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Aims/Introduction: As the extensor digitorum brevis muscle is a small muscle in the most distal part of the legs, its atrophy (EDBA) might reflect symmetric polyneuropathy (SPN). We aimed to clarify the EDBA‐related factors and the usefulness of bilateral EDBA detection for diagnosing SPN, especially diabetic SPN (DSPN). Materials and Methods: In 1,893 participants from the Japanese general population (investigation I) and 133 established diabetes patients (investigation II), relationships between EDBA and various factors including the traditional sitting style called "seiza'" (kneeling and sitting on one's heels) were investigated. Analyses were carried out by univariate and multivariate analysis, and SPN or DSPN was diagnosed by the criteria of "Probable DSPN" of the Toronto Consensus. The validity of EDBA detection for diagnosing SPN/DSPN was also evaluated. Results: Investigation I: EDBA was more prevalent in women than men (44% vs 20%). Significant EDBA‐related factors were aging and seiza habit regardless of sex. Male‐specific EDBA‐related factors were SPN and known diabetes. In men without seiza habit, EDBA was significantly associated with SPN regardless of diabetes, so EDBA seemed to be a useful sign for diagnosing SPN/DSPN. Investigation II: In men, DSPN was more prevalent in the EDBA group than the non‐EDBA group (71% vs 33%). Sensitivity, specificity, positive predictive value and kappa coefficient of EDBA detection for diagnosing DSPN were 44, 87, 67% and 0.323, showing fair agreement. Conclusions: EDBA detection might be a useful method to screen for distal symmetric polyneuropathy, such as DSPN in men, although the exclusion of individuals with seiza habit is necessary to improve accuracy. [ABSTRACT FROM AUTHOR]

Background: The risk of the development of proliferative diabetic retinopathy as well as abnormalities in the structure and/or function of the lacrimal functional unit significantly increases with an increase in diabetes mellitus duration, potentially leading to the development of dry eye. Purpose: To assess the state of the lacrimal functional unit in diabetic patients with dry eye and different durations of diabetes. Material and Methods: One hundred and twenty patients with both type 2 diabetes mellitus and dry eye disease were included in the study. Hemoglobin A1c levels and clinical manifestations of diabetic polyneuropathy and dry eye disease were comprehensively assessed. Results: We found that diabetes duration plays a dominant role in the nature of the course of dry eye disease in patients with type 2 diabetes mellitus. The main features of manifestations of dry eye disease in patients with diabetes mellitus are the predominance of the subjective symptoms in those with shorter diabetes duration and the absence of complaints of eye dryness as well as the presence of objective structural changes in the lacrimal functional unit in those with longer diabetes duration. Conclusion: Patients with long duration of diabetes mellitus have a latent course of dry eye disease and relatively severe structural abnormalities in the lacrimal functional unit. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Tabriz University of Medical Sciences & Health Services is the property of Tabriz University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Diabetes Mellitus is one of the most common metabolic diseases. The most frequent complication of DM is diabetic polyneuropathy. Diabetic polyneuropathy is related to high mortality, morbidity, hospitalization rate and serious level of economic burden. We aimed in this study to determine the risk factors that affect DPN pathology. Methods: Patients with abnormalities in the nerve conduction study constituted the polyneuropathy group, and patients without abnormalities formed the control group. When the laboratory values of the patients were analyzed, blood tests of 168 of 202 patients were reached. 117 of these patients had PNP and 51 did not have PNP. Results: In patients with PNP, glycolyzed hba1c ratio and fasting blood sugar were significantly higher than patients without PNP (p<.001). While HDL rate was lower in patients with PNP than those without PNP (p<0.01), TG/HDL ratio was higher (p<0.05). In patients with PNP, glycolyzed urea (p<0.001) and creatinine (p<0.01) were significantly higher than those without PNP. The serum level of 25 (OH) vitamin D was significantly lower in patients with PNP than in patients without PNP (p<0.05). Ferritin was significantly higher in patients with PNP than patients without (p<0 .01). Conclusions: Knowing and preventing risk factors for diabetic polyneuropathy, we can take a new direction to our treatment approaches and take early measures. Fasting blood sugar and hba1c control, regulation of lipid profile, monitoring of vitamin d and ferritin levels are particularly necessary for protection of polyneuropathy. [ABSTRACT FROM AUTHOR]

There are ca. 8 million persons with diabetes mellitus living in Germany. A late sequelae of diabetes is the diabetic foot syndrome (DFS), the prevalence of which is greatly increasing. It comprises all alterations of the foot as a result of diabetic polyneuropathy as well as microvascular and macrovascular (peripheral arterial occlusive disease, PAOD) alterations. Many of the ca. 250,000 newly diagnosed diabetic foot ulcers per year become chronic wounds. Despite intensive efforts for prevention, early diagnosis and adequate wound care, ca. 13,000 persons with diabetes undergo major limb amputation in Germany every year. With consistent treatment in interdisciplinary centers and by exhausting all possible methods of wound treatment, pressure relief as well as arterial revascularization, the major amputation rate in patients with diabetic foot problems can be reduced by 80%. With a suitable strategy of prevention, the recurrence rate of foot ulcers would be reduced. [ABSTRACT FROM AUTHOR]

Background: Peripheral neuropathy is a common complication of diabetes which can lead to impaired postural control. The aim of the present study was to investigate the effect of 12-week resistance training on balance, risk of falling and distribution of foot pressure in diabetic women with peripheral neuropathy. Methods: In a randomized clinical trial, 30 women with type 2 diabetes and diagnosed with peripheral neuropathy were randomly assigned into experimental (n=15) and control (n=15) groups. The experimental group underwent a circuit resistance training program with 50 of one-maximum repetition, 3 -sessions per week over 12 weeks. Before and following the experimental period static and dynamic balance, posture control and risk of falling were assessed. Results: Static and dynamic balance indices improved following the exercise intervention (P=0.0001). Moreover, risk of falling index decreased in the experimental group compared to control condition (P=0.0001). However, foot pressure distribution was unchanged following exercise intervention (P>0.05). Conclusion: Circuit training improved balance and risk of falling in diabetic patients with peripheral neuropathy. Therefore, they are suggested to include circuit training as a safe non-pharmacological intervention to improve balance and walking and to prevent falling. [ABSTRACT FROM AUTHOR]

