Imaging the eye and its relevance to diabetes care

Diabetes is a major cause of vision loss globally, yet this devastating complication is largely preventable. Early detection and treatment of diabetic retinopathy necessitates screening. Ocular imaging is widely used clinically, both for the screening and management of diabetic retinopathy. Common eye conditions, such as glaucoma, cataracts and retinal vessel thrombosis, and signs of systemic conditions, such as hypertension, are frequently revealed. As well as imaging by a skilled clinician during an eye examination, non-ophthalmic clinicians, such as general practitioners, endocrinologists, nurses and trained health workers, can also can carry out diabetic eye screening. This process usually comprises local imaging with remote grading, mostly human grading. However, grading incorporating artificial intelligence is emerging. In a clinical research context, retinal vasculature analyses using semi-automated software in many populations have identified associations between retinal vessel geometry, such as vessel caliber, and the risk of diabetic retinopathy and other chronic complications of type 1 and type 2 diabetes. Similarly, evaluation of corneal nerves by corneal confocal microscopy is revealing diabetes-related abnormalities, and associations with and predictive power for other chronic diabetes complications. As yet, the value of retinal vessel geometry and corneal confocal microscopy measures at an individual level is uncertain. In this article, targeting non-ocular clinicians and researchers, we review existent and emerging ocular imaging and grading tools, including artificial intelligence, and their associations between ocular imaging findings and diabetes and its chronic complications.

SUN-LB040 Associations of Testosterone and Sex Hormone Binding Globulin with the Risk of Cardiovascular Disease and Type 2 Diabetes in Men

Objective: Contrasting findings exist regarding the associations between circulating sex hormone-binding globulin (SHBG) and total testosterone (TT) with type 2 diabetes (T2D) and cardiovascular diseases (CVD) in men. We examined prospective associations of SHBG and TT with incident T2D and CVD, in a cohort of community-dwelling men. Methods: Participants were aged 35 years and over at enrolment (n=2563) and followed for an average of 4.95 years. This analysis included men without T2D (1597) or CVD (1492) at baseline, and with fasted morning serum SHBG (chemiluminescent immunoassay) and TT (LCMSMS) at both time points, and without meds affecting TT or SHBG. T2D was identified by either self-report, fasting glucose (≥7.0 mmol/L), HbA1c (≥ 6.5%) and/or prescriptions for diabetes medications. CVD was ascertained by self-report and/or hospital data linkage. Logistic binomial regressions were used to assess associations between SHBG and incident T2D & CVD, adjusting for self-reported psycho-social, demographic and health status and related behavioural factors; measured waist circumference, HBA1c and plasma glucose, triglycerides, high-sensitivity C-reactive protein. Sensitivity analyses assessed mediation effects of anxiety, sleep duration, shift work ≥3years, and obstructive sleep apnoea (OSA). Results: During an average follow-up of 4.95 years, 14.5% (n=232) and 6.7% (n=101) of men developed T2D and CVD, respectively. Baseline TT was independently associated with incident T2D (odds ratio (OR) =0.72, 95%CI= [0.57, 0.92], P=0.01). An inverse association of baseline SHBG levels with incident T2D (OR=0.77 [0.62, 0.95], P=0.02), was insignificant after adjustment for TT (OR=0.91 [0.71, 1.17], P=0.48 for SHBG. Baseline TT (OR=0.71 [0.52, 0.98], P=0.04) and SHBG (OR=1.54 [1.15, 2.06], P=0.003) were independently associated with incident CVD. A decrease in TT between time points was associated with incident T2D (OR=0.81 [0.68, 0.97], P=0.02) and CVD (OR=0.72 [0.56,0.92], P=0.01). There was no association between ΔSHBG and incident T2D and CVD. In the sensitivity analyses there was evidence for mediation effects of shift-work on the association of TT, but not SHBG with CVD (both baseline &change models), and of longer sleep duration, OSA and shift work on the association of TT with T2D (change TT model only). Conclusions Shift-work mediates associations of TT with CVD. All sleep parameters had mediation effects on the association of decreasing TT with T2D. Funding: NH&MRC Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Urinary Isoprostane Levels and Age-Related Macular Degeneration

Purpose

Oxidative stress, characterized by an excessive production of reactive oxygen intermediates has been suggested to play a role in the pathogenesis of age-related macular degeneration (AMD). We examined the association of urinary F2-isoprostanes (F2-IsoPs), a marker of lipid peroxidation and the most reliable marker of oxidative damage with AMD.

Methods

We included 238 adults with AMD and 390 age- and sex-matched controls without AMD who participated in a population-based cross-sectional study in Singapore (Singapore Chinese Eye Study, 2009-2011). AMD was graded from retinal photographs using the Wisconsin Age-Related Maculopathy Grading System. Urinary-free F2-IsoPs (pmol/mmol of creatinine) were measured by gas chromatography mass spectrometry (GC-MS). The association between F2-IsoPs and AMD was examined using unconditional logistic regression models adjusted for potential confounders including smoking, body mass index (BMI), blood pressure, total and high-density lipoprotein cholesterol, and history of cardiovascular disease.

