Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic ...Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.展开更多
BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical man...BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical manifestations.SCLC is most closely related to paraneoplastic syndrome,and some cases present as paraneoplastic peripheral neuropathy(PPN).PPN in SCLC appears early,lacks specificity,and often occurs before diagnosis of the primary tumor.It is easy to be misdiagnosed as a primary disease of the nervous system,leading to missed diagnosis and delayed diagnosis and treatment.CASE SUMMARY This paper reports two cases of SCLC with limb weakness as the first symptom.The first symptoms of one patient were rash,limb weakness,and abnormal electromyography.The patient was repeatedly referred to the hospital for limb weakness and rash for>1 year,during which time,treatment with hormones and immunosuppressants did not lead to significant improvement,and the condition gradually aggravated.The patient was later diagnosed with SCLC,and the dyskinesia did not worsen as the dermatomyositis improved after antineoplastic and hormone therapy.The second case presented with limb numbness and weakness as the first symptom,but the patient did not pay attention to it.Later,the patient was diagnosed with SCLC after facial edema caused by tumor thrombus invading the vein.However,he was diagnosed with extensive SCLC and died 1 year after diagnosis.CONCLUSION The two cases had PPN and abnormal electromyography,highlighting its correlation with early clinical indicators of SCLC.展开更多
Dear Editor,Traumatic optic neuropathy(TON)is a severe vision-threatening condition,with an incidence rate ranging from 0.7% to 2.5%[1].The limited regenerative capacity of the optic nerve and the challenges of nerve ...Dear Editor,Traumatic optic neuropathy(TON)is a severe vision-threatening condition,with an incidence rate ranging from 0.7% to 2.5%[1].The limited regenerative capacity of the optic nerve and the challenges of nerve transplantation result in substantial and irreversible visual loss in patients with TON.展开更多
Introduction Nonarteritic anterior ischemic optic neuropathy(NAION)is the most common acute optic neuropathy in patients over the age of 50 years(1).It is characterized by acute,painless vision loss in one eye which i...Introduction Nonarteritic anterior ischemic optic neuropathy(NAION)is the most common acute optic neuropathy in patients over the age of 50 years(1).It is characterized by acute,painless vision loss in one eye which is often noticed upon awakening.Commonly,there is an altitudinal visual field defect,though this can be variable(1).展开更多
AIM:To determine the risk factors and time to non-arteric ischemic optic neuropathy(NAION)occurrence among Thai type 2 diabetes mellitus(T2DM)patients.METHODS:A retrospective review of 266 newly diagnosed T2DM cases a...AIM:To determine the risk factors and time to non-arteric ischemic optic neuropathy(NAION)occurrence among Thai type 2 diabetes mellitus(T2DM)patients.METHODS:A retrospective review of 266 newly diagnosed T2DM cases at Rajavithi Hospital between 2007 and 2016 was conducted to determine time to occurrence of NAION and evaluate associated risk factors.RESULTS:Hypertension and dyslipidemia were the most common pre-existing vascular diseases and there was a significant male predominance in the NAION group.The mean age of the NAION group was significantly higher than that of the group without NAION.A higher proportion of subjects in the NAION group had hypertension,dyslipidemia,high diastolic blood pressure,smokers,and had a small cup-to-disc ratio(CDR).Higher levels of triglycerides and lowdensity lipoprotein-cholesterol in the group with NAION.Fiftyfive patients among 266 participants(20.68%)developed NAION during a mean follow-up time of 81.26±25.04mo.In a multivariable logistic regression analysis,dyslipidemia(OR=8.36,95%CI,3.447–20.273,P<0.001),high low density lipoprotein levels(OR=1.017,95%CI,1.004–1.029,P=0.009),and small CDR(OR=11.92,95%CI,4.477–31.741,P<0.001)were significant risk factors for NAION development.Smoking was the strongest predictive risk(OR=12.843,95%CI,3.959–41.659,P<0.001).Vascular complications of T2DM and aspirin were not associated with NAION.CONCLUSION:T2DM patients with dyslipidemia or a small CDR should be carefully followed up as they are at increased risk of developing NAION.展开更多
Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition.Diabetic peripheral neuropathy,a common complication of dia...Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition.Diabetic peripheral neuropathy,a common complication of diabetes,is characterized by nerve damage due to high blood sugar levels that lead to symptoms,such as pain,tingling,and numbness,primarily in the hands and feet.The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy,while also examining recent developments in this domain.The investigation encompassed an array of neuromodulation methods,including frequency rhythmic electrical modulated systems,dorsal root ganglion stimulation,and spinal cord stimulation.This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy.Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments.Through these efforts,we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.展开更多
Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retin...Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.展开更多
Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,gly...Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.展开更多
Diabetic neuropathy (DN) and impaired wound healing in diabetic foot ulcers(DFUs) are major complications of diabetes mellitus, driven by complex molecularmechanisms, including epigenetic modifications. Recent researc...Diabetic neuropathy (DN) and impaired wound healing in diabetic foot ulcers(DFUs) are major complications of diabetes mellitus, driven by complex molecularmechanisms, including epigenetic modifications. Recent research highlights therole of epigenetic markers including DNA methylation, histone modifications,and non-coding RNAs in regulating inflammatory responses, neuronal degeneration,and tissue repair. This review explores the epigenetics of DN and DFUs,emphasizing key regulatory pathways that influence disease progression andwound healing outcomes. Genome-wide DNA methylation studies reveal acceleratedepigenetic aging and metabolic memory effects in DN, contributing tosensory neuron dysfunction and neuropathic pain. Epigenetic dysregulation ofinflammatory mediators such as Toll-like receptors and the Nod-like receptorfamily, pyrin domain-containing 3 inflammasome further exacerbates neuronaldamage and delays wound healing. Additionally, histone deacetylases play apivotal role in oxidative stress regulation via the Nrf2 pathway, which is critical for both neuronal protection and angiogenesis in DFUs. Non-coding RNAs, particularly microRNAs (miRNAs),long non-coding RNAs (lncRNAs), and circular RNAs, are emerging as central regulators of the epigeneticcrosstalk between DN and DFUs. Several miRNAs, including miR-146a-5p and miR-518d-3p, are implicated inneuropathy severity, while lncRNAs such as nuclear enriched abundant transcript 1 modulate angiogenesis andwound repair. Cellular reprogramming of DFU fibroblasts has also been shown to induce pro-healing miRNAsignatures, offering potential therapeutic avenues. Furthermore, recent whole-genome and transcriptomic analysesof DFU-derived monocytes and Charcot foot lesions reveal unique epigenetic signatures that may serve as biomarkersfor early detection and personalized interventions. This epigenetic interplay between DN and DFUpathogenesis not only enhances our knowledge of disease mechanisms but also opens avenues for targetedepigenetic therapies to improve clinical outcomes.展开更多