Small nerve fibres located in the epidermis sense pain. Dysfunction of these fibres decreases the pain threshold known as small fibre neuropathy. Diabetes mellitus is accompanied by metabolic changes other than glucose, synergistically eliciting small fibre neuropathy. These findings suggest that various metabolic changes may be involved in small fibre neuropathy. Herein, we explored the correlation between pain sensation and changes in plasma metabolites in healthy Japanese subjects. The pain threshold evaluated from the intraepidermal electrical stimulation was used to quantify pain sensation in a total of 1021 individuals in the 2017 Iwaki Health Promotion Project. Participants with a pain threshold evaluated from the intraepidermal electrical stimulation index <0.20 mA were categorized into the pain threshold evaluated from the intraepidermal electrical stimulation index-low group ( n = 751); otherwise, they were categorized into the pain threshold evaluated from the intraepidermal electrical stimulation index-high group ( n = 270). Metabolome analysis of plasma was conducted using capillary electrophoresis time-of-flight mass spectrometry. The metabolite set enrichment analysis revealed that the metabolism of tryptophan was significantly correlated with the pain threshold evaluated from the intraepidermal electrical stimulation index in all participants ( P < 0.05). The normalized level of tryptophan was significantly decreased in participants with a high pain threshold evaluated from the intraepidermal electrical stimulation index. In addition to univariate linear regression analyses, the correlation between tryptophan concentration and the pain threshold evaluated from the intraepidermal electrical stimulation index remained significant after adjustment for multiple factors ( β = -0.07615, P < 0.05). These findings indicate that specific metabolic changes are involved in the deterioration of pain thresholds. Here, we show that abnormal tryptophan metabolism is significantly correlated with an elevated pain threshold evaluated from the intraepidermal electrical stimulation index in the Japanese population. This correlation provides insight into the pathology and clinical application of small fibre neuropathy., Competing Interests: Electrodes for intraepidermal electrical stimulation were supplied by Nihon Kohden Corp, Tokyo, Japan. All authors report no disclosures relevant to the manuscript., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

This study aimed to determine the efficacy of assessing the severity of diabetic polyneuropathy (DPN) in patients with untreated diabetes. Seventy-two patients with untreated type 2 diabetes who were hospitalized for glycemic control were enrolled and divided into the following two groups: patients who had no prior diagnosis and patients who were unattended or had discontinued treatment. Electrophysiological criteria consistent with Baba's classification were used to diagnose and assess the severity of DPN. The patients were divided into three subgroups: no DPN (stage 0), mild DPN (stage 1), and moderate or more-severe DPN (stages 2-4). Intergroup comparisons were performed for the clinical characteristics and the results of the nerve conduction studies. Twenty-two (30%), 25 (35%), and 25 (35%) patients were categorized into the no DPN, mild DPN, and moderate or more-severe DPN subgroups, respectively. The number of patients who were unattended or had discontinued treatment in the moderate or more-severe DPN subgroup was significantly higher than that in the no DPN subgroup. The patients in the moderate or more-severe DPN subgroup had an increased risk of developing diabetic retinopathy and nephropathy, with odds ratios of 19.5 and 11.0 for advanced stages of retinopathy and nephropathy, respectively. Thus, the assessment of the severity of DPN could aid in the prediction of the risk of developing diabetic complications in patients with untreated diabetes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Horinouchi, Deguchi, Mukai, Ijuin, Kawamoto and Nishio.)

Context: Due to the heterogenous clinical symptoms and deficits, the diagnosis of diabetic polyneuropathy (DPN) is still difficult in clinical routine leading to increased morbidity and mortality., Objective: We studied the correlation of phase angle (PhA) of bioelectrical impedance analysis (BIA) with clinical, laboratory and physical markers of DPN to evaluate PhA as possible diagnostic method for DPN., Materials and Methods: In this cross-sectional observational study as part of the Heidelberg Study on Diabetes and Complications we examined 104 healthy individuals and 205 patients with type 2 diabetes mellitus (T2D), amongst which 63 had DPN. The PhA was calculated from multi-frequency BIA. Nerve conduction studies (NCS), quantitative sensory testing (QST) and diffusion-weighted magnetic resonance neurography (MRN) to determine fractional anisotropy (FA) reflecting peripheral nerve integrity were performed., Results: T2D patients with DPN had lower PhA values (5.71 ± 0.10) compared to T2D patients without DPN (6.07 ± 0.08, p = 0.007,  + 6.1%) and healthy controls (6.18 ± 0.08, p < 0.001,  + 7.9%). Confounder-adjusted analyses showed correlations of the PhA with conduction velocities and amplitudes of the peroneal (β=0.28; β=0.31, p < 0.001) and tibial nerves (β=0.28; β=0.32, p < 0.001), Z-scores of QST (thermal detection β=0.30, p < 0.05) and the FA (β=0.60, p < 0.001). ROC analysis showed similar performance of PhA in comparison to mentioned diagnostic methods., Conclusion: The study shows that PhA is in comparison to other test systems used, at least an equally good and much easier to handle, investigator independent marker for detection of DPN., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Various diseases of the peripheral nervous system are associated with metabolic disorders of B vitamins. A lack of neurotropic vitamins, which began in the early stages of the development of a bacterial disease, led to its more rapid development. The article analyzes data on B vitamin deficiency in the pathogenesis of the most dangerous diseases of the peripheral nervous system. Information is provided about the dangers of the clinical use of the drug Combilipen for the treatment of such patients.

Objective: To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN)., Material and Methods: Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3-4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score - 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI)., Results: Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group ( p <0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months ( p <0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group ( p <0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain., Conclusion: Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.

Copyright of Neurologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• MScanFit is more sensitive in showing motor unit loss than nerve conduction studies in diabetic neuropathy. • MScanFit reveals motor involvement equal to sensory in diabetic neuropathy. • Muscle velocity recovery cycles (MVRCs) do not provide additional information in diabetic neuropathy. Motor Unit Number Estimation (MUNE) methods may be valuable in tracking motor unit loss in diabetic polyneuropathy (DPN). Muscle Velocity Recovery Cycles (MVRCs) provide information about muscle membrane properties. This study aimed to examine the utility of the MScanFit MUNE in detecting motor unit loss and to test whether the MVRCs could improve understanding of DPN pathophysiology. Seventy-nine type-2 diabetic patients were compared to 32 control subjects. All participants were examined with MScanFit MUNE and MVRCs in anterior tibial muscle. Lower limb nerve conduction studies (NCS) in peroneal, tibial and sural nerves were applied to diagnose large fiber neuropathy. NCS confirmed DPN for 47 patients (DPN +), with 32 not showing DPN (DPN−). MScanFit showed significantly decreased MUNE values and increased motor unit sizes, when comparing DPN + patients with controls (MUNE = 71.3 ± 4.7 vs 122.7 ± 3.8), and also when comparing DPN− patients (MUNE = 103.2 ± 5.1) with controls. MVRCs did not differ between groups. MScanFit is more sensitive in showing motor unit loss than NCS in type-2 diabetic patients, whereas MVRCs do not provide additional information. The MScanFit results suggest that motor changes are seen as early as sensory, and the role of axonal membrane properties in DPN pathophysiology should be revisited. [ABSTRACT FROM AUTHOR]

