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Quantities of comorbidities affects physical, but not mental health related quality of life in type 1 diabetes with confirmed polyneuropathy

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World Journal of Diabetes 2019年第2期10卷 87-95页

作者： Anne-Marie L Wegeberg Theresa Meldgaard Sofie Hyldahl Poul Erik Jakobsen Asbjφrn M Drewes Birgitte brock christina brock Mech-Sense Department of Gastroenterology and HepatologyAalborg University Hospital and Clinical InstituteAalborg UniversityAalborg 9000Denmark Steno Diabetes Center North Judland Region NordjyllandAalborg 9000Denmark Steno Diabetes Center Copenhagen Region HovedstadenGentofte 2820Denmark

BACKGROUND A large number of adults with long-term type 1 diabetes are affected by symmetrical peripheral *** complications increase socioeconomic expenses and diminish the individual quality of *** 36-Item Short Form Health Survey(SF-36)is a generic patient reported questionnaire,measuring mental and physical health related quality of *** hypothesized that diabetic neuropathy would decrease physical and mental quality of life measured with SF-36,and that clinical appearance may be associated with the *** To investigate if diabetic neuropathy would decrease physical and mental quality of life measured with SF-36,and if clinical appearance may be associated with the *** Forty-eight adults[age 50±9 years,10 females,disease duration 32(14-51)years]with verified diabetic symmetrical peripheral neuropathy and 21 healthy participants(age 51±6 years,6 females)underwent standardised nerve conduction testing and completed the SF-36 ***,disease duration,number of comorbidities,both diabetes related and nondiabetes related,vibration perception threshold,number of hypoglycaemic events,HbA1c and administration way of insulin was *** In comparison to healthy subjects,patients’mental composite score was not significantly diminished(51.9±8.9 vs 53.1±5.5,P=0.558),while the physical composite score was(46.3±11.7 vs 54.6±3.3,P=0.002).As expected,the overall physical health related symptoms in patients were associated to total number of comorbidities(P<0.0001),comorbidities relation to diabetes(P=0.0002)and HbA1c(P=0.005)as well as comorbidities not related to diabetes(P=0.0006).CONCLUSION The finding of this study emphasises the importance of focusing on quality of life in adults with diabetes and especially in those with multiple comorbidities as well as the possibility of HbA1c as a biomarker for severe complication.

关键词： Quality of life 36-Item Short Form Health Survey(SF-36) Diabetes mellitus,Type 1 Diabetic neuropathies Comorbidity

New technologies to investigate the brain-gut axis

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World Journal of Gastroenterology 2009年第2期15卷 182-191页

作者： Abhishek Sharma Dina Lelic christina brock Peter Paine Qasim Aziz Department of Gastrointestinal Science University of Manchester Manchester M13 9PL United Kingdom Neurogastro-enterology Group Wingate Institute of Neurogastroenterology Barts and the London School of Medicine and Dentistry London E1 2AJ United Kingdom Mech-Sense Department of Gastroenterology Aalborg Hospital Boulevarden 13 DK-9000 Aalborg Denmark

Functional gastrointestinal disorders are commonly encountered in clinical practice, and pain is their commonest presenting symptom. In addition, patients with these disorders often demonstrate a heightened sensitivity to experimental visceral stimulation, termed visceral pain hypersensitivity that is likely to be important in their pathophysiology. Knowledge of how the brain processes sensory information from visceral structures is still in its infancy. However, our understanding has been propelled by technological imaging advances such as functional Magnetic Resonance Imaging, Positron Emission Tomography, Magnetoencephalography, and Electroencephalography （EEG）. Numerous human studies have non-invasively demonstrated the complexity involved in functional pain processing, and highlighted a number of subcortical and cortical regions involved. This review will focus on the neurophysiological pathways （primary afferents, spinal and supraspinal transmission）, brainimaging techniques and the influence of endogenous and psychological processes in healthy controls and patients suffering from functional gastrointestinal disorders. Special attention will be paid to the newer EEG source analysis techniques. Understanding the phenotypic differences that determine an individual＇s response to injurious stimuli could be the key to understanding why some patients develop pain and hyperalgesia in response to inflammation/injury while others do not. For future studies, an integrated approach is required incorporating an individual＇s psychological, autonomic, neuroendocrine, neurophysiological, and genetic profile to define phenotypic traits that may be at greater risk of developing sensitised states in response to gut inflammation or injury.

