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
AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The stud...AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.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
BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle...BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.AIM To validate both sections(A and B)of the Michigan Neuropathy Screening Instrument(MNSI)in Polish(PL)patients with diabetes.METHODS A cross-sectional study using a test(A1,B1)and re-test(A2,B2)formula was performed in 80 patients with diabetes.The gold standard used for neuropathy detection was a nerve conduction study(NCS)which was performed in all participants.Reliability of the MNSI-PL was assessed using the Cronbach’s alpha,Kuder-Richardson formula 20(KR-20),split-half reliability,the Gottman split-half tests,and correlation between first and second half was accessed.Stability was assessed using an intraclass correlation coefficient(ICC).For external validation,we used simple linear correlation,binomial regression,and agreement between two different tools using a Bland-Altman plot analysis.RESULTS The scale was internally consistent(Cronbach’s alpha for the full scale:0.81 for A and 0.87 for B).MNSI-PL scores in test/retest showed high stability(ICC=0.73 for A and ICC=0.97 for B).The statistically important correlations between MNSI-PL and NCS were found for B1,B2,and A1(P<0.005).The cut-off points of≥3 for section A(sensitivity of 90%-100%;specificity of 33%-40%)and≥2 for section B(sensitivity of 81%-84%;specificity of 60%-70%)were obtained during neuropathy detection.CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.展开更多
BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as...BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.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
Objective:To determine the neuroprotective effects of apigenin against streptozotocin(STZ)-induced diabetic neuropathy(DN).Methods:To induce DN,Wistar rats(150-200 g)were administered with STZ(55 mg/kg,i.p.).Then they...Objective:To determine the neuroprotective effects of apigenin against streptozotocin(STZ)-induced diabetic neuropathy(DN).Methods:To induce DN,Wistar rats(150-200 g)were administered with STZ(55 mg/kg,i.p.).Then they were randomly assigned to various groups,viz.,normal,diabetic control,insulin(10 IU/kg,s.c.),apigenin(5,10,and 20 mg/kg,p.o.),and insulin(10 IU/kg)plus apigenin(20 mg/kg,p.o.).Various behavioral,biochemical,and molecular markers[tumor necrosis factor-alpha(TNF-α),interleukin(IL)-1β,IL-6,Toll-like receptor 4(TLR4),myeloid differentiation primary response 88(MyD88),and nuclear factor erythroid 2-related factor 2(Nrf2)]were assessed.Results:Apigenin(10 and 20 mg/kg,p.o.)substantially reduced plasma glucose levels,lipid profile,aspartate transaminase,alanine transaminase,glycated hemoglobin,and neural advanced glycation end products in STZ-induced DN rats(P<0.05).After apigenin intervention,STZ-induced changes in food and water intake,body weight,urine output,allodynia,hyperalgesia,and insulin levels were markedly improved(P<0.05).Neural antioxidant enzymes(superoxide dismutase and glutathione)and Na+K+ATPase activity were also considerably elevated(P<0.05)while the level of lipid peroxidation was diminished following apigenin therapy(P<0.05).Furthermore,apigenin markedly upregulated the Nrf2 mRNA level while downregulating the mRNA expressions of TNF-αand ILs and the protein expressions of TLR4 and MyD88(P<0.05).STZ-induced histological abnormalities in the sciatic nerve were also improved by apigenin treatment.Conclusions:Apigenin exerts its neuroprotective effect by modulating the inflammatory and oxidative stress pathways via regulating the TLR4-MyD88 signaling pathway.展开更多
BACKGROUND Methanol is a highly toxic,non-potable alcohol.Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol.Recently,alongside the coronavir...BACKGROUND Methanol is a highly toxic,non-potable alcohol.Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol.Recently,alongside the coronavirus disease 2019(COVID-19)pandemic,rumors circulated on social media that consuming alcohol can prevent or cure the virus,leading to a COVID-19 and methanol-induced optic neuropathy(MON)syndemic.AIM To investigate the impact of erythropoietin(EPO)on the outcomes of patients diagnosed with MON.METHODS In this prospective study,105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital.A comprehensive ocular examination was conducted for all participants.Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days.RESULTS The mean age of the participants was 39.9 years(±12.6).Ninety-four patients were male and eleven were female.The mean pre-treatment best corrected visual acuity(BCVA)improved from 2.0±0.86 to 1.39±0.69 logarithm of the minimum angle of resolution post-treatment(P<0.001),with significant improvement observed in all age categories and genders(P<0.001).Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h(P<0.001),and the post-treatment BCVA remained significant at all monthly follow-up visits(P<0.001).CONCLUSION EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure.Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.展开更多