Although diabetic polyneuropathy (DPN) is the commonest diabetic complication, its pathology remains to be clarified. As previous papers have suggested the neuroprotective effects of glucagon-like peptide-1 in DPN, the current study investigated the physiological indispensability of glucagon gene-derived peptides (GCGDPs) including glucagon-like peptide-1 in the peripheral nervous system (PNS). Neurological functions and neuropathological changes of GCGDP deficient (gcg −/−) mice were examined. The gcg −/− mice showed tactile allodynia and thermal hyperalgesia at 12–18 weeks old, followed by tactile and thermal hypoalgesia at 36 weeks old. Nerve conduction studies revealed a decrease in sensory nerve conduction velocity at 36 weeks old. Pathological findings showed a decrease in intraepidermal nerve fiber densities. Electron microscopy revealed a decrease in circularity and an increase in g -ratio of myelinated fibers and a decrease of unmyelinated fibers in the sural nerves of the gcg −/− mice. Effects of glucagon on neurite outgrowth were examined using an ex vivo culture of dorsal root ganglia. A supraphysiological concentration of glucagon promoted neurite outgrowth. In conclusion, the mice with deficiency of GCGDPs developed peripheral neuropathy with age. Furthermore, glucagon might have neuroprotective effects on the PNS of mice. GCGDPs might be involved in the pathology of DPN. • Deficiency of glucagon gene-derived peptides (GCGDPs) caused peripheral neuropathy with age in mice. • GCGDPs might have neuroprotective effects on the peripheral nervous system of mice. • Glucagon promoted neurite outgrowth of dorsal root ganglion neurons. [ABSTRACT FROM AUTHOR]

Diabetic neuropathy (DPN) is one of the most severe and yet most poorly understood complications of diabetes mellitus. In vivo imaging of dorsal root ganglia (DRG), a key structure for the understanding of DPN, has been restricted to animal studies. These have shown a correlation of decreased DRG volume with neuropathic symptom severity. Our objective was to investigate correlations of DRG morphology and signal characteristics at 3 Tesla (3T) magnetic resonance neurography (MRN) with clinical and serological data in diabetic patients with and without DPN. In this cross-sectional study, participants underwent 3T MRN of both L5 DRG using an isotropic 3D T2-weighted, fat-suppressed sequence with subsequent segmentation of DRG volume and analysis of normalized signal properties. Overall, 55 diabetes patients (66 ± 9 years; 32 men; 30 with DPN) took part in this study. DRG volume was smaller in patients with severe DPN when compared to patients with mild or moderate DPN (134.7 ± 21.86 vs 170.1 ± 49.22; p = 0.040). In DPN patients, DRG volume was negatively correlated with the neuropathy disability score (r = −0.43; 95%CI = −0.66 to −0.14; p = 0.02), a measure of neuropathy severity. DRG volume showed negative correlations with triglycerides (r = −0.40; 95%CI = −0.57 to −0.19; p = 0.006), and LDL cholesterol (r = −0.33; 95%CI = −0.51 to −0.11; p = 0.04). There was a strong positive correlation of normalized MR signal intensity (SI) with the neuropathy symptom score in the subgroup of patients with painful DPN (r = 0.80; 95%CI = 0.46 to 0.93; p = 0.005). DRG SI was positively correlated with HbA1c levels (r = 0.30; 95%CI = 0.09 to 0.50; p = 0.03) and the triglyceride/HDL ratio (r = 0.40; 95%CI = 0.19 to 0.57; p = 0.007). In this first in vivo study, we found DRG morphological degeneration and signal increase in correlation with neuropathy severity. This elucidates the potential importance of MR-based DRG assessments in studying structural and functional changes in DPN.

Amaç: Kiniğimizde Karpal Tünel Sendromu (KTS) nedeniyle cerrahi olarak müdahale edilenlerinin sonuçlarının diyabetes mellituslu (DM) olup olmamaya göre karşılaştırılması.Materyal ve Metot: 2009-2013 yılları arasında Karabük Üniversitesi Tıp Fakültesi Eğitim Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği’ne başvuran KTS tanısı almış hastalar bu retrospektif araştırmanın çalışma grubunu oluşturdu. Çalışma grubu 3 ayrı gruba ayrıldı; DM teşhisi olmayan grup (Grup 1, n=50), DM teşhisi olup polinöropatisi bulunmayan grup (Grup 2, n=45), DM teşhisi olup polinöropatisi olan grup (Grup 3, n=28). Hastaların semptomları operasyon öncesi ve sonrası kaydedilerek karşılaştırmalar yapıldı. Bulgular: Çalışmamızdaki gruplar yaş, cinsiyet, eğitim durumu, semptomların dağılımı açısından ameliyat öncesinde benzer bulundu. Hastaların semptomlarının son bir yıl içerisindeki değişimleri incelendiğinde, ağrı sempromunun Grup 1 (p=0,001) ve Grup 2’de (p=0,004) anlamlı seviyede azaldığı görülürken, Grup 3’te (p=0,581) değişmediği görüldü. Parestezi semptomunun, Grup 1 (p=0,001) ve Grup 2’de (p=0,017) anlamlı seviyede azaldığı görülürken, Grup 3’te (p=0,344) değişmediği görüldü. Ayrıca, güçsüzlük semptomunun Grup 1’de (p=0,029) anlamlı seviyede azaldığı izlenirken, Grup 2 (p=0,064) ve Grup 3’te (p=0,057) değişmediği izlendi. Sonuç: Çalışmada DM teşhisli hastaların polinöropatisinin olup olmamasının KTS sonucuna anlamlı derecede etki ettiğini izlenmiştir. Operasyon öncesinde ve sonrasında kişiler DM’li olsalar bile nöropati düzeylerinin izlemi yararlı olabilir.

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus. Management of patients with DPN is a complex medical and socioeconomic problem. The article presents the observational study results of 40 patients with type 2 diabetes mellitus complicated by DPN. Patients of the treatment group received Keltikan® complex in combination with basic therapy for 60 days, patients of the control group received only basic therapy. The treatment resulted in the positive changes observed in both groups, while the group taking Keltikan® complex showed more pronounced changes according to the total neurological symptoms (TSS) scale, the neuropathic dysfunctional score (NDS) scale, the neuropathic symptom score (NSS) scale, and also according to the electroneuromyography results.

