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
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 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
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
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
Diabetic gastrointestinal autonomic neuropathy(DGAN)is a common and debilitating complication of diabetes,characterized by autonomic dysfunction in the gastrointestinal system.The complex pathophysiology of DGAN invol...Diabetic gastrointestinal autonomic neuropathy(DGAN)is a common and debilitating complication of diabetes,characterized by autonomic dysfunction in the gastrointestinal system.The complex pathophysiology of DGAN involves neuronal injury that is intrinsically linked to gut dysbiosis.Multiple factors,including hyperglycemia,oxidative stress,and inflammation,significantly contribute to neuronal damage,manifesting as symptoms such as delayed gastric emptying,diarrhea,and constipation.Recent studies have demonstrated that patients with diabetes experience substantial alterations in gut microbiota composition,potentially exacerbating gastrointestinal symptoms.Microbial metabolites may modulate neurotransmitter synthesis and release,directly affecting autonomic nerve function,while dysbiosis amplifies oxidative stress and inflammation,further compromising the enteric nervous system and worsening DGAN.Advances in multi-omics technologies now provide deeper insights into molecular mechanisms of DGAN and its interactions with microbiota.Early diagnosis leveraging biomarkers,gut microbiota analysis,and advanced imaging promises more effective interventions.Emerging therapeutic strategies targeting oxidative stress,inflammation,and gut microbiota represent promising approaches for managing DGAN.Future research should focus on large-scale,multi-ethnic studies and therapies targeting specific microbial metabolites to refine diagnosis and treatment approaches.展开更多
Dear Editor,We present a case of vitreous amyloidosis in a patient who was previously confirmed as familial amyloidosis polyneuropathy(FAP)because of peripheral neuropathy symptom onset.Even though the patient had alr...Dear Editor,We present a case of vitreous amyloidosis in a patient who was previously confirmed as familial amyloidosis polyneuropathy(FAP)because of peripheral neuropathy symptom onset.Even though the patient had already undergone liver transplantation 5y prior,the extracellular deposition of amyloid in vitreous body greatly infected the patient’s visual function.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
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
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 Diabetic neuropathy(DN)is a progressive disorder with limited effective treatment options.AIM To identify potential therapeutic targets for DN by integrating plasma proteomic and transcriptomic data.METHODS...BACKGROUND Diabetic neuropathy(DN)is a progressive disorder with limited effective treatment options.AIM To identify potential therapeutic targets for DN by integrating plasma proteomic and transcriptomic data.METHODS A comprehensive analytical framework was developed to identify multi-omics biomarkers of DN.Protein-protein interaction network and Gene Ontology analyses were performed to explore the biological functions of biomarkers.Tier 1 target proteins were further analyzed.Candidate drug prediction and molecular docking studies were conducted to identify potential treatments while assessing the side effects of key target proteins.The mediation of immune cells in the association between proteins and DN was examined through two-step network Mendelian randomization(MR)analysis.RESULTS Nine DN-associated proteins were identified by analyzing protein quantitative trait loci from extensive genome-wide association study data.BTN3A1 and MICB were confirmed using MR,summary data-based MR,and colocalization analyses.Of the nine,HSPA1B,PSMB9,BTN3A1,SCGN,NOTUM,and MICB showed negative associations with DN,whereas WARS,BRD2,and CSNK2B were positive.Gene Ontology analysis indicated enrichment in inflammatory response and neuronal injury pathways.BTN3A1 and MICB were identified as Tier 1 targets.Drug prediction and molecular docking analyses indicated cyclosporin A as a potential therapeutic candidate.Two-step network MR analysis showed that MICB mediated DN through human leukocyte antigen-DR++monocytes.These integrated findings point to an immune-mediated mechanism with translational potential and nominate BTN3A1 and MICB for focused functional validation.CONCLUSION Our integrated multi-omics approach identified two promising therapeutic targets for DN,laying the groundwork for new treatment strategies and enhancing our understanding of MICB’s role in DN.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
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
AIM:To characterize the demographic and clinical features of ethambutol optic neuropathy(EON)in an Indonesian patient population and explore prognostic factors for visual recovery.METHODS:Retrospective study of 58 EON...AIM:To characterize the demographic and clinical features of ethambutol optic neuropathy(EON)in an Indonesian patient population and explore prognostic factors for visual recovery.METHODS:Retrospective study of 58 EON patients at an Indonesian eye center(2017-2022).Demographics,ethambutol treatment,ophthalmologic findings were collected.Visual outcomes after ethambutol cessation assessed at 3-12mo.Patients categorized as having visual improvement(≥2 Snellen lines and/or>5°visual field gain)or no improvement.RESULTS:Mean age was 55.5±12.9y,with 56.9%females.Median duration of ethambutol use was 9mo(range:2-20)at a mean daily dose of 19.7±5.3 mg/kg.At presentation,mean visual acuity was 1.3 logMAR(range:0-2.5),with normal fundus appearance in 72.4%of eyes.The most common visual field defect was generalized depression(52.4%).After ethambutol cessation,56.9%of patients had visual improvement.Younger age(50.24±13.8y vs 62.14±8.9y,P<0.01),lower ethambutol dose(17.3±5 vs 23.3±2.9 mg/kg‧d,P<0.01),shorter treatment duration(6.79±2.6mo vs 10.27±1.2mo,P<0.01),and absence of hypertension(16%vs 83%,P=0.012)or kidney disease(0 vs 83%,P<0.01)were associated with higher likelihood of visual improvement.Diabetes did not differ between groups(P=0.889).CONCLUSION:Over half experience visual recovery after ethambutol cessation.Younger age,lower cumulative dose,absence of hypertension or kidney disease predict better visual outcomes.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