BACKGROUND Thalidomide is an effective treatment for refractory Crohn’s disease(CD).However,thalidomide-induced peripheral neuropathy(TiPN),which has a large individual variation,is a major cause of treatment failure...BACKGROUND Thalidomide is an effective treatment for refractory Crohn’s disease(CD).However,thalidomide-induced peripheral neuropathy(TiPN),which has a large individual variation,is a major cause of treatment failure.TiPN is rarely predictable and recognized,especially in CD.It is necessary to develop a risk model to predict TiPN occurrence.AIM To develop and compare a predictive model of TiPN using machine learning based on comprehensive clinical and genetic variables.METHODS A retrospective cohort of 164 CD patients from January 2016 to June 2022 was used to establish the model.The National Cancer Institute Common Toxicity Criteria Sensory Scale(version 4.0)was used to assess TiPN.With 18 clinical features and 150 genetic variables,five predictive models were established and evaluated by the confusion matrix receiver operating characteristic curve(AUROC),area under the precision-recall curve(AUPRC),specificity,sensitivity(recall rate),precision,accuracy,and F1 score.RESULTS The top-ranking five risk variables associated with TiPN were interleukin-12 rs1353248[P=0.0004,odds ratio(OR):8.983,95%confidence interval(CI):2.497-30.90],dose(mg/d,P=0.002),brainderived neurotrophic factor(BDNF)rs2030324(P=0.001,OR:3.164,95%CI:1.561-6.434),BDNF rs6265(P=0.001,OR:3.150,95%CI:1.546-6.073)and BDNF rs11030104(P=0.001,OR:3.091,95%CI:1.525-5.960).In the training set,gradient boosting decision tree(GBDT),extremely random trees(ET),random forest,logistic regression and extreme gradient boosting(XGBoost)obtained AUROC values>0.90 and AUPRC>0.87.Among these models,XGBoost and GBDT obtained the first two highest AUROC(0.90 and 1),AUPRC(0.98 and 1),accuracy(0.96 and 0.98),precision(0.90 and 0.95),F1 score(0.95 and 0.98),specificity(0.94 and 0.97),and sensitivity(1).In the validation set,XGBoost algorithm exhibited the best predictive performance with the highest specificity(0.857),accuracy(0.818),AUPRC(0.86)and AUROC(0.89).ET and GBDT obtained the highest sensitivity(1)and F1 score(0.8).Overall,compared with other state-of-the-art classifiers such as ET,GBDT and RF,XGBoost algorithm not only showed a more stable performance,but also yielded higher ROC-AUC and PRC-AUC scores,demonstrating its high accuracy in prediction of TiPN occurrence.CONCLUSION The powerful XGBoost algorithm accurately predicts TiPN using 18 clinical features and 14 genetic variables.With the ability to identify high-risk patients using single nucleotide polymorphisms,it offers a feasible option for improving thalidomide efficacy in CD patients.展开更多
·AIM:To evaluate the functional and structural changes of photoreceptors in patients and asymptomatic carriers with Leber hereditary optic neuropathy(LHON)using fullfield electroretinography(FERG)and optical cohe...·AIM:To evaluate the functional and structural changes of photoreceptors in patients and asymptomatic carriers with Leber hereditary optic neuropathy(LHON)using fullfield electroretinography(FERG)and optical coherence tomography(OCT).·METHODS:Individuals diagnosed with LHON at the Renmin Hospital of Wuhan University and their family members were included in this cross-sectional observational study.The FERG a-wave amplitude of affected patients and asymptomatic carriers was analyzed.The thickness of the outer nuclear layer(ONL),inner and outer segment(IS/OS)and total photoreceptors in the macular fovea and parafovea were measured.·RESULTS:This study included 14 LHON patients(mean age:20.00±9.37y),12 asymptomatic carriers(mean age:39.83±6.48y),and 14 normal subjects(mean age:24.20±1.52y).The FERG results showed that the darkadapted 3.0 electroretinography and light-adapted 3.0 electroretinography a-wave amplitudes of patients and carriers were significantly decreased(P<0.001).The ONL and photoreceptors layers were slightly thicker in patients than in normal subjects(P<0.05),whereas they were thinner in carriers(P<0.05).There were no differences in IS/OS thickness among the groups(P>0.05).·CONCLUSION:Photoreceptors function is significantly impaired in LHON-affected patients and asymptomatic carriers.Meanwhile,photoreceptors morphology is slightly altered,mainly manifesting as a change in ONL thickness.展开更多
Background and purpose:Cerebellar ataxia,neuropathy,and vestibular areflexia syndrome(CANVAS)is a neurodegenerative disease of the cerebellum.The disease progression is slow,with up to 25%of people diagnosed needing t...Background and purpose:Cerebellar ataxia,neuropathy,and vestibular areflexia syndrome(CANVAS)is a neurodegenerative disease of the cerebellum.The disease progression is slow,with up to 25%of people diagnosed needing to use a wheelchair after 15 years from diagnosis.Vestibular symptoms arise from centrally-mediated ocular movement degradation and the reduced vestibular-ocular reflex functioning bilaterally.To date,no report has shown an improvement in VOR gain or gait outcome measures in someone with CANVAS after a course of vestibular physical therapy.Case description:A 65-year-old male,Patient X,first noticed symptoms in