Objective quantification of arm rigidity in MPTP-treated primates

Rigidity is a cardinal symptom of Parkinson's disease and is frequently used as an outcome measure in clinical and non-human primate studies examining the effects of medication or surgical intervention. A limitation of current rigidity assessment methods is that they are inherently subjective. To better understand the physiological mechanisms of rigidity and how various therapeutic approaches work, a more objective and quantitative method is needed. In this study, an automated arm rigidity testing (ART) system was developed to objectively quantify rigidity while the primate's limb was moved between two user-specified angles. Recordings of normal force versus elbow-angle were categorized according to area and slope. These quantitative measures of rigidity were investigated in three rhesus macaque monkeys treated with 1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine and compared with clinical assessment methods. The ART system incorporates electromyographical recordings that can detect and differentiate active from actual resistance. The ART system detected significant changes in rigidity measures following administration of apomorphine or deep brain stimulation of the globus pallidus internus. The most sensitive measures were total area, extension slope, and flexion slope. The ART system provides precise and reliable measures of rigidity that are objective and quantitative.     

Combined Insulin Pump Therapy with Real-Time Continuous Glucose Monitoring Significantly Improves Glycemic Control Compared to Multiple Daily Injection Therapy in Pump Na?ve Patients with Type 1 Diabetes; Single Center Pilot Study Experience

Objectives

This study assessed the safety and clinical effectiveness of the training protocol for initiating insulin pump therapy with real-time continuous glucose monitoring (MiniMed Paradigm REAL-Time System) in a stepwise approach on pump naive subjects with type 1 diabetes compared to a control group who remained on multiple daily injection (MDI) therapy.

Methods

This was a 15-week treat-to-target pilot study of 16 adult subjects (n = 50% male, age 45.9 ± 16 years) with type 1 diabetes (duration of diabetes 21.9 ± 11 years) on MDI therapy with hemoglobin A1c levels at or above 7.5% at baseline. Subjects were randomized to either the study arm (using a combined insulin pump and real-time continuous glucose monitoring system) or the control arm [which continued on MDI therapy with self-monitored blood glucose (SMBG) only]. All subjects dosed insulin according to results of SMBG by finger stick and uploaded data into the CareLink data management software.

Results

Significant improvements in glycemic control were observed from baseline in both study groups—study arm: pre-A1c 9.45 ± 0.55 and post-A1c 7.4 ± 0.66 (p = 0.00037); control arm: pre-A1c 8.58 ± 1.30 and post-A1c 7.5 ±1.01 (p = 0.04). Both arms had no incidence of severe hypoglycemia.

Conclusion

In this pilot study, the Paradigm REAL-Time System was initiated safely and effectively in type 1 diabetes patients who were pump naïve using a stepwise educational protocol.     

Insulin sensitivity: modulation by nutrients and inflammation

Insulin resistance is a major metabolic feature of obesity and is a key factor in the etiology of a number of diseases, including type 2 diabetes. In this review, we discuss potential mechanisms by which brief nutrient excess and obesity lead to insulin resistance and propose that these mechanisms of action are different but interrelated. We discuss how pathways that "sense" nutrients within skeletal muscle are readily able to regulate insulin action. We then discuss how obesity leads to insulin resistance via a complex interplay among systemic fatty acid excess, microhypoxia in adipose tissue, ER stress, and inflammation. In particular, we focus on the hypothesis that the macrophage is an important cell type in the propagation of inflammation and induction of insulin resistance in obesity. Overall, we provide our integrative perspective regarding how nutrients and obesity interact to regulate insulin sensitivity.