Salbutamol-induced electrophysiological changes show no correlation with electrophysiological changes during hyperinsulinaemic-hypoglycaemic clamp in young people with Type 1 diabetes.

AIMS: Hypoglycaemia causes QT-interval prolongation and appears pro-arrhythmogenic. Salbutamol, a ß2 -adrenoreceptor agonist also causes QT-interval prolongation. We hypothesized that the magnitude of electrophysiological changes induced by salbutamol and hypoglycaemia might relate to each other and that salbutamol could be used as a non-invasive screening tool for predicting an individual's electrophysiological response to hypoglycaemia. METHODS: Eighteen individuals with Type 1 diabetes were administered 2.5 mg of nebulized salbutamol. Participants then underwent a hyperinsulinaemic-hypoglycaemic clamp (2.5 mmol/l for 1 h). During both experiments, heart rate and serum potassium (and catecholamines during the clamp) were measured and a high-resolution electrocardiogram (ECG) was recorded at pre-set time points. Cardiac repolarization was measured by QT-interval duration adjusted for heart rate (QTc ), T-wave amplitude (Tamp ), T-peak to T-end interval duration (Tp Tend ) and T-wave area symmetry (Tsym ). The maximum changes vs. baseline in both experiments were assessed for their linear dependence. RESULTS: Salbutamol administration caused QTc and Tp Tend prolongation and a decrease in Tamp and Tsym . Hypoglycaemia caused increased plasma catecholamines, hypokalaemia, QTc and Tp Tend prolongation, and a decrease in Tamp and Tsym . No significant correlations were found between maximum changes in QTc [r = 0.15, 95% confidence interval (95% CI) -0.341 to 0.576; P = 0.553), Tp Tend (r = 0.075, 95% CI -0.406 to 0.524; P = 0.767), Tsym (r = 0.355, 95% CI -0.132 to 0.706; P = 0.149) or Tamp (r = 0.148, 95% CI -0.347 to 0.572; P = 0.558) in either experiment. CONCLUSIONS: Both hypoglycaemia and salbutamol caused pro-arrhythmogenic electrophysiological changes in people with Type 1 diabetes but were not related in any given individual. Salbutamol does not appear useful in assessing an individual's electrophysiological response to hypoglycaemia.

Alterations of tibialis anterior muscle activation pattern in subjects with type 2 diabetes and diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) is associated with loss of motor units (MUs), which can cause changes in the activation pattern of muscle fibres. This study investigated the pattern of muscle activation using high-density surface electromyography (HD-sEMG) signals from subjects with type 2 diabetes mellitus (T2DM) and DPN. Thirty-five adults participated in the study: 12 healthy subjects (HV), 12 patients with T2DM without DPN (No-DPN) and 11 patients with T2DM with DPN (DPN). HD-sEMG signals were recorded in the tibialis anterior muscle during an isometric contraction of ankle dorsiflexion at 50% of the maximum voluntary isometric contraction (MVIC) during 30-s. The calculated HD-sEMG signals parameters were the normalised root mean square (RMS), normalised median frequency (MDF), coefficient of variation (CoV) and modified entropy (ME). The RMS increased significantly (p = 0.001) with time only for the DPN group, while the MDF decreased significantly (p < 0.01) with time for the three groups. Moreover, the ME was significantly lower (p = 0.005), and CoV was significantly higher (p = 0.003) for the DPN group than the HV group. Using HD-sEMG, we have demonstrated a reduction in the number of MU recruited by individuals with DPN. This study provides proof of concept for the clinical utility of this technique for identifying neuromuscular impairment caused by DPN.

Cardiac arrhythmias and electrophysiologic responses during spontaneous hyperglycaemia in adults with type 1 diabetes mellitus.

AIM: We examined the effect of spontaneous hyperglycaemia in adults with type 1 diabetes mellitus (T1DM) and without history of cardiovascular disease on heart rate variability (HRV), cardiac repolarisation and incidence of cardiac arrhythmias. METHODS: Thirty-seven individuals with T1DM (age 17-50 years, 19 males, mean duration of diabetes 19.3 SD(9.6) years) underwent 96 h of simultaneous ambulatory 12-lead Holter ECG and blinded continuous interstitial glucose (IG) monitoring (CGM). HRV, QT interval and cardiac repolarisation were assessed during hyperglycaemia (IG ≥ 15 mmol/l) and compared with matched euglycaemia (IG 5-10 mmol/l) on a different day, separately during the day and night. Rates of arrhythmias were assessed by calculating incidence rate differences. RESULTS: Simultaneous ECG and CGM data were recorded for 2395 hours. During daytime hyperglycaemia vs euglycaemia the mean QTc interval duration was 404 SD(21)ms vs 407 SD(20)ms, P = 0.263. T-peak to T-end interval duration corrected for heart rate (TpTendc) shortened: 74.8 SD(16.1)ms vs 79.0 SD(14.8)ms, P = 0.033 and T-wave symmetry increased: 1.62 SD(0.33) vs 1.50 SD(0.39), P = 0.02. During night-time hyperglycaemia vs euglycaemia, the mean QTc interval duration was 401 SD(26)ms vs 404 SD(27)ms, P = 0.13 and TpTend shortened: 62.4 SD(12.0)ms vs 67.1 SD(11.8)ms, P = 0.003. The number of cardiac arrhythmias was low and confined to bradycardia and isolated ectopic beats. A considerable inter-subject and diurnal variability was observed. CONCLUSIONS: Hyperglycaemia in individuals with T1DM without known cardiovascular disease was not associated with clinically important cardiac arrhythmias.