his fourth decade of life and was diagnosed with(CANVAS)in his seventh decade.Patient X reported numbness and tingling in his hands and feet,decreased ability to perform daily activities,and several falls.Intervention:Patient X completed a four-month course of vestibular physical therapy,including vestibular ocular reflex exercises,balance training,gait training,and the VestAid application for eye gaze compliance monitoring.The Vestaid application uses eyes and facial recognition software to record the percentage of time that the patient kept their eyes on the target.Outcomes:After vestibular therapy,Patient X had a clinically meaningful improvement in gait speed:from 1.02 m/s to 1.13 m/s and in the Functional Gait Assessment from 20/30 to 27/30.Patient X's eye gaze compliance improved from a median of 43%(range 25e68%)to a median of 67%(58e83%).Discussion:This case study demonstrates that vestibular rehabilitation improved eye gaze compliance and functional outcomes in a person living with CANVAS.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
Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering ...Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering from road traffic accident.TON is a rare but serious complication secondary to ocular or head trauma,resulting in partial or complete visual loss.In China,the incidence of road traffic accident induced TON is on the rise.The rate of incidence has been reported about 0.5% to 5% in closed head trauma cases[1].展开更多
Dear Editor,W e read with great interest the study by Zhao et al[1],which evaluated optic neuropathy and changes in the amount of glial fibrillary acidic protein in the retina with intracameral injection of microbeads...Dear Editor,W e read with great interest the study by Zhao et al[1],which evaluated optic neuropathy and changes in the amount of glial fibrillary acidic protein in the retina with intracameral injection of microbeads into rabbits.The objective was to investigate whether the injection of microbeads into the anterior chamber can induce chronic intraocular hypertension in a glaucoma model in rabbits.展开更多
Diabetic neuropathy(DN)is a devastating disorder with an increasing prevalence globally.This epidemic can pose a critical burden on individuals and communities,subsequently affecting the productivity and economic outp...Diabetic neuropathy(DN)is a devastating disorder with an increasing prevalence globally.This epidemic can pose a critical burden on individuals and communities,subsequently affecting the productivity and economic output of a country.With more people living a sedentary lifestyle,the incidence of DN is escalating worldwide.Many researchers have relentlessly worked on ways to combat this devastating disease.Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN.Unfortunately,most of these therapies are only partially effective.Worse still,some are associated with unfavorable side effects.This narrative review aims to highlight current issues and challenges in the management of DN,especially from the perspective of molecular mechanisms that lead to its progression,with the hope of providing future direction in the management of DN.To improve the approaches to diabetic management,the suggested resolutions in the literature are also discussed in this review.This review will provide an in-depth understanding of the causative mechanisms of DN,apart from the insights to improve the quality and strategic approaches to DN management.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
BACKGROUND The effect of the sympathetic nervous system on peripheral arteries causes vasoconstriction when smooth muscle cells in the walls of blood vessels contract,which leads to narrowing of arteries and reduction...BACKGROUND The effect of the sympathetic nervous system on peripheral arteries causes vasoconstriction when smooth muscle cells in the walls of blood vessels contract,which leads to narrowing of arteries and reduction of the blood flow.AIM To compare sympathetic vasomotor activation of the brachial arteries in healthy subjects and patients with painful diabetic neuropathy;and therefore,to assess whether there is significant vasomotor dysfunction of medium sized arteries in diabetic neuropathy.METHODS The study included 41 diabetic neuropathy patients and 41 healthy controls.Baseline diameter and flow rate of the brachial arteries were measured.Then,using a bipolar stimulus electrode,a 10 mA,1 Hz electrical stimulus was administered to the median nerve at the wrist level for 5 s.The brachial artery diameter and blood flow rate were re-measured after stimulation.RESULTS In the control group,the median flow rate was 70.0 mL/min prior to stimulation and 35.0 mL/min after stimulation,with a statistically significant decrease(P<0.001),which is consistent with sympathetic nervous system functioning(vasoconstriction).In the diabetic neuropathy group,median flow rate before the stimulation was 35.0 mL/min.After stimulation,the median flow rate was 77.0 mL/min;thus,no significant decrease in the flow rate was detected.In the control group,the median brachial artery diameter,which was 3.6 mm prior to stimulation,decreased to 3.4 mm after stimulation,and this decrease was also statistically significant(P=0.046).In the diabetic neuropathy group,the median brachial artery diameter increased from 3.4 mm to 3.6 mm following nerve stimulation.Once again,no narrowing was observed.CONCLUSION Our research suggests that diabetic neuropathy results in significant vasomotor dysfunction of medium sized peripheral arteries.Physiological vasoconstriction in response to sympathetic activation is impaired in diabetic neuropathy.展开更多