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
AIM:To demonstrate the imaging findings of nonarteritic anterior ischemic optic neuropathy(NAION)using highresolution magnetic resonance imaging(MRI)sequences.METHODS:A retrospective review of 4y of medical records an...AIM:To demonstrate the imaging findings of nonarteritic anterior ischemic optic neuropathy(NAION)using highresolution magnetic resonance imaging(MRI)sequences.METHODS:A retrospective review of 4y of medical records and MRIs of nine patients suspected of having NAION who underwent orbit protocol MRI was conducted.The orbit MRI protocol included high-resolution three-dimensional(3D)T2-weighted imaging(HR 3D T2WI),high-resolution 3D contrast-enhanced T1-weighted imaging(HR-CE 3D T1WI),and high-resolution 3D T2-fluid-attenuated inversion recovery imaging(HR-CE 3D T2-FLAIR)and diffusionweighted imaging,if applicable.To rule out other causes of optic neuropathy such as inflammatory optic neuritis,we evaluated the presence of optic disc swelling,contrast enhancement at the optic disc,and other abnormal findings on these sequences.RESULTS:Among the 715 patients,9 were diagnosed with NAION.The median age of the patients was 62y(range,46–79y),and five patients(56%)were men.Two of these patients demonstrated optic disc swelling on HR 3D T2WI and focal contrast enhancement on HR-CE 3D T1WI.Eight patients showed focal contrast enhancement on HR-CE 3D T2-FLAIR imaging.Among these patients,five showed a focal contrast enhancement only on HR-CE 3D T2-FLAIR imaging.The most frequent location of the focal contrast enhancement was the superomedial(n=5,56%)followed by the medial(n=2,22%)and central(n=2,22%),and superior(n=1)aspects.In all three patients for whom diffusionweighted imaging was available,there was no evidence of diffusion restriction in the optic disc.CONCLUSION:This study demonstrates the imaging finding of NAION using high-resolution MRI sequences.HR-CE T2-FLAIR imaging is particularly useful in detecting NAION when combined with other high-resolution MRI sequences.It can provide additional insights into the pathophysiology of NAION,which may aid in obtaining an appropriate diagnosis and follow-up.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
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.
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 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.
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.
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.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY23H050005Zhejiang Medical Technology Project,No.2022RC009,No.2023XY238,and No.2024KY645.
文摘Diabetic gastrointestinal autonomic neuropathy(DGAN)is a common and debilitating complication of diabetes,characterized by autonomic dysfunction in the gastrointestinal system.The complex pathophysiology of DGAN involves neuronal injury that is intrinsically linked to gut dysbiosis.Multiple factors,including hyperglycemia,oxidative stress,and inflammation,significantly contribute to neuronal damage,manifesting as symptoms such as delayed gastric emptying,diarrhea,and constipation.Recent studies have demonstrated that patients with diabetes experience substantial alterations in gut microbiota composition,potentially exacerbating gastrointestinal symptoms.Microbial metabolites may modulate neurotransmitter synthesis and release,directly affecting autonomic nerve function,while dysbiosis amplifies oxidative stress and inflammation,further compromising the enteric nervous system and worsening DGAN.Advances in multi-omics technologies now provide deeper insights into molecular mechanisms of DGAN and its interactions with microbiota.Early diagnosis leveraging biomarkers,gut microbiota analysis,and advanced imaging promises more effective interventions.Emerging therapeutic strategies targeting oxidative stress,inflammation,and gut microbiota represent promising approaches for managing DGAN.Future research should focus on large-scale,multi-ethnic studies and therapies targeting specific microbial metabolites to refine diagnosis and treatment approaches.
文摘Dear Editor,We present a case of vitreous amyloidosis in a patient who was previously confirmed as familial amyloidosis polyneuropathy(FAP)because of peripheral neuropathy symptom onset.Even though the patient had already undergone liver transplantation 5y prior,the extracellular deposition of amyloid in vitreous body greatly infected the patient’s visual function.
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 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.
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 the Key Project of the Affiliated Hospital of North Sichuan Medical College,No.2023ZD008the Project of the Doctoral Initiation Fund,No.2023GC002+3 种基金Scientific Research and Development Program Project,No.2024PTZK008Sichuan Province Clinical Key Specialty Construction Project,No.2023GZZKP002Science and Technology Project of Nanchong,No.22SXQT0364Research Development Plan Project of Affiliated Hospital of North Sichuan Medical College,No.2024MPZK003.
