Diabetic peripheral neuropathy is a common complication of diabetes mellitus.Elucidating the pathophysiological metabolic mechanism impels the generation of ideal therapies.However,existing limited treatments for diab...Diabetic peripheral neuropathy is a common complication of diabetes mellitus.Elucidating the pathophysiological metabolic mechanism impels the generation of ideal therapies.However,existing limited treatments for diabetic peripheral neuropathy expose the urgent need for cell metabolism research.Given the lack of comprehensive understanding of energy metabolism changes and related signaling pathways in diabetic peripheral neuropathy,it is essential to explore energy changes and metabolic changes in diabetic peripheral neuropathy to develop suitable treatment methods.This review summarizes the pathophysiological mechanism of diabetic peripheral neuropathy from the perspective of cellular metabolism and the specific interventions for different metabolic pathways to develop effective treatment methods.Various metabolic mechanisms(e.g.,polyol,hexosamine,protein kinase C pathway)are associated with diabetic peripheral neuropathy,and researchers are looking for more effective treatments through these pathways.展开更多
BACKGROUND Diabetic peripheral neuropathy(DPN)is a debilitating complication of diabetes mellitus with limited available treatment options.Radix Salviae,a traditional Chinese herb,has shown promise in treating DPN,but...BACKGROUND Diabetic peripheral neuropathy(DPN)is a debilitating complication of diabetes mellitus with limited available treatment options.Radix Salviae,a traditional Chinese herb,has shown promise in treating DPN,but its therapeutic mech-anisms have not been systematically investigated.AIM Radix Salviae(Danshen in pinin),a traditional Chinese medicine(TCM),is widely used to treat DPN in China.However,the mechanism through which Radix Salviae treats DPN remains unclear.Therefore,we aimed to explore the mechanism of action of Radix Salviae against DPN using network pharmacology.METHODS The active ingredients and target genes of Radix Salviae were screened using the TCM pharmacology database and analysis platform.The genes associated with DPN were obtained from the Gene Cards and OMIM databases,a drug-com-position-target-disease network was constructed,and a protein–protein inter-action network was subsequently constructed to screen the main targets.Gene Ontology(GO)functional annotation and pathway enrichment analysis were performed via the Kyoto Encyclopedia of Genes and Genomes(KEGG)using Bioconductor.RESULTS A total of 56 effective components,108 targets and 4581 DPN-related target genes of Radix Salviae were screened.Intervention with Radix Salviae for DPN mainly involved 81 target genes.The top 30 major targets were selected for enrichment analysis of GO and KEGG pathways.CONCLUSION These results suggested that Radix Salviae could treat DPN by regulating the AGE-RAGE signaling pathway and the PI3K-Akt signaling pathway.Therefore,Danshen may affect DPN by regulating inflammation and apoptosis.展开更多
Circular RNAs(circRNAs)play a vital role in diabetic peripheral neuropathy.However,their expression and function in Schwann cells in individuals with diabetic peripheral neuropathy remain poorly understood.Here,we per...Circular RNAs(circRNAs)play a vital role in diabetic peripheral neuropathy.However,their expression and function in Schwann cells in individuals with diabetic peripheral neuropathy remain poorly understood.Here,we performed protein profiling and circRNA sequencing of sural nerves in patients with diabetic peripheral neuropathy and controls.Protein profiling revealed 265 differentially expressed proteins in the diabetic peripheral neuropathy group.Gene Ontology indicated that differentially expressed proteins were mainly enriched in myelination and mitochondrial oxidative phosphorylation.A real-time polymerase chain reaction assay performed to validate the circRNA sequencing results yielded 11 differentially expressed circRNAs.circ_0002538 was markedly downregulated in patients with diabetic peripheral neuropathy.Further in vitro experiments showed that overexpression of circ_0002538 promoted the migration of Schwann cells by upregulating plasmolipin(PLLP)expression.Moreover,overexpression of circ_0002538 in the sciatic nerve in a streptozotocin-induced mouse model of diabetic peripheral neuropathy alleviated demyelination and improved sciatic nerve function.The results of a mechanistic experiment showed that circ_0002538 promotes PLLP expression by sponging miR-138-5p,while a lack of circ_0002538 led to a PLLP deficiency that further suppressed Schwann cell migration.These findings suggest that the circ_0002538/miR-138-5p/PLLP axis can promote the migration of Schwann cells in diabetic peripheral neuropathy patients,improving myelin sheath structure and nerve function.Thus,this axis is a potential target for therapeutic treatment of diabetic peripheral neuropathy.展开更多
Diabetic peripheral neuropathy(DPN)is a common chronic complication of diabetes mellitus.One of the most common types is distal symmetric polyneuropathy,which begins as bilateral symmetry pain and hyperesthesia and gr...Diabetic peripheral neuropathy(DPN)is a common chronic complication of diabetes mellitus.One of the most common types is distal symmetric polyneuropathy,which begins as bilateral symmetry pain and hyperesthesia and gradually progresses into hypoesthesia with nerve fibre disorder and is frequently accompanied by depression and anxiety.Notably,more than half of patients with DPN can be asymptomatic,which tends to delay early detection.Furthermore,the study of adverse outcomes showed that DPN is a prominent risk factor for foot ulceration,gangrene and nontraumatic amputation,which decreases quality of life.Thus,it is essential to develop convenient diagnostic biomarkers with high sensitivity for screening and early intervention.It has been reported that there may be common pathways for microvascular and macrovascular complications of diabetes.The pathogenesis of both disorders involves vascular endothelial dysfunction.Emerging evidence indicates that traditional and novel cardiovascularrelated biomarkers have the potential to characterize patients by subclinical disease status and improve risk prediction.Additionally,beyond traditional cardiovascular-related biomarkers,novel cardiovascular-related biomarkers have been linked to diabetes and its complications.In this review,we evaluate the association between major traditional and nontraditional car-diovascular-related biomarkers of DPN,such as cardiac troponin T,B-type natriuretic peptide,Creactive protein,myeloperoxidase,and homocysteine,and assess the evidence for early risk factor-based management strategies to reduce the incidence and slow the progression of DPN.展开更多
BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of diabetes mellitus and can lead to serious complications.Therapeutic strategies for pain control are available but there are few approaches that...BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of diabetes mellitus and can lead to serious complications.Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness.AIM To investigate the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN.METHODS The acupuncture in DPN(ACUDPN)study was a two-armed,randomized,controlled,parallel group,open,multicenter clinical trial.Patients were randomized in a 1:1 ratio into two groups:The acupuncture group received 12 acupuncture treatments over 8 wk,and the control group was on a waiting list during the first 16 wk,before it received the same treatment as the other group.Both groups received routine care.Outcome parameters were evaluated after 8,16 and 24 wk and included neurological scores,such as an 11-point numeric rating scale(NRS)11 for hypesthesia,neuropathic pain symptom inventory(NPSI),neuropathy deficit score(NDS),neuropathy symptom score(NSS);nerve conduction studies(NCS)were assessed with a handheld point-of-care device.RESULTSSixty-two participants were included.The NRS for numbness showed a difference of 2.3(P<0.001)in favor of theacupuncture group,the effect persisted until week 16 with a difference of 2.2(P<0.001)between groups and 1.8points at week 24 compared to baseline.The NPSI was improved in the acupuncture group by 12.6 points(P<0.001)at week 8,the NSS score at week 8 with a difference of 1.3(P<0.001);the NDS and the TNSc score improvedfor the acupuncture group in week 8,with a difference of 2.0 points(P<0.001)compared to the control group.Effects were persistent in week 16 with a difference of 1.8 points(P<0.05).The NCS showed no meaningfulchanges.In both groups only minor side effects were reported.CONCLUSION Study results suggest that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reductionin neurological deficits.No serious adverse events were recorded and the adherence to treatment was high.Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirmthe results.展开更多