Results

Higher levels of F2-IsoPs were associated with AMD independent of potential confounders. Compared to quartile 1 (Q1) of F2-IsoPs, the multivariable odds ratio (95% confidence interval) of AMD in quartiles 2, 3, and 4 were 2.05 (1.26-3.32), 1.80 (1.10-2.94), and 1.76 (1.06-2.94), respectively. In subgroup analyses comparing Q4 to Q1, this association was stronger in women, those with BMI less than 25 kg/m2 and those with hypertension, but no significant interaction was found (P interaction > 0.1 for each strata).

Conclusions

Higher levels of urinary F2-IsoPs levels were associated with AMD independent of potential confounders in Chinese adults.

Lower Urinary Tract Symptoms, Depression, Anxiety and Systemic Inflammatory Factors in Men: A Population-Based Cohort Study

Background

The relationship between lower urinary tract symptoms (LUTS) and common mental health disorders such as depression and anxiety in men remains unclear. Inflammation has recently been identified as an independent risk factor for LUTS and depression. This study aimed to assess the association between depression, anxiety and LUTS, and the moderating influence of systemic inflammation, in the presence of other biopsychosocial confounders.

Methods

Participants were randomly-selected from urban, community-dwelling males aged 35–80 years at recruitment (n = 1195; sample response rate:67.8%). Of these, 730 men who attended baseline (2002–5) and follow-up clinic visits (2007–10), with complete outcome measures, and without prostate or bladder cancer and/or surgery, neurodegenerative conditions, or antipsychotic medications use, were selected for the present study. Unadjusted and multi-adjusted regression models of incident storage and voiding LUTS and incident depression and anxiety were combined with serum inflammatory markers (high-sensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), interleukin–6 (IL–6), myeloperoxidase (MPO), soluble e-selectin (e-Sel)) and socio-demographic, lifestyle, and health-related factors. Hierarchical multiple regression was used to assessed the moderating effect of inflammatory markers.

Results

The incidence of storage, voiding LUTS, depression and anxiety was 16.3% (n = 108), 12.1% (n = 88), 14.5% (n = 108), and 12.2% (n = 107). Regression models demonstrated that men with depression and anxiety at baseline were more likely to have incident storage, but not voiding LUTS (OR: 1.26, 99%CI: 1.01–4.02; and OR:1.74; 99%CI:1.05–2.21, respectively). Men with anxiety and storage LUTS at baseline were more likely to have incident depression (OR: 2.77, 99%CI: 1.65–7.89; and OR:1.45; 99%CI:1.05–2.36, respectively), while men with depression and voiding LUTS were more likely to have anxiety at follow-up (OR: 5.06, 99%CI: 2.81–9.11; and OR:2.40; 99%CI:1.16–4.98, respectively). CRP, TNF-α, and e-Sel were found to have significant moderating effects on the development of storage LUTS (1.06, 0.91–1.96, R² change: 12.7%), depression (1.17, 1.01–1.54, R² change: 9.8%), and anxiety (1.35, 1.03–1.76, R² change: 10.6%), respectively.

Conclusions

There is a bidirectional relationship between storage, but not voiding, LUTS and both depression and anxiety. We observed variable moderation effects for selected inflammatory markers on the development of depression, anxiety and storage LUTS.

Probe-based Real-time PCR Approaches for Quantitative Measurement of microRNAs

Probe-based quantitative PCR (qPCR) is a favoured method for measuring transcript abundance, since it is one of the most sensitive detection methods that provides an accurate and reproducible analysis. Probe-based chemistry offers the least background fluorescence as compared to other (dye-based) chemistries. Presently, there are several platforms available that use probe-based chemistry to quantitate transcript abundance. qPCR in a 96 well plate is the most routinely used method, however only a maximum of 96 samples or miRNAs can be tested in a single run. This is time-consuming and tedious if a large number of samples/miRNAs are to be analyzed. High-throughput probe-based platforms such as microfluidics (e.g. TaqMan Array Card) and nanofluidics arrays (e.g. OpenArray) offer ease to reproducibly and efficiently detect the abundance of multiple microRNAs in a large number of samples in a short time. Here, we demonstrate the experimental setup and protocol for miRNA quantitation from serum or plasma-EDTA samples, using probe-based chemistry and three different platforms (96 well plate, microfluidics and nanofluidics arrays) offering increasing levels of throughput.

The longitudinal association between inflammation and incident depressive symptoms in men: the effects of hs-CRP are independent of abdominal obesity and metabolic disturbances

BACKGROUND

This cohort study evaluates whether the association between low-grade inflammation and incident depressive symptoms is independent of abdominal obesity and metabolic disturbances.

METHODS

A cohort of 1167 non-depressed men aged 35 to 80 years were followed up over 5 years to assess incident depressive symptoms measured by the Centre for Epidemiology Scale-Depression or Beck Depression Inventory-I. Venous tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) were quantified at baseline and 5years. Logistic regression determined whether hsCRP, IL-6 and TNF-α were associated with incident depressive symptoms independent of abdominal obesity and metabolic factors. Ancillary analysis utilizing depression z scores stratified participants by waist circumference ≥ 102 cm and ≥2 metabolic disturbances.