Background:Diabetic retinal neuropathy(DRN)leads to significant visual impairment;however,no existing animal model fully replicates its neural alterations,and inconsistent induction protocols with high mortality rates...Background:Diabetic retinal neuropathy(DRN)leads to significant visual impairment;however,no existing animal model fully replicates its neural alterations,and inconsistent induction protocols with high mortality rates hinder long-term investigations.Methods:Adult male rabbits were randomly assigned to four experimental groups,each receiving a single intravenous injection of varying doses of alloxan and one control group.The safety and efficacy of alloxan in inducing diabetes were evaluated to determine the optimal dose.At 9 weeks following injection with alloxan,retinal function was assessed using full-field electroretinography(ERG)and visual evoked potentials(VEPs).Retinal structure was examined in rabbits using spectral-domain optical coherence tomography(SD-OCT),Optos ultra-widefield(Optos UWF)false-color imaging,and widefield fundus fluorescein angiography(WF-FFA).Results:Rabbits in the 80 mg/kg alloxan group exhibited fewer complications,lower mortality,and a higher model success rate compared to other groups.At 9 weeks post-injection,these rabbits demonstrated significantly elevated hemoglobin A1c and total cholesterol(p<0.05)relative to controls.ERG revealed statistically significant reductions in oscillatory potential and b-wave amplitudes(p<0.05),while VEP indicated decreased P2 amplitude(p<0.001)and prolonged P2 latency(p<0.05).SD-OCT,Optos UWF imaging,and WF-FFA demonstrated no significant changes in vascular abnormalities.Additionally,Hematoxylin and Eosin staining revealed retinal swelling(p<0.05),and immunofluorescence confirmed glial activation and neuronal loss.Conclusions:A single intravenous injection of 80 mg/kg alloxan effectively and safely induced DRN in rabbits,resulting in neural retina damage,thereby establishing this model as an ideal model for DRN research.展开更多
BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during ...BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.展开更多
Background:Diabetic peripheral neuropathy(DPN)is a prevalent and debilitating complication of diabetes mellitus,lacking effective treatment options.Despite unclear underlying mechanisms,electroacupuncture(EA)shows pro...Background:Diabetic peripheral neuropathy(DPN)is a prevalent and debilitating complication of diabetes mellitus,lacking effective treatment options.Despite unclear underlying mechanisms,electroacupuncture(EA)shows promise in relieving DPN symptoms.Neurotransmitter dysregulation is central to DPN pathophysiology.This study aimed to investigate EA’s effects on DPN via targeted neurotransmitter metabolomics.Methods:A streptozotocin-induced mouse model of DPN was developed,and EA treatment was administered for two weeks to assess the therapeutic potential of EA.Following the collection of sciatic nerve samples,LC-MS-based targeted metabolomics analyses investigations were performed to examine alterations in DPN-associated neurotransmitter metabolism brought on by EA therapy.Multivariate statistical analyses were employed to assess metabolite expression patterns,using cluster heatmaps to display neurotransmitter expression results.KEGG pathway analyses were also used to explore the functional classifications of these neurotransmitters and associated metabolic pathways.Results:Targeted neurotransmitter-focused metabolomics analyses led to the identification of 34 putative biomarkers associated with EA treatment,of which 5 showed significant changes,such as beta-alanine(increased by 80.37%,P=0.0004)and kynurenine(decreased by 29.36%,P=0.0163).KEGG pathway analysis indicated that changes in the abundance of these metabolites were associated with the cAMP signaling pathway,neuroactive ligand-receptor interactions,the synaptic vesicle cycle,and other pathways.Conclusion:The results indicate that EA can efficiently regulate neurotransmitter metabolism and restore peripheral nerve function,suggesting a feasible non-pharmacological strategy for DPN treatment and warranting clinical translation.展开更多
BACKGROUND The trend of risk prediction models for diabetic peripheral neuropathy(DPN)is increasing,but few studies focus on the quality of the model and its practical application.AIM To conduct a comprehensive system...BACKGROUND The trend of risk prediction models for diabetic peripheral neuropathy(DPN)is increasing,but few studies focus on the quality of the model and its practical application.AIM To conduct a comprehensive systematic review and rigorous evaluation of prediction models for DPN.METHODS A meticulous search was conducted in PubMed,EMBASE,Cochrane,CNKI,Wang Fang DATA,and VIP Database to identify studies published until October 2023.The included and excluded criteria were applied by the researchers to screen the literature.Two investigators independently extracted data and assessed the quality using a data extraction form and a bias risk assessment tool.Disagreements were resolved through consultation with a third investigator.Data from the included studies were extracted utilizing the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies.Additionally,the bias risk and applicability of the models were evaluated by the Prediction Model Risk of Bias Assessment Tool.RESULTS The systematic review included 14 studies with a total of 26 models.The area under the receiver operating characteristic curve of the 26 models was 0.629-0.938.All studies had high risks of bias,mainly due to participants,outcomes,and analysis.The most common predictors included glycated hemoglobin,age,duration of diabetes,lipid abnormalities,and fasting blood glucose.CONCLUSION The predictor model presented good differentiation,calibration,but there were significant methodological flaws and high risk of bias.Future studies should focus on improving the study design and study report,updating the model and verifying its adaptability and feasibility in clinical practice.展开更多
Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in t...Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.Objective To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN,with a focus on assessing its effectiveness on improving treatment response rates,alleviating pain,enhancing quality of life(QoL),and improving nerve conduction.Additionally,the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.Methods Six databases(PubMed,Embase,Cochrane Library,Web of Science,OVID,and China National knowledge infrastructure[CNKI])were searched from earliest available dates to December 1,2024,and only randomized controlled trials(RCTs)containing relevant search terms were included.Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome.Nerve conduction,pain scores,and QoL were assessed as secondary outcomes.The version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB 2)was used to examine methodological quality,and Stata 15.1 was used to take network meta-analysis.Results A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included.The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes:effective rate,pain scores,QoL,and nerve conduction.For effective rate,electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve(SUCRA)value of 62.9%,followed by acupoint application(56.9%)and moxibustion(52.3%).Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments(odds ratio[OR]=1.62,95%confidence interval[CI]−5.18 to 8.43).For alleviating pain,auricular acupressure had the highest SUCRA value(85.9%),while electroacupuncture and electroacupuncture combined with three-edged needle ranked second(63.4%)and third(51.0%),respectively.Auricular acupressure significantly reduced pain(SMD=−1.73,95%CI−3.54 to 0.08).For QoL,warming needle ranked first(SUCRA=92.0%),followed by electroacupuncture(48.7%)and filiform needle(43.0%).Warming needle significantly improved QoL scores(SMD=−0.75,95%CI−1.66 to 0.15).For nerve conduction,electroacupuncture combined with three-edged needle had the highest SUCRA value(100%),while moxibustion and filiform needle ranked second(65.3%)and third(39.2%),respectively.Electroacupuncture combined with three-edged had the best neuroprotective effect(SMD=1.85,95%CI 1.23 to 2.47).Conclusion Network meta-analysis based on the primary outcome(effective rate)suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy(CIPN).Secondary outcomes exhibited considerable heterogeneity:auricular acupressure demonstrated superior efficacy in pain relief,electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function,while warm needling was associated with more significant improvements in QoL.Given the variability in interventions across different outcome measures and the methodological limitations of included studies,the current evidence requires cautious interpretation.Systematic review registration:Registration number in PROSPERO:CRD42024560017.展开更多
BACKGROUND Diabetic peripheral neuropathy(DPN)is the most prevalent complication of type 2 diabetes mellitus(T2DM).Due to a lack of specific biomarkers,the early diagnosis of this disorder is limited.AIM To identify a...BACKGROUND Diabetic peripheral neuropathy(DPN)is the most prevalent complication of type 2 diabetes mellitus(T2DM).Due to a lack of specific biomarkers,the early diagnosis of this disorder is limited.AIM To identify and validate serum amino acids that could discriminate T2DM patients with DPN from those without DPN.METHODS T2DM patients with DPN,T2DM patients without DPN,and healthy controls were recruited for this study.The participants comprised two nonoverlapping cohorts:A training cohort(DPN=84 participants,T2DM=82 participants,normal=50 participants)and a validation cohort(DPN=112 participants,T2DM=93 participants,normal=58 participants).A prediction model of the ability of serum amino acids to distinguish DPN from T2DM was established using a logistic regression model,and area under the curve(AUC)analysis was used to evaluate the diagnostic ability of the model.In addition,the serum amino acid levels of 13 DPN patients were also detected before treatment and after 3 months of treatment.RESULTS A clinical detection method for the diagnosis of DPN based on a biomarker panel of three serum amino acids and diabetes duration was developed.The diagnostic model demonstrated AUC values of 0.805(95%CI:0.739-0.871)and 0.810(95%CI:0.750-0.870)in the training and verification cohorts,respectively.In the identification of T2DM patients and normal controls,the AUC values were 0.891(95%CI:0.836-0.945)and 0.883(95%CI:0.832-0.934)in the training and validation cohorts,respectively.Arginine and tyrosine levels were increased after treatment,whereas aspartic acid levels were decreased after treatment.CONCLUSION This study successfully identified and validated the metabolomic significance of arginine,tyrosine,and glutamic acid as potential biomarkers for diagnosing DPN.These findings are particularly valuable,as they establish a foundational step toward developing the first routine laboratory test for DPN.Moreover,the diagnostic model that was constructed in this study effectively distinguishes DPN patients from those with T2DM without neuropathy,thereby potentially facilitating early diagnosis and intervention.展开更多
Purpose:To explore the clinical value of Electromyography(EMG)and Heart Rate Variability(HRV)in the diagnosis of early DPN and provide the basis for early diagnosis,treatment,and prevention of DPN.Methods:105 patients...Purpose:To explore the clinical value of Electromyography(EMG)and Heart Rate Variability(HRV)in the diagnosis of early DPN and provide the basis for early diagnosis,treatment,and prevention of DPN.Methods:105 patients with type 2 diabetes mellitus(T2DM)in the Changji People’s Hospital were treated from January 2023 to December 2023.They were stratifi ed into DPN-symptomatic(DPN group,n=55)and DPN-asymptomatic(NDPN group,n=50)cohorts based on the presence or absence of clinically confi rmed diabetic peripheral neuropathy.The clinical biochemical indicators,nerve electromyography,and HRV parameters were obtained from electronic medical records,and diff erences in detection results were compared between the two groups.Logistic regression was applied to analyze the infl uencing factors of DPN in diabetes patients.The receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of EMG combined with other parameters for DPN.Results:From the results of the general information,diabetes duration,glycosylated hemoglobin(HbA1c),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC)and FBG in the DPN group were significantly differences compared with the NDPN group(p<0.05).There were no statistically significant differences in gender,age years,uric acid,and other general data(p>0.05).Compared with the NDPN group,the motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)of the ulnar nerve,median nerve,and tibial nerve in the DPN group were statistically signifi cant(p>0.05).The DPN group had higher average F wave latency and H wave latency in the tested nerve,with statistical signifi cance(p<0.05).HRV parameters decreased signifi cantly(SDNN,rMSSD,PNN50,and SDANN,all p<0.05).ROC analysis showed that the area under the ROC curve(AUC)of the combined diagnosis of DPN by duration of diabetes,HbA1c,EMG,and HRV was 0.897,the accuracy was 82.86%,the sensitivity was 78.00%,and the specifi city was 87.27%.The AUC of the combined diagnosis of the four parameters for DPN was signifi cantly higher than that of each alone(p<0.05).Conclusion:The combination of EMG and HRV has a high value in the assessment of DPN and can be used for early assessment of the extent of the lesion.展开更多
