Background and Aims / Part 1

The care of patients who undergo bariatric surgery is complex. These patients are not only severely obese, they are also burdened by the other expressions of the metabolic syndrome including type 2 diabetes, polycystic ovary syndrome, NASH, hypertension among other associated diseases. They pose challenges in selection, in assessment, in preparation for surgery, in post-operative care and, especially, in the management of late complications, including neuropathies due to malnutrition, episodic hypoglycemic attacks, internal hernias and mental health challenges

Methods / Part 2

Review of current approach to bariatric surgery. Comparison with other multidisciplinary centers such as pediatric hospitals, cancer centers, heart institutes

Results / Part 3

Surgeons do not have the resources, the time nor the training to address these issues alone. Interdisciplinary care is required at every stage of the progression before, during and after bariatric surgery.

Conclusions

Accordingly, it is time to follow the successful examples in the care of cancer and heart disease with the establishment of metabolic centers staffed by the various disciplines involved in the care of these complex and challenging patients. This presentation will review the early and long term outcomes of bariatric surgery, the shared pathology of the various expressions of the metabolic syndrome, the organizational structure of the proposed centers and approaches to certification for quality control.

Background and Aims

Diabetic Retinopathy (DR) is a fast-progressing disease, often resulting in blindness, early diagnosis being crucial to prevent further damage. Eye Fundus Images (EFI) can be analyzed to detect lesions and the degree of DR. Automated detection of individual lesions helps visualizing the lesions, characterizing their location, size and severity, and also detecting the degree of DR [1]. Deep learning is state-of-the-art in segmentation procedures. Aim: Evaluate state-of-the-art, deep learning-based, segmentation of EFI.

Methods

IDRID Diabetic Retinopathy dataset with 55 train and 28 test Eye Fundus Images (EFI), together with corresponding groundtruth label masks; DeepLabV3 vs Fully Convolutional Network (FCN): segmentation using deep convolution neural networks (DCNN) trained to recognize the lesions; DCNN is used to recognize lesions in test dataset; Metrics: (A) = Global Accuracy and Iou; (B) Per-lesion accuracy (OD=Optic Disk, HA=Haemorrhages, HE=Hard Exudates, SE=Soft Exudates, MA=MicroAneurisms, BK=bkground);

Results

Training Runtime: DeepLabV3 19 minutes with 1 GPU; FCN 635 minutes with 1 GPU; Accuracy (A) DeepLabV3 (acc 82.2%, IoU 32%), FCN (88.5%, IoU 38%); (B) DeepLabV3 (OD 95.3%, SE 84.1%, HA 65.3%, HE 95.2%, MA 83.9%, BK 80%), FCN (OD 95.3%, SE 62.1%, HA 58.1%, HE 80.2%, MA 63%, BK 89%).

Conclusions

Results show that DCNN approaches achieve relatively high accuracy but low IoU, and DeepLabV3 achieves better accuracy over individual lesions. Future work: the approaches need further developments to improve IoU, our focus of future work on the subject.

Background and Aims

The purpose of this study is to compare the cross-section-area(CSA) of ​​the median nerve according to the severity of carpal tunnel syndrome(CTS) in patients electrophysiologically diagnosed as CTS alone and diabetic polyneuropathy(DPN) with CTS.

Methods

DPN is diagnosed according to the criteria set forth in The Diabetes Control and Complications Trial. CTS is characterized by the Steven’s criteria. The severity of CTS was determined using Steven's classification. The CSA of the median nerve is measured at the distal wrist crease and forearm 12cm proximal to the distal wrist crease using ultrasonography.

Results

The comparison of median nerve CSA and wrist-to-forearm ratio showed significant differences between normal and CTS group, and normal and DPN-CTS group, but there was no significant difference between CTS group and DPN-CTS group (Table1,2).

Median nerve CSA at the distal wrist crease and the wrist-to-forearm ratio of CTS group and DPN-CTS group were compared according to CTS severity. There was no significant difference between both groups of any severity (Table3,4).

