Comparison of the Beta-Band Intermuscular Pool Coherence Between Chronic Non-specific Low Back Pain and Healthy Subjects

Objectives: The current study aimed to compare between the chronic non-specific low back pain (CNSLBP) and healthy subjects during four phases of the trunk flexion-extension task (standing, flexion, relaxation, and extension phases) by using pool coherence as well as pairwise coherence of Beta band Intermuscular coherence (Bb-IMC) and flexion relaxation phenomena. Methods: Twenty-four men with CNSLBP and 20 healthy men voluntarily participated in this study. All subjects performed three tests of Flexion-extension task (F-ET) while the surface electromyography (sEMGs) were recorded from the right erector spinal muscle of the lumbar region “1”, left erector spinal muscle of the lumbar region “2”, right gluteus maximus muscle”3”, left gluteus maximus muscle”4”, right hamstring muscle”5” and left hamstring muscle”6”. Accordingly, group A contains muscles 1, 4, and 6 and group B consists of muscles 2, 3, and 5. The pool coherence (PC) and the pairwise coherence (PWC) for all the above-mentioned muscles were calculated using Beta-band intermuscular coherence analysis. Thereafter, the mean pool coherence (mPC) was considered for group A and group B for four phases of F-ET in three groups as following: CNSLBP patients group, healthy subjects group and the third group included all subjects that participated in this study, whether patients or healthy and it was called the general group. Moreover, the mean pairwise coherence (mPWC) among each pair of group A and B muscles was calculated for four phases of F-ET using Bb-IMC in CNSLBP patients and healthy subjects. Results: These results indicated a high value of A mPC in the general group and healthy subjects in the flexion phase, whereas the same A mPC in CNSLBP patients was high in all phases of F-ET. On the other hand, while B mPC was high in the general group and healthy subjects in the extension phase; it was high in all phases of F-ET in CNSLBP patients; B mPC in CNSLBP patients was high in extension, standing, and flexion phases. A mPWC and B mPWC were not significantly different between CNSLBP patients and healthy subjects in all phases of F-ET. However, only A mPWC “1 - 4” and the A mPWC “4 - 6” were significantly smaller in CNSLBP patients compared to the healthy subjects in the relaxation and flexion phases, respectively. Hence, we suggest pool coherence of Bb-IMC, not pairwise coherence of Bb-IMC, to compare CNSLBP patients and healthy subjects. Conclusions: According to the present findings, we suggest using the pool coherence of Bb-IMC in the clinical examination for CNSLBP patients and studying the probable cortical effects and the effectiveness of various treatments on corticospinal tract function in CNSLBP.

Download Full-text

Test-retest Reliability of EMG β-Band Intermuscular Coherence of Non-specific Chronic Low Back Pain During Flexion-extension Task

Journal of Modern Rehabilitation ◽

10.18502/jmr.v15i2.7727 ◽

2021 ◽

Author(s):

Salah Ghazi ◽

Mohammad Reza Hadian ◽

Azadeh Shadmehr ◽

Saeed Talebian ◽

Gholamreza Olyaei ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Healthy Subjects ◽

Small Sample ◽

Low Back ◽

Beta Band ◽

Flexion Extension ◽

Intermuscular Coherence ◽

High Level

Introduction: This study aimed to investigate the reliability and agreement of the Beta-band Intermuscular Coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low Back Pain (NS-CLBP) patients and healthy subjects by studying four phases of the Flexion-Extension Task (F-ET): standing, flexion, relaxation, and extension phases. Materials and Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All subjects performed three trials of F-ET while the surface electromyography was recorded from the lumbar erector spinal, gluteus maximus, and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) for four phases of F-ET were used to analyze the intra- rater reliability and agreement of the measurements. Results: The investigation of ICC, SEM, and MDC showed that the reliability was moderate to a high level for pool and pairwise coherence of Bb-IMC in all mentioned muscles for four phases of the flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: So far, no studies have used the Bb-IMC method to study low back pain, which is carried out in our research to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET have moderate to a high level of reliability for using Bb-IMC and could be considered a tool for the NS-CLBP patients’ assessment. Despite the small sample size investigated, in clinical practice the using Bb-IMC measure can help to study the interaction of corticospinal in NS-CLBP and also in healthy subjects. This measure requires larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Further, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Download Full-text

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

Journal of Neurosurgery Spine ◽

10.3171/2021.9.spine21822 ◽

2021 ◽

pp. 1-11

Keyword(s):

Scale Score ◽

Neck Disability Index ◽

Implant Removal ◽

Odontoid Fractures ◽

Significant Difference ◽

Flexion Extension ◽

Group A ◽

Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

Download Full-text

Biomechanical Study of Cortical Bone Trajectory Screws in Intervertebral Fixation of Lumbar Tuberculosis

10.21203/rs.3.rs-680733/v1 ◽

2021 ◽

Author(s):

Chen-Wei Zhang ◽

Shi-Yuan Shi ◽

De-Xin Hu ◽

Shen-Ping Hu ◽

Jin-Ping Hu ◽

...

