244
| | - J. C. Pan
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - T. H. Nguyen
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - E. T. Brown
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - R. Hafler
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - B. A. Frio
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - B. E. Knox
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - G. A. Engbretson
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY 13244
| | - M. Haeri
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - L. Cui
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY 10461; and
| | - A. S. Glenn
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY 10461; and
| | - M. J. Charron
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY 10461; and
| | - R. B. Barlow
- *Center for Vision Research, Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY 13210
- To whom correspondence should be addressed at:
Center for Vision Research, Department of Ophthalmology, 3258 Weiskotten Hall, 750 East Adams Street, SUNY Upstate Medical University, Syracuse, NY 13210. E-mail:
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Abstract
BACKGROUND Published research indicated that fluctuations in blood glucose concentration (BGC) change the biochemical balance of the retina and may alter the sensitivity of retinal cells. Low-contrast flicker was used in this research to measure the changes in sensitivity of the retina accompanying shifts in BGC. METHODS In five subjects without diabetes and four subjects with diabetes, simultaneous measurements of flicker thresholds, using a two-alternative, forced choice psychometric test, and BGC, were made every 15 to 30 minutes for several hours, while BGC was allowed to fluctuate spontaneously. RESULTS Flicker thresholds were found to rise and fall, generally tracking BGC in each subject. First-day flicker threshold measurements were used to "calibrate" the method for each subject, and subsequent days' measurements were used to infer blood glucose. The resulting inferred blood glucose values correlated with BGC measured from blood samples in the range of 70 mg/dL to 500 mg/dL with a maximum error of +/-33% in 97% of the measurements. CONCLUSIONS The feasibility of using flicker sensitivity for monitoring blood glucose levels noninvasively is discussed. Improvements in the testing method can potentially reach +/-18% error margin with 1-minute measurements, according to computer simulations. Devices using a visual test would be inexpensive to manufacture and would need no disposable supplies. Planned research will assess the long-term stability of flicker threshold measurements and will determine the applicability of the technique in diabetic retinopathy, in hypoglycemia and in the presence of fatigue and inattention.
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Affiliation(s)
- J Castano
- RetiTech, Inc., El Sobrante, California 94803, USA
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