关键词： Brain-gut axis Central processing Neuraxis Neurophysiology

Sensory testing of the human gastrointestinal tract

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World Journal of Gastroenterology 2009年第2期15卷 151-159页

作者： christina brock Lars Arendt-Nielsen Oliver Wilder-Smith Asbjφrn Mohr Drewes Mech-Sense Department of Gastroenterology Aalborg Hospital DK-9000 Aalborg Denmark Center for Sensory-Motor Interactions Department of Health Science and Technology Aalborg University DK-9000 Aalborg Denmark Pain and Nociception Research Group Department of Anaesthesiology Radboud University Nijmegen Medical Centrethe Netherlands Mech-Sense Department of Gastro-enterology Aalborg Hospital DK-9000 Aalborg Denmark Author

The objective of this appraisal is to shed light on the various approaches to screen sensory information in the human gut. Understanding and characterization of sensory symptoms in gastrointestinal disorders is poor. Experimental methods allowing the investigator to control stimulus intensity and modality, as well as using validated methods for assessing sensory response have contributed to the understanding of pain mechanisms. Mechanical stimulation based on impedance planimetry allows direct recordings of luminal cross-sectional areas, and combined with ultrasound and magnetic resonance imaging, the contribution of different gut layers can be estimated. Electrical stimulation depolarizes free nerve endings non-selectively. Consequently, the stimulation paradigm （single, train, tetanic） influences the involved sensory nerves. Visual controlled electrical stimulation combines the probes with an endoscopic approach, which allows the investigator to inspect and obtain small biopsies from the stimulation site. Thermal stimulation （cold or warm） activates selectively mucosal receptors, and chemical substances such as acid and capsaicin （either alone or in combination） are used to evoke pain and sensitization. The possibility of multimodal （e.g. mechanical, electrical, thermal and chemical） stimulation in different gut segments has developed visceral pain research. The major advantage is involvement of distinctive receptors, various sensory nerves and different pain pathways mimicking clinical pain that favors investigation of central pain mechanisms involved in allodynia, hyperalgesia and referred pain. As impairment of descending control mechanisms partly underlies the pathogenesis in chronic pain, a cold pressor test that indirectly stimulates such control mechanisms can be added. Hence, the methods undoubtedly represent a major step forward in the future characterization and treatment of patients with various diseases of the gut, which provides knowledge to dinicians

关键词： Endoscopy Intestine Experimental Neurophysiology Pain

Assessment of the cardiovascular and gastrointestinal autonomic complications of diabetes

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World Journal of Diabetes 2016年第16期7卷 321-332页

作者： christina brock Birgitte brock Anne Grave Pedersen Asbjorn Mohr Drewes Niels Jessen Adam D Farmer Mech-Sense Department of Gastroenterology and Hepatology Aalborg University Hospital DK-9000 AalborgDenmark Department of Pharmacotherapy and Development University of Copenhagen DK-2450 CopenhagenDenmark Clinical Biochemistry Aarhus University DK-3780 Aarhus Denmark Department of Clinical Medicine Aarhus UniversityDK-3780 Aarhus Denmark Department of Gastroenterology University Hospitals of North Midlands Staffordshire WS73 JQ United Kingdom Centre for Digestive Diseases Wingate Institute of Neurogastroenterology Blizard Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London London EN1 1NX United Kingdom 不详

The global prevalence of diabetes mellitus is increasing; arguably as a consequence of changes in diet, lifestyle and the trend towards urbanization. Unsurprisingly, the incidence of both micro and macrovascular complications of diabetes mirrors this increasing prevalence. Amongst the complications with the highest symptom burden, yet frequently under-diagnosed and sub-optimally treated, is diabetic autonomic neuropathy, itself potentially resulting in cardiovascular autonomic neuropathy and gastrointestinal(GI) tract dysmotility. The aims of this review are fourfold. Firstly to provide an overview of the pathophysiological processes that cause diabetic autonomic neuropathy. Secondly, to discuss both the established and emerging cardiometric methods for evaluating autonomic nervous system function in vivo. Thirdly, to examine the tools for assessing pan-GI and segmental motility and finally, we will provide the reader with a summary of putative non-invasive biomarkers that provide a pathophysiological link between lowgrade neuro inflammation and diabetes, which may allow earlier diagnosis and intervention, which in future may improve patient outcomes.

