LDIflare small fiber function in normal glucose tolerant subjects with and without hypertriglyceridemia

Introduction: We explored determinants of small fiber function (SFF) in normoglycemic individuals to determine influence of metabolic parameters, including triglyceride (TG) levels. Methods: Dorsal foot SFF was assessed by the LDIflare method in 79 individuals without clinical neuropathy, including 43 controls (HC, <1.7 mmol/L), 17 with mild hypertriglyceridemia (MiTG, 1.7–2.25), and 19 with significant hypertriglyceridemia (HiTG, >2.25 mmol/L). Results: LDIflare was significantly smaller in HiTG compared with HC (4.4 ± 1.4 vs. 9.3 ± 2.9 cm²; P < 0.0001) and compared with the MiTG (4.4 ± 1.4 vs. 7.0 ± 2.1; P < 0.0001). Over all, an inverse correlation existed between LDIflare and age (?0.42; P < 0.0001), weight (r = ?0.37; P = 0.004), body mass index (BMI) (?0.51; P < 0.0001), Log₁₀ triglycerides (r = ?0.66; P < 0.0001), total cholesterol (r = ?0.26; P = 0.02), and TC/HDL ratio (r = ?0.40; P = 0.002). In multivariate regression analysis, Log₁₀ triglycerides (P < 0.0001) and age (P = 0.003) were the only independent predictors. Conclusions: There is an inverse correlation between small fiber function and triglycerides in normoglycemic individuals and abnormal SFF in normoglycemic hypertriglyceridemia. Larger prospective studies are required to confirm these findings and to determine whether reduced SFF heralds later clinical neuropathy. Muscle Nerve 52 : 113–119, 2015     

Levodopa‐carbidopa intestinal gel in advanced Parkinson's disease: Final 12‐month,open‐label results

Motor complications in Parkinson's disease (PD) are associated with long‐term oral levodopa treatment and linked to pulsatile dopaminergic stimulation. l ‐dopa‐carbidopa intestinal gel (LCIG) is delivered continuously by percutaneous endoscopic gastrojejunostomy tube (PEG‐J), which reduces l‐ dopa‐plasma–level fluctuations and can translate to reduced motor complications. We present final results of the largest international, prospective, 54‐week, open‐label LCIG study. PD patients with severe motor fluctuations (>3 h/day “off” time) despite optimized therapy received LCIG monotherapy. Additional PD medications were allowed >28 days post‐LCIG initiation. Safety was the primary endpoint measured through adverse events (AEs), device complications, and number of completers. Secondary endpoints included diary‐assessed off time, “on” time with/without troublesome dyskinesia, UPDRS, and health‐related quality‐of‐life (HRQoL) outcomes. Of 354 enrolled patients, 324 (91.5%) received PEG‐J and 272 (76.8%) completed the study. Most AEs were mild/moderate and transient; complication of device insertion (34.9%) was the most common. Twenty‐seven (7.6%) patients withdrew because of AEs. Serious AEs occurred in 105 (32.4%), most commonly complication of device insertion (6.5%). Mean daily off time decreased by 4.4 h/65.6% (P < 0.001). On time without troublesome dyskinesia increased by 4.8 h/62.9% (P < 0.001); on time with troublesome dyskinesia decreased by 0.4 h/22.5% (P = 0.023). Improvements persisted from week 4 through study completion. UPDRS and HRQoL outcomes were also improved throughout. In the advanced PD population, LCIG's safety profile consisted primarily of AEs associated with the device/procedure, l‐ dopa/carbidopa, and advanced PD. LCIG was generally well tolerated and demonstrated clinically significant improvements in motor function, daily activities, and HRQoL sustained over 54 weeks. © 2014 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.     

Proposed Nomenclature for Salt Intake and for Reductions in Dietary Salt

There is considerable confusion about what ranges of dietary salt^a could be considered low, normal, or high and also what ranges of reduction in dietary salt are small or large. The World Hypertension League with other organizations involved in dietary salt reduction have proposed a standardized nomenclature based on normal ancestral levels of salt intake and also on ranges of reduction in salt intake in clinical and population interventions. Low daily salt (sodium) intake where harm due to deficiency would be expected to occur is recommended to remain undefined because of inadequate research but likely <0.25 g (100 mg), normal (physiological) intake <2.5 g (1000 mg), recommended intake <5.0 g (2000 mg), high ≥5.0 g (2000 mg), very high >10 to 15 g (4000–6000 mg), and extremely high >15 g (6000 mg). Reductions in daily salt (sodium) intake are recommended to be called small if <2.5 g (1000 mg), moderate if 2.5 to 5.0 g (1000–2000 mg) and large if >5.0 g (2000 mg). Use of this nomenclature is likely to result in less confusion about salt intake and interventions to reduce dietary sodium.