Medical Specialties Commons^™

Use Of Social Adaptability Index To Explain Self-Care And Diabetes Outcomes, Jennifer A. Campbell, Rebekah J. Walker, Brittany L. Smalls, Leonard E. Egede

Center for Health Services Research Faculty Publications

Background: To examine whether the social adaptability index (SAI) alone or components of the index provide a better explanatory model for self-care and diabetes outcomes.

Methods: Six hundred fifteen patients were recruited from two primary care settings. A series of multiple linear regression models were run to assess (1) associations between the SAI and diabetes self-care/outcomes, and (2) associations between individual SAI indicator variables and diabetes self-care/outcomes. Separate models were run for each self-care behavior and outcome. Two models were run for each dependent variable to compare associations with the SAI and components of the index.

Results: The SAI has …

Pineal Gland Agenesis: Review And Case Illustration., Marcus A Cox, Michele Davis, Vlad Voin, Mohammadali Shoja, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Agenesis of the pineal gland has rarely been reported in the medical literature. Herein, we report a cadaveric specimen found to have agenesis of the pineal gland. The remaining gross examination of the brain was normal. A review of the literature was performed on this unusual finding.

Patterns, Control And Complications Of Diabetes From A Hospital Based Registry Established In A Low Income Country., J. Akhter, Asma Ahmed, Minaz Mawani, Laila Lakhani, Ayaz Kalsekar, Shehla Tabassum, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Diabetes registry enables practitioners to measure the characteristics and patterns of diabetes across their patient population. They also provide insight into practice patterns which can be very effective in improving care and preventing complications. The aim of this study was to assess the patterns, control levels and complications at the baseline of the patients attending clinic at the large tertiary care hospital in Karachi, Pakistan with the help of the registry. This can be used as a reference to monitor the control and also for a comparison between peer groups. Methods: This was a cross sectional study with the …

A Case Of Severe Insulin Resistance In A Diabetic Patient Being Treated For Acute Promyelocytic Leukemia With Arsenic And Glucocorticoids, Eric Shiffrin, Md, Intekhab Ahmed, Md, Serge Jabbour, Md, Facp, Face, Kevin Furlong, Do

Division of Endocrinology, Diabetes and Metabolic Diseases Posters

Objective:

To present a case of severe insulin resistance in a patient with a new diagnosis of acute promyelocytic leukemia (APML) treated with all-trans retinoic acid (ATRA), arsenic, and high-dose glucocorticoids.

Poster presented at Thomas Jefferson University House Staff Quality and Safety conference.

Microalbuminuria In Type-2 Diabetes Mellitus; The Tip Of Iceberg Of Diabetic Complications., Tauseef Ahmad, Imran Ulhaq, Minaz Mawani, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: To determine the prevalence of microalbuminuria and its association with hypertension and other diabetic complications among Type-2 diabetic patients attending at Aga Khan University Hospital Karachi.

Methods: 1280 Type-2 diabetes patients who visited the outpatient department of Aga Khan University Hospital from September 2014 to August 2016 were included in the study. Microalbuminuria was diagnosed if spot urinary microalbumin excretion was confirmed to be more than 20mg/l. Hypertension was diagnosed if BP >140/90 or already on antihypertensive medications. Other demographic, clinical and laboratory data were also recorded. Results: Microalbuminuria was diagnosed in 404(31.56%) patients and among these albuminuric patients …

Vitamin-D Toxicity And Other Non-Malignant Causes Of Hypercalcemia: A Retrospective Study At A Tertiary Care Hospital In Pakistan, Muhammad Naeem Khan, Qamar Masood, Mohammad Arsalan Siddiqui, Sabahat Naz, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Hypercalcemia is a common clinical problem; primary hyperparathyroidism and malignancy is commonest causes of hypercalcemia. Aetiology of hypercalcemia are changing, causes that were diseases of the past like Vitamin-D toxicity and milk alkali syndrome are observed more often. Vitamin-D deficiency is an important problem and overzealous replacement of Vitamin-D has been observed, suspected to cause toxicity.

