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Aziz N, Dash B, Wal P, Kumari P, Joshi P, Wal A. New Horizons in Diabetic Neuropathies: An Updated Review on their Pathology, Diagnosis, Mechanism, Screening Techniques, Pharmacological, and Future Approaches. Curr Diabetes Rev 2024; 20:e201023222416. [PMID: 37867268 DOI: 10.2174/0115733998242299231011181615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/16/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND One of the largest problems for global public health is diabetes mellitus (DM) and its micro and macrovascular consequences. Although prevention, diagnosis, and treatment have generally improved, its incidence is predicted to keep rising over the coming years. Due to the intricacy of the molecular mechanisms, which include inflammation, oxidative stress, and angiogenesis, among others, discovering treatments to stop or slow the course of diabetic complications is still a current unmet need. METHODS The pathogenesis and development of diabetic neuropathies may be explained by a wide variety of molecular pathways, hexosamine pathways, such as MAPK pathway, PARP pathway, oxidative stress pathway polyol (sorbitol) pathway, cyclooxygenase pathway, and lipoxygenase pathway. Although diabetic neuropathies can be treated symptomatically, there are limited options for treating the underlying cause. RESULT Various pathways and screening models involved in diabetic neuropathies are discussed, along with their possible outcomes. Moreover, both medicinal and non-medical approaches to therapy are also explored. CONCLUSION This study highlights the probable involvement of several processes and pathways in the establishment of diabetic neuropathies and presents in-depth knowledge of new therapeutic approaches intended to stop, delay, or reverse different types of diabetic complications.
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Affiliation(s)
- Namra Aziz
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, School of Medical Sciences, ADAMAS University, Kolkata 700 126, West Bengal, India
| | - Pranay Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
| | - Prachi Kumari
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
| | - Poonam Joshi
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun 248007, Uttarakhand, India
| | - Ankita Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
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Dos Santos M, Yahya A, Kluding P, Pasnoor M, Wick J, Liu W. The effect of type 2 diabetes and diabetic peripheral neuropathy on predictive grip force control. Exp Brain Res 2023; 241:2605-2616. [PMID: 37730970 DOI: 10.1007/s00221-023-06705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
This study investigated the impact of type 2 diabetes and diabetic peripheral neuropathy on grip force control during object manipulation. The study included three age-matched groups: type 2 diabetes alone (n = 11), type 2 diabetes with neuropathy (n = 13), and healthy controls (n = 12). Grip force control variables derived from lifting and holding an experimental cup were the ratio between grip force and load forces during lifting (GFR), latency 1 and latency 2, which represented the time between the object's grip and its lift-off from the table, and the period between object's lift-off and the grip force peak, respectively; time lag, which denoted the time difference between the grip and load force peaks during the lifting phase, and finally static force, which was the grip force average during the holding phase. Grip force control variables were compared between groups using one-way ANOVA and Kruskal-Wallis test. Post-hoc analysis was used to compare differences between groups. GFR and latency 1 showed significant differences between groups; the type 2 diabetes with neuropathy group showed larger GFR than the type 2 diabetes alone and healthy control groups. The latency 1was longer for the group with neuropathy in comparison with the health control group. There were no significant differences between groups for latency 2, time lag, and static force. Our results showed impaired GFR and latency 1 in participants with type 2 diabetes with neuropathy while the time lag was preserved. People with type 2 diabetes alone might not have any deficits in grip force control. Higher grip forces might expose people with type 2 diabetes and diabetic peripheral neuropathy to the risk of fatigue and injuring their hands. Future studies should investigate strategies to help people with type 2 diabetes with neuropathy adjust grip forces during object manipulation.
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Affiliation(s)
- Marcio Dos Santos
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, Miami, 800 S. Douglas Road, Suite 149, Coral Gables, FL, 33134, USA.