Diabetic peripheral neuropathy(DPN)is a common complication of diabetes and is characterized by sensory and motor impairments resulting from neural injury.Schwann cells(SCs),which are important for peripheral nerve fu...Diabetic peripheral neuropathy(DPN)is a common complication of diabetes and is characterized by sensory and motor impairments resulting from neural injury.Schwann cells(SCs),which are important for peripheral nerve function,are compromised under hyperglycemic conditions,leading to impaired axonal re-generation and demyelination.Autophagy,a cellular degradation process,is essential for SC function and significantly influences DPN progression.This article highlights the significance of autophagy in SCs and its potential as a pharmacotherapeutic target in DPN.We discuss the mechanisms of autophagy in SCs,including the mammalian target of rapamycin,adenosine monophosphate-activated protein kinase,and phosphatase and tensin homolog-induced putative kinase/parkin pathways,and their dysregulation in DPN.This article also exa-mines various natural products and chemical agents that modulate autophagy and enhance the efficacy of DPN treatment.These agents target key signaling pathways,such as adenosine monophosphate-activated protein kinase/mam-malian target of rapamycin and demonstrate potential in promoting nerve re-generation and restoring SC function.The roles of exosomes,long non-coding RNA,and proteins in the regulation of autophagy have also been explored.In conclusion,targeting autophagy in SCs is a promising strategy for DPN treatment and offers new insights into therapeutic interventions.Further research is war-ranted to fully exploit these targets for clinical applications.展开更多
Metformin-induced vitamin B12 deficiency is a prevalent condition among pa-tients with type 2 diabetes mellitus.In recent years,a growing body of evidence has demonstrated the association between vitamin B12 deficienc...Metformin-induced vitamin B12 deficiency is a prevalent condition among pa-tients with type 2 diabetes mellitus.In recent years,a growing body of evidence has demonstrated the association between vitamin B12 deficiency and the onset,progression,and worsening of diabetic neuropathy(DNP)as well as its im-provement with supplementation in cases of deficiency.Major clinical guidelines for diabetes and DNP remain vague in their recommendations for B12 measu-rement and supplementation,and some guidelines do not address it at all.Given that vitamin B12 therapy is an economical,safe,and widely available treatment in most countries and supported by emerging evidence of its potential benefits,greater efforts should be made to promote systematic screening for vitamin B12 deficiency in all patients with DNP before establishing a definitive diagnosis as well as in patients with diabetes with risk factors for deficiency.Vitamin B12 deficiency should be treated in all affected patients,and supplementation should be considered in those with borderline levels when confirmatory diagnostic tests for deficiency are unavailable.Clinical guidelines should place greater emphasis on the recommendations for measuring and supplementing vitamin B12 in these patients.展开更多
AIM:To evaluate the efficacy and safety of intravitreal low-dose(1 mg)triamcinolone acetonide(TA)in Chinese acute nonarteritic anterior ischemic optic neuropathy(NAION)patients.METHODS:Twenty-eight eyes of 28 patients...AIM:To evaluate the efficacy and safety of intravitreal low-dose(1 mg)triamcinolone acetonide(TA)in Chinese acute nonarteritic anterior ischemic optic neuropathy(NAION)patients.METHODS:Twenty-eight eyes of 28 patients with acute NAION(<30d of visual acuity loss)were enrolled and given intravitreal TA(IVTA)once.Visual field(VF),best corrected visual acuity(BCVA),retinal nerve fiber layer(RNFL)thickness,ganglion cell complex(GCC)thickness,radial peripapillary capillary(RPC)density,and intraocular pressure(IOP)were evaluated at baseline and 7d,1,3,and 6mo after IVTA.RESULTS:VF and BCVA were significant improved during the follow-up according to the mean deviation(MD),visual field index(VFI),and Early Treatment Diabetic Retinopathy Study(ETDRS)scores(all P<0.001).There was no significant difference between the group that received an injection less than 14d after illness onset and the group that received an injection more than 14d after illness onset.The RNFL thickness,GCC thickness and RPC density were significantly decreased(all P<0.001).Temporary ocular hypertension was present in five eyes.CONCLUSION:Low-dose IVTA may be an alternative safe treatment option for some NAION patients in the acute stage.However,optic nerve atrophy still existed.展开更多
Objective:Breast cancer in India is growing at an alarming rate,and the fact that it is currently being detected more frequently in the younger age groups is even more concerning.In India,a woman dies of breast cancer...Objective:Breast cancer in India is growing at an alarming rate,and the fact that it is currently being detected more frequently in the younger age groups is even more concerning.In India,a woman dies of breast cancer every 8 min,which is a terrible situation.Breast cancer claims one life for every two women who are diagnosed with it.However,the morbidity level is gradually increasing due to advanced medical treatment,but we need to be aware and alert.Methods:The research has been structured as a randomized controlled trial.A total of 180 breast cancer patients were taken from Acharya Vinoba Bhave Rural Hospital(AVBRH),Cancer Center Sawangi Meghe for the study as per inclusion and exclusion criteria.With intervention,the period of the study was 11 months.A signed consent form was taken from each participant and based on the answers before,during,and after the trial the data were analyzed using IBM SPSS v29.Results:The investigator believes that the Buerger-Allen exercise and Epsom salt foot bath will improve the symptoms in the symptomatic group of breast cancer patients and will prevent or delay the occurrence of peripheral neuropathy symptoms among the asymptomatic group as well as improve the overall quality of life(QoL).However,during the trial,if any of the study participants developed any side effects,they would be identified early and prompt treatment would be initiated.Conclusions:This study protocol aims to evaluate and compare the non-pharmacological treatment options for chemotherapy-induced peripheral neuropathy(CIPN)and to develop a new treatment option that will pave the way to lead a new non-pharmacological cost-effective treatment option for breast cancer patients which also could improve the QoL.展开更多
基金Supported by the King Salman Center for Disability Research,No.KSRG-2023-407.