Methods: This was a retrospective review of patients admitted at the Aga Khan University Hospital from January 2008 to December 2013 with hypercalcemia. We reviewed the electronic health records for laboratory and radiological studies, and discharge summaries to establish the cause of hypercalcemia. …

Effects Of Kdt501 On Metabolic Parameters In Insulin-Resistant Prediabetic Humans, Philip A. Kern, Brian S. Finlin, Dorothy Ross, Tania Boyechko, Beibei Zhu, Neile Grayson, Robert Sims, Jeffrey S. Bland

Internal Medicine Faculty Publications

Context: KDT501 is an isohumulone drug that has demonstrated beneficial effects on metabolic parameters in mice.

Objective: This study was intended to examine potential improvements in metabolism in humans.

Design and Setting: Changes in carbohydrate and lipid metabolism, along with inflammatory markers, were evaluated in prediabetic humans in a clinical research center.

Participants: Nine obese patients participated. All had prediabetes or normal glucose tolerance plus three features of metabolic syndrome.

Intervention: All participants were treated with escalating doses of KDT501 to a maximum dose of 1000 mg every 12 hours for a total of 28 days.

Outcome Measures: Changes in …

Idiopathic Hypogonadotropic Hypogonadism Reversal After Testosterone Replacement In A 34-Year-Old Male, Owais Rashid, Nanik Ram, Saad Farooq, Zareen Kiran,

Section of Diabetes, Endocrinology and Metabolism

A 34-year-old male presented to the endocrinology clinic with the complaint of the absence of facial, axillary and pubic hairs. Further history revealed absent ejaculations and decreased early morning erections. The patient had no history of headaches, visual problems or anosmia. On physical examination, there were sparse facial, axillary and pubic hairs, bilateral gynaecomastia, stretch penile length of 5 cm and bilateral testicular volume of 10 mL. Laboratory investigations showed low luteinising hormone, follicular stimulating hormone and testosterone with normal prolactin and thyroid profile. MRI of the pituitary gland showed no evidence of pituitary microadenoma or macroadenoma. The patient was …

Exploring Autonomy Support In Shared Decision Making And Patient Activation Of Diabetes Self-Care Behaviors, Carol Mahler Hamersky

Seton Hall University Dissertations and Theses (ETDs)

Introduction:

Chronic disease places a different set of demands on an individual and family. Self-care behaviors and daily decision making is an integral part of diabetes management. According to the CDC (2014), the prevalence of Diabetes is estimated at 29.1 million and an alarming 86 million Americans have Pre-diabetes. Despite a plethora of evidence on the importance of diabetes self-care behaviors on clinical outcomes, studies have highlighted the current disconnect of patients not able to follow self-care behavior recommendations and not asking for help from their health care providers. There is no literature on the impact of an autonomy supported …

Effect Of Postprandial Walking On The Glycemic Effect Of A Meal: Type I Diabetes, Samantha L. Hinojosa

Theses & Dissertations

This study was conducted to determine if 15 minutes of postprandial light walking has an effect on the glycemic response to a Boost® beverage in individuals with type 1 diabetes. Seven participants, 22.3 + 4.3 yrs, with type 1 diabetes completed the two days of data collection. On day 1, participants measured baseline fasting blood glucose (BG) with a glucometer, consumed a Boost® beverage, and sat quietly, repeating BG measurements 15, 30, 60, 90, and 120 minute. On day 2, participants repeated the protocol, but walked 15 minutes at a light pace (50-60% max HR) immediately after beverage consumption. The …

Rising Thyroid Cancer Incidence In Southern India: An Epidemic Of Overdiagnosis?, Indu Elizabeth Mathew, Aju Mathew

Internal Medicine Faculty Publications

Background: Thyroid cancer incidence is rising in high-income countries. This increase in disease burden is attributed to the phenomenon of overdiagnosis.

Objective: We aimed to investigate trends in thyroid cancer rates in India, focusing on the state of Kerala in southern India, which has reported a high incidence of the disease.

Design: Population-based study using data from the National Cancer Registry Program.