BACKGROUND Neuropathy may occur at some sites after catheterization for close examination of cardiac disease.Although the radial artery is considered a relatively uncomplicated site for catheterization,the radial arte...BACKGROUND Neuropathy may occur at some sites after catheterization for close examination of cardiac disease.Although the radial artery is considered a relatively uncomplicated site for catheterization,the radial artery and median nerve are in relatively close proximity,with the risk of median nerve injury depending on the angle of puncture.The purpose of this study was to report the outcomes of surgery performed for conservative therapy-resistant median neuropathy following forearm catheterization.CASE SUMMARY A 50-year-old woman experienced palsy from the right thumb to the radial side of the ring finger after catheterization from the radial artery of the right forearm.Paresthesia developed at the same site and a positive tinel-like sign was seen for the median nerve area at the high level of the puncture site.Nerve conduction study showed reduced compound muscle action potentials and loss of sensory nerve action potentials.Symptoms did not improve despite pharmacotherapy and the patient gradually developed flexion restrictions of the index and middle fingers.Median nerve injury and associated flexor tendon adhesion was diagnosed,and the patient was referred for surgery at 3 mo after injury.When the same area was opened,no injury to the median nerve epithelium was obvious,but the area of the positive tinel-like sign was highly adherent to surrounding tissue and to the flexor digitorum superficialis of the index and middle fingers.The surgery was terminated with adequate adhesion release.Rehabilitation was initiated postoperatively,improving neurological symptoms and range of motion of the fingers.Six months after surgery,the patient returned to daily activities without discomfort.CONCLUSION This case provides the appropriate diagnosis and treatment for a suspected peripheral nerve injury.展开更多
BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid...BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid plate of the optic disc are relatively crowded;however,a combination of the two is clinically uncommon.Herein,we reported a patient with NAION and concealed BRVO,for which the treatment and prognosis were not similar to those for NAION alone.CASE SUMMARY Herein,we report a case of NAION with concealed BRVO that did not improve with oral medication.A week later,we switched to intravenous drug administration to improve circulation,and the patient’s visual acuity and visual field recovered.Hormonal therapy was not administered throughout the study.This case suggested that:(1)Fundus fluorescein angiography(FFA)can help detect hidden BRVO along with the NAION diagnosis;(2)intravenous infusion of drugs to improve circulation has positive effects in treating such patients;and(3)NAION with concealed BRVO may not require systemic hormonal therapy,in contrast with the known treatment for simple NAION.CONCLUSION NAION may be associated with hidden BRVO,which can only be observed on FFA;intravenous therapy has proven effectiveness.展开更多
Rifampicin-resistant tuberculosis (RR-TB) is a global public health problem caused by mycobacterium tuberculosis resistant to Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known adverse eff...Rifampicin-resistant tuberculosis (RR-TB) is a global public health problem caused by mycobacterium tuberculosis resistant to Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known adverse effects of treatment regimens that cause significant morbidity. Pyridoxine is often added to treatment regimens for the prevention and/or treatment of these side effects. The basis and effectiveness of this practice are unclear. We conducted a systematic review to evaluate the effectiveness of pyridoxine in preventing and/or treating neuropathy and neurotoxicity associated with RR-TB treatment. We included studies with patients with RR-TB who experienced neuropathy or neurotoxicity attributed to RR-TB regimens and were given pyridoxine. Our findings showed contradicting evidence on the use of pyridoxine for preventing or treating neurotoxicity due to cycloserine in the treatment of RR-TB. Moreover, pyridoxine did not have a protective effect against neuropathy and/or neurotoxicity caused by other RR-TB regimens that do not contain isoniazid. In conclusion, we found that withdrawing or withholding medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and ethambutol, implicated in causing neuropathy or neurotoxicity was more effective than using pyridoxine to stop the progression of symptoms, and in some instances, led to their reversal over time.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.