| | - Abdalghani Yahya
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patricia Kluding
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Pi CX, Gui TJ, He QD, Yin F, Cai RJ, Wang Y, Xue QX, Tian XK, Wang T, Zhe XW. Glomerular filtration Rate, urine Albumin/ creatinine ratio and current perception threshold in patients with diabetic kidney disease. Diabetes Res Clin Pract 2022; 189:109934. [PMID: 35640744 DOI: 10.1016/j.diabres.2022.109934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetic microvascular complications, including diabetic kidney disease (DKD), retinopathy (DR), and neuropathy (DN), were major causes of morbidity and mortality in diabetic patients worldwide. It has been suggested that urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were not the only indicators of renal function impairment in DKD and that they were also associated with diabetic peripheral neuropathy (DPN) which might affect nerve conduction velocity (NCV). As 30-40% of DPN patients had no subjective symptoms, while current perception threshold (CPT) could detect sensory nerve damage at an early stage. As a result, we aimed to investigate correlation between UACR, eGFR and CPT in DKD patients. METHODS A total of 273 DKD patients from the First Affiliated Hospital of Kunming Medical University from January 2018 to June 2020 were enrolled to complete the CPT test. CPT values of the bilateral median nerve and superficial and deep peroneal nerves at 2000 Hz, 250 Hz, and 5 Hz were collected. RESULTS In normoesthesia and hypaesthesia patients with DKD, MDRD-eGFR correlated negatively with TC (r = -0.135, P = 0.037), left superficial peroneal and deep peroneal nerve 2000 Hz CPT (r = -0.205, P = 0.001) and right superficial peroneal and deep peroneal nerve 2000 Hz CPT (r = -0.154, P = 0.017). Besides, left and right superficial peroneal and deep peroneal nerve 2000 Hz CPT correlated with CKD-EPI-eGFR and UACR. Multivariate logistic regression analysis found left superficial peroneal and deep peroneal nerve 2000 Hz CPT was independently associated with both MDRD-eGFR and CKD-EPI-eGFR. CONCLUSION Decreased MDRD-eGFR and CKD-EPI-eGFR were expected to be a predictor of peripheral nerve injury in normoesthesia and hypaesthesia patients with DKD.
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Affiliation(s)
- Cheng-Xian Pi
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Teng-Juan Gui
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Qi-Da He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Fang Yin
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Ren-Jiao Cai
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Yue Wang
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Qiu-Xia Xue
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Xin-Kui Tian
- Division of Nephrology, Peking University Third Hospital, Beijing, PR China
| | - Tao Wang
- Division of Nephrology, Peking University Third Hospital, Beijing, PR China
| | - Xing-Wei Zhe
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China.
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Kawabata K, Sago T, Oowatari T, Shiiba S. Prolonged blockade of the cervical sympathetic nerve by stellate ganglion block accelerates therapeutic efficacy in trigeminal neuropathy. J Oral Sci 2021; 64:6-10. [PMID: 34789618 DOI: 10.2334/josnusd.21-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE Stellate ganglion block (SGB) is effective in treating head and neck pain and neuropathic diseases by increasing tissue blood flow through its sympatholytic effect. This study aimed to investigate the relationship between duration of cervical sympathetic nerve block by SGB and its therapeutic efficacy against trigeminal neuropathy after orthognathic surgery. METHODS Twenty-eight patients with trigeminal neuropathy were randomly assigned to two groups (mepivacaine and levobupivacaine) according to the drug used for SGB. Increased blood flow, which is a symptom of sympathetic blockade, was recorded for 180 min after SGB. Current perception threshold, warm or cool detection threshold, and tactile detection threshold were measured preoperatively, postoperatively, on day 10 after initiation of SGB, and 3 months postoperatively to compare therapeutic efficacy between the groups. RESULTS The levobupivacaine group had a significantly longer duration of increased blood flow compared with the mepivacaine group. Values of current perception threshold, warm and cool detection threshold, and tactile detection threshold significantly improved in the levobupivacaine group on day 10 after initiation of SGB and 3 months postoperatively. CONCLUSION A prolonged increase in blood flow due to long-term sympatholytic effects accelerates the therapeutic efficacy of SGB in trigeminal neuropathy.
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Affiliation(s)
- Kazune Kawabata
- Department of Science of Physical Functions, Division of Dental Anesthesiology, Kyushu Dental University
| | - Teppei Sago
- Department of Science of Physical Functions, Division of Dental Anesthesiology, Kyushu Dental University
| | - Tsuneto Oowatari
- Department of Dental Management of Compromised Patient, Kyushu Dental University
| | - Shunji Shiiba
- Department of Science of Physical Functions, Division of Dental Anesthesiology, Kyushu Dental University
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Nádró B, Lőrincz H, Molnár Á, Szentpéteri A, Zöld E, Seres I, Páll D, Paragh G, Kempler P, Harangi M, Sztanek F. Effects of alpha-lipoic acid treatment on serum progranulin levels and inflammatory markers in diabetic neuropathy. J Int Med Res 2021; 49:3000605211012213. [PMID: 34041950 PMCID: PMC8165837 DOI: 10.1177/03000605211012213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives Progranulin (PGRN) is a secreted growth factor that helps to regulate
neuronal survival by blocking tumor necrosis factor-alpha (TNFα) receptors.