Objectives:To discuss the mechanism of Sheng Yang San Huo decoction on diabetic peripheral neuropathy using the network pharmacology method.Methods:The BATMAN-TCM database,TCM-ID database,Chinese Natural Product Chemi...Objectives:To discuss the mechanism of Sheng Yang San Huo decoction on diabetic peripheral neuropathy using the network pharmacology method.Methods:The BATMAN-TCM database,TCM-ID database,Chinese Natural Product Chemical Composition Database,and TCMIP database were employed to screen the chemical active ingredients of each herb in Sheng Yang San Huo decoction based on the“Libinsky Drug Rules”.SwissTargetPrediction was used to screen effective action targets for each herb in the prescription.Additionally,Cytoscape 3.7.0 was utilized to construct a“drug-target”network.GeneCards,OMIM,and MaLaCards databases were utilized to gather targets related to diabetic peripheral neuropathy.VENNY 2.1 online platform was employed to match drug and disease targets,draw a Venn diagram,and construct a“drug-active compounds-common target”network using Cytoscape 3.7.0.gene ontology biological process analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis for the targets were conducted using the DAVID 6.8 database.Enrichment analysis results were visualized using the OmicShareTool online platform.Molecular docking was performed using CB-Dock2.Results:Following screening,a total of 217 active compounds and 132 potential targets were identified in Sheng Yang San Huo decoction.The effects are primarily enriched in pathways such as Lipid and Atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,and the IL-17 signaling pathway.The binding energy of the key active ingredients to the core protein targets of DPN was favorable.Conclusion:The study reveals the characteristics of multiple targets and pathways of Sheng Yang San Huo decoction,providing new insights for the clinical application of this prescription.展开更多
Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropath...Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.展开更多
Objective:This study aims to evaluate the reliability and validity of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy(PDPN).Methods:One hundred patients with PDPN a...Objective:This study aims to evaluate the reliability and validity of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy(PDPN).Methods:One hundred patients with PDPN and 70 patients with non-neuropathic pain were recruited from five grade III general hospitals in Guangzhou.Pain was assessed using the Leeds Assessment of Neuropathic Symptoms and Signs(LANSS),Douleur Neuropathique 4 questionnaire(DN4),and Brief Pain Inventory for Painful Diabetic Peripheral Neuropathy(BPI-DPN).Reliability was evaluated by internal consistency of the Cronbach's a coefficient and Guttman split-half.Construct validity was analyzed by factor analysis and Spearman correlation coefficients.Sensitivity and specificity were also assessed.Results:The Cronbach's a coefficients of the LANSS,DN4,and BPI-DPN were 0.735,0.750,and 0.898,respectively.The Guttman split-half coefficients of the LANSS,DN4,and BPIDPN were 0.660,0.726,and 0.849,respectively.The cumulative contributions of the LANSS,DN4,and BPI-DPN to the total variance were 61.945%,57.010%,and 66.056%,respectively.The items of the LANSS,DN4,and BPI-DPN presented high factorial loads,ranging from 0.387 to 0.841,0.137 to 0.948,and 0.487 to 0.953,respectively.The LANSS and DN4 exhibited sensitivities of 58.0%and 82.7%,respectively,and specificity of 97.1%.Conclusions:The LANSS or DN4 can be used to detect neuropathic pain in Chinese patients with PDPN.The BPI-DPN can be employed to monitor the effectiveness of pain intervention.展开更多
Diabetic peripheral neuropathy(DPN)was the most common complications of elderly diabetic,which could contribute to an increased risk of falling.Despite the increased prevalence of elderly diabetic,high risk of falls a...Diabetic peripheral neuropathy(DPN)was the most common complications of elderly diabetic,which could contribute to an increased risk of falling.Despite the increased prevalence of elderly diabetic,high risk of falls and serious consequences of falls in elderly with DPN,It is necessary to adopt means of reducing the risk of falls in elderly with DPN.Impaired balance in the elderly with DPN was the most important risk factor of increasing falls.This review will introduce the epidemiology of falls in elderly with DPN,analysis the reasons for high risk of falls in elderly with DPN,provide a review of the development of balance training in the intervention of fall risk in elderly with DPN and offer recommendations to medical personnels on how to provide an efficient balance training for elderly with DPN.展开更多
BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regul...BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regulation and redox homeostasis.However,the association between serum Sestrin2 and DPN is unknown.AIM To explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus(T2DM).METHODS A total of 96 T2DM patients and 39 healthy volunteers,matched by age and sex,participated in this cross-sectional study.Clinical features and metabolic indices were identified.Serum Sestrin2 was measured by ELISA.The association between Sestrin2 and DPN was studied.Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTS The 96 patients with T2DM were divided into DPN(n=47)and patients without DPN(n=49).Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined[9.10(5.41-13.53)ng/mL vs 12.75(7.44-23.80)ng/mL,P<0.01].T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers[14.58(7.93-26.62)ng/mL vs 9.10(5.41-13.53)ng/mL,P<0.01].However,T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN[9.86(6.72-21.71)ng/mL vs 14.58(7.93-26.62)ng/mL,respectively,P<0.01].Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index(r=0.672,P=0.000),hemoglobin A1c(HbA1c)(r=0.292,P=0.000),serum creatinine(r=0.206,P=0.016),triglycerides(r=0.731,P=0.000),and fasting glucose(r=0.202,P=0.040),and negatively associated with estimated glomerular filtration rate(r=-0.230,P=0.007).After adjustment for sex,age,HbA1c,and diabetes duration,multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels(P=0.000).Logistic regression analyses indicated that Sestrin2,diabetes duration,and high-density lipoprotein were strongly associated with DPN(odds ratio=0.855,1.411,and 0.041,respectively).CONCLUSION Our results show Sestrin2 is decreased in T2DM patients with DNP.As lower Sestrin2 is independently associated with DPN,Sestrin2 may contribute to progression of DPN in T2DM patients.展开更多
Objective:The objective of this study is to investigate the effect of mild moxibustion on quality of life of patients with type 2 diabetic peripheral neuropathy(DPN).Materials and Methods:Fifty‑five patients with type...Objective:The objective of this study is to investigate the effect of mild moxibustion on quality of life of patients with type 2 diabetic peripheral neuropathy(DPN).Materials and Methods:Fifty‑five patients with type 2 DPN from October 2018 to July 2019 were recruited in the present study and randomly divided into two groups:27 cases in the control group and 28 cases in the intervention group.The control group received routine treatment of hypoglycemic,hypotensive,mecobalamin nutritional nerve,while the intervention group received mild moxibustion on the basis of the control group.The course of treatment for both groups was 10 weeks.The quality of life of the two groups was assessed using short form‑36 health survey and compared with t‑test at 0.05 significance level.Results:The total score of the short form‑36 in the intervention group was higher than the control group(P<0.05);the scores of bodily pain,physical functioning(PF),general health(GH),and mental health dimensions in the intervention group increased significantly compared with the control group(P<0.05);the scores of role physical,social functioning(SF),vitality,and role‑emotional(RE)dimensions showed no between‑group difference(P>0.05).Conclusion:Mild moxibustion can effectively improve the quality of life of patients with type 2 DPN,relieve patient pain symptoms,and improve PF and GH.展开更多
