Background:Inflammation,caused by prolonged hyperglycemia,plays a substantially more important part in the progression of diabetic peripheral neuropathy(DPN).Notably,the MAPK pathway that mediates the Nuclear Factor-k...Background:Inflammation,caused by prolonged hyperglycemia,plays a substantially more important part in the progression of diabetic peripheral neuropathy(DPN).Notably,the MAPK pathway that mediates the Nuclear Factor-kappa B(NF-κB)pathway contributes to inflammation-induced peripheral nerve damage,affecting cell survival.Juan Bi Tong Luo(JBTL),a traditional Chinese medicine(TCM),has demonstrated favorable results in alleviating pain and numbness in patients with DPN;however,whether JBTL exerts its effect through the MAPK mediating NF-κB pathway remains unclear.Methods:This study investigated whether JBTL modulates apoptosis in DPN models and Schwann cells cultured in 100 mM of glucose by MAPK/NF-κB.Results:The JBTL altered inflammation,reduced peripheral nerve tissue damage,and improved cell survival rates by down-regulating MAPK/NF-κB.Conclusion:Our findings demonstrate that the effect of JBTL on DPN is likely mediated by suppressing inflammation induced by the MAPK/NF-κB pathway,thus providing evidence for the clinical efficacy of JBTL in treating DPN.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
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
Objective:Diabetic Peripheral Neuropathy(DPN)is a common chronic complication of diabetes that currently has no therapeutic recourse.Advanced DPN stages are characterized by severe symptoms that place a huge burden on...Objective:Diabetic Peripheral Neuropathy(DPN)is a common chronic complication of diabetes that currently has no therapeutic recourse.Advanced DPN stages are characterized by severe symptoms that place a huge burden on patients and healthcare systems.To the best of our knowledge,research hotspots within the field of DPN are yet to be visually analyzed,and so is the exploration of developmental dynamics within the same discipline.Methods:Herein,DPN articles published between 2002 and 2022 were retrieved from the Web of Science Core Collection database.Following that,bibliometric analysis was performed on these articles using CiteSpace,VOSviewer,Microsoft Excel,and R-bibliometrix tools.Results:We retrieved 2,761 DPN articles involving 11,605 researchers from 1,140 institutions in 99 countries/regions.The United States was the country/region with the highest number of publications.The most productive author was Malik Rayaz A from the University of Manchester,which was the most productive institution.The most co-cited journals were Diabetes Care,Pain,and Neurology.On the other hand,#0 neuropathic pain,#1 neuropathic pain treatment and#2 peripheral neuropathy were the most clustered keywords in co-cited references.Based on the clustering of keywords,timeline graphs,and citation bursts,“risk”,“corneal confocal microscopy”and“systematic review”were identifi ed as the key issues for future DPN research.Conclusion:This article summarizes the current DPN research status and focus areas,reveals the future development trend,and points out potential research directions for DPN scholars.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
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 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
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
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 a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have...BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.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
Background:This study aimed to discover whether Cistanche tubulosa affects the AKT/CASP3 pathway by regulating m6A methylation,to exert a protective effect against peripheral nerve injury in a Parkinson's Disease(...Background:This study aimed to discover whether Cistanche tubulosa affects the AKT/CASP3 pathway by regulating m6A methylation,to exert a protective effect against peripheral nerve injury in a Parkinson's Disease(PD)mouse model.Methods:In this study,network pharmacology analysis and the molecular docking virtual screening technique was used to filter Acteoside(Act),a potential neuroprotective agent of active components in Cistanche tubulosa.A PD-related peripheral neuropathy mouse model was established by MPTP induction,followed by 21 days treatment of oral Act(25,50,and 100 mg kg^(−1)).Pole climbing,automatic avoidance ability and hot plate sensory tests were evaluated to determine behavioral changes caused by central and peripheral nerve injury.The pathological alterations of dorsal root ganglion tissue and the protein levels of IL-6,AKT,and CASP3 under Act intervention,as well as the dynamic changes of FTO,METTL3,and YTHDF2 which are closely related to m6A methylation,were