文摘Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.
基金Supported by Science and Technology Plan Project of Jiaxing,No.2021AD30044Supporting Discipline of Neurology in Jiaxing,No.2023-ZC-006Affiliated Hospital of Jiaxing University,No.2020-QMX-16.
文摘BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical manifestations.SCLC is most closely related to paraneoplastic syndrome,and some cases present as paraneoplastic peripheral neuropathy(PPN).PPN in SCLC appears early,lacks specificity,and often occurs before diagnosis of the primary tumor.It is easy to be misdiagnosed as a primary disease of the nervous system,leading to missed diagnosis and delayed diagnosis and treatment.CASE SUMMARY This paper reports two cases of SCLC with limb weakness as the first symptom.The first symptoms of one patient were rash,limb weakness,and abnormal electromyography.The patient was repeatedly referred to the hospital for limb weakness and rash for>1 year,during which time,treatment with hormones and immunosuppressants did not lead to significant improvement,and the condition gradually aggravated.The patient was later diagnosed with SCLC,and the dyskinesia did not worsen as the dermatomyositis improved after antineoplastic and hormone therapy.The second case presented with limb numbness and weakness as the first symptom,but the patient did not pay attention to it.Later,the patient was diagnosed with SCLC after facial edema caused by tumor thrombus invading the vein.However,he was diagnosed with extensive SCLC and died 1 year after diagnosis.CONCLUSION The two cases had PPN and abnormal electromyography,highlighting its correlation with early clinical indicators of SCLC.
基金supported by Guangzhou Key Projects of Brain Science and Brain-Like Intelligence Technology(20200730009)the National Natural Science Foundation of China(81870656)the Natural Science Foundation of Guangdong Province of China(2017A030313610 and 2023A1515012397).
文摘Dear Editor,Traumatic optic neuropathy(TON)is a severe vision-threatening condition,with an incidence rate ranging from 0.7% to 2.5%[1].The limited regenerative capacity of the optic nerve and the challenges of nerve transplantation result in substantial and irreversible visual loss in patients with TON.
文摘Introduction Nonarteritic anterior ischemic optic neuropathy(NAION)is the most common acute optic neuropathy in patients over the age of 50 years(1).It is characterized by acute,painless vision loss in one eye which is often noticed upon awakening.Commonly,there is an altitudinal visual field defect,though this can be variable(1).
文摘AIM:To determine the risk factors and time to non-arteric ischemic optic neuropathy(NAION)occurrence among Thai type 2 diabetes mellitus(T2DM)patients.METHODS:A retrospective review of 266 newly diagnosed T2DM cases at Rajavithi Hospital between 2007 and 2016 was conducted to determine time to occurrence of NAION and evaluate associated risk factors.RESULTS:Hypertension and dyslipidemia were the most common pre-existing vascular diseases and there was a significant male predominance in the NAION group.The mean age of the NAION group was significantly higher than that of the group without NAION.A higher proportion of subjects in the NAION group had hypertension,dyslipidemia,high diastolic blood pressure,smokers,and had a small cup-to-disc ratio(CDR).Higher levels of triglycerides and lowdensity lipoprotein-cholesterol in the group with NAION.Fiftyfive patients among 266 participants(20.68%)developed NAION during a mean follow-up time of 81.26±25.04mo.In a multivariable logistic regression analysis,dyslipidemia(OR=8.36,95%CI,3.447–20.273,P<0.001),high low density lipoprotein levels(OR=1.017,95%CI,1.004–1.029,P=0.009),and small CDR(OR=11.92,95%CI,4.477–31.741,P<0.001)were significant risk factors for NAION development.Smoking was the strongest predictive risk(OR=12.843,95%CI,3.959–41.659,P<0.001).Vascular complications of T2DM and aspirin were not associated with NAION.CONCLUSION:T2DM patients with dyslipidemia or a small CDR should be carefully followed up as they are at increased risk of developing NAION.
文摘Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition.Diabetic peripheral neuropathy,a common complication of diabetes,is characterized by nerve damage due to high blood sugar levels that lead to symptoms,such as pain,tingling,and numbness,primarily in the hands and feet.The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy,while also examining recent developments in this domain.The investigation encompassed an array of neuromodulation methods,including frequency rhythmic electrical modulated systems,dorsal root ganglion stimulation,and spinal cord stimulation.This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy.Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments.Through these efforts,we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.
文摘Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.
基金funded by the Seed Funding of the Beijing University of Chinese Medicine(90011451310034).
文摘Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.
文摘Diabetic neuropathy (DN) and impaired wound healing in diabetic foot ulcers(DFUs) are major complications of diabetes mellitus, driven by complex molecularmechanisms, including epigenetic modifications. Recent research highlights therole of epigenetic markers including DNA methylation, histone modifications,and non-coding RNAs in regulating inflammatory responses, neuronal degeneration,and tissue repair. This review explores the epigenetics of DN and DFUs,emphasizing key regulatory pathways that influence disease progression andwound healing outcomes. Genome-wide DNA methylation studies reveal acceleratedepigenetic aging and metabolic memory effects in DN, contributing tosensory neuron dysfunction and neuropathic pain. Epigenetic dysregulation ofinflammatory mediators such as Toll-like receptors and the Nod-like receptorfamily, pyrin domain-containing 3 inflammasome further exacerbates neuronaldamage and delays wound healing. Additionally, histone deacetylases play apivotal role in oxidative stress regulation via the Nrf2 pathway, which is critical for both neuronal protection and angiogenesis in DFUs. Non-coding RNAs, particularly microRNAs (miRNAs),long non-coding RNAs (lncRNAs), and circular RNAs, are emerging as central regulators of the epigeneticcrosstalk between DN and DFUs. Several miRNAs, including miR-146a-5p and miR-518d-3p, are implicated inneuropathy severity, while lncRNAs such as nuclear enriched abundant transcript 1 modulate angiogenesis andwound repair. Cellular reprogramming of DFU fibroblasts has also been shown to induce pro-healing miRNAsignatures, offering potential therapeutic avenues. Furthermore, recent whole-genome and transcriptomic analysesof DFU-derived monocytes and Charcot foot lesions reveal unique epigenetic signatures that may serve as biomarkersfor early detection and personalized interventions. This epigenetic interplay between DN and DFUpathogenesis not only enhances our knowledge of disease mechanisms but also opens avenues for targetedepigenetic therapies to improve clinical outcomes.
