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      Assessment of the Relationship between Diabetic Retinopathy and Nailfold Capillaries in Type 2 Diabetics with a Noninvasive Method: Nailfold Videocapillaroscopy

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          Abstract

          Background and Objectives. Nailfold capillaroscopy is an easy and noninvasive technique used to investigate dermal microvasculature. Traditional investigations of vascularity do not detect changes until they are well-established in type 2 diabetics. The objective of the current study was to evaluate nailfold capillaries in type 2 diabetes mellitus patients and to determine the association of retinopathy with changes in the nailfold capillaries. Materials and Methods. Capillaroscopic findings by nailfold capillaroscopy and fundoscopic examinations were assessed in 216 patients with type 2 diabetes mellitus and 101 healthy controls included in this prospective study. Results. Retinopathy was detected in 43.05% of diabetic patients ( n = 93). Capillaroscopic findings including tortuosity ( p < 0.001), bushy capillary ( p < 0.001), neoformation ( p < 0.001), bizarre capillary ( p < 0.001), microhemorrhage ( p = 0.001), capillary ectasia ( p = 0.002), and aneurysm ( p = 0.004) were significantly higher in diabetic group than control group. In logistic regression analysis, only tortuosity was shown significant (OR, 2.16; p = 0.036). There was also a significant relation between diabetes duration and most of the capillaroscopic findings. Conclusion. Capillaroscopic changes were found to be correlated with diabetic retinopathy, in particular with longer disease duration in our study. Capillaroscopic imaging could be a useful new technique for assessment of diabetic microvascular changes.

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          Most cited references16

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          Diabetes mellitus and ischemic diseases: molecular mechanisms of vascular repair dysfunction.

          In patients with diabetes mellitus, the ability of ischemic tissue to synchronize the molecular and cellular events leading to restoration of tissue perfusion in response to the atherosclerotic occlusion of a patent artery is markedly impaired. As a consequence, adverse tissue remodeling and the extent of ischemic injury are intensified, leading to increased morbidity and mortality. Growing evidence from preclinical and clinical studies has implicated alterations in hypoxia-inducible factor 1 levels in the abrogation of proangiogenic pathways, including vascular endothelial growth factor A/phosphoinositide 3' kinase/AKT/endothelial nitric oxide synthase and in the activation of antiangiogenic signals characterized by accumulation of advanced glycation end products, reactive oxygen species overproduction, and endoplasmic reticulum stress. In addition, the diabetic milieu shows a switch toward proinflammatory antiregenerative pathways. Finally, the mobilization, subsequent recruitment, and the proangiogenic potential of the different subsets of angiogenesis-promoting bone marrow-derived cells are markedly impaired in the diabetic environment. In this review, we will give an overview of the current understanding on the signaling molecules contributing to the diabetes mellitus-induced impairment of postischemic revascularization mainly in the setting of myocardial infarction or critical limb ischemia.
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            Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated?

            Video nailfold capillaroscopy (NFC), considered as an extension of the widefield technique, allows a more accurate measuring and storing of capillary data and a better defining, analyzing, and quantifying of capillary abnormalities. Capillaroscopic study is often performed on the patients suspected of having microcirculation problems such as Raynaud's phenomenon as the main indication for nailfold capillaroscopy. Capillaroscopic findings based on microcirculation studies can provide useful information in the fields of pathophysiology, differential diagnosis, and monitoring therapy. Nailfold capillaroscopy provides a vital assessment in clinical practices and research; for example, its reputation in the early diagnosis of systemic sclerosis is well established and it is also used as a classification criterion in this regard. This review focuses on the manner of performing video nailfold capillaroscopy and on a common approach for measuring capillary dimensions in fingers and toes.
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              Raynaud's phenomenon and the role of capillaroscopy.

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                Author and article information

                Journal
                J Diabetes Res
                J Diabetes Res
                JDR
                Journal of Diabetes Research
                Hindawi Publishing Corporation
                2314-6745
                2314-6753
                2016
                13 December 2016
                : 2016
                : 7592402
                Affiliations
                1University of Health Sciences Antalya Training and Research Hospital, Department of Internal Medicine, Antalya, Turkey
                2University of Health Sciences Antalya Training and Research Hospital, Department of Rheumatology, Antalya, Turkey
                3University of Health Sciences Antalya Training and Research Hospital, Department of Ophthalmology, Antalya, Turkey
                4University of Health Sciences Antalya Training and Research Hospital, Department of Endocrinology, Antalya, Turkey
                Author notes

                Academic Editor: Xinghai Yao

                Author information
                http://orcid.org/0000-0002-2435-8248
                http://orcid.org/0000-0002-1720-8065
                Article
                10.1155/2016/7592402
                5187472
                28058264
                c0b57e77-73bf-4107-ad6e-a89e823d8b55
                Copyright © 2016 Seyit Uyar et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 August 2016
                : 22 November 2016
                Categories
                Research Article

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