Conclusions

The results of this study concluded that median nerve swelling at the wrist level in DPN CTS patients was thought to be due to compression effects on the wrist rather than the metabolic effect of diabetes.

Background and Aims

Skin autofluorescence (SAF) indicates a content of advanced glycation end products and oxidation state of tissues. The aim was to assess a correlation between SAF level, measured with fluorescence spectrometry, and glucose metabolism parameters in patients with diabetes mellitus type 1 and type 2 and in healthy participants.

Methods

We involved 53 healthy participants (age range 20-63 years), 53 type 1 diabetic patients (18-42 years), 23 type 2 diabetic patients (34-66 years). We did not include patients with skin diseases, severe renal dysfunction, severe concomitant diseases. Glycosylated hemoglobin (HbA1c) was measured (Bio-Rad, USA), capillary blood glucose level was assessed 9 times a day, glycemic variability parameters were calculated. SAF was measured with fluorescence–reflection multichannel fiber spectrometer FOS-1. Measurements were carried out at 10 points on the skin of forearms, the mean value was calculated. A statistic analysis was performed by Statistica 7.0 Software Package (StatSoft. Inc., USA). Correlation analysis was performed with Spearman test.

Results

We found a statistically significant correlation between SAF level and age in the control group (R=0.55; p<0.05), a significant correlation between SAF level and HbA1c level in type 1 diabetes group (R=0.40; p<0.05). No significant correlations were revealed in type 2 diabetes group.

Conclusions

We found a positive correlation between SAF intensity and HbA1c level, no correlations with glycemic variability parameters in young type 1 diabetic patients. The measurement of SAF with the spectrometer FOS-1 can be used for additional evaluation of diabetes complications risks.

Additional information: this research is supported by Russian Science Foundation (grant No. 17-75-30052).

Background and Aims

Aim -Charcot Foot is a cause of Non Healing Ulcers in aWDiabetic.Surgery or Total Contact Cast remain the mainstay of treatment.Topical Wound Oxygen (TWO2) have been used in healing of Diabetic Foot ulcers recently.Oxygen delivery to the wound reduce inflammation,increse Growth Factors and helps Epithelialization.This could be used in Charcot Foot Ulcer of a Diabetic presenting with co -morbidities .

Methods

Methods- A Diabetic Male with toe amputations 2^nd 3^rd 4^th 5^thtoe presented with chronic multiple plantar ulcers of right foot of Wagner Grade 1.Investigations showed impaired renal function,elevated Esr and Hscrp and Peripheral arterial disease and peripheral neuropathy. Radiological examination and Thermography showed signs of Charcot Foot. After informed consent the foot was kept in a sterile closed bag and cyclical pressure applied with TWO2 for ninety minutes for five days a week.These cycles were repeated for ten weeks .Debridement and dressing with sterile gauze with daily follow up was done .The healing was monitored with Thermography and pictures using Wound Zoom Camera. Antibiotics or other medications were avoided due to the co morbidities.

Results

Results- The Charco Foot with multiple plantar ulcers in a Diabetic with all small toe amputations healed with TWO2 with a cyclical pressure of 25mm of Hg given for 90 minutes for 5 days a week for ten weeks.

Conclusions

Conclusions- TWO2 is an option for healing of Chronic plantar ulcers in Charcot Foot in a Diabetic.

Background and Aims

Previous attempts to use photoplethysmography (PPG), tissue reflectance oximetry (TRO), Laser Doppler Flowmetry (LDF), etc. for dynamic evaluation of microvascular complications of diabetes mellitus (DM) have not led to success. We propose new method – incoherent optical fluctuation flowmetry (IOFF), which additionally allows to implement PPG and TRO within IOFF probe. Current study was aimed on the first validation of combined diagnostic IOFF-TRO-PPG technique for microcirculation assessment in patients with DM.