Keyword(s):

Lumbar Spine ◽

Internal Fixation ◽

Bone Graft ◽

Lateral Bending ◽

Flexion Extension ◽

Group A ◽

Group B ◽

Group D ◽

State 1 ◽

Screw Group

Abstract BackgroundWe aimed to explore the biomechanical stability and advantages of cortical bone trajectory (CBT) screws in the treatment of lumbar spine tuberculosis and provide biomechanical basis for the choice of clinical fixation methods. Methods16 pig spine specimens (T12-L5) were selected to simulate the lumbar spine(L2-L3) tuberculosis bone destruction model in vitro. The 16 specimens were randomly divided into 4 groups, and short segments (pedicle screws of the diseased vertebrae) were assigned respectively. Fixation (group A), short-segment fixation (group B), fixation with pedicle screw (group C), fixation with CBT screw (group D), 4 specimens in each group , Each specimen in each group was subjected to biomechanical testing in the state of complete specimen (state 1) and L2-3 spinal tuberculosis model bone graft fusion and internal fixation (state 2). Load each specimen on the spine 3D exercise machine, respectively apply moments of 2N·m, 2.5N·m, 1N·m, 3N·m, meanwhile record the movement of the specimens in the four directions of flexion，extension，lateral bending and torsion ROM, compare Simultaneously analyze each group of ROM. ResultsThe ROMs of flexion, extension, lateral bending, and torsion in group A in state 1 and state 3 modes were （8.47±1.76）°、（7.01±1.10）°、（5.03±0.92）°、（4.48±0.41）°and （4.78±0.07）°、（2.91±0.16）°、（2.66±0.09）°、（2.23±0.05）°; the ROMs of flexion, extension, lateral bending and torsion in group B in state 1 and state 3 modes were （7.32±0.75）°、（5.35±0.69）°、（3.44±0.51）°、（3.36±1.02）°and（3.51±0.29）°、（1.74±0.04）°、（1.53±0.31）°、（1.23±0.08）°; The ROMs of flexion, extension, lateral bending, and torsion in group C in state 1 and state 3 modes were （10.01±0.39）°、（9.05±0.25）°、（7.42±1.06）°、（6.92±1.15）°and （7.21±0.17）°、（5.07±0.02）°、（5.12±0.74）°、（4.58±0.01）°; The ROMs of flexion, extension, lateral bending, and torsion in group D in state 1 and state 3 modes were （9.20±1.37）°、（7.38±0.88）°、（6.89±1.22）°、（6.00±0.52）°and （6.06±0.16）°、（3.99±0.02）°、（3.85±0.08）°、（3.47±0.10）°. The ROM value of each fixed mode group under the state of bone graft fusion and internal fixation was lower than that of the intact state, and the difference was statistically significant (P<0.05)，The t values are 4.531, 5.346, 6.008, 4.149; 9.481, 16.181, 11.814, 4.769; 4.349, 8.002, 4.473, 4.800; 5.041, 4.146, 12.232, 10.58. ConclusionCBT screw disease intervertebral fixation can not only provide sufficient mechanical stability, but also provide stronger stability when using the same fixed segment, and The fixed segments are minimized.

Download Full-text

Radiofrequency renal denervation with different device for treatment in patient with uncontrolled hypertension

Systemic Hypertension ◽

10.26442/2075082x.2018.4.000043 ◽

2018 ◽

Vol 15 (4) ◽

pp. 34-38 ◽

Cited By ~ 1

Author(s):

R A Agaeva ◽

N M Danilov ◽

G V Shelkova ◽

O V Sagaydak ◽

V A Grigin ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Arterial Hypertension ◽