The antioxidant alpha-lipoic acid (ALA) is used in diabetic neuropathy to
improve nerve conduction and relieve neuropathic pain, but its effects on
PGRN levels have not yet been elucidated. Methods In this prospective study, 54 patients with type 2 diabetes and peripheral
neuropathy received 600 mg of ALA daily for 6 months. Twenty-four patients
with diabetes without neuropathy were also included in the study. Serum PGRN
and TNFα levels were determined using enzyme-linked immunosorbent assays. In
addition, current perception threshold (CPT) testing was used to assess
sensory neuropathy. Results After ALA treatment, serum PGRN levels were significantly increased and CPT
values were significantly improved. Furthermore, there were significant
positive correlations among TNFα, ICAM-1, and PGRN levels both before and
after ALA treatment. A significant negative correlation was observed between
the improvements in CPT and the PGRN levels. Furthermore, ICAM-1 levels were
an independent predictor of PGRN levels. Conclusions Changes in serum PGRN levels indicate that ALA treatment may have beneficial
effects on endothelial function and neuronal inflammation.
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Affiliation(s)
- Bíborka Nádró
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Hajnalka Lőrincz
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Ágnes Molnár
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Anita Szentpéteri
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Eszter Zöld
- Department of Ophthalmology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Ildikó Seres
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Dénes Páll
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - György Paragh
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Péter Kempler
- First Department of Internal Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Mariann Harangi
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Ferenc Sztanek
- Department of Internal Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
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Choi D, Kim BY, Jung CH, Kim CH, Mok JO. Association between Sleep Quality and Painless Diabetic Peripheral Neuropathy Assessed by Current Perception Threshold in Type 2 Diabetes Mellitus. Diabetes Metab J 2021; 45:358-367. [PMID: 32794384 PMCID: PMC8164947 DOI: 10.4093/dmj.2019.0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND It is known that the painful sensation of diabetic peripheral neuropathy (DPN) results in sleep problems in type 2 diabetes mellitus (T2DM). However, it is not known that the painless DPN also is associated with poor sleep quality in T2DM. The purpose of the current study was to investigate the association between painless DPN and poor sleep quality in T2DM. METHODS A total of 146 patients of T2DM who do not have any painful symptoms of DPN were recruited into the study. Among the patients, painless DPN was diagnosed by using the current perception threshold test. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire. RESULTS The percentage of painless DPN was significantly higher in the poor sleep quality group than the good sleep quality group (70.0% vs. 35.5%, P<0.001). In the subscale results, stimulus values at 2,000 Hz, hypoesthesia and hyperesthesia were more common in the poor sleep quality group than in the good sleep quality group (45.7% vs. 25.0%, P=0.009; 34.3% vs. 18.4%, P=0.029; 40.0% vs. 19.7%, P=0.007, respectively). The association of painless DPN and poor sleep quality remained significant after adjustment for significant covariates (odds ratio, 3.825; 95% confidence interval, 1.674 to 8.742; P<0.001). CONCLUSION The current study showed that painless DPN was associated with poor sleep quality. Future studies are required to clarify the pathophysiologic causal relationship between painless DPN and sleep quality.
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Affiliation(s)
- Dughyun Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chul-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji-Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics (Basel) 2021; 11:diagnostics11020165. [PMID: 33498918 PMCID: PMC7911433 DOI: 10.3390/diagnostics11020165] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.