基金Key Project of Joint Special Funds for Applied Basic Research of Yunnan Provincial Department of Science and Technology Kunming Medical University,Grant/Award Number:2018FE001-(180)Clinical Research Center of the First People's Hospital of Yunnan Province,Grant/Award Number:2023YJZX-LN01+2 种基金Kunming University of Science and Technology School of Medicine Postgraduate Innovation FundResearch Plan of the National Natural Science Foundation of China,Grant/Award Number:82460210Provincial Key Clinical Specialty Platform of the First People's Hospital of Yunnan Province,Grant/Award Number:2024EKKFKT-04。
文摘Background:Diabetic retinal neuropathy(DRN)leads to significant visual impairment;however,no existing animal model fully replicates its neural alterations,and inconsistent induction protocols with high mortality rates hinder long-term investigations.Methods:Adult male rabbits were randomly assigned to four experimental groups,each receiving a single intravenous injection of varying doses of alloxan and one control group.The safety and efficacy of alloxan in inducing diabetes were evaluated to determine the optimal dose.At 9 weeks following injection with alloxan,retinal function was assessed using full-field electroretinography(ERG)and visual evoked potentials(VEPs).Retinal structure was examined in rabbits using spectral-domain optical coherence tomography(SD-OCT),Optos ultra-widefield(Optos UWF)false-color imaging,and widefield fundus fluorescein angiography(WF-FFA).Results:Rabbits in the 80 mg/kg alloxan group exhibited fewer complications,lower mortality,and a higher model success rate compared to other groups.At 9 weeks post-injection,these rabbits demonstrated significantly elevated hemoglobin A1c and total cholesterol(p<0.05)relative to controls.ERG revealed statistically significant reductions in oscillatory potential and b-wave amplitudes(p<0.05),while VEP indicated decreased P2 amplitude(p<0.001)and prolonged P2 latency(p<0.05).SD-OCT,Optos UWF imaging,and WF-FFA demonstrated no significant changes in vascular abnormalities.Additionally,Hematoxylin and Eosin staining revealed retinal swelling(p<0.05),and immunofluorescence confirmed glial activation and neuronal loss.Conclusions:A single intravenous injection of 80 mg/kg alloxan effectively and safely induced DRN in rabbits,resulting in neural retina damage,thereby establishing this model as an ideal model for DRN research.
文摘BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.
基金supported by Pudong New Area Science and Technology Development Fund Special Research Project on the Livelihood of Institutions(No.PKJ2023-Y03)Pudong New Area Chinese Medicine Senior Teacher Training Program(No.PDZY-2023-0801)Talents Training Program of the Seventh People’s Hospital,Shanghai University of Traditional Chinese Medicine(No.JY2024-08).
文摘Background:Diabetic peripheral neuropathy(DPN)is a prevalent and debilitating complication of diabetes mellitus,lacking effective treatment options.Despite unclear underlying mechanisms,electroacupuncture(EA)shows promise in relieving DPN symptoms.Neurotransmitter dysregulation is central to DPN pathophysiology.This study aimed to investigate EA’s effects on DPN via targeted neurotransmitter metabolomics.Methods:A streptozotocin-induced mouse model of DPN was developed,and EA treatment was administered for two weeks to assess the therapeutic potential of EA.Following the collection of sciatic nerve samples,LC-MS-based targeted metabolomics analyses investigations were performed to examine alterations in DPN-associated neurotransmitter metabolism brought on by EA therapy.Multivariate statistical analyses were employed to assess metabolite expression patterns,using cluster heatmaps to display neurotransmitter expression results.KEGG pathway analyses were also used to explore the functional classifications of these neurotransmitters and associated metabolic pathways.Results:Targeted neurotransmitter-focused metabolomics analyses led to the identification of 34 putative biomarkers associated with EA treatment,of which 5 showed significant changes,such as beta-alanine(increased by 80.37%,P=0.0004)and kynurenine(decreased by 29.36%,P=0.0163).KEGG pathway analysis indicated that changes in the abundance of these metabolites were associated with the cAMP signaling pathway,neuroactive ligand-receptor interactions,the synaptic vesicle cycle,and other pathways.Conclusion:The results indicate that EA can efficiently regulate neurotransmitter metabolism and restore peripheral nerve function,suggesting a feasible non-pharmacological strategy for DPN treatment and warranting clinical translation.
基金Supported by Capital’s Funds for Health Improvement and Research,No.2024-4-4135.
文摘BACKGROUND The trend of risk prediction models for diabetic peripheral neuropathy(DPN)is increasing,but few studies focus on the quality of the model and its practical application.AIM To conduct a comprehensive systematic review and rigorous evaluation of prediction models for DPN.METHODS A meticulous search was conducted in PubMed,EMBASE,Cochrane,CNKI,Wang Fang DATA,and VIP Database to identify studies published until October 2023.The included and excluded criteria were applied by the researchers to screen the literature.Two investigators independently extracted data and assessed the quality using a data extraction form and a bias risk assessment tool.Disagreements were resolved through consultation with a third investigator.Data from the included studies were extracted utilizing the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies.Additionally,the bias risk and applicability of the models were evaluated by the Prediction Model Risk of Bias Assessment Tool.RESULTS The systematic review included 14 studies with a total of 26 models.The area under the receiver operating characteristic curve of the 26 models was 0.629-0.938.All studies had high risks of bias,mainly due to participants,outcomes,and analysis.The most common predictors included glycated hemoglobin,age,duration of diabetes,lipid abnormalities,and fasting blood glucose.CONCLUSION The predictor model presented good differentiation,calibration,but there were significant methodological flaws and high risk of bias.Future studies should focus on improving the study design and study report,updating the model and verifying its adaptability and feasibility in clinical practice.