Glomerular Filtration ◽

Filtration Rate ◽

Renal Denervation ◽

Renal Arteries ◽

General Group ◽

Radiofrequency Denervation ◽

Group A ◽

Group B

Objective. To study the efficacy and safety of radiofrequency renal denervation with mono-electrode and multi-electrode devices in patients with uncontrolled arterial hypertension during follow-up period. Materials and methods. The study included 42 patients with uncontrolled arterial hypertension (mean age 51±12 years), while receiving multicomponent antihypertensive therapy, including diuretic. All patients underwent radiofrequency denervation of the renal arteries with a mono-electrode (n=27; group A) and multi-electrode devices (n=15; group B). The safety of the procedure was assessed using creatinine and glomerular filtration rate (MDRD equation), as well as according to ultrasound of the kidneys and renal arteries. The effectiveness of the procedure was study according to office blood pressure (BP) and ambulatory BP monitoring (ABPM). Results. In the general group, according to office BP after 6 months, there decreased in systolic (SBP)/diastolic BP (DBP) by 28/13 mm Hg (p=0.000001). According to ABPM, there was a decrease in the average daily SBP by 9 mm Hg (p=0.007) and DBP by 6 mm Hg (p=0.03). No significant changes in creatinine and glomerular filtration rate were detected in the general group. According to ABPM, after 6 months in group B, there was a decrease in the average daily SBP/DBP by 13 and 6 mm Hg (p=0.1). In group A, according to the ABPM, after 6 months, there was a decrease in the average daily SBP and DBP by 7 mm Hg (p=0.001) and 4 mm Hg (p=0.03). After 1 year, according to the office BP, there was a decrease in SBP/DBP by 14/11 mm Hg (p=0.002), and after 3 years at 15/17 mm Hg (p=0.3). Conclusion. The results confirm the safety and efficacy of radiofrequency renal denervation. Renal denervation in combination with drug therapy leads to decreasing of BP after 6 months and in the long-term

Download Full-text

The expression levels of MicroRNA-146a, RANKL and OPG after non-surgical periodontal treatment

BMC Oral Health ◽

10.1186/s12903-021-01883-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mandana Sattari ◽

Ramezan Ali Taheri ◽

Reza ArefNezhad ◽

Hossein Motedayyen

Keyword(s):

Healthy Subjects ◽

Soft Tissues ◽

Alveolar Bone ◽

Periodontal Treatment ◽

Control Group ◽

Mrna Levels ◽

Clinical Attachment Loss ◽

Periodontal Tissues ◽

Group A ◽

Group B

Abstract Objective MicroRNA-146a (miR-146a) is a regulator of inflammatory response. Periodontitis is a disease with immune pathophysiology of the periodontium in which the inflammation results in the destruction of the soft tissues and alveolar bone. Therefore, the aim of this study was to investigate the expressions of miR-146a, OPG, and RANKL in diseased and healthy periodontal tissues to understand whether miR-146a expression level may associate with OPG and RANKL mRNA levels and OPG/RANKL ratio after non-surgical periodontal treatment. Methods The levels of miR-146a, RANKL, and OPG in gingival tissues from patients with generalized periodontitis stages II and III and grades A and B (n = 15, group A), patients with generalized periodontitis stages III and IV and grade C (n = 15, group B), and healthy individuals (n = 10) were determined by real-time PCR. The associations of miR-146a expression with OPG and RANKL levels were evaluated. Results The levels of miR-146a in two subgroups within periodontitis patients were significantly higher than healthy subjects (P < 0.0001). MiR-146a showed the increased level in group A of patients compared with group B (P < 0.05). Clinical parameters such as probing depth (PD) and clinical attachment loss (CAL) were significantly higher in patients than control group (P < 0.05). The levels of OPG and RANKL were increased in patients compared with healthy subjects, although the elevated levels were not statistically significant. MiR-146a was not associated with OPG and RANKL levels and OPG/RANKL ratio. Conclusions The results of this study failed to show the associations of miR-146a level with OPG and RANKL levels and OPG/RANKL ratio in periodontitis after non-surgical periodontal treatment.

Download Full-text

Exercise-Induced Platelet Activation in Myocardial Infarction Survivors with Normal Coronary Arteriogram

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661199 ◽

1984 ◽

Vol 52 (03) ◽

pp. 297-300 ◽

Cited By ~ 12

Author(s):

Ph Douste-Blazy ◽

P Sié ◽

B Boneu ◽

J Marco ◽

N Eche ◽

...