Objective:This study aimed to evaluate the effector mechanism of Yiqi Tongluo soup in alleviating diabetic peripheral neuropathy.Methods:Thirty male SD rats were divided into the control group,mode1 group,and Yiqi Ton...Objective:This study aimed to evaluate the effector mechanism of Yiqi Tongluo soup in alleviating diabetic peripheral neuropathy.Methods:Thirty male SD rats were divided into the control group,mode1 group,and Yiqi Tongluo group.Each group consists of 10 rats.Except for the normal group,a high-sugar and high-fat diet combined with streptozocin injection were administered to the groups to constnuct the type 2 diabetes mellitus model.Then,6.48 g/kg of Yiqi Tongluo soup was administered to the Yiqi Tongluo group every day by gavage.An equal volume of physiological saline was administered to the control and model groups every day by gavage.During the experiment,changes in blood glucose and nerve conduction velocity were monitored in all groups.After the experiment,hematoxylin and eosin and luxol fast blue staining were carried out,and morphological changes in the sciatic nerve and myelin sheath in all groups were observed.Western blot was used to observe changes in expression levels of autophagy related proteins,Beclin-1,LC3,and P62.Results:Blood glucose significantly increased,and nerve conduction velocity significantly decreased in the model group.Yiqi Tongluo soup significantly decreased blood glucose level while simultaneously increasing nerve conduction velocity.Hematoxylin and eosin and luxol fast blue myelin sheath staining results showed that Yiqi Tongluo soup could improve sciatic nerve disorder,irregular myelin sheath morphology,and demyelination in type 2 diabetes mellitus rats.Western blot results showed that Beclin-1 and LC3I/LC3I expression levels in the model group significantly decreased,while P62 level significantly increased.Compared with the model group,Beclin-1 and LC3II/LC3I expression levels significantly increased and P62 levels significantly decreased in the Yiqi Tongluo group.Conclusion:Yiqi Tongluo soup can inhibit diabetic peripheral neuropathy by increasing autophagy.展开更多
Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clin...Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The composition ratio of internal echo reduction and ambiguity in the observation group after three nerve treatments was significantly lower than that in the control group after treatment(P<0.05).In the correlation analysis,the three kinds of nerve CSA before and after treatment were negatively correlated with SCV and amplitude(P<0.05),and positively correlated with latency(P<0.05).Conclusion:The combination ofα-lipoic acid and Chinese medicine encapsulation technology has a good effect on the treatment and repair of DPN nerve damage,and can be routinely applied in clinical treatment.High-frequency ultrasound can intuitively observe changes in peripheral nerves and can be used to evaluate the prognosis of DPN.展开更多
Background:Diabetic peripheral neuropathy(DPN)is one of the most common complications of diabetes mellitus.Impaired neurological function is one of the main characteristics of DPN and is strongly associated with the i...Background:Diabetic peripheral neuropathy(DPN)is one of the most common complications of diabetes mellitus.Impaired neurological function is one of the main characteristics of DPN and is strongly associated with the inflammatory response.Our previous studies have confirmed that pestle needle can improve the nerve function of patients with DPN.But the mechanism of pestle needle treatment of DPN is still unclear.Methods:A total of 70 DPN patients who met the inclusion criteria were randomly divided into two groups.Control group(CG)(n=35)received DPN conventional treatment and the pestle needle group(PNG)(n=35)received pestle needle therapy at Zhiyang(DU09)eight array,Mingmen(DU04)eight array and Heche Road(from Mingmen(DU04)to Changqiang(DU01)),Zusanli(ST36),Sanyinjiao(SP06),Taixi(KI03)and Yongquan(KI01).Patients in the PNG group were required to take this treatment for 4 weeks,5 times a week.Examination indexes were collected before and after treatment,respectively.Nerve function was examined using the Toronto clinical scoring system and nerve conduction velocity detection.Serum inflammatory factors were measured by enzyme linked immunosorbent assay.Results:The Toronto clinical scoring system was significantly reduced in the PNG compared with the CG after treatment.The sensory nerve conduction velocity and motor nerve conduction velocity of the right peroneal and median nerves were significantly faster in the PNG than those in the CG(P<0.05).After treatment,serum interleukin-1 beta,interleukin-6 and tumor necrosis factor-alpha levels decreased in both groups,and the improvement of PNG was better than CG(P<0.05).Conclusion:The pestle needle can significantly improve the symptoms and nerve conduction velocity of DPN,and its mechanism may be related to the reduction of inflammatory factors.展开更多
Objective:To assess the effectiveness and safety of electroacupuncture for the treatment of diabetic peripheral neuropathy(DPN).Clinical studies in China have shown the beneficial effect of electroacupuncture compared...Objective:To assess the effectiveness and safety of electroacupuncture for the treatment of diabetic peripheral neuropathy(DPN).Clinical studies in China have shown the beneficial effect of electroacupuncture compared with conventional medicine.However,the effectiveness of electroacupuncture has not been well acknowledged internationally.Methods:We searched the following databases from their inception through February 2016:MEDLINE,the Cochrane Central Register of Controlled Trials(April,2015),SinoMed,China National Knowledge Infrastructure,VIP,Wanfang Database,Chinese Important Conference Papers Database,and the Chinese Dissertation Database.Randomized controlled trials(RCTs)were included if they compared electroacupuncture to conventional medicine,placebo,or no treatment on DPN patients.RevMan 5.3 software was used for data analysis,with effect estimate presented as relative risk(RR)and mean difference(MD)with a 95%confidence interval(CI).Results:Eleven RCTs involving 837 participants were included.The methodological quality of included RCTs was generally poor in terms of sequence generation,allocation concealment,blinding,incomplete outcome data,and selective outcome reporting.Meta-analysis showed that electroacupuncture had a better effect on global symptom improvement than methylcobalamin(RR Z 1.29;95%CI:1.14e1.46)and vitamin B(RR Z 1.60;95%CI:1.33e1.94).Only two RCTs reported adverse events.展开更多
Objective:To evaluate the clinical efficacy of combined/single use of Taohong Siwu decoction in the treatment for diabetic peripheral neuropathy(DPN)by meta-analysis.Methods:Database were searched electronically from ...Objective:To evaluate the clinical efficacy of combined/single use of Taohong Siwu decoction in the treatment for diabetic peripheral neuropathy(DPN)by meta-analysis.Methods:Database were searched electronically from the time databases established to November 2020 to collect randomized controlled trials of Taohong Siwu decoction combined with non-specific therapy for DPN in Chinese or English.The trial was assessed by 2 researchers independently,RevMan 5.3 software was used for meta-analysis.Results:A total of 13 studies included 970 patients.Meta-analysis showed that the combined/single use of Taohong Siwu decoction can further improve median sensory nerve velocity〔MD=4.86,95%CI(2.70,7.03),P<0.00001〕,and the curative effect〔OR=4.35,95%CI(3.1,6.06),P<0.00001〕,increase the velocity of the motor nerve〔MD=6.84,95%CI(6.14,7.55),P<0.00001〕,and the velocity of the sensory nerve〔MD=7.46,95%CI(5.84,9.08),P<0.00001〕,decrease TCM syndrome score〔MD=-5.61,95%CI(-6.63,-4.60),P<0.00001〕,and fasting blood-glucose〔MD=-0.24,95%CI(-0.37,-0.11),P<0.00001〕.The GRADE showed B level of evidence.Conclusion:Combined/single use of Taohong Siwu decoction in the treatment for DPN is effective.The safety is not clear,and more high-quality clinical studies are expected to be included to provide evidence support.展开更多
Western medicine mainly focuses on the conventional basic treatment of Diabetic peripheral neuropathy(DPN),such as blood glucose control,anti-oxidative stress,and nerve nutrition,but the efficacy and safety of the dru...Western medicine mainly focuses on the conventional basic treatment of Diabetic peripheral neuropathy(DPN),such as blood glucose control,anti-oxidative stress,and nerve nutrition,but the efficacy and safety of the drugs cannot be guaranteed.As an important prescription for promoting blood circulation,removing blood stasis and nourishing blood,Taohong Siwu Decoction can not only promote cell proliferation and repair,reduce inflammatory factors in the blood,reduce the whole blood viscosity and plasma viscosity,and has a good anticoagulation effect.Moreover,Taohong Siwu Decoction and its added or subtracted prescription,foot bath and combined acupuncture have the effect of regulating blood sugar,improving nerve conduction velocity and relieving clinical symptoms,without obvious adverse reactions.This article reviews Taohong Siwu Decoction and its addition and subtraction in the treatment of diabetic peripheral neuropathy.展开更多