comprehensively analyzed to observe the peripheral nerve protective efficacy of Act.Results:The results showed that peripheral neuropathy occurring with PD in the mouse model,which could be verified by behavioral tests and pathological histological changes.In addition to the previously established protective effect of Act on dopaminergic neurons in substantia nigra(SN),extensive follow-up studies demonstrated that Act effectively induced m6A methylation,which could further regulate the AKT/CASP3 pathway to play a therapeutic role.In this study,medium and high doses of Act played more obvious therapeutic roles.Conclusion:These findings suggest that Act may regulate the severity of peripheral nerve injury under the activation of the AKT/CASP3 signaling pathway by balancing the methylation level of m6A.These results provide a theoretical basis and experimental evidence for further research on the protective effect of Cistanche tubulosa on both the central and peripheral nerves in the treatment of PD.展开更多
BACKGROUND Peripheral neuropathy caused by diabetes is closely related to the vicious cycle of oxidative stress and mitochondrial dysfunction resulting from metabolic abnormalities.The effects mediated by the silent i...BACKGROUND Peripheral neuropathy caused by diabetes is closely related to the vicious cycle of oxidative stress and mitochondrial dysfunction resulting from metabolic abnormalities.The effects mediated by the silent information regulator type 2 homolog-1(SIRT1)/peroxisome proliferator-activated receptor-gamma coactivator-1α(PGC-1α)axis present new opportunities for the treatment of type 2 diabetic peripheral neuropathy(T2DPN),potentially breaking this harmful cycle.AIM To validate the effectiveness of electroacupuncture(EA)in the treatment of T2DPN and investigate its potential mechanism based on the SIRT1/PGC-1αaxis.METHODS The effects of EA were evaluated through assessments of metabolic changes,morphological observations,and functional examinations of the sciatic nerve,along with measurements of inflammation and oxidative stress.Proteins related to the SIRT1/PGC-1αaxis,involved in the regulation of mitochondrial biogenesis and antioxidative stress,were detected in the sciatic nerve using Western blotting to explain the underlying mechanism.A counterevidence group was created by injecting a SIRT1 inhibitor during EA intervention to support the hypothesis.RESULTS In addition to diabetes-related metabolic changes,T2DPN rats showed significant reductions in pain threshold after 9 weeks,suggesting abnormal peripheral nerve function.EA treatment partially restored metabolic control and reduced nerve damage in T2DPN rats.The SIRT1/PGC-1αaxis,which was downregulated in the model group,was upregulated by EA intervention.The endogenous antioxidant system related to the SIRT1/PGC-1αaxis,previously inhibited in diabetic rats,was reactivated.A similar trend was observed in inflammatory markers.When SIRT1 was inhibited in diabetic rats,these beneficial effects were abolished.CONCLUSION EA can alleviate the symptoms of T2DNP in experimental rats,and its effects may be related to the mitochondrial biogenesis and endogenous antioxidant system mediated by the SIRT1/PGC-1αaxis.展开更多
Objective To observe clinical therapeutic effects of warm needling and moxibustion on diabetic peripheral neuropathy （DPN） and their influence on nerve conduction velocity. Methods Fifty two cases were randomly divi...Objective To observe clinical therapeutic effects of warm needling and moxibustion on diabetic peripheral neuropathy （DPN） and their influence on nerve conduction velocity. Methods Fifty two cases were randomly divided into a treatment group （n =26） and a control group （n =26）. In addition to basic treatment for lowering blood sugar in both groups, Pǐshū （BL 20）, Shènshū （BL 23）, Huántiào （GB 30）, Zùsānlǐ （ST 36）, Yánglíngquán （GB 34）, Sānyīnjiāo （SP 6）, Tàixī （KI 3）, Qǔchí （LI 11）, Wàiguān （TE 5） and Hégǔ （LI 4） were selected for warm needling and moxibustion in the treatment group. Methycobal was intramuscularly injected in the control group. Clinical symptoms and conduction velocities of the tibial nerve and common peroneal nerve were compared before and after treatment. Results Warm needling and moxibustion could alleviate such clinical symptoms as numbness of limbs, pain and hypoesthesia, and obviously improve the conduction velocities of both tibial and common peroneal nerves. Conclusion Warm needling and moxibustion exhibit good therapeutic effects on diabetic peripheral neuropathy.展开更多