Keyword(s):

Myocardial Infarction ◽

Platelet Activation ◽

Plasma Levels ◽

Healthy Subjects ◽

Venous Blood ◽

Peak Exercise ◽

Platelet Factor ◽

Significant Difference ◽

Group A ◽

Group B

SummaryPlatelet activation may participate in the pathophysiology of myocardial infarction occurring in patients with normal coronary arteriogram. We investigated this possibility in a series of 9 such patients (group A) during a standardized bicycle excercise test as myocardial infarction had occurred in all of them during or soon after strong physical exercise. Twelve patients with effort-induced angina and coronary atherosclerosis (group B) and eleven healthy subjects (group C) served as test groups. Peripheral venous blood was collected by separate venipuncture before, at peak exercise and during recovery. As a sensitive index of activation, the shape of the circulating platelets was examined with a phase contrast microscope after instantaneous fixation of the whole blood. The percentage of non strictly disc-shaped platelets with one or more thin pseudopods was determined. Simultaneously, the plasma levels of platelet factor 4 (PF4) and of beta-thromboglobulin (β-TG) were measured. At rest, there was no significant difference in the platelet morphology nor in the plasma levels of platelet specific proteins between the three groups. During exercise, a significant change in platelet shape occurred in group A and B patients and not in the healthy subjects. This platelet activation was not related to myocardial ischemia since it occurred to a similar extent in group B patients who developed electrocardiographic changes and in group A patients who did not. There was no detectable release of platelet proteins during exercise in any group.

Download Full-text

Micro RNA-146a effect on Periodontitis is Independent on OPG/RANKL Axis

10.21203/rs.3.rs-598474/v1 ◽

2021 ◽

Author(s):

Mandana Sattari ◽

Somayeh Ghotloo ◽

Ramezan-Ali Taheri ◽

Reza ArefNezhad ◽

Hossein Motedayyen

Keyword(s):

Healthy Subjects ◽

Soft Tissues ◽

Alveolar Bone ◽

Micro Rna ◽

Control Group ◽

Clinical Attachment Loss ◽

Probing Depth ◽

Independent Mechanism ◽

Group A ◽

Group B

Abstract Background MicroRNA-146a (miR-146a) is a regulator of inflammatory response. Periodontitis is a disease with immune pathophysiology of the periodontium in which the inflammation results in the destruction of the soft tissues and alveolar bone. Therefore, this study was investigated whether miR-146a may contribute to periodontitis through affecting the levels of OPG and RANKL. Methods The levels of miR-146a, RANKL, and OPG in gingival tissues from patients with generalized periodontitis stages II and III and grades A and B (n = 15, group A), patients with generalized periodontitis stages III and IV and grade C (n = 15, group B), and healthy individuals (n = 10) were determined by real-time PCR. The associations of miR-146a expression with OPG and RANKL levels were evaluated. Results The levels of miR-146a in two subgroups within periodontitis patients were significantly higher than healthy subjects (P < 0.0001). MiR-146a showed the increased level in group A of patients compared with group B (P < 0.05). Clinical parameters such as probing depth (PD) and clinical attachment loss (CAL) were significantly higher in patients than control group (P < 0.05). The levels of OPG and RANKL were increased in patients compared with healthy subjects, although the elevated levels were not statistically significant. MiR-146a was not associated with the levels of OPG and RANKL. Conclusion The results of this study failed to show the effect of miR-146a on the pathophysiology of disease through OPG/RANKL axis. Clinical Relevancy: MiR-146a may participate in the pathophysiology of disease through independent mechanism(s) of OPG/RANKL axis.

Download Full-text

A COMPARATIVE CLINICAL STUDY ON THE EFFICACY OF MARMA CHIKITSA AND STIMULATION OF MARMA POINTS USING TENS IN MANAGEMENT OF CERVICAL SPONDYLOSIS

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj07p4052020 ◽

2020 ◽

Vol p4 (05) ◽

pp. 2408-2414

Author(s):

Raj Kiran ◽

Gururaja D.

Keyword(s):

Cervical Spondylosis ◽

Disc Disease ◽

Hand Muscles ◽

Mild Improvement ◽

Flexion Extension ◽

Comparative Clinical Study ◽

Group A ◽

Hand Muscle ◽

Group B ◽

Side Bending

Background: Cervical Spondylosis a degenerative disc disease, pain being the main first concern along with stiffness and decreased movements of neck. Marma chikitsa is done by employing electrical stimula-tion using TENS or adapting Varma chikitsa explained in Siddha system of medicine on Marma points ex-plained by Acharya Sushruta. Objectives: To compare the efficacy of Marma manipulation and electrical stimulation using TENS in the management of Cervical Spondylosis. Methods: 40 Subjects diagnosed with Cervical Spondylosis was divided into 2 groups of 20 each. Group A was treated with TENS and Group B was treated with Marma Chikitsa for 7 days respectively. Results: The outcome of treatment after 14 days was statistically significant based in criteria taken for study. Interpretation & Conclusion: Group A showed better effect in reducing stiffness, pain, and improves an-gle of flexion, extension, side bending, tendon reflexes, power of hand muscle and rotation of neck. Whereas Group B was effective in improving the restricted movements, tenderness and mild improvement on power of hand muscles.

