Diabetic peripheral neuropathy: age-stratified glycemic control.

Background: We explore the effect of suboptimal glycemic control on the incidence of diabetic peripheral neuropathy (DPN) in both non-elderly and elderly patients with type 2 diabetes mellitus (T2DM). Methods: A 6-year follow-up study (2013-2019) enrolled T2DM patients aged >20 without DPN. Participants were classified into two groups: those below 65 years (non-elderly) and those 65 years or older (elderly). Biochemical measurements, including glycated hemoglobin (HbA1C), were recorded regularly. DPN was diagnosed using the Michigan Neuropathy Screening Instrument examination. The outcome was DPN occurrence in 2019. Results: In 552 enrollments (69% non-elderly), DPN occurred in 8.4% non-elderly and 24.0% elderly patients. A higher initial HbA1C level was significantly linked with a higher risk of future DPN in the non-elderly group (adjusted odds ratio [AOR] 1.46, 95% CI 1.13-1.89, p=0.004). In comparison, HbA1c at the end of the study period was not associated with DPN in the non-elderly group (AOR 1.17, 95% CI 0.72-1.90, p=0.526). In the elderly group, no statistical relationship was found between HbA1C levels and DPN, either in 2013 or in 2019. Conclusion: Suboptimal glycemic control at baseline, rather than at the end of the study period, predicts an increased risk of future DPN in individuals with T2DM under age 65. This correlation is not seen in elderly patients. Therefore, we recommend implementing enhanced glycemic control early in middle-aged T2DM patients and propose individualized therapeutic strategies for diabetes in different age groups.

Dual antiplatelet therapy is associated with favorable outcome in acute minor stroke with an onset-to-door time beyond 24 h.

BACKGROUND/PURPOSE: In patients with noncardioembolic acute minor ischemic stroke (AMIS), dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel within 24 h after stroke onset was more effective than aspirin alone. This study investigated the efficacy and safety of DAPT in AMIS patients with an onset-to-door time (OTDT) of more than 24 h. METHODS: This was a retrospective analysis of a prospective stroke registry from 2015 to 2021. Patients with AMIS and an OTDT within seven days were classified into the Early (≤24 h) and Late groups (>24 h) according to the time of antiplatelet administration after stroke onset. RESULTS: In total, 691 patients were identified. Of these, 446 (64.5%) and 245 (35.5%) patients were classified into the Early and Late groups, respectively. The rates of recurrent infarction and symptomatic intracranial hemorrhage at 90 days were similar between the single antiplatelet therapy (SAPT) and DAPT subgroups in both the Early and Late groups. More patients in the DAPT subgroup had a favorable outcome (modified Rankin scale of 0-1) at 90 days in both Early (84.2% versus 75.0%, p = 0.016) and Late (88.2% versus 76.9%, p = 0.040) groups. DAPT was independently associated with a favorable outcome in both the Early (odds ratio, 1.95; 95% CI, 1.15-3.32; p = 0.013) and Late (odds ratio, 2.72; 95% CI, 1.14-6.48; p = 0.024) groups. CONCLUSION: In patients with AMIS and an OTDT of more than 24 h, DAPT was associated with a favorable outcome at 90 days.

Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study.

Introduction: The efficacy of patent foramen ovale (PFO) closure in the elderly population is unclear. We aimed to investigate the efficacy and safety of PFO closure in non-elderly and elderly patients. Methods: Patients over 18 years of age with cryptogenic stroke (CS) or transient ischemic attack and PFO were prospectively enrolled and classified into two groups according to treatment: (1) closure of PFO (the PFOC group) and (2) medical treatment alone (the non-PFOC group). The primary outcome was a composite of recurrent cerebral ischemic events and all-cause mortality during the follow-up period. A modified Ranking Scale [mRS] at 180 days was recorded. The safety outcomes were procedure-related adverse events and periprocedural atrial fibrillation. The results between the PFOC and non-PFOC groups in non-elderly (<60 years) and elderly (≥60 years) patients were compared. Results: We enrolled 173 patients, 78 (45%) of whom were elderly. During a mean follow-up of 2.5 years, the incidence of primary outcome was significantly lower in the PFOC group (6.2% vs. 17.1%, hazard ratio[HR] = 0.35, 95% CI 0.13-0.97, p = 0.043) in adjusted Cox regression analysis. Compared with the non-PFOC group, the PFOC group had a numerically lower risk of the primary outcome in both the elderly (HR 0.26, 95% CI 0.07-1.01, p = 0.051) and the non-elderly (HR 0.61, 95% CI 0.11-3.27, p = 0.574) groups. In addition, patients with PFO closure in the elderly group had a lower median mRS at 180 days (p = 0.002). The rate of safety outcome was similar between the non-elderly and elderly groups. Discussion: PFO closure was associated with a reduced risk of the primary outcome in patients with PFO and CS in our total cohort, which included non-elderly and elderly patients. Compared to those without PFO closure, elderly patients with PFO closure had a better functional outcome at 180 days. PFO closure might be considered in selected elderly patients with PFO.

Renal impairment is one of appropriate predictors of future diabetic peripheral neuropathy: a hospital-based 6-year follow-up study.

