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The main purpose of this study is to examine the differences of preventive management utilizations and diabetes complications in Asian Americans and Non-Hispanic whites using multiple years (2002-2013) Behavioral Risk Factor Surveillance System (BRFSS). SAS for complex survey procedures were used to perform the data analysis. Odds ratios (OR) were calculated to compare the prevalence of diabetes complications and preventive management rate in Asian with white. Compared to white, the prevalence of diabetes retinopathy in Asians were higher, while the rates of neuropathy and cardiovascular complications, pneumonia shot, personally management as well as management diabetes with doctors were lower. The prevalence of routine checkup in Asian was not significantly different from the prevalence in white. More attentions should be paid on Asians for diabetes related retinopathy.

Approved for public release; distribution is unlimited / The connection between eye disease and diabetes is proven and is no longer a point of conjecture. In focusing attention on the retina, profound inroads have been made in the fight against this dreaded disorder of the blood. By carefully imaging the blood vessels in the eye, medical professionals can make accurate diagnoses based upon the changes and abnormalities observed. In addition, because the vasculature in the retina is extremely sensitive to fluctuations in normal bodily processes, often the first indication of diabetes and many other diseases manifest themselves here and are found during routine eye examinations. This thesis will explore the possibilities of a new method of retinal imaging by the blending and application of existing technologies. With the use of an automated, infrared-based imaging system, problems related to human error and the limitations of existing methods can be readily resolved and the groundwork can be laid for a new standard of accuracy in retinal imaging. Most importantly, it will automate the entire procedure providing medical specialists heretofore unavailable accuracy in their diagnoses. / http://archive.org/details/functionalspecif00domb / Lieutenant, United States Navy

This thesis reports an investigation from the “bedside” back to the “bench”. That is, from the economic evaluation of a medical intervention to basic research and development of a contractility assay. The underlying theme of this thesis is cellular contractility, which was stimulated from our laboratory’s work in the microvascular complications of Diabetic Retinopathy (DR). The health economic perspective of this thesis evaluates the cost effectiveness and cost utility of DR prognosis using the prog-DR test. This novel prognostic test developed in our laboratory relies on the contractile response of blood vessels to detect subjects with high risk of developing DR. Markov modeling based on information in the literature was used to estimate the outcomes of a hypothetical population. The costs, health and utility outcomes of DR were compared to the potential outcomes if the prog-DR test was used. The model show that the prog-DR test can improve the health of the hypothetical population as measured in the number of life years (LY), sight years (SY) and quality-adjusted life years (QALY). The prog-DR test was more cost effective than the benchmark of annual or bi-annual screening and the incremental cost effectiveness ratio (ICER) appears to be at an acceptable level. Scenario and sensitivity analysis also show that the cost effectiveness of the prog-DR test can be improved by (i) better blood glucose management post prog-DR test, (ii) targeted screening (as opposed to population-wide screening) and (iii) reduced costs of both screening and management of DM and DR. The physiological perspective of the thesis aimed to develop a contractility assay for DR that was based on a 3D scaffold, which was affordable, easy to make and mimicked the three dimensional physiological environment of blood vessels. The contractility assay was developed using a 3D, hollow scaffold (PE-PAH capsule) and involved (i) the selection of the optimal core material, (ii) optimisation of the manufacturing process, (iii) characterisation of the scaffold and (iv) ensuring that cells can be grown on it. The cyto-biocompatibility of the candidate polyelectrolyte Poly(Sodium 4-Styrene Sulfonate) (PSS) and Poly(Allylamine Hydrochloride) (PAH) in the thin films format were investigated using three different cell lines and the effects of these thin films were also compared to titanium and titanium nitride thin films. In essence, PSS and PAH are not cytotoxic and was used to develop the contractile scaffold, PE-PAH capsule. This scaffold is relative elastic and the contractile force exerted by the 3T3-L1 cells was calculated based on the deformation of the PE-PAH capsule. The contractility assay was sufficiently sensitive to detect the nano-Newton magnitude of force developed by individual cells and discriminated the change in force due to disruption of the F-actin cytoskeleton by forskolin and cytochalasin D.

Thesis (M.A.S.), Memorial University of Newfoundland, 2000. / Bibliography: leaves 70-71.