Download Full-text

The effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi w.s.r. to Sciatica

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.4.4.1 ◽

2019 ◽

Vol 4 (04) ◽

Author(s):

Bhagyashree VG ◽

Shridhar Rao SM

Keyword(s):

Pain Management ◽

Signs And Symptoms ◽

Modern Medicine ◽

Spinal Nerve ◽

Daily Routine ◽

Lumbar Region ◽

Management Objectives ◽

Symptomatic Management ◽

Group A ◽

Group B

Gridhrasi is a disease explained by Brihatrayees in the context of Vatavyadhi Adhyaya. The earliest reference about the details of Gridhrasi is available from Sushruta Samhita (1500 BC). Gridhrasi is included in Vatajna Natmaja Vyadhi and also considered as Mahagada by Acharya Charaka. In all Ayurvedic literature, there is no direct reference regarding Nidana, but it is included in Vataja Nanatmaja Vyadhi, general Vata Prakopaka Hetus are to be considered. On the basis of symptoms, Gridhrasi can be correlated with the disease Sciatica in the modern parlance, which occurs because of spinal nerve irritation and characterized by its distinct nature of pain in distribution of sciatic nerve and often it is associated with lumbago. The Gridhrasi is commonly seen in society as a major problem which incapacitates patient to perform his daily routine activities because of severe pain from Katin Pradesha to Padanguli. In modern medicine in reference to sciatica treatment, there is no definitemn curative treatment other than symptomatic management. Objectives of the study was to evaluate the effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi w.s.r. to Sciatica and to compare the effect of Bindu Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi. In present study 40 patients with confirmed clinical diagnosis of Gridhrasi/Sciatica were selected randomly and divided into two groups of each 20 patients. Group A patients were treated with Asthapada Panchaloha Shalaka Agnikarma and Group B patients were treated with Bindu Panchaloha Shalaka Agnikarma. After the treatment it was observed that there was statistically significant results in the main signs and symptoms i.e. pain in lumbar region, numbness, SLR test. The study shows that the treatment is statistically significant in Group A when compared to Group B. Group A overall result is 87.29% and Group B overall result is 84.64%.

Download Full-text

Urinary excretion of transferrin by non-insulin-dependent diabetics: a marker for early complications?

Clinical Chemistry ◽

10.1093/clinchem/35.8.1672 ◽

1989 ◽

Vol 35 (8) ◽

pp. 1672-1674 ◽

Cited By ~ 34

Author(s):

C K Cheung ◽

C S Cockram ◽

V T Yeung ◽

R Swaminathan

Keyword(s):

Arterial Pressure ◽

Urinary Excretion ◽

Healthy Subjects ◽

Healthy Controls ◽

Early Complications ◽

Group A ◽

Insulin Dependent ◽

Group B ◽

Insulin Dependent Diabetic ◽

Sensitive Marker

Abstract We measured concentrations of transferrin (TRF, in micrograms), and creatinine (Cr, in millimoles) in samples of untimed urine from 53 healthy subjects and 157 non-insulin-dependent diabetic (NIDD) subjects. The urinary TRF/Cr ratio was significantly higher in the NIDD group (P less than 0.001). If NIDD subjects are grouped according to their Alb/Cr ratio into normal albuminuria (Group A, Alb/Cr less than 2.5 mg/mmol), microalbuminuria (Group B, Alb/Cr 2.5-26.8 mg/mmol), and macroalbuminuria (Group C, Alb/Cr greater than 26.8 mg/mmol), the TRF/Cr ratios in all three groups exceeded those for healthy controls. Moreover, this ratio was higher in Group B than in Group A and higher in Group C than in Group B. The value for TRF/Cr was clearly abnormal (i.e., exceeded the 95th percentile value found in healthy subjects) in 61%, 95%, and 100% of Group A, B, and C subjects, respectively. The TRF/Cr ratio was significantly higher in those NIDD subjects with clinical retinopathy, and it correlated with arterial pressure. Evidently, TRF/Cr may be increased early in NIDD subjects, and it may be a sensitive marker for detecting development of complications of diabetes.

Download Full-text