基金Supported by National Key Research and Development Program of China:2022YFC3500701。
文摘Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.Objective To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN,with a focus on assessing its effectiveness on improving treatment response rates,alleviating pain,enhancing quality of life(QoL),and improving nerve conduction.Additionally,the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.Methods Six databases(PubMed,Embase,Cochrane Library,Web of Science,OVID,and China National knowledge infrastructure[CNKI])were searched from earliest available dates to December 1,2024,and only randomized controlled trials(RCTs)containing relevant search terms were included.Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome.Nerve conduction,pain scores,and QoL were assessed as secondary outcomes.The version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB 2)was used to examine methodological quality,and Stata 15.1 was used to take network meta-analysis.Results A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included.The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes:effective rate,pain scores,QoL,and nerve conduction.For effective rate,electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve(SUCRA)value of 62.9%,followed by acupoint application(56.9%)and moxibustion(52.3%).Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments(odds ratio[OR]=1.62,95%confidence interval[CI]−5.18 to 8.43).For alleviating pain,auricular acupressure had the highest SUCRA value(85.9%),while electroacupuncture and electroacupuncture combined with three-edged needle ranked second(63.4%)and third(51.0%),respectively.Auricular acupressure significantly reduced pain(SMD=−1.73,95%CI−3.54 to 0.08).For QoL,warming needle ranked first(SUCRA=92.0%),followed by electroacupuncture(48.7%)and filiform needle(43.0%).Warming needle significantly improved QoL scores(SMD=−0.75,95%CI−1.66 to 0.15).For nerve conduction,electroacupuncture combined with three-edged needle had the highest SUCRA value(100%),while moxibustion and filiform needle ranked second(65.3%)and third(39.2%),respectively.Electroacupuncture combined with three-edged had the best neuroprotective effect(SMD=1.85,95%CI 1.23 to 2.47).Conclusion Network meta-analysis based on the primary outcome(effective rate)suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy(CIPN).Secondary outcomes exhibited considerable heterogeneity:auricular acupressure demonstrated superior efficacy in pain relief,electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function,while warm needling was associated with more significant improvements in QoL.Given the variability in interventions across different outcome measures and the methodological limitations of included studies,the current evidence requires cautious interpretation.Systematic review registration:Registration number in PROSPERO:CRD42024560017.
基金Supported by the Youth Fund for Specialized Clinical Research of the Health Commission,No.20214Y0149.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is the most prevalent complication of type 2 diabetes mellitus(T2DM).Due to a lack of specific biomarkers,the early diagnosis of this disorder is limited.AIM To identify and validate serum amino acids that could discriminate T2DM patients with DPN from those without DPN.METHODS T2DM patients with DPN,T2DM patients without DPN,and healthy controls were recruited for this study.The participants comprised two nonoverlapping cohorts:A training cohort(DPN=84 participants,T2DM=82 participants,normal=50 participants)and a validation cohort(DPN=112 participants,T2DM=93 participants,normal=58 participants).A prediction model of the ability of serum amino acids to distinguish DPN from T2DM was established using a logistic regression model,and area under the curve(AUC)analysis was used to evaluate the diagnostic ability of the model.In addition,the serum amino acid levels of 13 DPN patients were also detected before treatment and after 3 months of treatment.RESULTS A clinical detection method for the diagnosis of DPN based on a biomarker panel of three serum amino acids and diabetes duration was developed.The diagnostic model demonstrated AUC values of 0.805(95%CI:0.739-0.871)and 0.810(95%CI:0.750-0.870)in the training and verification cohorts,respectively.In the identification of T2DM patients and normal controls,the AUC values were 0.891(95%CI:0.836-0.945)and 0.883(95%CI:0.832-0.934)in the training and validation cohorts,respectively.Arginine and tyrosine levels were increased after treatment,whereas aspartic acid levels were decreased after treatment.CONCLUSION This study successfully identified and validated the metabolomic significance of arginine,tyrosine,and glutamic acid as potential biomarkers for diagnosing DPN.These findings are particularly valuable,as they establish a foundational step toward developing the first routine laboratory test for DPN.Moreover,the diagnostic model that was constructed in this study effectively distinguishes DPN patients from those with T2DM without neuropathy,thereby potentially facilitating early diagnosis and intervention.
基金supported by the Key Program of the Changji Prefecture Science and Technology Program(2023S04-10,2023S06-03).
文摘Purpose:To explore the clinical value of Electromyography(EMG)and Heart Rate Variability(HRV)in the diagnosis of early DPN and provide the basis for early diagnosis,treatment,and prevention of DPN.Methods:105 patients with type 2 diabetes mellitus(T2DM)in the Changji People’s Hospital were treated from January 2023 to December 2023.They were stratifi ed into DPN-symptomatic(DPN group,n=55)and DPN-asymptomatic(NDPN group,n=50)cohorts based on the presence or absence of clinically confi rmed diabetic peripheral neuropathy.The clinical biochemical indicators,nerve electromyography,and HRV parameters were obtained from electronic medical records,and diff erences in detection results were compared between the two groups.Logistic regression was applied to analyze the infl uencing factors of DPN in diabetes patients.The receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of EMG combined with other parameters for DPN.Results:From the results of the general information,diabetes duration,glycosylated hemoglobin(HbA1c),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC)and FBG in the DPN group were significantly differences compared with the NDPN group(p<0.05).There were no statistically significant differences in gender,age years,uric acid,and other general data(p>0.05).Compared with the NDPN group,the motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)of the ulnar nerve,median nerve,and tibial nerve in the DPN group were statistically signifi cant(p>0.05).The DPN group had higher average F wave latency and H wave latency in the tested nerve,with statistical signifi cance(p<0.05).HRV parameters decreased signifi cantly(SDNN,rMSSD,PNN50,and SDANN,all p<0.05).ROC analysis showed that the area under the ROC curve(AUC)of the combined diagnosis of DPN by duration of diabetes,HbA1c,EMG,and HRV was 0.897,the accuracy was 82.86%,the sensitivity was 78.00%,and the specifi city was 87.27%.The AUC of the combined diagnosis of the four parameters for DPN was signifi cantly higher than that of each alone(p<0.05).Conclusion:The combination of EMG and HRV has a high value in the assessment of DPN and can be used for early assessment of the extent of the lesion.