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Hata M, Omi M, Kobayashi Y, Nakamura N, Miyabe M, Ito M, Makino E, Kanada S, Saiki T, Ohno T, Imanishi Y, Himeno T, Kamiya H, Nakamura J, Ozawa S, Miyazawa K, Kurita K, Goto S, Takebe J, Matsubara T, Naruse K. Transplantation of human dental pulp stem cells ameliorates diabetic polyneuropathy in streptozotocin-induced diabetic nude mice: the role of angiogenic and neurotrophic factors. Stem Cell Res Ther 2020; 11:236. [PMID: 32546222 PMCID: PMC7298811 DOI: 10.1186/s13287-020-01758-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/10/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Masaki Hata
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Maiko Omi
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yasuko Kobayashi
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Nobuhisa Nakamura
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Megumi Miyabe
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Mizuho Ito
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Eriko Makino
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Saki Kanada
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Tomokazu Saiki
- Department of Pharmacy, Dental Hospital, Aichi Gakuin University, Nagoya, Japan
| | - Tasuku Ohno
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yuka Imanishi
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Tatsuhito Himeno
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hideki Kamiya
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Jiro Nakamura
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shogo Ozawa
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Ken Miyazawa
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Shigemi Goto
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Jun Takebe
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Tatsuaki Matsubara
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Keiko Naruse
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan.
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Yang H, Sloan G, Ye Y, Wang S, Duan B, Tesfaye S, Gao L. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front Endocrinol (Lausanne) 2020; 10:929. [PMID: 32010062 PMCID: PMC6978915 DOI: 10.3389/fendo.2019.00929] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. It leads to distressing and expensive clinical sequelae such as foot ulceration, leg amputation, and neuropathic pain (painful-DPN). Unfortunately, DPN is often diagnosed late when irreversible nerve injury has occurred and its first presentation may be with a diabetic foot ulcer. Several novel diagnostic techniques are available which may supplement clinical assessment and aid the early detection of DPN. Moreover, treatments for DPN and painful-DPN are limited. Only tight glucose control in type 1 diabetes has robust evidence in reducing the risk of developing DPN. However, neither glucose control nor pathogenetic treatments are effective in painful-DPN and symptomatic treatments are often inadequate. It has recently been hypothesized that using various patient characteristics it may be possible to stratify individuals and assign them targeted therapies to produce better pain relief. We review the diagnostic techniques which may aid the early detection of DPN in the clinical and research environment, and recent advances in precision medicine techniques for the treatment of painful-DPN.
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Affiliation(s)
- Heng Yang
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gordon Sloan
- Diabetes Research Unit, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Yingchun Ye
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuo Wang
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bihan Duan
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Ling Gao
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
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Park K, Kim Y, Kim J, Kang S, Park JS, Ahn CW, Nam JS. Supplementation with Korean Red Ginseng Improves Current Perception Threshold in Korean Type 2 Diabetes Patients: A Randomized, Double-Blind, Placebo-Controlled Trial. J Diabetes Res 2020; 2020:5295328. [PMID: 32025522 PMCID: PMC6991165 DOI: 10.1155/2020/5295328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many Type 2 diabetes (T2DM) patients in Korea take Korean Red Ginseng (KRG) for various reasons. In this study, we investigated the effects of KRG administration on diabetic peripheral neuropathy in T2DM patients. METHODS This study was a randomized, double-blind, placebo-controlled trial. Participants were randomly allocated to either the placebo or KRG group and took corresponding tablets for 24 weeks. The primary outcomes were changes in current perception threshold (CPT) at week 24. Secondary outcomes were altered fasting plasma glucose, HbA1c, and various metabolic and inflammatory markers at week 24. RESULTS Sixty-one patients completed the study. The CPT of the lower extremities at various frequencies exhibited significant improvements at week 24 in the KRG group. Other metabolic parameters were not altered after 24 weeks in both groups. In the subgroup analysis, CPT levels were improved in those with a longer diabetes duration or who already had neuropathy at the beginning of the study, and insulin resistance was improved in patients with a shorter diabetes duration. CONCLUSION Twenty-four week administration of KRG in T2DM patients resulted in a significant improvement in neuropathy, especially in those with a longer diabetes duration. A further, larger population study with a longer follow-up period is warranted to verify the effects of KRG on diabetic neuropathy.