RESULTS

Incident depressive symptoms occurred in 95 men at 5 years (8.14% of total). Clinically relevant depressive symptoms were associated with baseline hsCRP (adjusted OR=1.04; 95% CI 1.00-1.07, p=.03) and annualized ΔhsCRP (adjusted OR=1.04; 95% CI 1.01-1.08, p=.02). Ancillary analysis showed that the association between annualized ΔhsCRP and depression z score was only significant in men with waist circumference<102 cm (β=.19, p<.001) and ≤1 metabolic disturbance (β=.18, p<.001). None of the measured cytokines were significantly associated with depression.

CONCLUSIONS

hsCRP and annualized ΔhsCRP were positively associated with depressive symptoms in a cohort of men. Further investigation into the role of abdominal obesity and metabolic disturbances in the inflammation-depression hypothesis is warranted.

[The assessment of thyroid gland function in patients with non-insulin dependent diabetes mellitus (type II)]

The aim of the study was to assess thyroid gland function in non-insulin dependent diabetes mellitus patients under different therapeutic regimens. There were examined 75 patients with type II diabetes mellitus, age range 33-80 years (average 65.24 +/- 14.32 years) including 46 women and 29 men. Group I was treated with insulin, group II--with diet, and group III--with sulfonylurea derivatives oral antidiabetic agents. Control group consisted of 91 healthy persons in appropriate age. The highest glucose levels were in insulin treated group--174.17 +/- 40.31 mg%, and were significantly higher from the values observed in oral antidiabetic agents treated group (169.89 +/- 41.34 mg%), and in diet treated group, where glucose levels were the lowest--134.57 +/- 25.06 mg%. In both groups--patients treated with insulin and with oral antidiabetic agents a positive correlation between fT4 and glycated hemoglobin levels were observed. Performed experiments and investigations suggest: 1. There are no differences in thyroid gland function in patients with non-insulin dependent diabetes mellitus. 2. Different therapies (diet, insulin therapy, oral antidiabetic agents) have no influence on thyroid gland function.

Estimation of health state and physical efficiency of children from rural area of Lubin-Glogow copper-basin and lead levels in blood serum. Preliminary results

The aim of the work was to estimate the health state and physical efficiency of children from rural area of Lubin-Głogów Copper-Basin in correlation with lead levels in blood. Lead concentration in blood showed increase tendency together with age of the children. In both sexes together with rise in lead concentration in blood enlargement of palatine tonsils was observed. In children with a higher lead concentration in blood lower values of physical fitness parameters are recorded.

[Current opinions about the role of peptide C in the human organism]

This article present a review on the physiological activity and possible mechanism of action of C-peptide and clinical significance of using this hormone in the treatment of diabetes mellitus. The present results might suggest that, contrary to the prevailing view, C-peptide possesses biological activity and plays an important part in the attenuating or preventing from diabetic complications. It is important to realize that this discovery might someday revolutionize diabetes treatment, however further studies will be required to define and confirm the exact mechanism of C-peptide activity.

[Activity of converting enzyme angiotensin I to angiotensin II (ACE) in patients with diabetes type II]

The aim of the work was evaluation of activity of angiotensin converting enzyme (ACE) in non-insulin dependent diabetes mellitus depending on evidence of hypertonia, duration of diabetes and possibility of fat metabolism disturbances. 20 patients were studied (16 women and 4 men, average age 57.5 years). Average time of duration of diabetes was approximately 9 years (from 1 year to 25 years). The control group included 68 people (34 women and 34 men) in age of 19 to 67 years. Convertase activity was determined by Friedland and Silverstein's spectrofluorometric assay. Average ACE activity values in diabetic patient (44.45 +/- 13.14 mmol/ml/min) were close up to control group values and were not significantly different. Similar significant difference was not ascertain between average ACE activity values in patients with more than and less than 10 years of diabetes, in patients with hypercholesterolemia over and less 300 mg%, in patients with and without hypertonia and in patients with and without LDL hypercholesterolemia over and less 200 mg%. Positive correlation was observed between ACE activity values and triglyceride levels in patients with less than 10 years of diabetes (r = 0.88, p < 0.01) and in patients with hypercholesterolemia over 300 mg% (r = 0.75, p < 0.01). In this last group, in addition, the positive correlation was present between ACE activity values and total cholesterol levels (r = 0.86, p < 0.001). Correlation between ACE activity and total cholesterol level was ascertained in patients with LDL hypercholesterolemia over 200 mg% too (r = 0.81, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of the thymus in the human body]

The work deals with contemporary opinions on the endocrinological function of thymus. The latest information concerning T cell maturation has also been provided. It has been shown that there is a direct relationship between the process of lymphocyte T proliferation and formation of the organism tolerance to self. The current opinions dealing with the phenomenon of the thymus involution have been given stressing its advantageous significance for human organism. The work shows wide connections of the gland in question with other organs. The participation of thymus in pathogenesis of some disease entities has also been presented.