Purpose: Small fiber dysfunction is common in subjects with diabetic polyneuropathy (DPN). It is unsettled, however, whether marginal glucose intolerance is implicated in the onset and progression of small fiber dysfunction. Herein, we explored the relationship between glycated hemoglobin levels (HbA1c) and pain sensation in the Japanese population.Methods: A population-based study of 894 individuals (352 men, 542 women; average age 53.8 ± 0.5 years) and 55 subjects with impaired fasting glucose (IFG) in the 2017 Iwaki project were enrolled in this study. Individuals with diabetes were excluded. Relationships between pain threshold for intraepidermal electrical stimulation (P-IES) and parameters associated with metabolic syndrome were examined.Results: P-IES was elevated with increasing of age in women but not in men. Average P-IES (mA) was increased in IFG subjects (n = 55, 0.20 ± 0.03) compared with normoglycemic/non-IFG individuals (n = 894, 0.15 ± 0.01) (p < 0.01). It was comparable between IFG and a group of normal high HbA1c (5.9–6.4%). Univariate linear regression analyses showed no influence of sex, triglyceride, or cholesterol on the value of P-IES. In contrast, there were significant correlations between P-IES and serum HbA1c level (ß = 0.120, p < 0.001) Adjustments for the multiple clinical measurements confirmed positive correlation of P-IES with HbA1c (ß = 0.077, p = 0.046).Conclusion: Individuals with normal high HbA1c exhibited an elevated P-IES in a healthy Japanese population which may be useful for the screening of subclinical DPN.

Background: To our knowledge, no clinical study has previously been performed to investigate changes in the retinal ganglion cell complex (GCC) in diabetes mellitus (DM) patients differing in severity of diabetic polyneuropathy (DPN). Purpose: To identify changes in the GCC in patients with DPN differing in severity of the disease. Materials and Methods: A total of 575 patients (1150 eyes) with type 2 diabetes mellitus were included in the prospective analysis. DPN was diagnosed in 210 (36.5%) patients with DM. In addition to routine eye examination, retinal OCT was performed, and the macular GCC was assessed. Results: We found that the state of GCC in patients with DPN depends on the severity of the disease, and mean average GCC thicknesses in DM patients with N1A, N1B, and N3 stages DPN, were 8.4%, 8.6%, and 11.0% lower than in controls (95.8 ± 8.2 μm) (p < 0.001). In addition, in N1A, N1B, N2A, N2B and N3 stages DPN, mean focal loss volume (FLV) values were 8.4, 8.7, 14.1, 14.3, and 15.3 times, respectively, lower, whereas mean global loss volume (GLV) values were 119.1%, 124.8%, 231.3%, 239.6%, and 358.1%, respectively, higher, than in age-matched healthy controls. Conclusion: Retinal ganglion cell complex changes depend on the severity of diabetic polyneuropathy.

Background: To our knowledge, no clinical study has previously been performed to investigate morphometric changes in the lamina cribrosa in diabetes mellitus (DM) patients differing in severity of diabetic polyneuropathy (DPN). Purpose: To identify changes in the lamina cribrosa in patients with DPN differing in severity of the disease. Materials and Methods: A total of 575 patients (1150 eyes) with type 2 diabetes mellitus were included in the prospective analysis of changes in the lamina cribrosa. DPN was diagnosed in 210 (36.5%) patients with DM. In addition to routine eye examination, retinal and optic nerve OCT was performed. Thickness of the cribriform plate and scleral canal area were measured. Results: A relationship was found between the state of the lamina cribrosa and the severity of diabetic polyneuropathy in patients with diabetes mellitus. The mean thicknesses of the lamina cribrosa in DM patients without evidence of DPN, and those with N1A, N1B, N2A, N2B, and N3 stages DPN, were 1.5-fold, 1.9-fold, 2.0-fold, 2.7-fold, 2.8-fold, and 3.0-fold higher than in controls (303 ± 56 μm) (p < 0.001). Conclusion: We found that, in patients with DM, lamina cribrosa thickness increased with increase in severity of DPN.

Background. Diagnosis and treatment of diabetic polyneuropathy is of particular importance for patients with diabetes mellitus and can lead to severe consequences. The purpose of the study was to increase the effectiveness of treatment for neuropathic pain by inclusion of keltican and polarizing light into the comprehensive therapy of diabetic polyneuropathy. Materials and methods. We examined 99 patients with type 2 diabetes mellitus complicated by diabetic polyneuropathy. Patients were divided into 3 groups: the control group included 32 patients who received standard treatment, 32 persons in the second group additionally received 1 capsule of keltican three times a day for a month, and 35 diabetic patients of the third group were assigned additional 12 procedures of polarizing light. The assessment of neuropathic pain severity was performed using a DN4 modified questionnaire. Results. The positive clinical effect of treatment was observed in all groups after 12 days of treatment, and maintained for 3 months in groups 2 and 3, and it lasted for 6 months in the group with additional prescription of keltican. Conclusions. The inclusion of keltican and polarizing light in the standard comprehensive therapy of diabetic polyneuropathy increases the clinical efficacy of neuropathic pain treatment. Using a DN4 questionnaire with a modified evaluation scale to assess neuropathic pain severity helps to optimize diagnosis of such complications in diabetic patients.

The efficacy and safety of purine receptor agonists in patients with chronic pain have been analysed. The data on the clinical application of purine analgesia in the management of pain syndrome are reviewed. The use of purine analgesia for the treatment of patients with chronic neuropathic pain is scientifically justified. The central mechanisms of purine receptor agonists and their analgesic activity are described in detail. It has been shown that purine receptor agonists have a strong analgesic effect and a narrow range of side effects, and they effectively relieve neuropathic pain by influencing the purinergic regulatory mechanism. The mechanisms of the analgesic effect of B vitamins (B1, B6, B12) that have their own analgesic potential are considered — which is of great importance in the pharmacotherapy of polyneuropathies. It should be noted that the prescription of B vitamins is pathogenetically justified in diabetic polyneuropathy, and a combination of B vitamins is more efficacious than a monotherapy.

Background. The prevalence of diabetes mellitus has been epidemically increasing throughout all the world population, and diabetic polyneuropathy (PNP-DM) is one of the most common neurologic manifestation of this disease. Clinical research has proved that effective bedside screening of PNP-DM can significantly reduce the incidence of foot ulcer and limb amputation. Objective. To measure the diagnostic test of polyneuropathy scoring, monofilament 10-g SemmesWeinstein test, and 128 Hz tuning fork test as an early detection measure for PNP-DM. Methods. This research was conducted using a cross sectional approach from Januari 2016 to Juli 2017. Results. Among the total study population of 43 (23 men and 20 woman), Modified Toronto Score has the highest sensitivity (100%), PPV (93%) and accuracy (93%). Toronto score has the highest NPV (9%). Conclusion. Modified Toronto Score has good diagnostic value as screening tool in PNP-DM.

Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: −1.04, 95% CI: −1.68 to −0.40), MNSI symptoms (MD: −1.11, 95% CI: −1.89 to −0.33) and VPT (MD: −4.22, 95% CI: −8.04 to −0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD −0.42, 95% CI −1.72 to 0.90), MNSI clinical symptoms (MD −0.38, 95% CI −1.96 to 1.2) and VPT (MD −4.22, 95% CI −12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.

Introduction: Diabetic polyneuropathy (DPN) is a major chronic neurological complication of diabetes mellitus (DM) and typically presents as diabetic sensory polyneuropathy (DSPN). Whereas some patients with similar risk factors develop polyneuropathy, others don't, which suggests that genetics plays an important role in the progression of disease. The proteasome modulator 9 gene (PSMD9) is a transcriptional regulator of the insulin gene and its variants cause beta-cell dysfunction that devastates insulin transcription. The aim of this study was to determine the correlation between PSMD9 rs14259 polymorphism and the risk of DSPN in Turkish DM patients with DPN. Methods: The study included 31 DM patients with DSPN and 29 healthy controls. All participants underwent electrophysiological investigation. In addition, DNA was isolated from peripheral blood samples for the genotyping of PSMD9 rs14259 polymorphism. Results: Mean age in the DSPN and control groups was 58.03±9.59 years and 57.62±12.32 years, respectively. There were significant differences between the DSPN and controls groups in the frequencies of the genotype for AA (n=9 and n=12, respectively), AG (n=10 and n=15, respectively), and GG (n=12 and n=2, respectively). According to the distribution of PSMD9 rs14259 polymorphism, 45.2% (n=28) of the patients and 67.2% (n=39) of the controls had the A allele, and 54.8% (n=34) of the patients and 32.8% (n=19) of the controls had the G allele, whereas the frequency of the G allele of rs14259 was significantly higher in the DSPN group (X²=1.059, P=0.015) than in the control group (OR: 2.49; 95% CI: 1.18-5.23). Conclusion: The present findings show that the GG genotype and G allele of PSMD9 rs14259 polymorphism may be associated with an increased risk of DSPN in Turkish DM patients. [ABSTRACT FROM AUTHOR]

Diabetic neuropathy (DPN) is one of the most severe and yet most poorly understood complications of diabetes mellitus. In vivo imaging of dorsal root ganglia (DRG), a key structure for the understanding of DPN, has been restricted to animal studies. These have shown a correlation of decreased DRG volume with neuropathic symptom severity. Our objective was to investigate correlations of DRG morphology and signal characteristics at 3 Tesla (3T) magnetic resonance neurography (MRN) with clinical and serological data in diabetic patients with and without DPN. In this cross-sectional study, participants underwent 3T MRN of both L5 DRG using an isotropic 3D T2-weighted, fat-suppressed sequence with subsequent segmentation of DRG volume and analysis of normalized signal properties. Overall, 55 diabetes patients (66 ± 9 years; 32 men; 30 with DPN) took part in this study. DRG volume was smaller in patients with severe DPN when compared to patients with mild or moderate DPN (134.7 ± 21.86 vs 170.1 ± 49.22; p = 0.040). In DPN patients, DRG volume was negatively correlated with the neuropathy disability score (r = −0.43; 95%CI = −0.66 to −0.14; p = 0.02), a measure of neuropathy severity. DRG volume showed negative correlations with triglycerides (r = −0.40; 95%CI = −0.57 to −0.19; p = 0.006), and LDL cholesterol (r = −0.33; 95%CI = −0.51 to −0.11; p = 0.04). There was a strong positive correlation of normalized MR signal intensity (SI) with the neuropathy symptom score in the subgroup of patients with painful DPN (r = 0.80; 95%CI = 0.46 to 0.93; p = 0.005). DRG SI was positively correlated with HbA1c levels (r = 0.30; 95%CI = 0.09 to 0.50; p = 0.03) and the triglyceride/HDL ratio (r = 0.40; 95%CI = 0.19 to 0.57; p = 0.007). In this first in vivo study, we found DRG morphological degeneration and signal increase in correlation with neuropathy severity. This elucidates the potential importance of MR-based DRG assessments in studying structural and functional changes in DPN. [ABSTRACT FROM AUTHOR]

Objective: Diabetes Mellitus is one of the most common metabolic diseases. The most frequent complication of DM is diabetic polyneuropathy. Diabetic polyneuropathy is related to high mortality, morbidity, hospitalization rate and serious level of economic burden. We aimed in this study to determine the risk factors that affect DPN pathology. Methods: Patients with abnormalities in the nerve conduction study constituted the polyneuropathy group, and patients without abnormalities formed the control group. When the laboratory values of the patients were analyzed, blood tests of 168 of 202 patients were reached. 117 of these patients had PNP and 51 did not have PNP. Results: In patients with PNP, glycolyzed hba1c ratio and fasting blood sugar were significantly higher than patients without PNP (p<.001). While HDL rate was lower in patients with PNP than those without PNP (p<0.01), TG/HDL ratio was higher (p<0.05). In patients with PNP, glycolyzed urea (p<0.001) and creatinine (p<0.01) were significantly higher than those without PNP. The serum level of 25(OH) vitamin D was significantly lower in patients with PNP than in patients without PNP (p<0.05). Ferritin was significantly higher in patients with PNP than patients without (p<0 .01). Conclusions: Knowing and preventing risk factors for diabetic polyneuropathy, we can take a new direction to our treatment approaches and take early measures. Fasting blood sugar and hba1c control, regulation of lipid profile, monitoring of vitamin d and ferritin levels are particularly necessary for protection of polyneuropathy. [ABSTRACT FROM AUTHOR]

Background: We investigated the risk of carpal tunnel syndrome (CTS) in diabetic polyneuropathy (DPN).Methods: This study was conducted using records from the National Health Insurance System (NHIS). We divided patients diagnosed with diabetes mellitus (DM) into those with and without DPN. We assessed the effect of DPN on the risk of CTS using Cox proportional hazards regression analyses.Results: DPN was associated with an increased risk of CTS (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12-1.58). In sub-analyses, female gender (HR, 1.45; 95% CI, 1.20-1.76), presence of type 2 DM (HR, 1.36; 95% CI, 1.11-1.64), and age 35 to 64 years (HR 1.35; 95% CI, 1.11-1.64) were significantly associated with an increased risk of CTS.Conclusions: Patients with DPN had an increased risk of CTS compared with the non-DPN group, particularly females, those with type 2 DM, and those aged 35 to 64 years. [ABSTRACT FROM AUTHOR]