Objective:To investigate the effect of pestle needle treatment on Nrf2 pathway and the relationship with oxidative stress in diabetic peripheral neuropathy.Methods:Patients with DPN who met the inclusion criteria were...Objective:To investigate the effect of pestle needle treatment on Nrf2 pathway and the relationship with oxidative stress in diabetic peripheral neuropathy.Methods:Patients with DPN who met the inclusion criteria were randomly divided into control and test groups with 30 patients in each group in a 1:1 allocation ratio.Both groups were given basic treatment,and the pestle group was treated with needle pestle therapy 5 times a week for a total of 4 weeks of intervention.Serum SOD and GSH PX levels were examined by colorimetry before and after intervention;Serum Keap1/Nrf2/ARE signaling pathway related factors expression levels were measured by ELISA;Keap1 and Nrf2 mRNA expression was determined by RT-PCR.Results:Compared with the control group,SOD and GSH-Px in the test group were significantly increased,Keap1 expression was decreased,Nrf2 expression was increased,Keap1 mRNA expression was significantly decreased,and Nrf2 mRNA expression was significantly increased.Conclusions:the pestle needle may enhance the body's antioxidant capacity by modulating the Keap1/Nrf2/ARE signaling pathway to enhance the production of its downstream antioxidant enzymes SOD and GSH Px,thereby protecting and repairing the damaged peripheral nerves in DPN patients.展开更多
BACKGROUND: Ceramide galactosyltransferase (CGT) protein and mRNA expression defect can cause the abnormal morphology and slowing conduction velocity of peripheral nerve. Morphologic change and functional disorder of ...BACKGROUND: Ceramide galactosyltransferase (CGT) protein and mRNA expression defect can cause the abnormal morphology and slowing conduction velocity of peripheral nerve. Morphologic change and functional disorder of myelin sheath and axon appear when diabetic peripheral neuropathy (DPN) occurs. Whether electroacupuncture at Zusanli(ST 36) and Shenshu(BL 32) points can enhance the expression of CGT protein and mRNA in the DPN tissue? OBJECTIVE: To observe the effect of electroacupuncture at Zusanli and Shenshu points on motor, sensory conduction velocity and CGT mRNA and its protein expression of sciatic nerve in rats with DPN. DESIGN: A randomized and controlled animal experiment.SETTING: Department of Neurology and Central Laboratory, Yueyang Hospital of Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine.MATERIALS: Totally 60 healthy male Wistar rats of clean grade, aged 4 month, with body mass of 200 to 220 g, were enrolled in this study. Streptozotocin (STZ, Sigma Company of USA, Batch No. S-0130).METHODS: This study was carried out in the Animal Experimental Center and Central Laboratory, Yueyang Hospital of Traditional Chinese & Western Medicine during February 2005 to March 2006. ① Fifteen rats were randomly chosen,serving as normal group.All the other rats were intraperitoneally injected once with STZ to develop experimental diabetic rat models. If fasting blood glucose was ≥15 mmol/L,sensory nerve and motor nerve conduction velocity of sciatic nerve was obviously slowed, tail-swaying temperature threshold was increased and myelinated nerve fiber of sciatic nerve changed, DPN models were successful. The successful model rats were randomly assigned into 3 groups: model group, control group(electroacupuncture at non-meridian-non-acupoint)and electroacupuncture group [electroacupuncture at Zusanli and Shenshu points], with 15 rats each. The rats in the normal group and model group were untouched. In the electroacupuncture group (electroacupuncture at Zusanli and Shenshu points), Shenshu point (double) and Zusanli point (double) were chosen referencing to The Atlas of the Rat’s Acupoints. G6805-Ⅱ electric acupuncture apparatus was used, and current intensity was controlled at 20 min/time, once every other day, 12 times within 24 days. In the control group, the tip of rat-tail was stimulated, and the concrete procedures were the same as in the electroacupuncture at Zusanli and Shenshu points. ② Motor nerve conduction velocity and sensory nerve conduction velocity of rats were detected with neuroelectrophysiology detector in the end of the treatment, and the expressions of CGT protein and mRNA of sciatic nerve were detected with immunohistochemical method and fluorescent quantitative PCR technique. MAIN OUTCOME MEASURES: ① Motor and sensory nerve conduction velocity. ② The expression of CGT protein and its mRNA.RESULTS: All the 60 rats entered the stage of result analysis. ① Comparison of motor and sensory nerve conduction velocity of rats after electroacupuncture: Motor nerve conduction velocity of rats in the model group[(31.37±3.69) m/s], control group [(32.74±5.42) m/s] and electroacupuncture group [(41.30 ±1.15) m/s] was significantly lower than that in the normal group [(41.30±1.15) m/s, P < 0.01]; The sensory nerve conduction velocity of rats in the model group[(18.17±9.54) m/s], control group [(21.39±5.61) m/s]and electroacupuncture group [(35.81±4.59) m/s] was significantly lower than that in the normal group [(46.38±6.32) m/s,P < 0.01]; The motor and sensory nerve conduction velocity of electroacupuncture group was significantly higher than that in the model group [(38.04.±2.01) m/s vs. (32.74±5.42) m/s,(35.81±4.59) m/s vs. (21.39±5.61) m/s,P < 0.01]. ② Comparison of the expression of CGT protein of sciatic nerve of rats: The number of CGT positive cells of sciatic nerve in model group, control group or electroacupuncture group was significantly smaller than that in normal group [(9 770.33±1 461.73), (10 588.13±1 119.52), (27 518.27±9 078.29), (37 769.67±4 021.81)/μm2,P < 0.01]; The number of CGT positive cells of the sciatic nerve in the electroacupuncture group was significantly larger than that in the model group and control group (P < 0.01). The number of CGT positive cells of sciatic nerve was close between control group and electroacupuncture group (P > 0.05). ③ Comparison of CGT mRNA expression of sciatic nerve of rats: Ct value of CGT mRNA of sciatic nerve of rats in the model group,control group and electroacupuncture group was significantly higher than that in the normal group (13.75±2.60,14.81±2.80,11.67±1.75,9.30±0.98,P < 0.01); Ct value of CGT mRNA of sciatic nerve of rats in the electroacupuncture group was significantly lower than that in the model group and control group (P < 0.01), and that was close between electroacupuncture group and control group (P > 0.05). CONCLUSION: Electroacupuncture at Zusanli and Shenshu points can increase motor and sensory nerve conduction velocity of rats with DPN. It might be associated with up-regulating the expression of CGT mRNA and its protein.展开更多
Painful diabetic peripheral neuropathy is one of the common chronic complications of diabetes."Pain"is the most typical symptom in patients,which seriously affects their quality of life.Traditional Chinese m...Painful diabetic peripheral neuropathy is one of the common chronic complications of diabetes."Pain"is the most typical symptom in patients,which seriously affects their quality of life.Traditional Chinese medicine(TCM)treatment of the disease includes oral administration of Chinese medicine,TCM fumigation and acupuncture,etc.,which can significantly reduce the pain of patients and reduce the frequency of disease.Chinese decoctions regulate the imbalance of yin and yang in the human body through syndrome differentiation,so as to achieve the balance of yin and yang,which will then eliminate the disease.Chinese medicine fumigation make the medicine seep into the body from the skin to exert the medical effects,and nourish and dredge the meridians.There is no pain if the meridians are smooth flowing,there will be pain if the meridians are blocked,fumigation can be used alone or assisted by other treatment methods to enhance the efficacy.The characteristics of acupuncture are rapid painrelief,economic and convenient,and can quickly relieve pain for patients with low tolerance.展开更多
基金supported by the Projects of the National Key R&D Program of China,Nos.2021YFC2400803(to YO),2021YFC2400801(to YQ)the National Natural Science Foundation of China,Nos.82002290(to YQ),82072452(to YO),82272475(to YO)+5 种基金the Young Elite Scientist Sponsorship Program by Cast,No.YESS20200153(to YQ)the Sino-German Mobility Programme,No.M-0699(to YQ)the Excellent Youth Cultivation Program of Shanghai Sixth People’s Hospital,No.ynyq202201(to YQ)the Shanghai Sailing Program,No.20YF1436000(to YQ)the Medical Engineering Co-Project of University of Shanghai for Science and Technology,10-22-310-520(to YO)a grant from Shanghai Municipal Health Commission,No.202040399(to YO).