This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also in...This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also investigated the factors associated with the development of s DPN and compared factors between the sD PN and confirmed DPN(cDPN). This cross-sectional study involved 240 T2DM patients who were successively admitted to the endocrinology wards of Wuhan Union Hospital over the period of January to December 2014. Data on the medical history, physical and laboratory examinations were collected. DPN was diagnosed using NCS. One-way ANOVA with least significant difference(LSD) analysis or chi-square tests was used to compare parameters among DNP-free, s DPN and c DPN patients. Independent factors associated with s DPN were determined using logistic regression. The results showed that 50.8% of the participants had DPN, and among them, 17.1% had sDPN. sDPN showed significant independent associations with age, height, HbA1c, presence of atherosclerosis and diabetic retinopathy. Patients with DPN differed significantly from those without DPN with respect to age, duration of disease(DOD), HbA1c, presence of atherosclerosis, diabetic retinopathy, nephropathy and hypertension. Patients with cDPN, relative to those with sDPN, had significantly longer DOD and higher prevalence of peripheral artery disease(PAD) and coronary artery disease(CAD). Our study suggests that a significant number of T2DM patients are affected by s DPN, and the development of this condition is associated with advanced age, tall stature, poor glycaemic control, presence of diabetic retinopathy and atherosclerosis. On the other hand, patients with cDPN tend to have a longer DOD and are more likely to suffer from PAD and CAD.展开更多
Background:Bortezomib results in peripheral neuropathy(PN)in approximately 50%of patients,during multiple myeloma(MM)treatment,a complication known as Bortezomib-induced peripheral neuropathy(BIPN).The drug response v...Background:Bortezomib results in peripheral neuropathy(PN)in approximately 50%of patients,during multiple myeloma(MM)treatment,a complication known as Bortezomib-induced peripheral neuropathy(BIPN).The drug response varies among individuals.Genetic factor may play an important role in BIPN.Methods:A nextgeneration sequencing(NGS)panel containing 1659 targets from 233 genes was used to identify risk variants for developing BIPN in 204 MM patients who received bortezomib therapy.mRNA expression of MTHFR and ALDH1A1 in 62 peripheral blood samples was detected by real-time quantitative PCR(RT-qPCR).Serum homocysteine(Hcy)levels were detected in 40 samples by chemiluminescent microparticle immunoassay(CMIA).Results:Compared with the non-BIPN group(n=89),a total of 8 significantly associated single nucleotide polymorphisms(SNPs)were identified in the BIPN group(n=115):MTHFR(rs1801131,rs1801133,rs17421511),EPHX1(rs1051740),MME(rs2016848),ALDH1A1(rs6151031),HTR7(rs1935349)and CYP2A6(rs8192720).The mRNA expression level of MTHFR in newly diagnosed patients with peripheral neuritis after treatment(NP group)was lower than that of newly diagnosed patients without peripheral neuritis after treatment(NnP group)(1.70±0.77 vs.2.81±0.97,p=0.009).Serum Hcy levels were significantly higher in BIPN group than in non-BIPN group(11.66±1.79μmol/L vs.8.52±3.29μmol/L,p=0.016)and healthy controls(11.66±1.79μmol/L vs.8.55±2.13μmol/L,p≤0.001).Conclusion:CYP2A6,EPHX1,MTHFR,ALDH1A1,HTR7,MME and BIPN are linked in Chinese MM patients.BIPN is more likely to occur in patients with lower MTHFR mRNA expression,which might result in higher serum Hcy levels.展开更多
<strong>Introduction:</strong> <span style="font-family:Verdana;">Oxaliplatin is a platinum-derivative chemotherapeutic agent used in digestive tumours, in the adjuvant and metastatic setti...<strong>Introduction:</strong> <span style="font-family:Verdana;">Oxaliplatin is a platinum-derivative chemotherapeutic agent used in digestive tumours, in the adjuvant and metastatic setting. Oxaliplatin can cause a chronic peripheral sensory neuropathy which impacts</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">the quality of life and is dose limiting. To date, no therapeutic strategies have proved effective in the treatment of oxaliplatin-induced peripheral neuropathy (OIPN). </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A computerized search of the literature on PubMed database was performed. Publisher original articles were included if they focused on treatment of peripheral neuropathy among patients submitted to oxaliplatin. Eleven out of 242 reviewed papers met our inclusion criteria and were subjected to a 19-item quality checklist. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The included studies differed with respect to study design, patient population and sample size, neuropathic symptoms assessment and efficacy measure. Most studies had an</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">adequate quality. Ten trials tested one drug, and one pilot study tested a non-pharmacological treatment</span><span style="font-family:Verdana;">—</span><span style="font-family:Verdana;">the neurofeedback. Of these, 3 trials included only patients submitted to oxaliplatin-based chemotherapy. Duloxetine showed moderate efficacy in 3 trials. Topical treatment with capsaicin or 10% amitriptyline was promisors in 2 single-arm trials with a </span><span style="font-family:Verdana;">few </span><span style="font-family:Verdana;">sample</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">In the last decade, there wasn</span></span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">t an improvement in the treatment of chronic OIPN. The duloxetine is the unique drug with moderate efficacy on the treatment of OIPN. There is insufficient evidence to support a recommendation for any other treatment.</span>展开更多