基金the National Natural Science Foundation of China(No.82201200).
文摘AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.
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 Ministry of Health Subvention from the IT Simple System of the Wroclaw Medical University by Wroclaw Medical University,No.SUBZ.C310.22.075the MCDTR grant from the National Institute of Diabetes and Digestive and Kidney Diseases,No.P30DK092926.
文摘BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.AIM To validate both sections(A and B)of the Michigan Neuropathy Screening Instrument(MNSI)in Polish(PL)patients with diabetes.METHODS A cross-sectional study using a test(A1,B1)and re-test(A2,B2)formula was performed in 80 patients with diabetes.The gold standard used for neuropathy detection was a nerve conduction study(NCS)which was performed in all participants.Reliability of the MNSI-PL was assessed using the Cronbach’s alpha,Kuder-Richardson formula 20(KR-20),split-half reliability,the Gottman split-half tests,and correlation between first and second half was accessed.Stability was assessed using an intraclass correlation coefficient(ICC).For external validation,we used simple linear correlation,binomial regression,and agreement between two different tools using a Bland-Altman plot analysis.RESULTS The scale was internally consistent(Cronbach’s alpha for the full scale:0.81 for A and 0.87 for B).MNSI-PL scores in test/retest showed high stability(ICC=0.73 for A and ICC=0.97 for B).The statistically important correlations between MNSI-PL and NCS were found for B1,B2,and A1(P<0.005).The cut-off points of≥3 for section A(sensitivity of 90%-100%;specificity of 33%-40%)and≥2 for section B(sensitivity of 81%-84%;specificity of 60%-70%)were obtained during neuropathy detection.CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
基金Supported by the National Cheng Kung University Hospital,Taiwan,No.NCKUH-11210036.
文摘BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.
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.
文摘Objective:To determine the neuroprotective effects of apigenin against streptozotocin(STZ)-induced diabetic neuropathy(DN).Methods:To induce DN,Wistar rats(150-200 g)were administered with STZ(55 mg/kg,i.p.).Then they were randomly assigned to various groups,viz.,normal,diabetic control,insulin(10 IU/kg,s.c.),apigenin(5,10,and 20 mg/kg,p.o.),and insulin(10 IU/kg)plus apigenin(20 mg/kg,p.o.).Various behavioral,biochemical,and molecular markers[tumor necrosis factor-alpha(TNF-α),interleukin(IL)-1β,IL-6,Toll-like receptor 4(TLR4),myeloid differentiation primary response 88(MyD88),and nuclear factor erythroid 2-related factor 2(Nrf2)]were assessed.Results:Apigenin(10 and 20 mg/kg,p.o.)substantially reduced plasma glucose levels,lipid profile,aspartate transaminase,alanine transaminase,glycated hemoglobin,and neural advanced glycation end products in STZ-induced DN rats(P<0.05).After apigenin intervention,STZ-induced changes in food and water intake,body weight,urine output,allodynia,hyperalgesia,and insulin levels were markedly improved(P<0.05).Neural antioxidant enzymes(superoxide dismutase and glutathione)and Na+K+ATPase activity were also considerably elevated(P<0.05)while the level of lipid peroxidation was diminished following apigenin therapy(P<0.05).Furthermore,apigenin markedly upregulated the Nrf2 mRNA level while downregulating the mRNA expressions of TNF-αand ILs and the protein expressions of TLR4 and MyD88(P<0.05).STZ-induced histological abnormalities in the sciatic nerve were also improved by apigenin treatment.Conclusions:Apigenin exerts its neuroprotective effect by modulating the inflammatory and oxidative stress pathways via regulating the TLR4-MyD88 signaling pathway.
文摘BACKGROUND Methanol is a highly toxic,non-potable alcohol.Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol.Recently,alongside the coronavirus disease 2019(COVID-19)pandemic,rumors circulated on social media that consuming alcohol can prevent or cure the virus,leading to a COVID-19 and methanol-induced optic neuropathy(MON)syndemic.AIM To investigate the impact of erythropoietin(EPO)on the outcomes of patients diagnosed with MON.METHODS In this prospective study,105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital.A comprehensive ocular examination was conducted for all participants.Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days.RESULTS The mean age of the participants was 39.9 years(±12.6).Ninety-four patients were male and eleven were female.The mean pre-treatment best corrected visual acuity(BCVA)improved from 2.0±0.86 to 1.39±0.69 logarithm of the minimum angle of resolution post-treatment(P<0.001),with significant improvement observed in all age categories and genders(P<0.001).Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h(P<0.001),and the post-treatment BCVA remained significant at all monthly follow-up visits(P<0.001).CONCLUSION EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure.Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.