文摘Diabetic peripheral neuropathy is a common complication of diabetes mellitus.Elucidating the pathophysiological metabolic mechanism impels the generation of ideal therapies.However,existing limited treatments for diabetic peripheral neuropathy expose the urgent need for cell metabolism research.Given the lack of comprehensive understanding of energy metabolism changes and related signaling pathways in diabetic peripheral neuropathy,it is essential to explore energy changes and metabolic changes in diabetic peripheral neuropathy to develop suitable treatment methods.This review summarizes the pathophysiological mechanism of diabetic peripheral neuropathy from the perspective of cellular metabolism and the specific interventions for different metabolic pathways to develop effective treatment methods.Various metabolic mechanisms(e.g.,polyol,hexosamine,protein kinase C pathway)are associated with diabetic peripheral neuropathy,and researchers are looking for more effective treatments through these pathways.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a debilitating complication of diabetes mellitus with limited available treatment options.Radix Salviae,a traditional Chinese herb,has shown promise in treating DPN,but its therapeutic mech-anisms have not been systematically investigated.AIM Radix Salviae(Danshen in pinin),a traditional Chinese medicine(TCM),is widely used to treat DPN in China.However,the mechanism through which Radix Salviae treats DPN remains unclear.Therefore,we aimed to explore the mechanism of action of Radix Salviae against DPN using network pharmacology.METHODS The active ingredients and target genes of Radix Salviae were screened using the TCM pharmacology database and analysis platform.The genes associated with DPN were obtained from the Gene Cards and OMIM databases,a drug-com-position-target-disease network was constructed,and a protein–protein inter-action network was subsequently constructed to screen the main targets.Gene Ontology(GO)functional annotation and pathway enrichment analysis were performed via the Kyoto Encyclopedia of Genes and Genomes(KEGG)using Bioconductor.RESULTS A total of 56 effective components,108 targets and 4581 DPN-related target genes of Radix Salviae were screened.Intervention with Radix Salviae for DPN mainly involved 81 target genes.The top 30 major targets were selected for enrichment analysis of GO and KEGG pathways.CONCLUSION These results suggested that Radix Salviae could treat DPN by regulating the AGE-RAGE signaling pathway and the PI3K-Akt signaling pathway.Therefore,Danshen may affect DPN by regulating inflammation and apoptosis.
基金supported by the National Natural Science Foundation of China,Nos.81772094(to ZBC),81974289(to ZBC)the Key Research and Development Program of Hubei Province,No.2020BCB031(to ZBC)Natural Science Foundation of Hubei Province,No.2020CFB433(to YTL).
文摘Circular RNAs(circRNAs)play a vital role in diabetic peripheral neuropathy.However,their expression and function in Schwann cells in individuals with diabetic peripheral neuropathy remain poorly understood.Here,we performed protein profiling and circRNA sequencing of sural nerves in patients with diabetic peripheral neuropathy and controls.Protein profiling revealed 265 differentially expressed proteins in the diabetic peripheral neuropathy group.Gene Ontology indicated that differentially expressed proteins were mainly enriched in myelination and mitochondrial oxidative phosphorylation.A real-time polymerase chain reaction assay performed to validate the circRNA sequencing results yielded 11 differentially expressed circRNAs.circ_0002538 was markedly downregulated in patients with diabetic peripheral neuropathy.Further in vitro experiments showed that overexpression of circ_0002538 promoted the migration of Schwann cells by upregulating plasmolipin(PLLP)expression.Moreover,overexpression of circ_0002538 in the sciatic nerve in a streptozotocin-induced mouse model of diabetic peripheral neuropathy alleviated demyelination and improved sciatic nerve function.The results of a mechanistic experiment showed that circ_0002538 promotes PLLP expression by sponging miR-138-5p,while a lack of circ_0002538 led to a PLLP deficiency that further suppressed Schwann cell migration.These findings suggest that the circ_0002538/miR-138-5p/PLLP axis can promote the migration of Schwann cells in diabetic peripheral neuropathy patients,improving myelin sheath structure and nerve function.Thus,this axis is a potential target for therapeutic treatment of diabetic peripheral neuropathy.
基金National Natural Science Foundation of China,No.82100922.
文摘Diabetic peripheral neuropathy(DPN)is a common chronic complication of diabetes mellitus.One of the most common types is distal symmetric polyneuropathy,which begins as bilateral symmetry pain and hyperesthesia and gradually progresses into hypoesthesia with nerve fibre disorder and is frequently accompanied by depression and anxiety.Notably,more than half of patients with DPN can be asymptomatic,which tends to delay early detection.Furthermore,the study of adverse outcomes showed that DPN is a prominent risk factor for foot ulceration,gangrene and nontraumatic amputation,which decreases quality of life.Thus,it is essential to develop convenient diagnostic biomarkers with high sensitivity for screening and early intervention.It has been reported that there may be common pathways for microvascular and macrovascular complications of diabetes.The pathogenesis of both disorders involves vascular endothelial dysfunction.Emerging evidence indicates that traditional and novel cardiovascularrelated biomarkers have the potential to characterize patients by subclinical disease status and improve risk prediction.Additionally,beyond traditional cardiovascular-related biomarkers,novel cardiovascular-related biomarkers have been linked to diabetes and its complications.In this review,we evaluate the association between major traditional and nontraditional car-diovascular-related biomarkers of DPN,such as cardiac troponin T,B-type natriuretic peptide,Creactive protein,myeloperoxidase,and homocysteine,and assess the evidence for early risk factor-based management strategies to reduce the incidence and slow the progression of DPN.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of diabetes mellitus and can lead to serious complications.Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness.AIM To investigate the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN.METHODS The acupuncture in DPN(ACUDPN)study was a two-armed,randomized,controlled,parallel group,open,multicenter clinical trial.Patients were randomized in a 1:1 ratio into two groups:The acupuncture group received 12 acupuncture treatments over 8 wk,and the control group was on a waiting list during the first 16 wk,before it received the same treatment as the other group.Both groups received routine care.Outcome parameters were evaluated after 8,16 and 24 wk and included neurological scores,such as an 11-point numeric rating scale(NRS)11 for hypesthesia,neuropathic pain symptom inventory(NPSI),neuropathy deficit score(NDS),neuropathy symptom score(NSS);nerve conduction studies(NCS)were assessed with a handheld point-of-care device.RESULTSSixty-two participants were included.The NRS for numbness showed a difference of 2.3(P<0.001)in favor of theacupuncture group,the effect persisted until week 16 with a difference of 2.2(P<0.001)between groups and 1.8points at week 24 compared to baseline.The NPSI was improved in the acupuncture group by 12.6 points(P<0.001)at week 8,the NSS score at week 8 with a difference of 1.3(P<0.001);the NDS and the TNSc score improvedfor the acupuncture group in week 8,with a difference of 2.0 points(P<0.001)compared to the control group.Effects were persistent in week 16 with a difference of 1.8 points(P<0.05).The NCS showed no meaningfulchanges.In both groups only minor side effects were reported.CONCLUSION Study results suggest that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reductionin neurological deficits.No serious adverse events were recorded and the adherence to treatment was high.Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirmthe results.