The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient's sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. Multivariable logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p = 0.005), advanced age (OR 1.06, p = 0.001), increased body weight (OR 1.04, p = 0.018), duration of DM (OR 1.05, p = 0.036) and male gender (OR 3.69, p = 0.011) were significantly associated with future DPN. In addition, patients with T2DM under the age of 65 with higher serum creatinine concentration (OR 8.91, p = 0.005) and higher baseline HbA1C (OR 1.71, p < 0.001) revealed significantly associated with future DPN. In conclusion, this is the first large scaled hospital-based study with long term follow-up to investigate risk factors for DPN in Taiwanese. Lower eGFR and higher serum creatinine concentration, particularly in people under the age of 65, are predictors of future DPN in Taiwanese people with T2DM. Other predictors included advanced age, increased body weight, duration of DM, male gender for all ages and HbA1c in enrolled patients under the age of 65. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.

A Decade of Ground Deformation in Kunming (China) Revealed by Multi-Temporal Synthetic Aperture Radar Interferometry (InSAR) Technique.

Large-scale urbanization has brought about severe ground subsidence in Kunming (China), threatening the stability of urban infrastructure. Mapping of the spatiotemporal variations of ground deformation is urgently needed, along with summarization of the causes of the subsidence over Kunming with the purpose of disaster prevention and mitigation. In this study, for the first time, a multi-temporal interferometric synthetic aperture radar (InSAR) technique with L-band Advanced Land Observation Satellite (ALOS-1) and X-band Constellation of Small Satellites for Mediterranean basin Observation (COSMO-SkyMed) data was applied to Kunming to derive the time series deformation from 2007 to 2016. The annual deformation velocity revealed two severe subsiding regions in Kunming, with a maximum subsidence of 35 mm/y. The comparison of the deformation between InSAR and leveling showed root-mean-square error (RMSE) values of about 4.5 mm for the L-band and 3.7 mm for the X-band, indicating that our results were reliable. We also found that the L-band illustrated a larger amount of subsidence than the X-band in the tested regions. This difference was mainly caused by the different synthetic aperture radar (SAR)-acquired times and imaging geometries between the L- and X-band SAR images. The vertical time series deformation over two severe subsiding regions presented an approximate linear variation with time, where the cumulative subsidence reached 209 mm during the period of 2007-2016. In view of relevant analyses, we found that the subsidence in Kunming was the result of soft soil consolidation, building load, and groundwater extraction. Our results may provide scientific evidence regarding the sound management of urban construction to mitigate potential damage to infrastructure and the environment.

Emergency Response Using Volunteered Passenger Aircraft Remote Sensing Data: A Case Study on Flood Damage Mapping.

Current satellite remote sensing data still have some inevitable defects, such as a low observing frequency, high cost and dense cloud cover, which limit the rapid response to ground changes and many potential applications. However, passenger aircraft may be an alternative remote sensing platform in emergency response due to the high revisit rate, dense coverage and low cost. This paper introduces a volunteered passenger aircraft remote sensing method (VPARS) for emergency response. It uses the images captured by the passenger volunteers during flight. Based on computer vision algorithms and geocoding procedures, these images can be processed into a mosaic orthoimage for rapid ground disaster mapping. Notable, due to the relatively low flight latitude, small clouds can be easily removed by stacking multi-angle tilt images in the VPARS method. A case study on the 2019 Guangdong flood monitoring validates these advantages. The frequent aircraft revisit time, intensive flight coverage, multi-angle images and low cost of the VPARS make it a potential way to complement traditional remote sensing methods in emergency response.

An Improved Quadrilateral Fitting Algorithm for the Water Column Contribution in Airborne Bathymetric Lidar Waveforms.

In this paper, an improved method based on a mixture of Gaussian and quadrilateral functions is presented to process airborne bathymetric LiDAR waveforms. In the presented method, the LiDAR waveform is fitted to a combination of three functions: one Gaussian function for the water surface contribution, another Gaussian function for the water bottom contribution, and a new quadrilateral function to fit the water column contribution. The proposed method was tested on a simulated dataset and a real dataset, with the focus being mainly on the performance of retrieving bottom response and water depths. We also investigated the influence of the parameter settings on the accuracy of the bathymetry estimates. The results demonstrate that the improved quadrilateral fitting algorithm shows a superior performance in terms of low RMSE and a high detection rate in the water depth and magnitude retrieval. What's more, compared with the use of a triangular function or the existing quadrilateral function to fit the water column contribution, the presented method retrieved the least noise and the least number of unidentified waveforms, showed the best performance in fitting the return waveforms, and had consistent fitting goodness for all different water depths.

Formation of the 2015 Shenzhen landslide as observed by SAR shape-from-shading.

The time-series topography change of a landfill site before its failure has rarely been surveyed in detail. However, this information is important for both landfill management and early warning of landslides. Here, we take the 2015 Shenzhen landslide as an example, and we use the radar shape-from-shading (SFS) technique to retrieve time-series digital elevation models of the landfill. The results suggest that the total filling volume reached 4,074,300 m3 in the one and a half years before the landslide, while 2,817,400 m3 slid down in the accident. Meanwhile, the landfill rate in most areas exceeded 2 m/month, which is the empirical upper threshold in landfill engineering. Using topography captured on December 12, 2015, the slope safety analysis gives a factor of safety of 0.932, suggesting that this slope was already hazardous before the landslide. We conclude that the synthetic aperture radar (SAR) SFS technique has the potential to contribute to landfill failure monitoring.