SUDOSCAN in Combination with the Michigan Neuropathy Screening Instrument Is an Effective Tool for Screening Diabetic Peripheral Neuropathy.

BACKGROUND: Screening for diabetic peripheral neuropathy (DPN) is important to prevent severe foot complication, but the detection rate of DPN is unsatisfactory. We investigated whether SUDOSCAN combined with Michigan Neuropathy Screening Instrument (MNSI) could be an effective tool for screening for DPN in people with type 2 diabetes mellitus (T2DM) in clinical practice. METHODS: We analysed the data for 144 people with T2DM without other cause of neuropathy. The presence of DPN was confirmed according to the Toronto Consensus criteria. Electrochemical skin conductance (ESC) of the feet was assessed using SUDOSCAN. We compared the discrimination power of following methods, MNSI only vs. SUDOSCAN only vs. MNSI plus SUDOSCAN vs. MNSI plus 10-g monofilament test. RESULTS: Confirmed DPN was detected in 27.8% of the participants. The optimal cut-off value of feet ESC to distinguish DPN was 56 µS. We made the DPN screening scores using the corresponding odds ratios for MNSI-Questionnaire, MNSI-Physical Examination, SUDOSCAN, and 10-g monofilament test. For distinguishing the presence of DPN, the MNSI plus SUDOSCAN model showed higher areas under the receiver operating characteristic curve (AUC) than MNSI only model (0.717 vs. 0.638, P=0.011), and SUDOSCAN only model or MNSI plus 10-g monofilament test showed comparable AUC with MNSI only model. CONCLUSION: The screening model for DPN that includes both MNSI and SUDOSCAN can detect DPN with acceptable discrimination power and it may be useful in Korean patients with T2DM.

pH-Dependent interaction mechanism of lignin nanofilms.

Lignin has been spotlighted as an abundant renewable bioresource for use in material technologies and applications such as biofuels, binders, composites, and nanomaterials for drug delivery. However, owing to its complex and irregular structure, it is difficult to investigate its fundamental interaction mechanism, which is necessary to promote its use. In this study, a surface forces apparatus (SFA) was used to investigate the pH-dependent molecular interactions between a lignin nanofilm and five functionalized self-assembled monolayers (SAMs). The lignin nanofilm adhered most strongly to the amine-functionalized SAM, indicating that the molecular interactions with lignin were mainly electrostatic and cation-π interactions. The force-distance profile between lignin and a methyl-functionalized SAM revealed pH-dependent interactions similar to those between two lignin nanofilms. This finding indicates that the dominant cohesion mechanism is hydrophobic interactions. A quartz crystal microbalance with dissipation was used to investigate the adsorption of free lignin molecules on functionalized SAMs. Lignin molecules, which were free in solution, were most effectively adsorbed to the phenyl-functionalized SAM. To investigate whether the nanoscopic interaction forces could be extended to macroscopic properties, the compressive strength of activated carbon-lignin composites prepared at different pH values was evaluated. As the pH increased, the compressive strength decreased owing to the reduced hydrophobic interactions between the activated carbon and lignin, consistent with the SFA results. These quantitative results regarding lignin interactions can advance the potential use of lignin as an eco-friendly biomaterial.

Diabetic Peripheral Neuropathy as a Risk Factor for Sarcopenia.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is prevalent in patients with type 2 diabetes, and its prevalence increases with age. A previous study demonstrated the association between DPN and muscle dysfunction; however, there are limited data on the association between DPN and sarcopenia. METHODS: We enrolled patients with type 2 diabetes and measured hand grip strength (HGS), lean body mass using a bio-impedance analysis, and gait speed using a 4-m walking test. Sarcopenia was diagnosed according to the criteria from the Asian Working Group for Sarcopenia. We also performed various examinations of neuropathy, including both small- and large-fiber neuropathy. RESULTS: Among 170 participants (mean age, 61.5±6.6 years), 24 (14.1%) were diagnosed with sarcopenia. The Michigan Neuropathy Screening Instrument Questionnaire (MNSI-Q) scores were higher in patients with sarcopenia than in those without sarcopenia (2.7±1.3 vs. 2.4±1.3; p=0.008). However, other neuropathy examination results were not significantly associated with sarcopenia. The MNSI-Q score was negatively associated with HGS, with an odds ratio (OR) of 1.367 (95% confidence interval [CI], 1.122-1.667) in predicting the presence of sarcopenia. After adjusting for sex, body mass index, and diabetes duration, the MNSI-Q score was associated with the presence of sarcopenia (adjusted OR=1.310; 95% CI, 1.041-1.647). CONCLUSION: In this population with type 2 diabetes, patients with sarcopenia had higher neuropathy questionnaire scores than those without sarcopenia. Therefore, active screening for sarcopenia should be performed in subjects with DPN.