基金the 2022 Chongqing Natural Science Foundation(Postdoctoral Project)(CSTB2022NSCQ-BHX0690)the 2022 Chongqing Postdoctoral Innovation Talent Support Plan(CQBX202212)the 2023 Chongqing Science and Health Joint Medical Research Project(2023QNXM002).
文摘Objectives:To discuss the mechanism of Sheng Yang San Huo decoction on diabetic peripheral neuropathy using the network pharmacology method.Methods:The BATMAN-TCM database,TCM-ID database,Chinese Natural Product Chemical Composition Database,and TCMIP database were employed to screen the chemical active ingredients of each herb in Sheng Yang San Huo decoction based on the“Libinsky Drug Rules”.SwissTargetPrediction was used to screen effective action targets for each herb in the prescription.Additionally,Cytoscape 3.7.0 was utilized to construct a“drug-target”network.GeneCards,OMIM,and MaLaCards databases were utilized to gather targets related to diabetic peripheral neuropathy.VENNY 2.1 online platform was employed to match drug and disease targets,draw a Venn diagram,and construct a“drug-active compounds-common target”network using Cytoscape 3.7.0.gene ontology biological process analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis for the targets were conducted using the DAVID 6.8 database.Enrichment analysis results were visualized using the OmicShareTool online platform.Molecular docking was performed using CB-Dock2.Results:Following screening,a total of 217 active compounds and 132 potential targets were identified in Sheng Yang San Huo decoction.The effects are primarily enriched in pathways such as Lipid and Atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,and the IL-17 signaling pathway.The binding energy of the key active ingredients to the core protein targets of DPN was favorable.Conclusion:The study reveals the characteristics of multiple targets and pathways of Sheng Yang San Huo decoction,providing new insights for the clinical application of this prescription.
文摘Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.
文摘Objective:This study aims to evaluate the reliability and validity of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy(PDPN).Methods:One hundred patients with PDPN and 70 patients with non-neuropathic pain were recruited from five grade III general hospitals in Guangzhou.Pain was assessed using the Leeds Assessment of Neuropathic Symptoms and Signs(LANSS),Douleur Neuropathique 4 questionnaire(DN4),and Brief Pain Inventory for Painful Diabetic Peripheral Neuropathy(BPI-DPN).Reliability was evaluated by internal consistency of the Cronbach's a coefficient and Guttman split-half.Construct validity was analyzed by factor analysis and Spearman correlation coefficients.Sensitivity and specificity were also assessed.Results:The Cronbach's a coefficients of the LANSS,DN4,and BPI-DPN were 0.735,0.750,and 0.898,respectively.The Guttman split-half coefficients of the LANSS,DN4,and BPIDPN were 0.660,0.726,and 0.849,respectively.The cumulative contributions of the LANSS,DN4,and BPI-DPN to the total variance were 61.945%,57.010%,and 66.056%,respectively.The items of the LANSS,DN4,and BPI-DPN presented high factorial loads,ranging from 0.387 to 0.841,0.137 to 0.948,and 0.487 to 0.953,respectively.The LANSS and DN4 exhibited sensitivities of 58.0%and 82.7%,respectively,and specificity of 97.1%.Conclusions:The LANSS or DN4 can be used to detect neuropathic pain in Chinese patients with PDPN.The BPI-DPN can be employed to monitor the effectiveness of pain intervention.
文摘Diabetic peripheral neuropathy(DPN)was the most common complications of elderly diabetic,which could contribute to an increased risk of falling.Despite the increased prevalence of elderly diabetic,high risk of falls and serious consequences of falls in elderly with DPN,It is necessary to adopt means of reducing the risk of falls in elderly with DPN.Impaired balance in the elderly with DPN was the most important risk factor of increasing falls.This review will introduce the epidemiology of falls in elderly with DPN,analysis the reasons for high risk of falls in elderly with DPN,provide a review of the development of balance training in the intervention of fall risk in elderly with DPN and offer recommendations to medical personnels on how to provide an efficient balance training for elderly with DPN.
基金National Natural Science Foundation of China,No.81870593Natural Science Foundation of Shandong Province of China,No.ZR2020MH106+1 种基金Medical Health Science and Technology Project of Shandong Province,No.202003060396 and No.202003060400Quality Improvement of Postgraduate Education in Shandong Province,No.SDYAL19156.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regulation and redox homeostasis.However,the association between serum Sestrin2 and DPN is unknown.AIM To explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus(T2DM).METHODS A total of 96 T2DM patients and 39 healthy volunteers,matched by age and sex,participated in this cross-sectional study.Clinical features and metabolic indices were identified.Serum Sestrin2 was measured by ELISA.The association between Sestrin2 and DPN was studied.Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTS The 96 patients with T2DM were divided into DPN(n=47)and patients without DPN(n=49).Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined[9.10(5.41-13.53)ng/mL vs 12.75(7.44-23.80)ng/mL,P<0.01].T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers[14.58(7.93-26.62)ng/mL vs 9.10(5.41-13.53)ng/mL,P<0.01].However,T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN[9.86(6.72-21.71)ng/mL vs 14.58(7.93-26.62)ng/mL,respectively,P<0.01].Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index(r=0.672,P=0.000),hemoglobin A1c(HbA1c)(r=0.292,P=0.000),serum creatinine(r=0.206,P=0.016),triglycerides(r=0.731,P=0.000),and fasting glucose(r=0.202,P=0.040),and negatively associated with estimated glomerular filtration rate(r=-0.230,P=0.007).After adjustment for sex,age,HbA1c,and diabetes duration,multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels(P=0.000).Logistic regression analyses indicated that Sestrin2,diabetes duration,and high-density lipoprotein were strongly associated with DPN(odds ratio=0.855,1.411,and 0.041,respectively).CONCLUSION Our results show Sestrin2 is decreased in T2DM patients with DNP.As lower Sestrin2 is independently associated with DPN,Sestrin2 may contribute to progression of DPN in T2DM patients.
基金This study was support by Jiangsu Administration of Traditional Chinese Medicine:National TCM clinical research base open topic(JD:201711)。
文摘Objective:The objective of this study is to investigate the effect of mild moxibustion on quality of life of patients with type 2 diabetic peripheral neuropathy(DPN).Materials and Methods:Fifty‑five patients with type 2 DPN from October 2018 to July 2019 were recruited in the present study and randomly divided into two groups:27 cases in the control group and 28 cases in the intervention group.The control group received routine treatment of hypoglycemic,hypotensive,mecobalamin nutritional nerve,while the intervention group received mild moxibustion on the basis of the control group.The course of treatment for both groups was 10 weeks.The quality of life of the two groups was assessed using short form‑36 health survey and compared with t‑test at 0.05 significance level.Results:The total score of the short form‑36 in the intervention group was higher than the control group(P<0.05);the scores of bodily pain,physical functioning(PF),general health(GH),and mental health dimensions in the intervention group increased significantly compared with the control group(P<0.05);the scores of role physical,social functioning(SF),vitality,and role‑emotional(RE)dimensions showed no between‑group difference(P>0.05).Conclusion:Mild moxibustion can effectively improve the quality of life of patients with type 2 DPN,relieve patient pain symptoms,and improve PF and GH.
基金This study was supported by the Natural Science Foundation of Dibet(No.XZ2018ZRG-05).