Participants: We used data from the Population Based Cancer Registries for Thiruvananthapuram (capital of Kerala state), Delhi, Mumbai, Bangalore, and Chennai. We used data for three reporting periods from 2005 to 2014 (represented as 2006, 2009, and 2012). …

The Interactive Effect Of Diabetes Family Conflict And Depression On Insulin Bolusing Behaviors For Youth., Genevieve Maliszewski, Susana R. Patton, L Kurt Midyett, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Adherence to type 1 diabetes management declines as children enter adolescence. For youth, psychosocial variables including mood and interpersonal relationships play a large role in diabetes maintenance. The current study assessed the unique and interactive roles diabetes family conflict and depression have on insulin bolusing behaviors for youth ages 10-16 years.

METHODS: Ninety-one youth-parent dyads completed a survey assessing family conflict and depression. Mean daily blood glucose levels, mealtime insulin bolus scores ( BOLUS), and glycated hemoglobin (HbA1c) were collected from the medical record as outcome variables.

RESULTS: Parent-reported diabetes-related family conflict and youths' endorsed depression both significantly predicted …

A Mixed-Methods Study: Self-Efficacy And Barriers To Participation In Workplace Wellness Programs, Massiel Perez-Calhoon

Dissertations

America needs a healthy workforce to sustain the country. The scourge of obesity continues to plague Americans despite government initiatives such as the Affordable Care Act and wellness programs in the workplace to combat this epidemic. However, despite initiatives to make America healthy, barriers continued to impede the nation’s health. Lack of awareness and sensitivity to what motivates individual participants versus group participants built formidable barriers to accessing all workplace employees equitably. The purpose of this study was twofold. First, the intent of this study was to explore the relationship between self-efficacy and the impact on participation and engagement when …

The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey

Scholarly and Creative Works Conference (2015 - 2021)

Type 1 Diabetes Mellitus accounts for approximately 5% of the diabetic population (CDC, 2015). Numerous complications must be avoided when a diabetic is insulin dependent. Women who are diabetic who are planning to conceive a family have special considerations. Little research has been focused into how to best manage Type 1 diabetics during pregnancy. Since Type 1 diabetes is predominantly diagnosed between birth and 30 years of age, many Type 1 diabetics have potential to become pregnant without knowing how to best manage their diabetes. Poor glycemic control in diabetics has been related to miscarriages, stillbirths, malformations, and macrosomia (Lapolla, …

Primary Adrenal Non-Hodgkin Lymphoma: A Case Report And Review Of The Literature, Nanik Ram, Owais Rashid, Saad Farooq, Imran Ulhaq, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Lymphomas are cancers that arise from the white blood cells and have been traditionally divided into two large subtypes: Hodgkin and non-Hodgkin lymphoma. B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma; almost 85% of patients with lymphoma have this variant. Lymphomas can potentially arise from any lymphoid tissue located in the body; however, primary adrenal non-Hodgkin lymphoma is extremely rare. We report the history, examination findings, and laboratory results of a 50-year-old man diagnosed with a primary left adrenal diffuse large B-cell lymphoma.

CASE PRESENTATION: A 50-year-old Pakistani man presented to our hospital with progressively increasing pain …

Positive Affect Predicts Cerebral Glucose Metabolism In Late Middle-Aged Adults., Christopher Nicholas, Siobhan M Hoscheidt, Lindsay R Clark, Annie M Racine, Sara E Berman, Rebecca L Koscik, N Maritza Dowling, Sanjay Asthana, Bradley T Christian, Mark A Sager, Sterling C Johnson

GW Biostatistics Center

Positive affect is associated with a number of health benefits; however, few studies have examined the relationship between positive affect and cerebral glucose metabolism, a key energy source for neuronal function and a possible index of brain health. We sought to determine if positive affect was associated with cerebral glucose metabolism in late middle-aged adults (n = 133). Participants completed the positive affect subscale of the Center for Epidemiological Studies Depression Scale at two time points over a two-year period and underwent 18F-fluorodeoxyglucose-positron emission tomography scanning. After controlling for age, sex, perceived health status, depressive symptoms, anti-depressant use, family …

Diabetes, Cardiovascular Disease, And Chronic Kidney Disease In South Asia: Current Status And Future Directions, Anoop Misra, Nikhil Tandon, Shah Ebrahim, Naveed Sattar, Dewan Alam, Usha Shrivastava, K M Venkat Narayan, Tazeen H. Jafar

Section of Pulmonary & Critical Care

No abstract provided.