Objective To observe the clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy （ClPN）. Methods Ninety ClPN patients with breast cancer conforming to inclusive criteria were randomly ...Objective To observe the clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy （ClPN）. Methods Ninety ClPN patients with breast cancer conforming to inclusive criteria were randomly divided into an acupuncture group （group A）, a mecobalamin group （group B） and an acupoint injection group （group C） according to random number table, with 30 cases in each group. In group A, acupuncture was conducted at bilateral Q0chi （I~ LI 11）, H6g6 （~ LI 4）, Z0s^nlT （~__~ ST 36）, S^nyinji^o （^-- ~ SP 6） and Xu^h~i （J~ SP 10）; in group B, intramuscular injection with I mL of mecobalamin injection was conducted; and in group C, acupoint selection was the same as group A, and 0.1 mL of mecobalamin injection was injected into each acupoint, respectively. The treatment was conducted once every three days in each group, and the changes of clinical efficacy, nerve electrophysiology and hemorrheology indicators after treatment for 10 times were observed. Result The total effective rate of group C was 93.1% （27/29）, which was higher than 78.6% （22/28） in group A and 83.3% （25/30） in group B, and the differences among three groups were statistically significant （all P〈0.01）; conduction velocity of lesion nerves was improved in group B and group C, the improvement in group C was obviously superior to the other two groups （all P〈0.01）, hemorrheology indicator was improved in group A and group C （both P〈0.05）. Conclusion The efficacy of acupoint injection with mecobalamin for breast cancer CIPN was significant, which can not only improve the nerve conduction velocity, but also improve the hemorrheology indicator.展开更多
Objective: To observe the clinical efficacy and differences of the Zhuyu Juanbi formula delivered through ultrasound at Zusanli on patients with chemotherapy-induced peripheral neuropathy (CIPN) due to paclitaxel inje...Objective: To observe the clinical efficacy and differences of the Zhuyu Juanbi formula delivered through ultrasound at Zusanli on patients with chemotherapy-induced peripheral neuropathy (CIPN) due to paclitaxel injection. Methods: A total of 72 breast cancer patients with CIPN were randomly divided into two groups. The treatment group (36 cases) was treated with oral methylcobalamin plus ultrasonic medicine permeating Zhuyu Juanbi formulae, while the control group (36 cases) was treated with oral methylcobalamin alone. Following two 2 cycles of continuous treatment, the efficacy of peripheral neurotoxicity, TCM syndrome score, FACT/GOG-Ntx score, total neuropathy score, and safety indicators of gynecological cancer patients were observed in the two groups. Result: In the treatment of CIPN, the addition of ultrasonic medicine permeating Zhuyu Juanbi formulae was more effective than oral methylcobalamin alone in reducing peripheral neurotoxicity and improving the quality of life of patients. The difference between the two groups was statistically significant (P < 0.05), and ultrasound drug penetration Zhuyu Juanbi formulae significantly reduced the FACT/ GOG-Ntx score and TNS score in the treatment group. In terms of drug safety, it rarely caused adverse reactions such as grade 3 and 4 leukopenia, and the safety profile was therefore good. Conclusion: The combination of ultrasonic medicine permeating Zhuyu Juanbi formulae and methylcobalamin has been demonstrated to be an effective treatment for peripheral neurotoxicity in patients with PIPN. It has been shown to significantly improve the clinical symptoms of PIPN patients, improve the quality of life of patients, and have a good safety profile.展开更多
基金funded by grants from the Suzhou Gusu Health Talents Project(grant No.GSWS2024050 to Liu W)Natural Science Foundation Project of Nanjing University of Chinese Medicine(grant No.XZR2021043 to Liu W and grant No.XZR2023021 to Huang F)+1 种基金Suzhou Science Education Health Youth Project(grant No.KJXW2021046 to Liu W)Suzhou Major Disease Multi-center Clinical Research Project(grant No.DZXYJ202410 to Huang F).