Background: Diabetic polyneuropathy (DPN) is a chronic, symmetric, length‐dependent sensorimotor polyneuropathy, people with peripheral neuropathy caused by diabetes often experience balance disorder. Foam texture and sand texture improve balance by providing increased stimulation of sensory receptors of the plantar surface of the foot. Aim: To find out the effect of foam texture versus sand texture on balance with diabetic polyneuropathy. Method: a total of 30 subjects age 35 to 70 years (male and female) having diabetic polyneuropathy were included in the study on the basis of selection criteria. Patients have been divided into 2 groups. Group A received balance and conventional exercise on foam texture and group B received balance and conventional exercise on sand texture (30 minutes,5 times /week, 6 weeks) Outcome measures have been taken on day 1 and after 6 weeks. the data was analyzed using. SPSS 21. Conclusion: This study concluded that balance exercise on foam texture shows significant improvement in balance in diabetic polyneuropathy patients. [ABSTRACT FROM AUTHOR]

Background: Dental pulp stem cells (DPSCs) have high proliferation and multi-differentiation capabilities that maintain their functionality after cryopreservation. In our previous study, we demonstrated that cryopreserved rat DPSCs improved diabetic polyneuropathy and that the efficacy of cryopreserved rat DPSCs was equivalent to that of freshly isolated rat DPSCs. The present study was conducted to evaluate whether transplantation of cryopreserved human DPSCs (hDPSCs) is also effective for the treatment of diabetic polyneuropathy. Methods: hDPSCs were isolated from human impacted third molars being extracted for orthodontic reasons. Eight weeks after the induction of diabetes in nude mice, hDPSCs (1 × 105/limb) were unilaterally transplanted into the hindlimb skeletal muscle, and vehicle (saline) was injected into the opposite side as a control. The effects of hDPSCs were analyzed at 4 weeks after transplantation. Results: hDPSC transplantation significantly ameliorated reduced sensory perception thresholds, delayed nerve conduction velocity, and decreased the blood flow to the sciatic nerve in diabetic mice 4 weeks post-transplantation. Cultured hDPSCs secreted the vascular endothelial growth factor (VEGF) and nerve growth factor (NGF) proteins. A subset of the transplanted hDPSCs was localized around the muscle bundles and expressed the human VEGF and NGF genes at the transplanted site. The capillary/muscle bundle ratio was significantly increased on the hDPSC-transplanted side of the gastrocnemius muscles in diabetic mice. Neutralizing antibodies against VEGF and NGF negated the effects of hDPSC transplantation on the nerve conduction velocity in diabetic mice, suggesting that VEGF and NGF may play roles in the effects of hDPSC transplantation on diabetic polyneuropathy. Conclusions: These results suggest that stem cell transplantation with hDPSCs may be efficacious in treating diabetic polyneuropathy via the angiogenic and neurotrophic mechanisms of hDPSC-secreted factors. [ABSTRACT FROM AUTHOR]

Clinical trials for diabetic polyneuropathy (DPN) have failed to identify therapeutic impacts that have arrested or reversed the disorder, despite a long history. This review considers DPN in the context of a unique neurodegenerative disorder that targets peripheral neurons and their companion glial cells. The approach is to examine what cells, cell substructures, and pathways are implicated in causing DPN and how they might be addressed therapeutically. These include axonopathy, neuronopathy, hyperglycemia, polyol flux, advanced glycation endproduct (AGE)‐receptor AGE signaling, growth factor disruption, abnormal insulin signaling, and abnormalities of other intrinsic neuron pathways. Mitochondrial dysfunction and lipid toxicity are largely delegated to the companion review in this issue by Stino and Feldman. Finally, the linkage between axon plasticity of cutaneous nerves, peripheral neuroregenerative pathways, and diabetes are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of burn injury on spatio-temporal gait parameters and gait symmetry in individuals with diabetic polyneuropathy (DPN)-related lower extremity burn injury.Methods: Demographic information and the physical examinations of the lower extremities of 14 patients with unilateral lower extremity burn injury due to DPN (DPNB) and 14 uninjured patients with DPN (DPN0) were recorded. The GAITRite computerized gait analysis system was used to evaluate the spatio-temporal parameters of gait. Symmetry Index (SI) was calculated to determine gait symmetry. The Mann Whitney U test was used to determine the demographical and clinical differences between the groups, the Wilcoxon's test was used to compare both sides of all the participants for all gait parameters and linear regression analysis was used to find the variables that affect gait parameters.Results: The groups were similar in terms of their demographic information except for age. Compared with the DPN0 group, DPNB group had increased extent of area with sensory loss and severity of DPN, decreased ankle joint range of motions and intrinsic foot muscles strength and they displayed lower gait speed, step length, stride length and swing percentage but their double support and stance percentage were increased.Conclusion: This study results have shown that, spatio-temporal gait parameters of DPNB patients are different. These differences in spatiotemporal parameters are found on both sides, probably owing to the symmetric and bilateral sensory loss is superior to unilateral burn injury due to symmetrical and bilateral sensory loss. Gait analysis should be considered in order to reveal the changes in gait parameters and to improve appropriate healing process of patients with DPN-related lower extremity burn injury. [ABSTRACT FROM AUTHOR]