Promotion Of New Diabetes Products In The District Of Columbia, Joy Eckert, Dilpan Sundaramoorthy, Alycia Hogenmiller

GW Research Days 2016 - 2020

Background: Growth in pharmaceutical expenditures for diabetes outpaced growth in diabetes prevalence. Prescribers accepting gifts and meals from pharmaceutical companies have been linked with higher prescription rates and costs[1]. Pharmaceutical marketing to these prescribers and patients often promotes newer, more expensive drugs, such as the GLP-1 analogues and SGL-2 inhibitors. These two drug classes are more expensive but no more effective than metformin,[2] the recommended first-line treatment for diabetes, and the oldest and cheapest available treatment. We investigated how cost of diabetes treatment was affected by marketing practices in the District of Columbia.

Methods: The AccessRx program …

Evaluation Of Evidence Of Adrenal Insufficiency In Trials Of Normocortisolemic Patients Treated With Mifepristone., Kevin C J Yuen, Andreas Moraitis, Dat Nguyen

Articles, Abstracts, and Reports

Context: Adrenal insufficiency (AI) is an important medical concern for clinicians when normocortisolemia is achieved during treatment of endogenous Cushing syndrome (CS).

Objective: To examine symptoms of potential AI in a large population of normocortisolemic patients without CS treated with mifepristone, a glucocorticoid receptor antagonist indicated for the treatment of patients with CS.

Methods: We conducted a pooled safety analysis of five phase 3, placebo-controlled clinical trials of normocortisolemic adults without CS but diagnosed with psychotic depression (n = 1460). Patients were treated with once-daily mifepristone 300 mg (n = 110), 600 mg (n = 471), or 1200 mg (n …

Using Mobile Health (Mhealth) Technology In The Management Of Diabetes Mellitus, Physical Inactivity, And Smoking, Hasan Rehman, Ayeesha Kamran Kamal, Saleem Sayani, Pamela B. Morris, Anwar T. Merchant, Salim S. Virani

Department of Medicine

Purpose of Review: Cardiovascular mortality remains high due to insufficient progress made in managing cardiovascular risk factors such as diabetes mellitus, physical inactivity, and smoking. Healthy lifestyle choices play an important role in the management of these modifiable risk factors. Mobile health or mHealth is defined as the use of mobile computing and communication technologies (i.e., mobile phones, wearable sensors) for the delivery of health services and healthrelated information. In this review, we examine some recent studies that utilized mHealth tools to improve management of these risk factors, with examples from developing countries where available.
Recent Findings: The mHealth …

Ferritin And Percent Transferrin Saturation Levels Predict Type 2 Diabetes Risk And Cardiovascular Disease Outcomes, Leo R. Zacharski, Galina Shamayeva, Bruce K. Chow, Ralph G. Depalma

Dartmouth Scholarship

Introduction: Type 2 diabetes (T2D) and cardiovascular disease (CVD) risk associate withferritin and percent transferrin saturation (%TS) levels. However, increased risk has been observed at levels considered within the “normal range” for these markers.

Objective: To define normative ferritin and %TS levels associated with T2D and CVD risk.

Methods: Six-monthly ferritin, %TS and hemoglobin levels from 1,277 iron reduction clinical trial participants with CVD (peripheral arterial disease, 37% diabetic) permitted pair-wise analysis using Loess Locally Weighted Smoothing plots. Curves showed continuous quantitative ferritin, hemoglobin (reflecting physiologic iron requirements), and %TS (reflecting iron transport and sequestration) levels over a wide range …

Long-Term Excess Risk Of Stroke In People With Type 2 Diabetes In Sweden According To Blood Pressure Level: A Population-Based Case-Control Study., C Hedén Ståhl, M Lind, A-M Svensson, M Kosiborod, S Gudbjörnsdottir, A Pivodic, Mark A. Clements, A Rosengren

Manuscripts, Articles, Book Chapters and Other Papers

AIMS: To estimate the risk of stroke in people with Type 2 diabetes with different blood pressure levels compared with the risk in the general population in Sweden.