Methods

Oscillometric tonometry, IOFF, PPG and TRO techniques were combined in single device and used to assess a set of 7 parameters of central and peripheral hemodynamics. Pilot measurements were conducted on 18 DM patients (8 with diabetic retinopathy and 10 without it) and 18 healthy volunteers. To consider influence of peripheral and central hemodynamic factors (heart rate, blood pressure, arterial stiffness, blood flow, etc.) in assessment of skin microvasculature functional state (including endothelial and neurogenic regulation), we calculated complex diagnostic criterion (DC) as the weighted function of all measured quantities.

Results

DC in the control group was -0.5±1.9, in DM patients without retinopathy – -3.1±1.1, in DM patients with retinopathy – -4.9±1.5. ANOVA with LSD post-hoc analysis showed all groups were pairwise different. DC parameter allowed us to classify patients into these three groups with 72.2% accuracy.

Conclusions

The device, created on the basis of IOFF, allows to perform comprehensive assessment of peripheral hemodynamics and to reveal microcirculation disorders of various genesis. In long term, the proposed technology can be used to assess DM complications risk and as additional endpoint in DM management.

Background and Aims

Non-invasive microcirculation assessment is a promising additional method to estimate the risks of complications development and to monitor the treatment efficacy. Aim of this study was to show that a non-invasive microcirculation assessment, using a laser Doppler flowmetry (LDF), can be used to evaluate odds of complications in patients with diabetes.

Methods

The study included 107 volunteers without diabetes (Group 1) and 250 diabetes patients which were divided into two groups: patients without retinopathy (Group 2) and those with retinopathy (Group 3). Perfusion was assessed using Laser Doppler Flowmetry during local heating test on the dorsal surface of the forearm.

Results

The highest difference between groups was revealed in the “slope of the microcirculatory curve in the first two minutes of heating” parameter: the Kruskal-Wallis test with post hoc Dunn tests showed that all three groups were pairwise different with p<0,01. A logistic regression analysis was performed for patients with diabetes mellitus: odds ratio for retinopathy (95% CL) with HbA1c (1% increase) was 1.09 (0.94 - 1.26), with diabetes duration (1 year increase) - 1.16 (1.11 - 1.22), with “slope” parameter - 0.26 (0.21 - 0.57).

Conclusions

Use of the LDF method enabled to determine skin microcirculation disorders both in patients with retinopathy and in those without it. It was shown that these microcirculatory disorders - unlike the singly measured HbA1c - indicate increased odds of retinopathy in a diabetes patient. We suppose that this parameter can be used in prospect for the additional control of the risks of the retinopathy development.

Background and Aims

To investigate whether the Lower limb vascular intervention or Autologous platelet-rich gel (APR) treatment would benefit patients with diabetic lower extremity arterial disease (LEAD) with foot ulcer.

Methods

A total 82 diabetic LEAD with foot ulcer patients were recruited and divided into 3 groups: group A (30 patients received basal treatment), group B (21 patients received basal and autologous platelet-rich gel treatment), group C (31 patients received basal and Lower limb vascular intervention treatment), all patients had a routine follow-up visit for 6 months. The baseline characters and parameters were detected. After treatment, changes from baseline of all parameters were recorded. The differences among each groups and the relationship among each parameters were conducted.

Results

There were no difference in ABI and major amputation between group A and B (P>0.05), compared with group A and B, the ABI and major amputation rate of the C group were improved (P<0.05); There were no significant difference in Tcpo2, heal rate and minor amputation between A and C group (P>0.05), and compared with group A and C, the Tcpo2, heal rate and minor amputation of B group were improved (P<0.05). The logistic regression analysis indicated that the major amputation was mainly associated with ABI, and the minor amputation was mainly associated with Tcpo2. The lower limb vascular intervention can improve the ABI and reduce the major amputation, and the APR improves the Tcpo2 and reduces the minor amputation.

Conclusions

In diabetic LEAD with foot ulcer, major amputation was mainly associated with ABI, while minor amputation was mainly associated with Tcpo2. Interventional surgery mainly improves the ABI and reduces the incidence of major amputation with the improvement of macro-vascular, and the APR mainly improves the local Tcpo2, and reduces the incidence of minor amputations with the improvement of microcirculation.