文摘Objective:This study aimed to evaluate the effector mechanism of Yiqi Tongluo soup in alleviating diabetic peripheral neuropathy.Methods:Thirty male SD rats were divided into the control group,mode1 group,and Yiqi Tongluo group.Each group consists of 10 rats.Except for the normal group,a high-sugar and high-fat diet combined with streptozocin injection were administered to the groups to constnuct the type 2 diabetes mellitus model.Then,6.48 g/kg of Yiqi Tongluo soup was administered to the Yiqi Tongluo group every day by gavage.An equal volume of physiological saline was administered to the control and model groups every day by gavage.During the experiment,changes in blood glucose and nerve conduction velocity were monitored in all groups.After the experiment,hematoxylin and eosin and luxol fast blue staining were carried out,and morphological changes in the sciatic nerve and myelin sheath in all groups were observed.Western blot was used to observe changes in expression levels of autophagy related proteins,Beclin-1,LC3,and P62.Results:Blood glucose significantly increased,and nerve conduction velocity significantly decreased in the model group.Yiqi Tongluo soup significantly decreased blood glucose level while simultaneously increasing nerve conduction velocity.Hematoxylin and eosin and luxol fast blue myelin sheath staining results showed that Yiqi Tongluo soup could improve sciatic nerve disorder,irregular myelin sheath morphology,and demyelination in type 2 diabetes mellitus rats.Western blot results showed that Beclin-1 and LC3I/LC3I expression levels in the model group significantly decreased,while P62 level significantly increased.Compared with the model group,Beclin-1 and LC3II/LC3I expression levels significantly increased and P62 levels significantly decreased in the Yiqi Tongluo group.Conclusion:Yiqi Tongluo soup can inhibit diabetic peripheral neuropathy by increasing autophagy.
基金National natural science foundation of China(No.81701891)Guided scientific research project of Shiyan science and technology bureau(No.18Y63)。
文摘Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The composition ratio of internal echo reduction and ambiguity in the observation group after three nerve treatments was significantly lower than that in the control group after treatment(P<0.05).In the correlation analysis,the three kinds of nerve CSA before and after treatment were negatively correlated with SCV and amplitude(P<0.05),and positively correlated with latency(P<0.05).Conclusion:The combination ofα-lipoic acid and Chinese medicine encapsulation technology has a good effect on the treatment and repair of DPN nerve damage,and can be routinely applied in clinical treatment.High-frequency ultrasound can intuitively observe changes in peripheral nerves and can be used to evaluate the prognosis of DPN.
基金the Science and Technology Development Project of Hospital of Chengdu University of Traditional Chinese Medicine(No.21HL26).
文摘Background:Diabetic peripheral neuropathy(DPN)is one of the most common complications of diabetes mellitus.Impaired neurological function is one of the main characteristics of DPN and is strongly associated with the inflammatory response.Our previous studies have confirmed that pestle needle can improve the nerve function of patients with DPN.But the mechanism of pestle needle treatment of DPN is still unclear.Methods:A total of 70 DPN patients who met the inclusion criteria were randomly divided into two groups.Control group(CG)(n=35)received DPN conventional treatment and the pestle needle group(PNG)(n=35)received pestle needle therapy at Zhiyang(DU09)eight array,Mingmen(DU04)eight array and Heche Road(from Mingmen(DU04)to Changqiang(DU01)),Zusanli(ST36),Sanyinjiao(SP06),Taixi(KI03)and Yongquan(KI01).Patients in the PNG group were required to take this treatment for 4 weeks,5 times a week.Examination indexes were collected before and after treatment,respectively.Nerve function was examined using the Toronto clinical scoring system and nerve conduction velocity detection.Serum inflammatory factors were measured by enzyme linked immunosorbent assay.Results:The Toronto clinical scoring system was significantly reduced in the PNG compared with the CG after treatment.The sensory nerve conduction velocity and motor nerve conduction velocity of the right peroneal and median nerves were significantly faster in the PNG than those in the CG(P<0.05).After treatment,serum interleukin-1 beta,interleukin-6 and tumor necrosis factor-alpha levels decreased in both groups,and the improvement of PNG was better than CG(P<0.05).Conclusion:The pestle needle can significantly improve the symptoms and nerve conduction velocity of DPN,and its mechanism may be related to the reduction of inflammatory factors.
基金This research was supported by the Beijing Individual Outstanding Talent Training Projects to Support the Young Backbone People(No.20140000204400001).
文摘Objective:To assess the effectiveness and safety of electroacupuncture for the treatment of diabetic peripheral neuropathy(DPN).Clinical studies in China have shown the beneficial effect of electroacupuncture compared with conventional medicine.However,the effectiveness of electroacupuncture has not been well acknowledged internationally.Methods:We searched the following databases from their inception through February 2016:MEDLINE,the Cochrane Central Register of Controlled Trials(April,2015),SinoMed,China National Knowledge Infrastructure,VIP,Wanfang Database,Chinese Important Conference Papers Database,and the Chinese Dissertation Database.Randomized controlled trials(RCTs)were included if they compared electroacupuncture to conventional medicine,placebo,or no treatment on DPN patients.RevMan 5.3 software was used for data analysis,with effect estimate presented as relative risk(RR)and mean difference(MD)with a 95%confidence interval(CI).Results:Eleven RCTs involving 837 participants were included.The methodological quality of included RCTs was generally poor in terms of sequence generation,allocation concealment,blinding,incomplete outcome data,and selective outcome reporting.Meta-analysis showed that electroacupuncture had a better effect on global symptom improvement than methylcobalamin(RR Z 1.29;95%CI:1.14e1.46)and vitamin B(RR Z 1.60;95%CI:1.33e1.94).Only two RCTs reported adverse events.
基金Major Science and Technology Project of Major New Drugs(No.2017ZX09304019)。
文摘Objective:To evaluate the clinical efficacy of combined/single use of Taohong Siwu decoction in the treatment for diabetic peripheral neuropathy(DPN)by meta-analysis.Methods:Database were searched electronically from the time databases established to November 2020 to collect randomized controlled trials of Taohong Siwu decoction combined with non-specific therapy for DPN in Chinese or English.The trial was assessed by 2 researchers independently,RevMan 5.3 software was used for meta-analysis.Results:A total of 13 studies included 970 patients.Meta-analysis showed that the combined/single use of Taohong Siwu decoction can further improve median sensory nerve velocity〔MD=4.86,95%CI(2.70,7.03),P<0.00001〕,and the curative effect〔OR=4.35,95%CI(3.1,6.06),P<0.00001〕,increase the velocity of the motor nerve〔MD=6.84,95%CI(6.14,7.55),P<0.00001〕,and the velocity of the sensory nerve〔MD=7.46,95%CI(5.84,9.08),P<0.00001〕,decrease TCM syndrome score〔MD=-5.61,95%CI(-6.63,-4.60),P<0.00001〕,and fasting blood-glucose〔MD=-0.24,95%CI(-0.37,-0.11),P<0.00001〕.The GRADE showed B level of evidence.Conclusion:Combined/single use of Taohong Siwu decoction in the treatment for DPN is effective.The safety is not clear,and more high-quality clinical studies are expected to be included to provide evidence support.
基金National Natural Science Foundation of China(No.81774304)。
文摘Western medicine mainly focuses on the conventional basic treatment of Diabetic peripheral neuropathy(DPN),such as blood glucose control,anti-oxidative stress,and nerve nutrition,but the efficacy and safety of the drugs cannot be guaranteed.As an important prescription for promoting blood circulation,removing blood stasis and nourishing blood,Taohong Siwu Decoction can not only promote cell proliferation and repair,reduce inflammatory factors in the blood,reduce the whole blood viscosity and plasma viscosity,and has a good anticoagulation effect.Moreover,Taohong Siwu Decoction and its added or subtracted prescription,foot bath and combined acupuncture have the effect of regulating blood sugar,improving nerve conduction velocity and relieving clinical symptoms,without obvious adverse reactions.This article reviews Taohong Siwu Decoction and its addition and subtraction in the treatment of diabetic peripheral neuropathy.