文摘Background:Inflammation,caused by prolonged hyperglycemia,plays a substantially more important part in the progression of diabetic peripheral neuropathy(DPN).Notably,the MAPK pathway that mediates the Nuclear Factor-kappa B(NF-κB)pathway contributes to inflammation-induced peripheral nerve damage,affecting cell survival.Juan Bi Tong Luo(JBTL),a traditional Chinese medicine(TCM),has demonstrated favorable results in alleviating pain and numbness in patients with DPN;however,whether JBTL exerts its effect through the MAPK mediating NF-κB pathway remains unclear.Methods:This study investigated whether JBTL modulates apoptosis in DPN models and Schwann cells cultured in 100 mM of glucose by MAPK/NF-κB.Results:The JBTL altered inflammation,reduced peripheral nerve tissue damage,and improved cell survival rates by down-regulating MAPK/NF-κB.Conclusion:Our findings demonstrate that the effect of JBTL on DPN is likely mediated by suppressing inflammation induced by the MAPK/NF-κB pathway,thus providing evidence for the clinical efficacy of JBTL in treating DPN.
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.
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.
基金supported by the Anhui Provincial Key Research and Development PlanThis study was supported by National Key Research and Development Program of China(No.2023YFF0724803)Yunnan Province“Xingdian Talent Support Program”Yunling Scholar Special Project(No.XDYC-YLXZ-2022-0027)Scientific Research Fund Project of Yunnan Provincial Education Department(No.2025Y0634,No.2025Y0627).
文摘Objective:Diabetic Peripheral Neuropathy(DPN)is a common chronic complication of diabetes that currently has no therapeutic recourse.Advanced DPN stages are characterized by severe symptoms that place a huge burden on patients and healthcare systems.To the best of our knowledge,research hotspots within the field of DPN are yet to be visually analyzed,and so is the exploration of developmental dynamics within the same discipline.Methods:Herein,DPN articles published between 2002 and 2022 were retrieved from the Web of Science Core Collection database.Following that,bibliometric analysis was performed on these articles using CiteSpace,VOSviewer,Microsoft Excel,and R-bibliometrix tools.Results:We retrieved 2,761 DPN articles involving 11,605 researchers from 1,140 institutions in 99 countries/regions.The United States was the country/region with the highest number of publications.The most productive author was Malik Rayaz A from the University of Manchester,which was the most productive institution.The most co-cited journals were Diabetes Care,Pain,and Neurology.On the other hand,#0 neuropathic pain,#1 neuropathic pain treatment and#2 peripheral neuropathy were the most clustered keywords in co-cited references.Based on the clustering of keywords,timeline graphs,and citation bursts,“risk”,“corneal confocal microscopy”and“systematic review”were identifi ed as the key issues for future DPN research.Conclusion:This article summarizes the current DPN research status and focus areas,reveals the future development trend,and points out potential research directions for DPN scholars.
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.
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 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 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.
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National Natural Science Foundation of China,No.82270881 and No.82200928National High-Level Hospital Clinical Research Funding,No.BJ-2023-124 and No.BJ-2023-130.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.