Background and Aims

To evaluate intercourse of microcirculatory bed, EF parameters changes with nerves electrical activity metrics and compare them among patients with different HbA1C.

Methods

Patients (N=161) were divided into 3 groups: G1 -HbA1C<7% (N=46, men 54%, age 53.15±8.71), G2 -7≤HbA1C<9% (N=64.55% male, age 53.6±9.3), G3 -HbA1C>9%, N=51.51% males, age 53.53±8.54).

Digital capillaroscopy included capillary coiling (CC), polymorphism, network density, perivascular zone, arterial/ apex/ venous segments diameters estimation. Pulse wave velocity (PWV), endothelial function (EF) were measured by plethysmography. N.suralis, n.peroneus M-response amplitude (Mr-A), excitation propagation velocity (EPV), M-response triggering threshold (Mr-TT), residual latency were evaluated with stimulation electromyography.

Results

G2 in comparison to G1 revealed: decreased n.suralis Mr-A (p=0.04), reduced EPV (p=0.03), higher Mr-TT detection rate (p<0.01); decreased n.peroneus Mr-A (p=0.03); reduced EPV (p=0.02); increased capillary polymorphism (p=0.02), CC (p=0.06), venous/arterial segment ratio (p=0.04), increased PWV (p=0.02). Comparison between G3 and G2 also revealed statistical significance.

Microcirculatory disorders are minimally associated with diabetic polyneuropathy: direct correlation of capillary density with n.suralis EPV (p<0.05), and inverse correlation with increased n.peroneus Mr-TT (p<0.05).

The interrelation between EF and n.suralis Mr-A was determined. The correlation of PWV was revealed with: n.suralis Mr-TT and n.peroneus increase, n.peroneus low-amplitude F-waves with fallout and EPV.

Conclusions

Motor neuropathy was found more distinct than sensorial in 7≤HbA1C<9% group.

Interrelation between microvascular and neurological disorders identified minimally. Only capillary density correlated with EPV n.suralis, n.peroneus Mr-TT. Macrovascular violations (PWV increase, EF decrease) more than microvascular were associated with nerves electrical activity impairment. Interrelations between microcirculation, stimulation electromyography parameters and glucose+HbA1C were found.

Background and Aims

Aims: to assess the effects of associated autoimmune diseases on glycemic control, growth, metabolic parameters in children with type 1 diabetes (T1D) and to select the most predictive genetic, immune and metabolic risk factors of polyglandular autoimmunity in children with T1D.

Methods

72 children with combined autoimmune pathology (main group, age 11.98±3.79 years) and 75 patients with isolated T1D (control group, age 11.09±3.31 years) were recruited. Groups were comparable in age (p=0.17) and T1D duration (p=0.26). Anthropometric parameters, insulin doses, biochemical blood parameters, glycosylated hemoglobin (HbA1c), thyroid hormones and thyroid peroxidase antibodies (anti-TPO) levels were assessed.

Results

In the main group 49 children had combinations of T1D with autoimmune thyroiditis (AIT), 17 − celiac disease, 2 – Graves' disease, 4 – AIT and celiac disease. Body mass index and height z-scores in both groups corresponded to the mean age values and didn’t differ significantly (p=0.82 and 0.71 respectively). HbA1c level in children with combined autoimmune pathology was higher than in the control group (8.23±1.91% vs 7.47±1.22%, p=0.006). There was no difference in insulin requirement (p=0.93).

Both groups demonstrated similar values of biochemical blood parameters: lipidogram, serum iron, and ferritin (p>0.05). Higher anti-TPO antibodies were revealed in the main group (327.41±469.91 IU/ml) compared to the control group (40.42±26.33 IU/ml, p=0.0001).

Conclusions

At the present stage of the study we hasn’t found any difference in anthropometric and biochemical parameters in children with coexisting disorders compared with patients with isolated T1D. Children with polyglandular autoimmune pathology showed more poor glycemic control indicators.