Diabetic retinopathy (DR) was characterized by numerous hyperglycemia-dependent cellular and pathological changes in the retina, including retinal ischemia/reperfusion (I/R) injury. To determine the role of the 2nd enzyme of polyol pathway in relation with the pathogenesis in ischemic retinopathy, SDH deficient mice, C57BL/LiA, that lacked SDH activity, was used to study the pathogenesis of diabetic retinopathy, which also included I/R injury. Wild type and SDH-deficient mice were subjected to I/R injury by transiently occluding middle cerebral artery for two hours and twenty-two hour of reperfusion. The rationale of this study was to investigate the effect by blocking the conversion of sorbitol to fructose by SDH null mutation (SDH -/-), leading to accumulation of sorbitol level and reduction of oxidative stress, as demonstrated by the polyol pathway. Results: After induction with transient MCAO, there was increase in the thickness of OLM to ILM ipsilateral SDH+/+ compared with contralateral SDH+/+ (from 84 +/- 1 to 96 +/- 2 μm) while that of ipsilateral SDH-/- compared with contralateral SDH -/- (from 77 +/- 2 to 90 +/- 2 μm) suggested that there was edema after ischemic reperfusion injury. The result showed that there was increased cellular edema in ipsilateral retina of both SDH +/+ and SDH -/- retina after transient MCAO. The level of immunoreactivity against Aquaporin-4 and nitrotyrosine in studying the presence of oxidative stress; glutamine synthetase and glutamate in studying the toxicity of astrocyte glutamate; sarco-endoplasmic reticulum Ca2+-ATPase (SERCA) in studying the regulation Ca2+ homeostasis was determined using immunohistochemistry. For all the antibodies, there was similar immunoreactivity level between the contralateral side of both SDH+/+ and SDH -/- mice. For the SDH+/+ group, there was increase in signal in the ipsilateral retina in comparison with the contralateral one. On the other hand, for the SDH-/- group, similar result was observed. There was increase in signal and it was found more in the ipsilateral retina in comparison with the contralateral retina. Finally, in the ipsilateral retina of both SDH +/+ and SDH -/- mice, increased immunoreactivity was found in both but their difference was not statistically significant. This concluded that SDH deletion and subsequent accumulation of sorbitol metabolites did not contribute significantly in the role of pathogenesis of ischemic retinopathy especially in mice after I/R injury. / published_or_final_version / Anatomy / Master / Master of Medical Sciences

While carotenoids are essential for visual function, their potential role in diabetic retinopathy is not known. By providing carrot powder, this study examined carotenoid metabolism and visual function in Type 1 diabetes. Wistar rats (n=30) were assigned to diet either with or without carrot enrichment (15%, w/w) for 12 weeks. Type 1 diabetes was induced with streptozotocin at 3 weeks. Retinal function and anatomical integrity were assessed along with retinoid and carotenoid levels in the serum, liver, and retina. Loss of ERG oscillatory potentials, with normal histology indicated early stage retinopathy. Healthy animals fed carrot diet showed highest b-wave amplitudes; reflecting higher phototransduction. Diabetic animals fed carrot diet had the lowest b-wave amplitudes, reduced retinoids liver reserves, and highest α- and β-carotene, suggesting disturbance of conversion during diabetes. Consequently carrot powder at concentrations used by this study cannot be recommended for diabetic retinopathy.

Preterm birth may lead to complications during the neonatal period that can cause visual dysfunctions. Retinopathy of prematurity (ROP) and neurological complications are well known reasons for visual dysfunctions, but preterm children with no or only mild ROP and no evident neurological problems may also be affected visually when they grow up. Retinal development starts early after gestation and continues long after birth. Major processes are underway during the second half of pregnancy when preterm children are born, and a preterm birth could possibly have a negative effect on normal retinal development. The aims of the studies were to evaluate retinal morphology and function in former preterm children and compare the results with children born at term. Former preterm children aged 5 to 17 years and born in a gestational age (GA) of 32 weeks or less were included in the different study groups. Children of similar ages who were born at term and with normal visual acuity (VA) acted as controls. Best corrected VA and refraction in cycloplegia were assessed in all children. Macular thickness and retinal nerve fiber layer (RNFL) thickness were measured with optical coherent tomography (OCT). Total retinal function was assessed with fullfield electroretinography (ffERG) and central macular function was assessed with multifocal electroretinography (mfERG). Preterm children had thicker central maculae than controls. There was a positive correlation between central macular thickness and GA at birth. RNFL thickness was reduced in the preterm children with severe ROP and treated ROP, but children with mild or no ROP did not differ from the fullterm children. The photoreceptor function measured with ffERG and the macular function measured with mfERG were reduced in the preterm group compared to controls. Preterm birth affects the retina both morphologically and functionally, and ROP has been suggested to be a reason for retinal changes. However, the results of this thesis indicate that children with no ROP also have retinal changes, suggesting an effect of prematurity itself. There were no correlations between any retinal changes and VA, but it is possible that larger studies using improved techniques may elucidate this further.

While carotenoids are essential for visual function, their potential role in diabetic retinopathy is not known. By providing carrot powder, this study examined carotenoid metabolism and visual function in Type 1 diabetes. Wistar rats (n=30) were assigned to diet either with or without carrot enrichment (15%, w/w) for 12 weeks. Type 1 diabetes was induced with streptozotocin at 3 weeks. Retinal function and anatomical integrity were assessed along with retinoid and carotenoid levels in the serum, liver, and retina. Loss of ERG oscillatory potentials, with normal histology indicated early stage retinopathy. Healthy animals fed carrot diet showed highest b-wave amplitudes; reflecting higher phototransduction. Diabetic animals fed carrot diet had the lowest b-wave amplitudes, reduced retinoids liver reserves, and highest α- and β-carotene, suggesting disturbance of conversion during diabetes. Consequently carrot powder at concentrations used by this study cannot be recommended for diabetic retinopathy.

Thesis (Ph. D.)--University of Hong Kong, 2008. / Also available in print.