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Affiliation(s)
- Kahui Park
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - YuSik Kim
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Republic of Korea
| | - Junghye Kim
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Shinae Kang
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Republic of Korea
| | - Jong Suk Park
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Republic of Korea
| | - Chul Woo Ahn
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Republic of Korea
| | - Ji Sun Nam
- Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Republic of Korea
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Yahya A, Kluding P, Pasnoor M, Wick J, Liu W, Dos Santos M. The impact of diabetic peripheral neuropathy on pinch proprioception. Exp Brain Res 2019; 237:3165-3174. [PMID: 31586215 DOI: 10.1007/s00221-019-05663-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/28/2019] [Indexed: 12/01/2022]
Abstract
This study aims to investigate the impact of type 2 diabetes (T2D) and diabetic peripheral neuropathy (DPN) on pinch proprioception and to establish the correlations with sensory impairments. We collected data from a total of 36 participants (healthy, n = 12; T2D without DPN, n = 11; and T2D + DPN, n = 13), all matched for age, 60 ± 6 years. Pinch proprioception was determined through 3 trials of attempts to actively reproduce 15° of pinch position without visual feedback. Target accuracy and precision was compared between groups using Kruskal-Wallis test. Sensation was tested through the two-point discrimination and Semmes-Weinstein monofilaments applied on the fingers. Sensory measures were correlated with pinch proprioception measures via Spearman's rank test. The T2D + DPN group showed significant decrements in accuracy and precision as compared to the T2D-only (p = 0.003 and p = 0.006, respectively) and the healthy groups (both p = 0.002); no significant differences were found between T2D-only and healthy. Spearman's rank showed moderate (r = 0.45-0.66, p < 0.001) correlations between pinch proprioception and sensory measures. Our results showed pinch proprioception disruption in people with T2D + DPN, but not in people with T2D-only. The awareness of pinch proprioceptive deficits is paramount for the safety of individuals with T2D and DPN. Moderate correlations between sensory impairments and pinch proprioceptive deficits suggest that not only superficial/discriminative sensation is implicated in proprioceptive decrements. Other mechanisms such as damage to muscle spindles or central nervous system associated with T2D + DPN warrant further investigations.
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Affiliation(s)
- Abdalghani Yahya
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Mail stop 2002, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Patricia Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Mail stop 2002, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Mail stop 2002, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Marcio Dos Santos
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Mail stop 2002, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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12
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Seok HY, Do SY, Motamedi GK, Cho YW. Symptom‐related changes in current perception threshold of restless legs syndrome. J Sleep Res 2019; 29:e12890. [DOI: 10.1111/jsr.12890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/16/2019] [Accepted: 06/02/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Hung Youl Seok
- Department of Neurology Dongsan Medical Center School of Medicine Keimyung University Daegu Republic of Korea
| | - So Young Do
- Department of Neurology Dongsan Medical Center School of Medicine Keimyung University Daegu Republic of Korea
| | - Gholam K. Motamedi
- Department of Neurology Georgetown University Hospital Washington DC USA
| | - Yong Won Cho
- Department of Neurology Dongsan Medical Center School of Medicine Keimyung University Daegu Republic of Korea
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13
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Correlation of systemic arterial stiffness with changes in retinal and choroidal microvasculature in type 2 diabetes. Sci Rep 2019; 9:1401. [PMID: 30718731 PMCID: PMC6361886 DOI: 10.1038/s41598-018-37969-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022] Open
Abstract
This study was conducted to assess whether systemic arterial stiffness, indicated by cardio-ankle vascular index (CAVI), is related to changes in the microvasculature of the retina and choroid in diabetes mellitus (DM). This study included 113 patients with a confirmed diagnosis of type-2 DM. Among them, 18 patients did not have diabetic retinopathy (DR), 71 had non-proliferative DR (NPDR), and 24 had proliferative DR (PDR). The mean CAVI was 7.58 ± 1.41 in no DR, 8.72 ± 1.47 in NPDR, and 8.43 ± 1.25 in PDR group. Of the 113 eyes, 42 (37.2%) were classified as abnormal CAVI group (CAVI ≥ 9). This group had significantly higher cardiac autonomic neuropathy risk index score, decreased central choroidal thickness, and decreased choroidal vascularity index (CVI). Deep foveal avascular zone area was higher in the abnormal CAVI group. After adjustment for possible confounding factors, CAVI showed negative correlation with the CVI (r = -0.247, P = 0.013). In conclusion, there was a significant correlation between arteriosclerosis and choroidal vascular changes in DR. We suggest prompt ophthalmic evaluation in patients with systemic arteriosclerosis. If the ophthalmologist notes advanced DR, the patient should be referred to a cardiovascular clinic for detailed evaluation of systemic arteriosclerosis.
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14
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Park JH, Won JC. Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold. Diabetes Metab J 2018; 42:519-528. [PMID: 30398037 PMCID: PMC6300437 DOI: 10.4093/dmj.2018.0068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. METHODS We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results. RESULTS A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. CONCLUSION NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.