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Xinjiang Uygur Autonomous Region Science and Technology Department-Tianshan Innovation Team Program Project,Grant/Award Number:2023D14006Xinjiang Uygur Autonomous Region Science and Technology Department-Natural Science Foundation,Grant/Award Number:2023D01C115。
文摘Background:This study aimed to discover whether Cistanche tubulosa affects the AKT/CASP3 pathway by regulating m6A methylation,to exert a protective effect against peripheral nerve injury in a Parkinson's Disease(PD)mouse model.Methods:In this study,network pharmacology analysis and the molecular docking virtual screening technique was used to filter Acteoside(Act),a potential neuroprotective agent of active components in Cistanche tubulosa.A PD-related peripheral neuropathy mouse model was established by MPTP induction,followed by 21 days treatment of oral Act(25,50,and 100 mg kg^(−1)).Pole climbing,automatic avoidance ability and hot plate sensory tests were evaluated to determine behavioral changes caused by central and peripheral nerve injury.The pathological alterations of dorsal root ganglion tissue and the protein levels of IL-6,AKT,and CASP3 under Act intervention,as well as the dynamic changes of FTO,METTL3,and YTHDF2 which are closely related to m6A methylation,were comprehensively analyzed to observe the peripheral nerve protective efficacy of Act.Results:The results showed that peripheral neuropathy occurring with PD in the mouse model,which could be verified by behavioral tests and pathological histological changes.In addition to the previously established protective effect of Act on dopaminergic neurons in substantia nigra(SN),extensive follow-up studies demonstrated that Act effectively induced m6A methylation,which could further regulate the AKT/CASP3 pathway to play a therapeutic role.In this study,medium and high doses of Act played more obvious therapeutic roles.Conclusion:These findings suggest that Act may regulate the severity of peripheral nerve injury under the activation of the AKT/CASP3 signaling pathway by balancing the methylation level of m6A.These results provide a theoretical basis and experimental evidence for further research on the protective effect of Cistanche tubulosa on both the central and peripheral nerves in the treatment of PD.
基金National Natural Science Foundation of China,No.82074532,No.82374577,No.82305375,No.82305376,and No.82405567The Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD).
文摘BACKGROUND Peripheral neuropathy caused by diabetes is closely related to the vicious cycle of oxidative stress and mitochondrial dysfunction resulting from metabolic abnormalities.The effects mediated by the silent information regulator type 2 homolog-1(SIRT1)/peroxisome proliferator-activated receptor-gamma coactivator-1α(PGC-1α)axis present new opportunities for the treatment of type 2 diabetic peripheral neuropathy(T2DPN),potentially breaking this harmful cycle.AIM To validate the effectiveness of electroacupuncture(EA)in the treatment of T2DPN and investigate its potential mechanism based on the SIRT1/PGC-1αaxis.METHODS The effects of EA were evaluated through assessments of metabolic changes,morphological observations,and functional examinations of the sciatic nerve,along with measurements of inflammation and oxidative stress.Proteins related to the SIRT1/PGC-1αaxis,involved in the regulation of mitochondrial biogenesis and antioxidative stress,were detected in the sciatic nerve using Western blotting to explain the underlying mechanism.A counterevidence group was created by injecting a SIRT1 inhibitor during EA intervention to support the hypothesis.RESULTS In addition to diabetes-related metabolic changes,T2DPN rats showed significant reductions in pain threshold after 9 weeks,suggesting abnormal peripheral nerve function.EA treatment partially restored metabolic control and reduced nerve damage in T2DPN rats.The SIRT1/PGC-1αaxis,which was downregulated in the model group,was upregulated by EA intervention.The endogenous antioxidant system related to the SIRT1/PGC-1αaxis,previously inhibited in diabetic rats,was reactivated.A similar trend was observed in inflammatory markers.When SIRT1 was inhibited in diabetic rats,these beneficial effects were abolished.CONCLUSION EA can alleviate the symptoms of T2DNP in experimental rats,and its effects may be related to the mitochondrial biogenesis and endogenous antioxidant system mediated by the SIRT1/PGC-1αaxis.
文摘Objective To observe clinical therapeutic effects of warm needling and moxibustion on diabetic peripheral neuropathy （DPN） and their influence on nerve conduction velocity. Methods Fifty two cases were randomly divided into a treatment group （n =26） and a control group （n =26）. In addition to basic treatment for lowering blood sugar in both groups, Pǐshū （BL 20）, Shènshū （BL 23）, Huántiào （GB 30）, Zùsānlǐ （ST 36）, Yánglíngquán （GB 34）, Sānyīnjiāo （SP 6）, Tàixī （KI 3）, Qǔchí （LI 11）, Wàiguān （TE 5） and Hégǔ （LI 4） were selected for warm needling and moxibustion in the treatment group. Methycobal was intramuscularly injected in the control group. Clinical symptoms and conduction velocities of the tibial nerve and common peroneal nerve were compared before and after treatment. Results Warm needling and moxibustion could alleviate such clinical symptoms as numbness of limbs, pain and hypoesthesia, and obviously improve the conduction velocities of both tibial and common peroneal nerves. Conclusion Warm needling and moxibustion exhibit good therapeutic effects on diabetic peripheral neuropathy.