基金National Natural Science Foundation of China,No.81973398,No.81730103,No.81573507 and No.82020108031The National Key Research and Development Program,No.2017YFC0909300 and No.2016YFC0905001+5 种基金Guangdong Provincial Key Laboratory of Construction Foundation,No.2017B030314030 and No.2020B1212060034Science and Technology Program of Guangzhou,No.201607020031National Engineering and Technology Research Center for New Drug Druggability Evaluation(Seed Program of Guangdong Province),No.2017B090903004The 111 Project,No.B16047China Postdoctoral Science Foundation,No.2019M66324,No.2020M683140 and No.2020M683139Natural Science Foundation of Guangdong Province,No.2022A1515012549 and No.2023A1515012667.
文摘BACKGROUND Thalidomide is an effective treatment for refractory Crohn’s disease(CD).However,thalidomide-induced peripheral neuropathy(TiPN),which has a large individual variation,is a major cause of treatment failure.TiPN is rarely predictable and recognized,especially in CD.It is necessary to develop a risk model to predict TiPN occurrence.AIM To develop and compare a predictive model of TiPN using machine learning based on comprehensive clinical and genetic variables.METHODS A retrospective cohort of 164 CD patients from January 2016 to June 2022 was used to establish the model.The National Cancer Institute Common Toxicity Criteria Sensory Scale(version 4.0)was used to assess TiPN.With 18 clinical features and 150 genetic variables,five predictive models were established and evaluated by the confusion matrix receiver operating characteristic curve(AUROC),area under the precision-recall curve(AUPRC),specificity,sensitivity(recall rate),precision,accuracy,and F1 score.RESULTS The top-ranking five risk variables associated with TiPN were interleukin-12 rs1353248[P=0.0004,odds ratio(OR):8.983,95%confidence interval(CI):2.497-30.90],dose(mg/d,P=0.002),brainderived neurotrophic factor(BDNF)rs2030324(P=0.001,OR:3.164,95%CI:1.561-6.434),BDNF rs6265(P=0.001,OR:3.150,95%CI:1.546-6.073)and BDNF rs11030104(P=0.001,OR:3.091,95%CI:1.525-5.960).In the training set,gradient boosting decision tree(GBDT),extremely random trees(ET),random forest,logistic regression and extreme gradient boosting(XGBoost)obtained AUROC values>0.90 and AUPRC>0.87.Among these models,XGBoost and GBDT obtained the first two highest AUROC(0.90 and 1),AUPRC(0.98 and 1),accuracy(0.96 and 0.98),precision(0.90 and 0.95),F1 score(0.95 and 0.98),specificity(0.94 and 0.97),and sensitivity(1).In the validation set,XGBoost algorithm exhibited the best predictive performance with the highest specificity(0.857),accuracy(0.818),AUPRC(0.86)and AUROC(0.89).ET and GBDT obtained the highest sensitivity(1)and F1 score(0.8).Overall,compared with other state-of-the-art classifiers such as ET,GBDT and RF,XGBoost algorithm not only showed a more stable performance,but also yielded higher ROC-AUC and PRC-AUC scores,demonstrating its high accuracy in prediction of TiPN occurrence.CONCLUSION The powerful XGBoost algorithm accurately predicts TiPN using 18 clinical features and 14 genetic variables.With the ability to identify high-risk patients using single nucleotide polymorphisms,it offers a feasible option for improving thalidomide efficacy in CD patients.
基金Supported by the National Natural Science Foundation of China (No.82101115)Wuhan University Independent Innovation Fund Youth Project (No.2042021kf0094)。
文摘·AIM:To evaluate the functional and structural changes of photoreceptors in patients and asymptomatic carriers with Leber hereditary optic neuropathy(LHON)using fullfield electroretinography(FERG)and optical coherence tomography(OCT).·METHODS:Individuals diagnosed with LHON at the Renmin Hospital of Wuhan University and their family members were included in this cross-sectional observational study.The FERG a-wave amplitude of affected patients and asymptomatic carriers was analyzed.The thickness of the outer nuclear layer(ONL),inner and outer segment(IS/OS)and total photoreceptors in the macular fovea and parafovea were measured.·RESULTS:This study included 14 LHON patients(mean age:20.00±9.37y),12 asymptomatic carriers(mean age:39.83±6.48y),and 14 normal subjects(mean age:24.20±1.52y).The FERG results showed that the darkadapted 3.0 electroretinography and light-adapted 3.0 electroretinography a-wave amplitudes of patients and carriers were significantly decreased(P<0.001).The ONL and photoreceptors layers were slightly thicker in patients than in normal subjects(P<0.05),whereas they were thinner in carriers(P<0.05).There were no differences in IS/OS thickness among the groups(P>0.05).·CONCLUSION:Photoreceptors function is significantly impaired in LHON-affected patients and asymptomatic carriers.Meanwhile,photoreceptors morphology is slightly altered,mainly manifesting as a change in ONL thickness.
