320-OR: Axonal Swellings in Diabetic Patients With and Without Neuropathy
Bibliographic record
Abstract
Background: Up to 50% of patients with diabetes develop peripheral neuropathy (DPN). DPN is associated with low intraepidermal nerve fiber density (IENFD), and morphometric degenerative changes such as axonal swellings are also observed. The relationship of swellings to DPN status has not yet been delineated. Methods: In total 207 patients with type 2 diabetes and 24 age- and gender-matched healthy controls were included in the study. Included in the analysis were participants whose IENFD was >0.5 fiber/mm, thus allowing swelling ratio calculation (n=156). The patients underwent a rigorous DPN assessment, including a neurological examination, nerve conduction studies, skin biopsy and quantitative sensory testing. Patients were divided into three groups: without DPN (n=35), with painless DPN (n=72), and with painful DPN (n=100). Axonal swellings were defined as enlargements on nerve fibers exceeding 1.5 μm in diameter. Swelling ratio was obtained by dividing the number of swellings with IENFD. Results: Median (IQR) IENFD was significantly different between the groups: without DPN: 6.15 (4.9;8.08) fibers/mm; painless DPN: 1.65 (1.07;2.73); painful DPN: 1.4 (0.80;2.12); controls: 5.8 (4.95;8.0), P<0.01. Median swelling ratios were also significantly different between groups: without DPN: 0.34 (0.16;0.55); painless DPN: 0.14 (0;0.55); painful DPN: 0 (0;0.31); and controls: 0 (0;0.6), p<0.01. This difference disappeared when only including patients with somewhat preserved IENFD (IENFD >2) (P=0.4). Patients with diabetes and IENFD >2 had higher swelling ratio compared with healthy controls, regardless of neuropathy status (P<0.01). Swelling ratio did not correlate with BMI, diabetes duration, pain or Toronto Clinical Neuropathy score (P>0.1), but did correlate negatively with HbA1c levels when only including all patients with IENFD >0.5 (P=0.04). Conclusions: Axonal swellings are present in most diabetic patients with preserved IENFD and may indicate morphological changes of nerve fibers. Disclosure P. Karlsson: Advisory Panel; Self; Grünenthal. S. Gylfadottir: None. S. Tesfaye: Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation, WÖRWAG Pharma. Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc., NAPP Pharmaceuticals Limited, Neurometrix, Novo Nordisk Inc., Pfizer Inc. Other Relationship; Self; Impeto Medical. A.S. Rice: Research Support; Self; Orion. Other Relationship; Self; Imperial College Consultants, Spinifex/Novartis. J.R. Nyengaard: None. T.S. Jensen: None. D. Bennett: Consultant; Self; Lilly Diabetes, Orion, Theranexus. A. Themistocleous: None. Funding Novo Nordisk Foundation (NNF14OC0011633); Danish Diabetes Academy (to P.K.)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".