METHODS: This prospective case-control study included 408 076 people with Type 2 diabetes, aged ≥ 18 years, and free of prior stroke, registered in the Swedish National Diabetes Register 1998-2011. Age- and sex-matched control subjects (n = 1 913 507) without stroke from the general population were included. Stroke diagnoses were retrieved using International Classification of Disease codes from the Swedish patient and death registers. Cox hazard ratios and 95% confidence intervals …

Evaluating Parents' Self-Efficacy For Diabetes Management In Pediatric Type 1 Diabetes., Amy E. Noser, Susana R. Patton, Jason Van Allen, Michael B. Nelson, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To examine the factor structure and construct validity of the Maternal Self-Efficacy for Diabetes Management Scale (MSED) in 135 youth ( Mage  = 13.50  ±  1.83 years), with type 1 diabetes mellitus.

Method: The study used exploratory factor analysis (EFA) to examine the factor structure and correlations to examine relationships among MSED factors and select parent and child diabetes-related health behaviors and outcomes.

Results: EFA identified an 11-item three-factor solution (χ 2 (25, n  = 133)  = 40.22, p  < .03, RMSEA = 0.07, CFI = 0.98, TLI = 0.97), with factors corresponding to parents' perceived ability to manage their child's diabetes (MSED-M), problem-solve issues surrounding glycemic control (MSED-P), and teach their child about diabetes care (MSED-T). Correlational analyses revealed significant associations between the MSED-M and MSED-T and parent-reported optimism and youth's diabetes-specific self-efficacy. The MSED-T was also associated with glycated hemoglobin and self-monitoring blood glucose.

Conclusions: Results provide preliminary evidence for the reliability and validity of a three-factor solution of the MSED.

Effects Of Cetp Inhibition With Anacetrapib On Metabolism Of Vldl-Tg And Plasma Apolipoproteins C-Ii, C-Iii, And E, John S. Millar, Michael E. Lassman, Tiffany Thomas, Rajasekhar Ramakrishnan, Patricia Jumes, Richard L. Dunbar, Emil M. Degoma, Amanda L. Baer, Wahida Karmally, Daniel S. Donovan, Hashmi Rafeek, John A. Wagner, Stephen Holleran, Joseph Obunike, Yang Liu, Soumia Aoujil, Taylor Standiford, David E. Gutstein, Henry N. Ginsberg, Daniel J. Rader, Gissette Reyes-Soffer

Publications and Research

Cholesteryl ester transfer protein (CETP) mediates the transfer of HDL cholesteryl esters for triglyceride (TG) in VLDL/LDL. CETP inhibition, with anacetrapib, increases HDL-cholesterol, reduces LDL-cholesterol, and lowers TG levels. This study describes the mechanisms responsible for TG lowering by examining the kinetics of VLDL-TG, apoC-II, apoC-III, and apoE. Mildly hypercholesterolemic subjects were randomized to either placebo (N = 10) or atorvastatin 20 mg/qd (N = 29) for 4 weeks (period 1) followed by 8 weeks of anacetrapib, 100 mg/qd (period 2). Following each period, subjects underwent stable isotope metabolic studies to determine the fractional catabolic rates (FCRs) and production rates …

Apolipoprotein E4 And Insulin Resistance Interact To Impair Cognition And Alter The Epigenome And Metabolome, Lance A. Johnson, Eileen Ruth S. Torres, Soren Impey, Jan F. Stevens, Jacob Raber

Physiology Faculty Publications

Apolipoprotein E4 (E4) and type 2 diabetes are major risk factors for cognitive decline and late onset Alzheimer’s disease (AD). E4-associated phenotypes and insulin resistance (IR) share several features and appear to interact in driving cognitive dysfunction. However, shared mechanisms that could explain their overlapping pathophysiology have yet to be found. We hypothesized that, compared to E3 mice, E4 mice would be more susceptible to the harmful cognitive effects of high fat diet (HFD)-induced IR due to apoE isoform-specific differences in brain metabolism. While both E3 and E4 mice fed HFD displayed impairments in peripheral metabolism and cognition, deficits in …

Incidental Metastatic Mediastinal Atypical Carcinoid In A Patient With Parathyroid Adenoma: A Case Report., Zareen Kiran,, Asma Ahmed, Owais Rashid, Saira Fatima, Faizan Malik, Saulat H. Fatimi, Mubasher Ikram

Department of Medicine

Background: Atypical carcinoid arising from the mediastinal tissue is a rare neuroendocrine tumor and an association with parathyroid adenoma is very unusual. We report an unusual case of atypical carcinoid of mediastinum with metastasis in a patient presenting with parathyroid adenoma, which is the first case to be reported from Pakistan.