基金Supported by Natural Science Foundation of Hunan Province,No.2023JJ60497Chinese Medicine Research Program of Hunan Province,No.2021169Xiangtan Medical Research Project Plan,No.2022-xtyx-34 and No.2022-xtyx-36.
文摘Diabetic peripheral neuropathy(DPN)is a common complication of diabetes and is characterized by sensory and motor impairments resulting from neural injury.Schwann cells(SCs),which are important for peripheral nerve function,are compromised under hyperglycemic conditions,leading to impaired axonal re-generation and demyelination.Autophagy,a cellular degradation process,is essential for SC function and significantly influences DPN progression.This article highlights the significance of autophagy in SCs and its potential as a pharmacotherapeutic target in DPN.We discuss the mechanisms of autophagy in SCs,including the mammalian target of rapamycin,adenosine monophosphate-activated protein kinase,and phosphatase and tensin homolog-induced putative kinase/parkin pathways,and their dysregulation in DPN.This article also exa-mines various natural products and chemical agents that modulate autophagy and enhance the efficacy of DPN treatment.These agents target key signaling pathways,such as adenosine monophosphate-activated protein kinase/mam-malian target of rapamycin and demonstrate potential in promoting nerve re-generation and restoring SC function.The roles of exosomes,long non-coding RNA,and proteins in the regulation of autophagy have also been explored.In conclusion,targeting autophagy in SCs is a promising strategy for DPN treatment and offers new insights into therapeutic interventions.Further research is war-ranted to fully exploit these targets for clinical applications.
文摘Metformin-induced vitamin B12 deficiency is a prevalent condition among pa-tients with type 2 diabetes mellitus.In recent years,a growing body of evidence has demonstrated the association between vitamin B12 deficiency and the onset,progression,and worsening of diabetic neuropathy(DNP)as well as its im-provement with supplementation in cases of deficiency.Major clinical guidelines for diabetes and DNP remain vague in their recommendations for B12 measu-rement and supplementation,and some guidelines do not address it at all.Given that vitamin B12 therapy is an economical,safe,and widely available treatment in most countries and supported by emerging evidence of its potential benefits,greater efforts should be made to promote systematic screening for vitamin B12 deficiency in all patients with DNP before establishing a definitive diagnosis as well as in patients with diabetes with risk factors for deficiency.Vitamin B12 deficiency should be treated in all affected patients,and supplementation should be considered in those with borderline levels when confirmatory diagnostic tests for deficiency are unavailable.Clinical guidelines should place greater emphasis on the recommendations for measuring and supplementing vitamin B12 in these patients.
基金Supported by the National Key R&D Program of China(No.2016YFC0904800,No.2019YFC0840607)the National Science and Technology Major Project of China(No.2017ZX09304010)the Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2018BP04).
文摘AIM:To evaluate the efficacy and safety of intravitreal low-dose(1 mg)triamcinolone acetonide(TA)in Chinese acute nonarteritic anterior ischemic optic neuropathy(NAION)patients.METHODS:Twenty-eight eyes of 28 patients with acute NAION(<30d of visual acuity loss)were enrolled and given intravitreal TA(IVTA)once.Visual field(VF),best corrected visual acuity(BCVA),retinal nerve fiber layer(RNFL)thickness,ganglion cell complex(GCC)thickness,radial peripapillary capillary(RPC)density,and intraocular pressure(IOP)were evaluated at baseline and 7d,1,3,and 6mo after IVTA.RESULTS:VF and BCVA were significant improved during the follow-up according to the mean deviation(MD),visual field index(VFI),and Early Treatment Diabetic Retinopathy Study(ETDRS)scores(all P<0.001).There was no significant difference between the group that received an injection less than 14d after illness onset and the group that received an injection more than 14d after illness onset.The RNFL thickness,GCC thickness and RPC density were significantly decreased(all P<0.001).Temporary ocular hypertension was present in five eyes.CONCLUSION:Low-dose IVTA may be an alternative safe treatment option for some NAION patients in the acute stage.However,optic nerve atrophy still existed.
基金supported by study protocol(No.DMIHER(DU)IEC/2023/22).
文摘Objective:Breast cancer in India is growing at an alarming rate,and the fact that it is currently being detected more frequently in the younger age groups is even more concerning.In India,a woman dies of breast cancer every 8 min,which is a terrible situation.Breast cancer claims one life for every two women who are diagnosed with it.However,the morbidity level is gradually increasing due to advanced medical treatment,but we need to be aware and alert.Methods:The research has been structured as a randomized controlled trial.A total of 180 breast cancer patients were taken from Acharya Vinoba Bhave Rural Hospital(AVBRH),Cancer Center Sawangi Meghe for the study as per inclusion and exclusion criteria.With intervention,the period of the study was 11 months.A signed consent form was taken from each participant and based on the answers before,during,and after the trial the data were analyzed using IBM SPSS v29.Results:The investigator believes that the Buerger-Allen exercise and Epsom salt foot bath will improve the symptoms in the symptomatic group of breast cancer patients and will prevent or delay the occurrence of peripheral neuropathy symptoms among the asymptomatic group as well as improve the overall quality of life(QoL).However,during the trial,if any of the study participants developed any side effects,they would be identified early and prompt treatment would be initiated.Conclusions:This study protocol aims to evaluate and compare the non-pharmacological treatment options for chemotherapy-induced peripheral neuropathy(CIPN)and to develop a new treatment option that will pave the way to lead a new non-pharmacological cost-effective treatment option for breast cancer patients which also could improve the QoL.