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Affiliation(s)
- Joong Hyun Park
- Department of Neurology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Chul Won
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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15
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Seno SI, Shimazu H, Kogure E, Watanabe A, Kobayashi H. Factors Affecting and Adjustments for Sex Differences in Current Perception Threshold With Transcutaneous Electrical Stimulation in Healthy Subjects. Neuromodulation 2018; 22:573-579. [PMID: 30484916 PMCID: PMC6766980 DOI: 10.1111/ner.12889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/05/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Current perception threshold (CPT) measurement is a noninvasive, easy, and semi-objective method for determining sensory function using transcutaneous electrical stimulation. Previous studies have shown that CPT is determined by physical characteristics, such as sex, age, physical sites, and presence of neuropathy. Although the CPT reported in males is clearly higher than that in females, the reason for this difference remains unclear. This study investigates the cause of sex-based differences in CPT and suggests an adjustment method, which may suppress the sex difference in CPT. MATERIALS AND METHODS Electrical stimulation was applied with PainVision® via five sizes of circular surface electrodes. Seventy healthy participants were examined thrice under each electrode. The relationship among body water percentage, body fat percentage, and CPT was then analyzed. RESULTS CPT values are higher in males than that in females, with statistically significant sex differences with each electrode pairs (EL 1: p < 0.001; EL 2: p = 0.006; EL 3: p < 0.001; EL 4: p < 0.001; EL 5: p < 0.001). By adjusting for body fat percentage or body water percentage, the log-transformation values (CPT values) no longer exhibit sex differences with any electrode pairs (body fat: p = 0.09; body water: p = 0.08). CONCLUSION We conclude that sensitivity for perceiving electrical stimulation can be influenced by the subjects' characteristics, such as body fat or body water percentages.
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Affiliation(s)
- Shin-Ichiro Seno
- Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Hideaki Shimazu
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Ishikawa, Japan
| | - Eiki Kogure
- Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Atsushi Watanabe
- Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Hiroko Kobayashi
- Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
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16
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Omi M, Hata M, Nakamura N, Miyabe M, Ozawa S, Nukada H, Tsukamoto M, Sango K, Himeno T, Kamiya H, Nakamura J, Takebe J, Matsubara T, Naruse K. Transplantation of dental pulp stem cells improves long-term diabetic polyneuropathy together with improvement of nerve morphometrical evaluation. Stem Cell Res Ther 2017; 8:279. [PMID: 29237486 PMCID: PMC5729514 DOI: 10.1186/s13287-017-0729-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 02/08/2023] Open
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. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0729-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maiko Omi
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Masaki Hata
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Nobuhisa Nakamura
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Megumi Miyabe
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Shogo Ozawa
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Hitoshi Nukada
- Department of Medicine, University of Otago Medical School, PO Box 913, Great King Street, Dunedin, New Zealand
| | - Masami Tsukamoto
- Laboratory of Peripheral Nerve Pathophysiology, Department of Sensory and Motor Systems, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
| | - Kazunori Sango
- Laboratory of Peripheral Nerve Pathophysiology, Department of Sensory and Motor Systems, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
| | - Tatsuhito Himeno
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Hideki Kamiya
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Jiro Nakamura
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Jun Takebe
- Department of Removable Prosthodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Tatsuaki Matsubara
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan
| | - Keiko Naruse
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, 464-8651, Japan.
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PainVision® Apparatus for Assessment of Efficacy of Pulsed Radiofrequency Combined with Pharmacological Therapy in the Treatment of Postherpetic Neuralgia and Correlations with Measurements. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5670219. [PMID: 28357404 PMCID: PMC5357555 DOI: 10.1155/2017/5670219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/24/2017] [Indexed: 12/18/2022]
Abstract
Objective. PainVision device was a developed application for the evaluation of pain intensity. The objective was to assess the efficacy and safety of pulsed radiofrequency (PRF) combined with pharmacological therapy in the treatment of postherpetic neuralgia (PHN). We also discussed the correlation of the measurements. Method. Forty patients with PHN were randomized for treatment with PRF combined with pharmacological therapy (PRF group, n = 20) or pharmacological therapy (control group, n = 20) at postoperative 48 hours. The efficacy measure was pain degree (PD) that was assessed by PainVision and visual analog scale (VAS), short form Mcgill pain questionnaire (SF-Mcgill), and numeric rate scale sleep interference score (NRSSIS). Correlations between PD, VAS, SF-Mcgill, and NRSSIS were determined. Results. The PD for persistent pain (PP) and breakthrough pain (BTP) at postoperative 48 hours assessed by PainVision were significantly lower in PRF group than in control group (PD-PP, P < 0.01; PD-BTP, P < 0.01). PD and VAS were highly correlated for both persistent pain (r = 0.453, ρ = 0.008) and breakthrough pain (r = 0.64, ρ = 0.001). Conclusion. PRF was well tolerated and superior to isolated pharmacological therapy in the treatment of PHN. PainVision device showed great value in the evaluation of pain intensity and PD had an excellent correlation with VAS and SF-Mcgill.