基金Sichuan Provincial Administration of Traditional Chinese Medicine Science and Technology Research Special Project(No.2021MS544)。
文摘Objective:To investigate the effect of pestle needle treatment on Nrf2 pathway and the relationship with oxidative stress in diabetic peripheral neuropathy.Methods:Patients with DPN who met the inclusion criteria were randomly divided into control and test groups with 30 patients in each group in a 1:1 allocation ratio.Both groups were given basic treatment,and the pestle group was treated with needle pestle therapy 5 times a week for a total of 4 weeks of intervention.Serum SOD and GSH PX levels were examined by colorimetry before and after intervention;Serum Keap1/Nrf2/ARE signaling pathway related factors expression levels were measured by ELISA;Keap1 and Nrf2 mRNA expression was determined by RT-PCR.Results:Compared with the control group,SOD and GSH-Px in the test group were significantly increased,Keap1 expression was decreased,Nrf2 expression was increased,Keap1 mRNA expression was significantly decreased,and Nrf2 mRNA expression was significantly increased.Conclusions:the pestle needle may enhance the body's antioxidant capacity by modulating the Keap1/Nrf2/ARE signaling pathway to enhance the production of its downstream antioxidant enzymes SOD and GSH Px,thereby protecting and repairing the damaged peripheral nerves in DPN patients.
基金the National Nat-ural Science Foundation of Chi-na, No. 30472238 the Grantfrom Bureau of Public Health ofShanghai City, No. 05JC14053Shanghai Key Subjects Con-struction Program, No. T0302
文摘BACKGROUND: Ceramide galactosyltransferase (CGT) protein and mRNA expression defect can cause the abnormal morphology and slowing conduction velocity of peripheral nerve. Morphologic change and functional disorder of myelin sheath and axon appear when diabetic peripheral neuropathy (DPN) occurs. Whether electroacupuncture at Zusanli(ST 36) and Shenshu(BL 32) points can enhance the expression of CGT protein and mRNA in the DPN tissue? OBJECTIVE: To observe the effect of electroacupuncture at Zusanli and Shenshu points on motor, sensory conduction velocity and CGT mRNA and its protein expression of sciatic nerve in rats with DPN. DESIGN: A randomized and controlled animal experiment.SETTING: Department of Neurology and Central Laboratory, Yueyang Hospital of Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine.MATERIALS: Totally 60 healthy male Wistar rats of clean grade, aged 4 month, with body mass of 200 to 220 g, were enrolled in this study. Streptozotocin (STZ, Sigma Company of USA, Batch No. S-0130).METHODS: This study was carried out in the Animal Experimental Center and Central Laboratory, Yueyang Hospital of Traditional Chinese & Western Medicine during February 2005 to March 2006. ① Fifteen rats were randomly chosen,serving as normal group.All the other rats were intraperitoneally injected once with STZ to develop experimental diabetic rat models. If fasting blood glucose was ≥15 mmol/L,sensory nerve and motor nerve conduction velocity of sciatic nerve was obviously slowed, tail-swaying temperature threshold was increased and myelinated nerve fiber of sciatic nerve changed, DPN models were successful. The successful model rats were randomly assigned into 3 groups: model group, control group(electroacupuncture at non-meridian-non-acupoint)and electroacupuncture group [electroacupuncture at Zusanli and Shenshu points], with 15 rats each. The rats in the normal group and model group were untouched. In the electroacupuncture group (electroacupuncture at Zusanli and Shenshu points), Shenshu point (double) and Zusanli point (double) were chosen referencing to The Atlas of the Rat’s Acupoints. G6805-Ⅱ electric acupuncture apparatus was used, and current intensity was controlled at 20 min/time, once every other day, 12 times within 24 days. In the control group, the tip of rat-tail was stimulated, and the concrete procedures were the same as in the electroacupuncture at Zusanli and Shenshu points. ② Motor nerve conduction velocity and sensory nerve conduction velocity of rats were detected with neuroelectrophysiology detector in the end of the treatment, and the expressions of CGT protein and mRNA of sciatic nerve were detected with immunohistochemical method and fluorescent quantitative PCR technique. MAIN OUTCOME MEASURES: ① Motor and sensory nerve conduction velocity. ② The expression of CGT protein and its mRNA.RESULTS: All the 60 rats entered the stage of result analysis. ① Comparison of motor and sensory nerve conduction velocity of rats after electroacupuncture: Motor nerve conduction velocity of rats in the model group[(31.37±3.69) m/s], control group [(32.74±5.42) m/s] and electroacupuncture group [(41.30 ±1.15) m/s] was significantly lower than that in the normal group [(41.30±1.15) m/s, P < 0.01]; The sensory nerve conduction velocity of rats in the model group[(18.17±9.54) m/s], control group [(21.39±5.61) m/s]and electroacupuncture group [(35.81±4.59) m/s] was significantly lower than that in the normal group [(46.38±6.32) m/s,P < 0.01]; The motor and sensory nerve conduction velocity of electroacupuncture group was significantly higher than that in the model group [(38.04.±2.01) m/s vs. (32.74±5.42) m/s,(35.81±4.59) m/s vs. (21.39±5.61) m/s,P < 0.01]. ② Comparison of the expression of CGT protein of sciatic nerve of rats: The number of CGT positive cells of sciatic nerve in model group, control group or electroacupuncture group was significantly smaller than that in normal group [(9 770.33±1 461.73), (10 588.13±1 119.52), (27 518.27±9 078.29), (37 769.67±4 021.81)/μm2,P < 0.01]; The number of CGT positive cells of the sciatic nerve in the electroacupuncture group was significantly larger than that in the model group and control group (P < 0.01). The number of CGT positive cells of sciatic nerve was close between control group and electroacupuncture group (P > 0.05). ③ Comparison of CGT mRNA expression of sciatic nerve of rats: Ct value of CGT mRNA of sciatic nerve of rats in the model group,control group and electroacupuncture group was significantly higher than that in the normal group (13.75±2.60,14.81±2.80,11.67±1.75,9.30±0.98,P < 0.01); Ct value of CGT mRNA of sciatic nerve of rats in the electroacupuncture group was significantly lower than that in the model group and control group (P < 0.01), and that was close between electroacupuncture group and control group (P > 0.05). CONCLUSION: Electroacupuncture at Zusanli and Shenshu points can increase motor and sensory nerve conduction velocity of rats with DPN. It might be associated with up-regulating the expression of CGT mRNA and its protein.
基金Shaanxi Province 2020 Key Research and Development Program Project(2020SF-276)Xi'an Health Bureau Science and Technology Project(J201902018)。
文摘Painful diabetic peripheral neuropathy is one of the common chronic complications of diabetes."Pain"is the most typical symptom in patients,which seriously affects their quality of life.Traditional Chinese medicine(TCM)treatment of the disease includes oral administration of Chinese medicine,TCM fumigation and acupuncture,etc.,which can significantly reduce the pain of patients and reduce the frequency of disease.Chinese decoctions regulate the imbalance of yin and yang in the human body through syndrome differentiation,so as to achieve the balance of yin and yang,which will then eliminate the disease.Chinese medicine fumigation make the medicine seep into the body from the skin to exert the medical effects,and nourish and dredge the meridians.There is no pain if the meridians are smooth flowing,there will be pain if the meridians are blocked,fumigation can be used alone or assisted by other treatment methods to enhance the efficacy.The characteristics of acupuncture are rapid painrelief,economic and convenient,and can quickly relieve pain for patients with low tolerance.