文摘Background and purpose:Cerebellar ataxia,neuropathy,and vestibular areflexia syndrome(CANVAS)is a neurodegenerative disease of the cerebellum.The disease progression is slow,with up to 25%of people diagnosed needing to use a wheelchair after 15 years from diagnosis.Vestibular symptoms arise from centrally-mediated ocular movement degradation and the reduced vestibular-ocular reflex functioning bilaterally.To date,no report has shown an improvement in VOR gain or gait outcome measures in someone with CANVAS after a course of vestibular physical therapy.Case description:A 65-year-old male,Patient X,first noticed symptoms in his fourth decade of life and was diagnosed with(CANVAS)in his seventh decade.Patient X reported numbness and tingling in his hands and feet,decreased ability to perform daily activities,and several falls.Intervention:Patient X completed a four-month course of vestibular physical therapy,including vestibular ocular reflex exercises,balance training,gait training,and the VestAid application for eye gaze compliance monitoring.The Vestaid application uses eyes and facial recognition software to record the percentage of time that the patient kept their eyes on the target.Outcomes:After vestibular therapy,Patient X had a clinically meaningful improvement in gait speed:from 1.02 m/s to 1.13 m/s and in the Functional Gait Assessment from 20/30 to 27/30.Patient X's eye gaze compliance improved from a median of 43%(range 25e68%)to a median of 67%(58e83%).Discussion:This case study demonstrates that vestibular rehabilitation improved eye gaze compliance and functional outcomes in a person living with CANVAS.
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Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering from road traffic accident.TON is a rare but serious complication secondary to ocular or head trauma,resulting in partial or complete visual loss.In China,the incidence of road traffic accident induced TON is on the rise.The rate of incidence has been reported about 0.5% to 5% in closed head trauma cases[1].
基金Supported by the Cadre Health Research Program of Sichuan Province(No.2023-119)Science&Technology Department of Sichuan Province(China)Funding Project(No.2021YFS0221)+3 种基金1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(No.2022HXFH032No.ZYJC21058No.2021-023No.2022-014)。
文摘Dear Editor,W e read with great interest the study by Zhao et al[1],which evaluated optic neuropathy and changes in the amount of glial fibrillary acidic protein in the retina with intracameral injection of microbeads into rabbits.The objective was to investigate whether the injection of microbeads into the anterior chamber can induce chronic intraocular hypertension in a glaucoma model in rabbits.
文摘Diabetic neuropathy(DN)is a devastating disorder with an increasing prevalence globally.This epidemic can pose a critical burden on individuals and communities,subsequently affecting the productivity and economic output of a country.With more people living a sedentary lifestyle,the incidence of DN is escalating worldwide.Many researchers have relentlessly worked on ways to combat this devastating disease.Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN.Unfortunately,most of these therapies are only partially effective.Worse still,some are associated with unfavorable side effects.This narrative review aims to highlight current issues and challenges in the management of DN,especially from the perspective of molecular mechanisms that lead to its progression,with the hope of providing future direction in the management of DN.To improve the approaches to diabetic management,the suggested resolutions in the literature are also discussed in this review.This review will provide an in-depth understanding of the causative mechanisms of DN,apart from the insights to improve the quality and strategic approaches to DN management.
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.
