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T he diabetic neuropathies are heterogeneous , affecting different parts of the nervous system that present with diverse clinical manifestations. They may be focal or diffuse. Most common among the neuropathies are chronic sensorimotor distal symmetric polyneu-ropathy (DPN) and the autonomic neuropathies. DPN is a diagnosis of exclusion. The early(More)
Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20(More)
The hyporheic zone is an active ecotone between the surface stream and groundwater. Exchanges of water, nutrients, and organic matter occur in response to variations in discharge and bed topography and porosity. Upwelling subsurface water supplies stream organisms with nutrients while downwelling stream water provides dissolved oxygen and organic matter to(More)
PURPOSE To assess the diagnostic validity of a fully automated image analysis algorithm of in vivo confocal microscopy images in quantifying corneal subbasal nerves to diagnose diabetic neuropathy. METHODS One hundred eighty-six patients with type 1 and type 2 diabetes mellitus (T1/T2DM) and 55 age-matched controls underwent assessment of neuropathy and(More)
PURPOSE Corneal confocal microscopy is a reiterative, rapid, noninvasive in vivo clinical examination technique capable of imaging corneal nerve fibers. Nerve fiber tortuosity may indicate a degenerative and attempted regenerative response of nerve fibers to diabetes. The purpose of this study was to define alterations in the tortuosity of corneal nerve(More)
Process-based ecological river restoration: visualizing three-dimensional connectivity and dynamic vectors to recover lost linkages. ABSTRACT. Human impacts to aquatic ecosystems often involve changes in hydrologic connectivity and flow regime. Drawing upon examples in the literature and from our experience, we developed conceptual models and used simple(More)
OBJECTIVE—To evaluate the efficacy and safety of a-lipoic acid (ALA) over 4 years in mild-to-moderate diabetic distal symmetric sensorimotor polyneuropathy (DSPN). RESEARCH DESIGN AND METHODS—In a multicenter randomized double-blind parallel-group trial, 460 diabetic patients with mild-to-moderate DSPN were randomly assigned to oral treatment with 600 mg(More)
Ecological constraints in subsurface environments relate directly to groundwater flow, hydraulic conductivity, interstitial biogeochemistry, pore size, and hydrological linkages to adjacent aquifers and surface ecosystems. Groundwater ecology has evolved from a science describing the unique subterranean biota to its current form emphasising(More)
Most hypotheses explaining the general gradient of higher diversity toward the equator are implicit or explicit about greater species packing in the tropics. However, global patterns of diversity within guilds, including trophic guilds (i.e., groups of organisms that use similar food resources), are poorly known. We explored global diversity patterns of a(More)
Environmental flow rules are developed to provide a flow regime necessary to maintain healthy river and floodplain ecosystems in rivers regulated for human uses. However, few studies have experimentally assessed potential ecological mechanisms causing declines in the health and productivity of freshwater fish assemblages in regulated rivers to inform the(More)