Background: Diabetic polyneuropathy (DPN) is the most common and early developing complication of diabetes mellitus, and the key contributor for foot ulcers development, with no specific therapies available. Different studies have shown that mesenchymal stem cell (MSC) administration is able to ameliorate DPN; however, limited cell survival and safety reasons hinder its transfer from bench to bedside. MSCs secrete a broad range of antioxidant, neuroprotective, angiogenic, and immunomodulatory factors (known as conditioned medium), which are all decreased in the peripheral nerves of diabetic patients. Furthermore, the abundance of these factors can be boosted in vitro by incubating MSCs with a preconditioning stimulus, enhancing their therapeutic efficacy. We hypothesize that systemic administration of conditioned medium derived from preconditioned MSCs could reverse DPN and prevent foot ulcer formation in a mouse model of type II diabetes mellitus. Methods: Diabetic BKS db/db mice were treated with systemic administration of conditioned medium derived from preconditioned human MSCs; conditioned medium derived from non-preconditioned MSCs or vehicle after behavioral signs of DPN was already present. Conditioned medium or vehicle administration was repeated every 2 weeks for a total of four administrations, and several functional and structural parameters characteristic of DPN were evaluated. Finally, a wound was made in the dorsal surface of both feet, and the kinetics of wound closure, re-epithelialization, angiogenesis, and cell proliferation were evaluated. Results: Our molecular, electrophysiological, and histological analysis demonstrated that the administration of conditioned medium derived from non-preconditioned MSCs or from preconditioned MSCs to diabetic BKS db/db mice strongly reverts the established DPN, improving thermal and mechanical sensitivity, restoring intraepidermal nerve fiber density, reducing neuron and Schwann cell apoptosis, improving angiogenesis, and reducing chronic inflammation of peripheral nerves. Furthermore, DPN reversion induced by conditioned medium administration enhances the wound healing process by accelerating wound closure, improving the re-epithelialization of the injured skin and increasing blood vessels in the wound bed in a skin injury model that mimics a foot ulcer. Conclusions: Studies conducted indicate that MSC-conditioned medium administration could be a novel cell-free therapeutic approach to reverse the initial stages of DPN, avoiding the risk of lower limb amputation triggered by foot ulcer formation and accelerating the wound healing process in case it occurs. [ABSTRACT FROM AUTHOR]

Introduction: Assessment of sensory impairment in diabetic patients by pain threshold test using intraepidermal electrical stimulation (IES) is a recently developed technique. However, there are no normative pain thresholds in healthy people.Methods: We examined pain, vibration, and pressure thresholds in 178 healthy subjects using IES, vibration perception testing (VPT), and Semmes-Weinstein monofilament testing (SWMT).Results: The mean values for each age group for pain threshold ranged from 0.07 to 0.12 mA. Pain thresholds were unaffected by age. As the age increased, VPT values decreased from 18.0 to 10.6 seconds and SWMT values increased from 21.4 to 45.3 g/mm2 . There were no significant differences in pain threshold, VPT, and SWMT between men and women.Discussion: The pain threshold test appears to be useful for diabetic neuropathy screening because normative values are not affected by age. [ABSTRACT FROM AUTHOR]

Copyright of Mezdunarodnyj Nevrologiceskij Zurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This exploratory study compared the lower-limb muscle mass (thigh muscle mass [TMM] and lower-leg muscle mass [LLMM]) in type 2 diabetic patients with and without diabetic polyneuropathy (DPN). Methods: A total of 130 patients with type 2 diabetes, hospitalized for glycemic control, were enrolled in this cross-sectional study. TMM and LLMM were measured using the bioelectrical impedance method. The muscle mass value was normalized by the bodyweight, and the total muscle mass was calculated by combining the muscle mass on the left and right (%TMM and %LLMM). DPN was evaluated according to the Japanese criteria. Anthropometric parameters, blood pressure, laboratory data, exercise habits, medication, related index of diabetes, and diabetic complications were analyzed. Results: Sixty patients, comprising of 32 males (47.8%) and 28 females (44.4%) with type 2 diabetes (46.2%), had DPN. The %TTM and %LLMM were significantly lower in type 2 diabetic patients with DPN than in those without DPN. Multiple regression analysis identified DPN, age, and hemoglobin A1c (HbA1c) as the determinants of %TMM, and DPN and HbA1c were identified as the determinants of %LLMM in type 2 diabetic patients. Discussion: The %TMM and %LLMM were significantly decreased in type 2 diabetic patients with DPN. DPN was found to be the strongest determinant of %TMM and %LLMM. Preventing and improving DPN, through active physical therapy, may increase the muscle mass of the lower limbs. [ABSTRACT FROM AUTHOR]

Background/Aims: Repetitive transcranial magnetic stimulation and transcutaneous electrical nerve stimulation have been studied repeatedly to reduce diabetic neuropathic pain. The objective of this study was to compare the effects of aerobic training plus one of the treatment therapies on decreasing pain severity in patients with diabetic peripheral neuropathy. Methods: A total of 30 patients with diabetic peripheral neuropathy were randomly assigned into two equal groups: group A and group B. Both groups received aerobic training exercises. Group A received repetitive transcranial magnetic stimulation, and Group B received transcutaneous electrical nerve stimulation for 5 consecutive days in 1 week. Outcome measures included pain severity assessment using the Visual Analogue Scale and the serum β-endorphin levels. Results: There was a non-significant difference in pre-treatment (P=0.061) and post-treatment (P=0.652) in the Visual Analogue Scale scores between groups. However, β-endorphin levels were significantly different between groups in post- (P=0.015) rather than pre-treatment (P=0.459) levels. A significant moderate correlation between β-endorphin levels and Visual Analogue Scale scores was found in group A (r=−0.6783) at (P=0.008), while it was not significant in group B (r=0.043) at (P=0.883). Conclusions: Adding transcutaneous electrical nerve stimulation or repetitive transcranial magnetic stimulation therapies to aerobic training showed similar effects in reducing pain severity in patients with diabetic peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Diabetic polyneuropathy, which is a chronic symmetrical length‐dependent sensorimotor polyneuropathy, is the most common form of diabetic neuropathy. Although diabetic polyneuropathy is the most important risk factor in cases of diabetic foot, given its poor prognosis, the criteria for diagnosis and staging of diabetic polyneuropathy has not been established; consequently, no disease‐modifying treatment is available. Most criteria and scoring systems that were previously proposed consist of clinical signs, symptoms and quantitative examinations, including sensory function tests and nerve conduction study. However, in diabetic polyneuropathy, clinical symptoms, including numbness, pain and allodynia, show no significant correlation with the development of pathophysiological changes in the peripheral nervous system. Therefore, these proposed criteria and scoring systems have failed to become a universal clinical end‐point for large‐scale clinical trials evaluating the prognosis in diabetes patients. We should use quantitative examinations of which validity has been proven. Nerve conduction study, for example, has been proven effective to evaluate dysfunctions of large nerve fibers. Baba's classification, which uses a nerve conduction study, is one of the most promising diagnostic methods. Loss of small nerve fibers can be determined using corneal confocal microscopy and intra‐epidermal nerve fiber density. However, no staging criteria have been proposed using these quantitative evaluations for small fiber neuropathy. To establish a novel diagnostic and staging criteria of diabetic polyneuropathy, we propose three principles to be considered: (i) include only generalizable objective quantitative tests; (ii) exclude clinical symptoms and signs; and (iii) do not restrictively exclude other causes of polyneuropathy. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Transplantation of stem cells promotes axonal regeneration and angiogenesis in a paracrine manner. In the present study, we examined whether the secreted factors in conditioned medium of stem cells from human exfoliated deciduous teeth (SHED‐CM) had beneficial effects on diabetic polyneuropathy in mice. Materials and Methods: Conditioned medium of stem cells from human exfoliated deciduous teeth was collected 48 h after culturing in serum‐free Dulbecco's modified Eagle's medium (DMEM), and separated into four fractions according to molecular weight. Dorsal root ganglion neurons from C57BL/6J mice were cultured with SHED‐CM or DMEM to evaluate the effect on neurite outgrowth. Streptozotocin‐induced diabetic mice were injected with 100 μL of SHED‐CM or DMEM into the unilateral hindlimb muscles twice a week over a period of 4 weeks. Peripheral nerve functions were evaluated by the plantar test, and motor and sensory nerve conduction velocities. Intraepidermal nerve fiber densities, capillary number‐to‐muscle fiber ratio, capillary blood flow and morphometry of sural nerves were also evaluated. Results: Conditioned medium of stem cells from human exfoliated deciduous teeth significantly promoted neurite outgrowth of dorsal root ganglion neurons compared with DMEM. Among four fractions of SHED‐CM, the only fraction of <6 kDa promoted the neurite outgrowth of dorsal root ganglion neurons. In addition, SHED‐CM significantly prevented decline in sensory nerve conduction velocities compared with DMEM in diabetic mice. Although SHED‐CM did not improve intraepidermal nerve fiber densities or morphometry of sural nerves, SHED‐CM ameliorated the capillary number‐to‐muscle fiber ratio and capillary blood flow. Conclusions: These results suggested that SHED‐CM might have a therapeutic effect on diabetic polyneuropathy through promoting neurite outgrowth, and the increase in capillaries might contribute to the improvement of neural function. [ABSTRACT FROM AUTHOR]