Case presentation: A 51-year-old Pakistani man was seen in postoperative intensive care after right parathyroidectomy and mediastinal mass resection for the management of postoperative hypocalcaemia. He had a background history of dyspnea. Examination was unremarkable. Preoperative laboratory evaluation revealed a calcium level of 12.7 mg/dl, phosphate of 1.9 mg/dl, …

A Systematic Study Of Dysregulated Microrna In Type 2 Diabetes Mellitus., Yuqing He, Yuanlin Ding, Biyu Liang, Juanjuan Lin, Taek-Kyun Kim, Haibing Yu, Hanwei Hang, Kai Wang

Articles, Abstracts, and Reports

MicroRNAs (miRNAs) are small noncoding RNAs that modulate the cellular transcriptome at the post-transcriptional level. miRNA plays important roles in different disease manifestation, including type 2 diabetes mellitus (T2DM). Many studies have characterized the changes of miRNAs in T2DM, a complex systematic disease; however, few studies have integrated these findings and explored the functional effects of the dysregulated miRNAs identified. To investigate the involvement of miRNAs in T2DM, we obtained and analyzed all relevant studies published prior to 18 October 2016 from various literature databases. From 59 independent studies that met the inclusion criteria, we identified 158 dysregulated miRNAs in …

Pcsk9 Genetic Variants And Risk Of Type 2 Diabetes: A Mendelian Randomisation Study, A. Schmidt, D. Swerdlow, M. Holmes, R. Patel, Z. Fairhurst-Hunter, Cara L. Carty, +Several Additional Authors

Pediatrics Faculty Publications

BACKGROUND:

Statin treatment and variants in the gene encoding HMG-CoA reductase are associated with reductions in both the concentration of LDL cholesterol and the risk of coronary heart disease, but also with modest hyperglycaemia, increased bodyweight, and modestly increased risk of type 2 diabetes, which in no way offsets their substantial benefits. We sought to investigate the associations of LDL cholesterol-lowering PCSK9 variants with type 2 diabetes and related biomarkers to gauge the likely effects of PCSK9 inhibitors on diabetes risk.

METHODS:

In this mendelian randomisation study, we used data from cohort studies, randomised controlled trials, case control studies, and …

Parental Perception And Childhood Obesity: Contributors To Incorrect Perception, Hiba Ashraf, Nida Ilyas Shamsi, Ruhma Ashraf

Medical College Documents

Objectives: To determine parental recognition of their child's weight, and to identify the contributing reasons for incorrect perception.

Method: This cross-sectional study was conducted from April to October 2010 at Aga Khan University Hospital, Karachi, and comprised parents of healthy children aged 5-14 years. An interviewer-based pre-tested questionnaire consisting of socio-demographic details, anthropometric measurements, and parental perception about their child's weight was administered. Data was analysed using SPSS 21. Both univariate and multivariate logistic regression were applied to assess for the risk factors associated with incorrect parental perception.

Results: Parents of a total of 330 eligible children …

Whole Genome Expression Profiling Associates Activation Of Unfolded Protein Response With Impaired Production And Release Of Epinephrine After Recurrent Hypoglycemia, J Kim, Edmund La Gamma, T Estabrook, N Kudrick, Bistra Nankova

NYMC Faculty Publications

Recurrent hypoglycemia can occur as a major complication of insulin replacement therapy, limiting the long-term health benefits of intense glycemic control in type 1 and advanced type 2 diabetic patients. It impairs the normal counter-regulatory hormonal and behavioral responses to glucose deprivation, a phenomenon known as hypoglycemia associated autonomic failure (HAAF). The molecular mechanisms leading to defective counter-regulation are not completely understood. We hypothesized that both neuronal (excessive cholinergic signaling between the splanchnic nerve fibers and the adrenal medulla) and humoral factors contribute to the impaired epinephrine production and release in HAAF. To gain further insight into the molecular mechanism(s) …