文摘BACKGROUND The effect of the sympathetic nervous system on peripheral arteries causes vasoconstriction when smooth muscle cells in the walls of blood vessels contract,which leads to narrowing of arteries and reduction of the blood flow.AIM To compare sympathetic vasomotor activation of the brachial arteries in healthy subjects and patients with painful diabetic neuropathy;and therefore,to assess whether there is significant vasomotor dysfunction of medium sized arteries in diabetic neuropathy.METHODS The study included 41 diabetic neuropathy patients and 41 healthy controls.Baseline diameter and flow rate of the brachial arteries were measured.Then,using a bipolar stimulus electrode,a 10 mA,1 Hz electrical stimulus was administered to the median nerve at the wrist level for 5 s.The brachial artery diameter and blood flow rate were re-measured after stimulation.RESULTS In the control group,the median flow rate was 70.0 mL/min prior to stimulation and 35.0 mL/min after stimulation,with a statistically significant decrease(P<0.001),which is consistent with sympathetic nervous system functioning(vasoconstriction).In the diabetic neuropathy group,median flow rate before the stimulation was 35.0 mL/min.After stimulation,the median flow rate was 77.0 mL/min;thus,no significant decrease in the flow rate was detected.In the control group,the median brachial artery diameter,which was 3.6 mm prior to stimulation,decreased to 3.4 mm after stimulation,and this decrease was also statistically significant(P=0.046).In the diabetic neuropathy group,the median brachial artery diameter increased from 3.4 mm to 3.6 mm following nerve stimulation.Once again,no narrowing was observed.CONCLUSION Our research suggests that diabetic neuropathy results in significant vasomotor dysfunction of medium sized peripheral arteries.Physiological vasoconstriction in response to sympathetic activation is impaired in diabetic neuropathy.
文摘BACKGROUND Neuropathy may occur at some sites after catheterization for close examination of cardiac disease.Although the radial artery is considered a relatively uncomplicated site for catheterization,the radial artery and median nerve are in relatively close proximity,with the risk of median nerve injury depending on the angle of puncture.The purpose of this study was to report the outcomes of surgery performed for conservative therapy-resistant median neuropathy following forearm catheterization.CASE SUMMARY A 50-year-old woman experienced palsy from the right thumb to the radial side of the ring finger after catheterization from the radial artery of the right forearm.Paresthesia developed at the same site and a positive tinel-like sign was seen for the median nerve area at the high level of the puncture site.Nerve conduction study showed reduced compound muscle action potentials and loss of sensory nerve action potentials.Symptoms did not improve despite pharmacotherapy and the patient gradually developed flexion restrictions of the index and middle fingers.Median nerve injury and associated flexor tendon adhesion was diagnosed,and the patient was referred for surgery at 3 mo after injury.When the same area was opened,no injury to the median nerve epithelium was obvious,but the area of the positive tinel-like sign was highly adherent to surrounding tissue and to the flexor digitorum superficialis of the index and middle fingers.The surgery was terminated with adequate adhesion release.Rehabilitation was initiated postoperatively,improving neurological symptoms and range of motion of the fingers.Six months after surgery,the patient returned to daily activities without discomfort.CONCLUSION This case provides the appropriate diagnosis and treatment for a suspected peripheral nerve injury.
文摘BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid plate of the optic disc are relatively crowded;however,a combination of the two is clinically uncommon.Herein,we reported a patient with NAION and concealed BRVO,for which the treatment and prognosis were not similar to those for NAION alone.CASE SUMMARY Herein,we report a case of NAION with concealed BRVO that did not improve with oral medication.A week later,we switched to intravenous drug administration to improve circulation,and the patient’s visual acuity and visual field recovered.Hormonal therapy was not administered throughout the study.This case suggested that:(1)Fundus fluorescein angiography(FFA)can help detect hidden BRVO along with the NAION diagnosis;(2)intravenous infusion of drugs to improve circulation has positive effects in treating such patients;and(3)NAION with concealed BRVO may not require systemic hormonal therapy,in contrast with the known treatment for simple NAION.CONCLUSION NAION may be associated with hidden BRVO,which can only be observed on FFA;intravenous therapy has proven effectiveness.
文摘Rifampicin-resistant tuberculosis (RR-TB) is a global public health problem caused by mycobacterium tuberculosis resistant to Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known adverse effects of treatment regimens that cause significant morbidity. Pyridoxine is often added to treatment regimens for the prevention and/or treatment of these side effects. The basis and effectiveness of this practice are unclear. We conducted a systematic review to evaluate the effectiveness of pyridoxine in preventing and/or treating neuropathy and neurotoxicity associated with RR-TB treatment. We included studies with patients with RR-TB who experienced neuropathy or neurotoxicity attributed to RR-TB regimens and were given pyridoxine. Our findings showed contradicting evidence on the use of pyridoxine for preventing or treating neurotoxicity due to cycloserine in the treatment of RR-TB. Moreover, pyridoxine did not have a protective effect against neuropathy and/or neurotoxicity caused by other RR-TB regimens that do not contain isoniazid. In conclusion, we found that withdrawing or withholding medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and ethambutol, implicated in causing neuropathy or neurotoxicity was more effective than using pyridoxine to stop the progression of symptoms, and in some instances, led to their reversal over time.