关键词： Autonomic nervous system Gastrointestinal dysmotility Neuroinflammation Biomarkers Diabetic neuropathy

Electrophysiology as a tool to unravel the origin of pancreatic pain

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World Journal of Gastrointestinal Pathophysiology 2014年第1期5卷 33-39页

作者： Dina Lelic Sφren Schou Olesen Carina Graversen christina brock Massimiliano Valeriani Asbjφrn Mohr Drewes Mech-Sense Department of Gastroenterology of HepatologyM?lleparkvej 4Aalborg University Hospital Division of Neurology Ospedale Pediatrico Bambino GesùIRCCS Department of Health Science and Technology Center for Sensory-Motor InteractionsAalborg University

Intense abdominal pain is the most common symptom in chronic pancreatitis, but the underlying mechanisms are not completely understood and pain management remains a significant clinical *** focus of pain origin in chronic pancreatitis traditionally has been on the pancreatic gland, assuming pain to originate in the pancreas or its surrounding organs. However, research in the last decade points to abnormal central nervous system pain *** this reason, electroencephalography has been receiving increasing attention. In contrast to imaging methods such as functional magnetic resonance and positron emission tomography, electroencephalogram has excellent temporal resolution making it possible to investigate central processing of pain on a millisecond time scale. Moreover, continuously advancing methodology made it possible to explore brain sources responsible for generation of evoked potentialsand hence to study brain reorganization due to pain in chronic pancreatitis. The aim of this review is to give an overview of the current methods and findings in electroencephalography as a tool to unravel the origin of pancreatic pain.

关键词： Chronic pancreatitis Electrophysiology Evoked potentials Brain source localization Electroencephalography frequency analysis Visceral pain Chronic pain Pancreatic pain

Brain changes in diabetes mellitus patients withgastrointestinal symptoms

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World Journal of Diabetes 2016年第2期7卷 14-26页

作者： Anne M Drewes Eirik Søfteland Georg Dimcevski Adam D Farmer christina brock Jens B Frøkjær Klaus Krogh Asbjørn M Drewes Department of Medicine Haukeland University Hospital5021 BergenNorway Centre for Digestive Diseases Blizard Institute of Cell and Molecular ScienceWingate Institute of NeurogastroenterologyBarts and the London School of Medicine and DentistryQueen Mary University of LondonLondon E1 2AJUnited Kingdom Department of Gastroenterology University Hospitals of North MidlandsStoke on TrentStraffordshire ST4 6QGUnited Kingdom Mech-Sense Department of Gastroenterology and Hepatology and Clinical InstituteAalborg University Hospital9100 AalborgDenmark Department of Radiology Aalborg University Hospital9100 AalborgDenmark Neurogastroenterology Unit Department of Hepatology and GastroenterologyAarhus University Hospital8000 AarhusDenmark

Diabetes mellitus is a common disease and its prevalence is increasing worldwide. In various studies up to 30%-70% of patients present dysfunction and complications related to the gut. To date several clinical studies have demonstrated that autonomic nervous system neuropathy and generalized neuropathy of the central nervous system(CNS) may play a major role. This systematic review provides an overview of the neurodegenerative changes that occur as a consequence of diabetes with a focus on the CNS changes and gastrointestinal(GI) dysfunction. Animal models where diabetes was induced experimentally support that the disease induces changes in CNS. Recent investigations with electroencephalography and functional brain imaging in patients with diabetes confirm these structural and functional brain changes. Encephalographic studies demonstrated that altered insular processing of sensory stimuli seems to be a key player in symptom generation. In fact one study indicated that the more GI symptoms the patients experienced, the deeper the insular electrical source was located. The electroencephalography was often used in combination with quantitative sensory testingmainly showing hyposensitivity to stimulation of GI organs. Imaging studies on patients with diabetes and GI symptoms mainly showed microstructural changes,especially in brain areas involved in visceral sensory processing. As the electrophysiological and imaging changes were associated with GI and autonomic symptoms they may represent a future therapeutic target for treating diabetics either pharmacologically or with neuromodulation.

关键词： Diabetes mellitus Gastrointestinal Electroencephalogram Magnetic resonance imaging Brain