文摘BACKGROUND Diabetic neuropathy(DN)is a progressive disorder with limited effective treatment options.AIM To identify potential therapeutic targets for DN by integrating plasma proteomic and transcriptomic data.METHODS A comprehensive analytical framework was developed to identify multi-omics biomarkers of DN.Protein-protein interaction network and Gene Ontology analyses were performed to explore the biological functions of biomarkers.Tier 1 target proteins were further analyzed.Candidate drug prediction and molecular docking studies were conducted to identify potential treatments while assessing the side effects of key target proteins.The mediation of immune cells in the association between proteins and DN was examined through two-step network Mendelian randomization(MR)analysis.RESULTS Nine DN-associated proteins were identified by analyzing protein quantitative trait loci from extensive genome-wide association study data.BTN3A1 and MICB were confirmed using MR,summary data-based MR,and colocalization analyses.Of the nine,HSPA1B,PSMB9,BTN3A1,SCGN,NOTUM,and MICB showed negative associations with DN,whereas WARS,BRD2,and CSNK2B were positive.Gene Ontology analysis indicated enrichment in inflammatory response and neuronal injury pathways.BTN3A1 and MICB were identified as Tier 1 targets.Drug prediction and molecular docking analyses indicated cyclosporin A as a potential therapeutic candidate.Two-step network MR analysis showed that MICB mediated DN through human leukocyte antigen-DR++monocytes.These integrated findings point to an immune-mediated mechanism with translational potential and nominate BTN3A1 and MICB for focused functional validation.CONCLUSION Our integrated multi-omics approach identified two promising therapeutic targets for DN,laying the groundwork for new treatment strategies and enhancing our understanding of MICB’s role in DN.
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AIM:To characterize the demographic and clinical features of ethambutol optic neuropathy(EON)in an Indonesian patient population and explore prognostic factors for visual recovery.METHODS:Retrospective study of 58 EON patients at an Indonesian eye center(2017-2022).Demographics,ethambutol treatment,ophthalmologic findings were collected.Visual outcomes after ethambutol cessation assessed at 3-12mo.Patients categorized as having visual improvement(≥2 Snellen lines and/or>5°visual field gain)or no improvement.RESULTS:Mean age was 55.5±12.9y,with 56.9%females.Median duration of ethambutol use was 9mo(range:2-20)at a mean daily dose of 19.7±5.3 mg/kg.At presentation,mean visual acuity was 1.3 logMAR(range:0-2.5),with normal fundus appearance in 72.4%of eyes.The most common visual field defect was generalized depression(52.4%).After ethambutol cessation,56.9%of patients had visual improvement.Younger age(50.24±13.8y vs 62.14±8.9y,P<0.01),lower ethambutol dose(17.3±5 vs 23.3±2.9 mg/kg‧d,P<0.01),shorter treatment duration(6.79±2.6mo vs 10.27±1.2mo,P<0.01),and absence of hypertension(16%vs 83%,P=0.012)or kidney disease(0 vs 83%,P<0.01)were associated with higher likelihood of visual improvement.Diabetes did not differ between groups(P=0.889).CONCLUSION:Over half experience visual recovery after ethambutol cessation.Younger age,lower cumulative dose,absence of hypertension or kidney disease predict better visual outcomes.
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AIM:To demonstrate the imaging findings of nonarteritic anterior ischemic optic neuropathy(NAION)using highresolution magnetic resonance imaging(MRI)sequences.METHODS:A retrospective review of 4y of medical records and MRIs of nine patients suspected of having NAION who underwent orbit protocol MRI was conducted.The orbit MRI protocol included high-resolution three-dimensional(3D)T2-weighted imaging(HR 3D T2WI),high-resolution 3D contrast-enhanced T1-weighted imaging(HR-CE 3D T1WI),and high-resolution 3D T2-fluid-attenuated inversion recovery imaging(HR-CE 3D T2-FLAIR)and diffusionweighted imaging,if applicable.To rule out other causes of optic neuropathy such as inflammatory optic neuritis,we evaluated the presence of optic disc swelling,contrast enhancement at the optic disc,and other abnormal findings on these sequences.RESULTS:Among the 715 patients,9 were diagnosed with NAION.The median age of the patients was 62y(range,46–79y),and five patients(56%)were men.Two of these patients demonstrated optic disc swelling on HR 3D T2WI and focal contrast enhancement on HR-CE 3D T1WI.Eight patients showed focal contrast enhancement on HR-CE 3D T2-FLAIR imaging.Among these patients,five showed a focal contrast enhancement only on HR-CE 3D T2-FLAIR imaging.The most frequent location of the focal contrast enhancement was the superomedial(n=5,56%)followed by the medial(n=2,22%)and central(n=2,22%),and superior(n=1)aspects.In all three patients for whom diffusionweighted imaging was available,there was no evidence of diffusion restriction in the optic disc.CONCLUSION:This study demonstrates the imaging finding of NAION using high-resolution MRI sequences.HR-CE T2-FLAIR imaging is particularly useful in detecting NAION when combined with other high-resolution MRI sequences.It can provide additional insights into the pathophysiology of NAION,which may aid in obtaining an appropriate diagnosis and follow-up.
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.