基金supported by the Scientific Research Grants from the Ministry of Education of China[No.005-383(6-144)]
文摘This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also investigated the factors associated with the development of s DPN and compared factors between the sD PN and confirmed DPN(cDPN). This cross-sectional study involved 240 T2DM patients who were successively admitted to the endocrinology wards of Wuhan Union Hospital over the period of January to December 2014. Data on the medical history, physical and laboratory examinations were collected. DPN was diagnosed using NCS. One-way ANOVA with least significant difference(LSD) analysis or chi-square tests was used to compare parameters among DNP-free, s DPN and c DPN patients. Independent factors associated with s DPN were determined using logistic regression. The results showed that 50.8% of the participants had DPN, and among them, 17.1% had sDPN. sDPN showed significant independent associations with age, height, HbA1c, presence of atherosclerosis and diabetic retinopathy. Patients with DPN differed significantly from those without DPN with respect to age, duration of disease(DOD), HbA1c, presence of atherosclerosis, diabetic retinopathy, nephropathy and hypertension. Patients with cDPN, relative to those with sDPN, had significantly longer DOD and higher prevalence of peripheral artery disease(PAD) and coronary artery disease(CAD). Our study suggests that a significant number of T2DM patients are affected by s DPN, and the development of this condition is associated with advanced age, tall stature, poor glycaemic control, presence of diabetic retinopathy and atherosclerosis. On the other hand, patients with cDPN tend to have a longer DOD and are more likely to suffer from PAD and CAD.
基金supported by the“GZ Hematologic Malignancy MARKER GHROMOS of Education Department of Liaoning Province”Grant(Grant Number:07102).
文摘Background:Bortezomib results in peripheral neuropathy(PN)in approximately 50%of patients,during multiple myeloma(MM)treatment,a complication known as Bortezomib-induced peripheral neuropathy(BIPN).The drug response varies among individuals.Genetic factor may play an important role in BIPN.Methods:A nextgeneration sequencing(NGS)panel containing 1659 targets from 233 genes was used to identify risk variants for developing BIPN in 204 MM patients who received bortezomib therapy.mRNA expression of MTHFR and ALDH1A1 in 62 peripheral blood samples was detected by real-time quantitative PCR(RT-qPCR).Serum homocysteine(Hcy)levels were detected in 40 samples by chemiluminescent microparticle immunoassay(CMIA).Results:Compared with the non-BIPN group(n=89),a total of 8 significantly associated single nucleotide polymorphisms(SNPs)were identified in the BIPN group(n=115):MTHFR(rs1801131,rs1801133,rs17421511),EPHX1(rs1051740),MME(rs2016848),ALDH1A1(rs6151031),HTR7(rs1935349)and CYP2A6(rs8192720).The mRNA expression level of MTHFR in newly diagnosed patients with peripheral neuritis after treatment(NP group)was lower than that of newly diagnosed patients without peripheral neuritis after treatment(NnP group)(1.70±0.77 vs.2.81±0.97,p=0.009).Serum Hcy levels were significantly higher in BIPN group than in non-BIPN group(11.66±1.79μmol/L vs.8.52±3.29μmol/L,p=0.016)and healthy controls(11.66±1.79μmol/L vs.8.55±2.13μmol/L,p≤0.001).Conclusion:CYP2A6,EPHX1,MTHFR,ALDH1A1,HTR7,MME and BIPN are linked in Chinese MM patients.BIPN is more likely to occur in patients with lower MTHFR mRNA expression,which might result in higher serum Hcy levels.