Virtual cycling effort is dependent on power update rate.

Cycling ergometer protocols are commonly integrated with a virtual reality environment (VRE), especially because of its static position that also allows multiple exercise experiments. Concerning VRE scenarios, visually delayed situations like the ones produced at excessive low update rates can also affect the sense of presence and physiological responses. However, the main interface between the subject and a cycling VRE is the power applied over the crank, and there are only a few experiments to evaluate the effect of delayed situations on this particular interface. Thus, this work aims to investigate the effects of the power update rate (PUR) over the subject`s performance on an avatar-based simulator during a drafting task. A custom cycling VRE was built, and 21 male recreational cyclists (175.9 ± 7.5 cm; 76.5 ± 13.9 kg) were tested at six different PUR levels from 100 to 3000 ms. As a result, PUR affects performance scores (virtual distance, efficiency, and heart rate, p < 0.01) at the given VRE conditions. The case-by-case analysis of the groups reveals that higher update rates always lead to a statistical equivalent or superior performance. Nevertheless, no parameter shows any group difference between 500 ms and lower PUR. These results suggest that virtual cycling protocols should consider PUR and other delay-related mechanisms as possible intervening factors over physiological responses and performance scores.

Numerical study of the electrical conductivity and polarization in a suspension of spherical cells.

The spatial distribution of electrical potential and current in a suspension of spherical cells under an applied electric field was numerically obtained using the equivalent circuit method (ECM). The effect of the proximity of the cells was studied in a set of simulations where the volumetric fraction varied from 0.24 to 0.66. The results show that the transmembrane potential for cells in the suspension is lower than the theoretically predicted value for a single dielectric membrane under a uniform electric field. It was also observed that as the volumetric fraction is increased, the transmembrane potential on the pole of the cells decreases linearly. Furthermore, the conductivity of the suspension was also observed to be a function of the volumetric fraction and this result is in a good agreement with the Maxwell's model for spherical particles suspended in a volume conductor.

Methodology for hypoglycaemia detection based on the processing, analysis and classification of the electroencephalogram.

Hypoglycaemia (blood glucose level below 3.8 mmol l(-1)) is the most common complication in the treatment of diabetes with insulin and can cause a number of problems. Previous works have shown that hypoglycaemia causes changes in the electroencephalogram (EEG) signal. In this investigation, portable apparatus was developed to record the EEG, and a methodology was implemented, using digital signal processing and artificial neural networks (ANNs), to detect hypoglycaemia. Sixteen EEG recordings were made on eight subjects with diabetes (five male, three female), aged 35 +/- 13.5 years (mean +/- SD), during the day, over periods of 5.7 +/- 2 min. Ten of these recordings (in seven subjects) included periods of normoglycaemia and spontaneous hypoglycaemia. The result of the off-line ANN classification for each of these ten recordings was an overall accuracy rate of 71.3%, sensitivity of 71.1% and specificity of 71.5%. In the classification using four recordings from a single subject, the accuracy was 80.6%, with a sensitivity of 77.8% and a specificity of 83.9%. In the classification using recordings from five different subjects to train the ANN, the obtained accuracy rate was 49.2%, with a sensitivity of 76% and a specificity of 32.5%. The result of the classification in real time, for one subject, was an accuracy rate of 85.2%, with a sensitivity of 60% and a specificity of 100%. In conclusion, the methodology proposed and implemented justifies further studies with the objective of constructing a hypoglycaemia detector system based on the processing and classification of the EEG.

Influence of the KCl concentration on rat sinus node recovery time in vitro

The influence of changes in the KCl concentration of the bath fluid ([KCl]o) on the corrected sinus node recovery time (CSNRT) was studied using the continuous pacing method (M1) and the method of stimulation with premature pulses (M2). M1 and M2 were compared in Krebs-Henseleit solution containing normal (4.6 mM), low (3.1mM, LoKCl) and hight (6.1 mM, HiKCl) [KCl]o. The results revealed that HiKCl increased CSNRT (P < 0.01) and changed the prematurit-CSNRT relationship (P<0.01), whereas LoKCL did not change CSNRT. M1 and M2 were different (P<0.01) regardless of [KCl]o, except for pacing intervals near the spontaneous cycle length

Influence of stimulatory parameters on simus node recovery time: an in vitro study

The effects of pacing frequency, overdrive duration and stimulus amplitude on the sinus node recovery time (SNRT) were studied in the isolated right atrium of the rat. a positive relationship between pacing frequency and the SNRT was observed, whereas overdrive duration ans stimulus amplitude did not affect SNRT. There was no significant interaction among the factors studied. The effect of frequency upon SNRT probably does not involve neurotransmitter release due to stimulation, since in vitro pretreatment with atropine plus propranolol does change the SNRT - frequency relation

Sistema especialista de auxílio à detecção do câncer de próstata / Expert system aid for the detection of prostate cancer

This paper presents the development of an expert system in urological area to support the detection of prostate cancer...