Abstract Background Although previous reports have revealed the therapeutic potential of stem cell transplantation in diabetic polyneuropathy, the effects of cell transplantation on long-term diabetic polyneuropathy have not been investigated. In this study, we investigated whether the transplantation of dental pulp stem cells (DPSCs) ameliorated long-term diabetic polyneuropathy in streptozotocin (STZ)-induced diabetic rats. Methods Forty-eight weeks after STZ injection, we transplanted DPSCs into the unilateral hindlimb skeletal muscles. Four weeks after DPSC transplantation (i.e., 52 weeks after STZ injection) the effects of DPSC transplantation on diabetic polyneuropathy were assessed. Results STZ-induced diabetic rats showed significant reductions in the sciatic motor/sensory nerve conduction velocity, increases in the current perception threshold, and decreases in capillary density in skeletal muscles and intra-epidermal nerve fiber density compared with normal rats, all of which were ameliorated by DPSC transplantation. Furthermore, sural nerve morphometrical analysis revealed that the transplantation of DPSCs significantly increased the myelin thickness and area. DPSC-conditioned media promoted the neurite outgrowth of dorsal root ganglion neurons and increased the viability and myelin-related protein expression of Schwann cells. Conclusions These results indicated that the transplantation of DPSCs contributed to the neurophysiological and neuropathological recovery from a long duration of diabetic polyneuropathy.

Introduction. The multidisciplinary approach, including pharmacological therapy, educational therapy, cognitive-behavioral therapy (CBT) has the leading role in management of patients with diabetic polyneuropathy (DPN). There is no domestic experience in the multidisciplinary treatment of DPN patients. Study purpose – study of efficiency of DPN patients management using a multidisciplinary approach. Patients and methods. The study included 50 patients (29 women and 21 men) aged 20 to 78 years (mean age = 57.6 ± 10.2 years) with diabetes mellitus (DM) of type 1 and 2 and DPN. All patients received multidisciplinary treatment consisting of pharmacotherapy, educational programs, KPT. All patients by Cocarnit (for 9 days). The observation period for the patients was 12 weeks. All the patients underwent assessment of neuropathic and asthenic symptoms. Results. Many patients were newly diagnosed with concomitant neurological (lumboischalgia, cervicalgia, tunnel syndromes, headaches, insomnia) and emotional (anxiety, depression) disorders. Authentically significant reduction in the average positive neuropathic and asthenic symptoms, improvement in average pain sensitivity was observed from Day 10 and persisted until 12 weeks of observation. Best value of effectiveness of interdisciplinary treatment was observed in patients with Stage 2 DPN. Conclusion. There is a low level of diagnostics of combined neurological and emotional disorders in patients with diabetes and DPN. The multidisciplinary treatment allows relatively quickly and firmly to reduce the severity of neuropathic and asthenic symptoms in DPN patients, most effectively – at the Stage 2A of DPN. The use of Cocarnit is effective and safe in complex therapy of DPN patients.

Background. Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. Diabetic polyneuropathy can be a cause of MGD. Purpose: To improve the efficacy of diagnosis of MGD in patients with severe complications of diabetic polyneuropathy. Materials and Methods: Standard ophthalmological examination, the Schirmer’s test before and 2 hours after eyelid compression, the Norn’s test, the OPI test, a compression test, an IVAD test, contact meibography with green filter were performed. Severe complications of diabetic polyneuropathy (N3 stage) were recorded in 25 patients (50 eyes). A control group consisted of 97 persons (194 eyes) without diabetes. Results and Discussion: The Schirmer’s test was 2.7 times reduced in patients with N3 stage (4.83 mm) in comparison with that in the control group (12.82) (p

• MScanFit MUNE yields detailed information on motor unit loss. • Motor involvement in diabetic neuropathy may be present as early as sensory involvement. • MScanFit MUNE provides sensitive detection of motor involvement in diabetic polyneuropathy. Detection of motor involvement in diabetic polyneuropathy (DPN) by nerve conduction studies (NCS) does not occur until there is substantial loss of motor units, because collateral reinnervation maintains compound muscle action potential (CMAP) amplitude. Motor unit number estimation (MUNE) methods may therefore be more sensitive. This study was undertaken to test whether the novel method, MScanFit MUNE (MScan) can detect motor involvement in DPN despite normal NCS. Fifty-two type-2 diabetic patients and 38 healthy controls were included. The median nerve was examined in all participants using standard NCS and a detailed CMAP scan, used for MScan. Additional lower extremity NCS in patients were used for DPN diagnosis. Of 52 diabetic patients, 21 had NCS-defined DPN while lower extremity NCS were normal in 31 patients. MScan motor unit number and size showed higher sensitivity and incidence of abnormality than motor NCS parameters, and a similar sensitivity to sensory NCS. MScan is able to detect motor axonal damage at times when collateral reinnervation limits NCS changes. MScan is a sensitive method to detect motor involvement in DPN, which our data suggests is present as early as sensory. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)