文摘<strong>Introduction:</strong> <span style="font-family:Verdana;">Oxaliplatin is a platinum-derivative chemotherapeutic agent used in digestive tumours, in the adjuvant and metastatic setting. Oxaliplatin can cause a chronic peripheral sensory neuropathy which impacts</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">the quality of life and is dose limiting. To date, no therapeutic strategies have proved effective in the treatment of oxaliplatin-induced peripheral neuropathy (OIPN). </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A computerized search of the literature on PubMed database was performed. Publisher original articles were included if they focused on treatment of peripheral neuropathy among patients submitted to oxaliplatin. Eleven out of 242 reviewed papers met our inclusion criteria and were subjected to a 19-item quality checklist. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The included studies differed with respect to study design, patient population and sample size, neuropathic symptoms assessment and efficacy measure. Most studies had an</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">adequate quality. Ten trials tested one drug, and one pilot study tested a non-pharmacological treatment</span><span style="font-family:Verdana;">—</span><span style="font-family:Verdana;">the neurofeedback. Of these, 3 trials included only patients submitted to oxaliplatin-based chemotherapy. Duloxetine showed moderate efficacy in 3 trials. Topical treatment with capsaicin or 10% amitriptyline was promisors in 2 single-arm trials with a </span><span style="font-family:Verdana;">few </span><span style="font-family:Verdana;">sample</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">In the last decade, there wasn</span></span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">t an improvement in the treatment of chronic OIPN. The duloxetine is the unique drug with moderate efficacy on the treatment of OIPN. There is insufficient evidence to support a recommendation for any other treatment.</span>
基金Supported by Chongqing Municipal Health and Family Planning Commission(medical scientific research project):2015 MSXM 082
文摘Objective To observe the clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy （ClPN）. Methods Ninety ClPN patients with breast cancer conforming to inclusive criteria were randomly divided into an acupuncture group （group A）, a mecobalamin group （group B） and an acupoint injection group （group C） according to random number table, with 30 cases in each group. In group A, acupuncture was conducted at bilateral Q0chi （I~ LI 11）, H6g6 （~ LI 4）, Z0s^nlT （~__~ ST 36）, S^nyinji^o （^-- ~ SP 6） and Xu^h~i （J~ SP 10）; in group B, intramuscular injection with I mL of mecobalamin injection was conducted; and in group C, acupoint selection was the same as group A, and 0.1 mL of mecobalamin injection was injected into each acupoint, respectively. The treatment was conducted once every three days in each group, and the changes of clinical efficacy, nerve electrophysiology and hemorrheology indicators after treatment for 10 times were observed. Result The total effective rate of group C was 93.1% （27/29）, which was higher than 78.6% （22/28） in group A and 83.3% （25/30） in group B, and the differences among three groups were statistically significant （all P〈0.01）; conduction velocity of lesion nerves was improved in group B and group C, the improvement in group C was obviously superior to the other two groups （all P〈0.01）, hemorrheology indicator was improved in group A and group C （both P〈0.05）. Conclusion The efficacy of acupoint injection with mecobalamin for breast cancer CIPN was significant, which can not only improve the nerve conduction velocity, but also improve the hemorrheology indicator.
文摘Objective: To observe the clinical efficacy and differences of the Zhuyu Juanbi formula delivered through ultrasound at Zusanli on patients with chemotherapy-induced peripheral neuropathy (CIPN) due to paclitaxel injection. Methods: A total of 72 breast cancer patients with CIPN were randomly divided into two groups. The treatment group (36 cases) was treated with oral methylcobalamin plus ultrasonic medicine permeating Zhuyu Juanbi formulae, while the control group (36 cases) was treated with oral methylcobalamin alone. Following two 2 cycles of continuous treatment, the efficacy of peripheral neurotoxicity, TCM syndrome score, FACT/GOG-Ntx score, total neuropathy score, and safety indicators of gynecological cancer patients were observed in the two groups. Result: In the treatment of CIPN, the addition of ultrasonic medicine permeating Zhuyu Juanbi formulae was more effective than oral methylcobalamin alone in reducing peripheral neurotoxicity and improving the quality of life of patients. The difference between the two groups was statistically significant (P < 0.05), and ultrasound drug penetration Zhuyu Juanbi formulae significantly reduced the FACT/ GOG-Ntx score and TNS score in the treatment group. In terms of drug safety, it rarely caused adverse reactions such as grade 3 and 4 leukopenia, and the safety profile was therefore good. Conclusion: The combination of ultrasonic medicine permeating Zhuyu Juanbi formulae and methylcobalamin has been demonstrated to be an effective treatment for peripheral neurotoxicity in patients with PIPN. It has been shown to significantly improve the clinical symptoms of PIPN patients, improve the quality of life of patients, and have a good safety profile.