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The Measurement of the Sensory Recovery Period in Zygoma and Blow-Out Fractures with Neurometer Current Perception Threshold. Arch Plast Surg 2016; 43:411-7. [PMID: 27689047 PMCID: PMC5040842 DOI: 10.5999/aps.2016.43.5.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Facial hypoesthesia is one of the most troublesome complaints in the management of facial bone fractures. However, there is a lack of literature on facial sensory recovery after facial trauma. The purpose of this study was to evaluate the facial sensory recovery period for facial bone fractures using Neurometer. Methods Sixty-three patients who underwent open reduction of zygomatic and blowout fractures between December 2013 and July 2015 were included in the study. The facial sensory status of the patients was repeatedly examined preoperatively and postoperatively by Neurometer current perception threshold (CPT) until the results were normalized. Results Among the 63 subjects, 30 patients had normal Neurometer results preoperatively and postoperatively. According to fracture types, 17 patients with blowout fracture had a median recovery period of 0.25 months. Twelve patients with zygomatic fracture had a median recovery period of 1.00 month. Four patients with both fracture types had a median recovery period of 0.625 months. The median recovery period of all 33 patients was 0.25 months. There was no statistically significant difference in the sensory recovery period between types and subgroups of zygomatic and blowout fractures. In addition, there was no statistically significant difference in the sensory recovery period according to Neurometer results and the patients' own subjective reports. Conclusions Neurometer CPT is effective for evaluating and comparing preoperative and postoperative facial sensory status and evaluating the sensory recovery period in facial bone fracture patients.
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Inceu GV, Veresiu IA. Measurement of current perception thresholds using the Neurometer(®) - applicability in diabetic neuropathy. ACTA ACUST UNITED AC 2015; 88:449-52. [PMID: 26733741 PMCID: PMC4689234 DOI: 10.15386/cjmed-491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/02/2015] [Accepted: 07/24/2015] [Indexed: 01/04/2023]
Abstract
The incidence of diabetes mellitus is continuously growing worldwide, while the specific chronic complications that it induces have a negative impact on life expectancy andquality, entailing extremely high costs of healthcare services. Diabetic peripheral neuropathy is one of the most common chronic complications of diabetes, affecting almost half of diabetic people during life. This review aims at summarizing the evidence on the advantages and the usefulness of current perception threshold measurement for peripheral diabetic neuropathy assessment. Among the different methods used for the screening and diagnosis of diabetic neuropathy, measurement of current perception threshold using the Neurometer® has the ability to assess three sub-types of nerve fiber by producing transcutaneous electrical stimuli at frequencies of 2000, 250 and 5 Hz. Current evidence shows that this method provides a useful, noninvasive evaluation technique of patients with peripheral nervous system disorders, being able to detect neuropathy in the earliest and asymptomatic stages.
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Affiliation(s)
- Georgeta Victoria Inceu
- Department of Diabetes, , Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Andrei Veresiu
- Department of Diabetes, , Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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20
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Nogami K, Taniguchi S. Stellate Ganglion Block, Compared With Xenon Light Irradiation, Is a More Effective Treatment of Neurosensory Deficits Resulting From Orthognathic Surgery, as Measured by Current Perception Threshold. J Oral Maxillofac Surg 2015; 73:1267-74. [PMID: 25900233 DOI: 10.1016/j.joms.2015.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the relative effectiveness of stellate ganglion blockade (SGB) versus xenon light irradiation (XLI) for the treatment of neurosensory deficits resulting from orthognathic surgery as determined by a comparison of prospective measurements of electrical current perception thresholds (CPTs) and ranged CPTs (R-CPTs). MATERIALS AND METHODS CPT and R-CPT in the mental foramen area were measured during electrical stimulation at 98 different sites on the body in patients who had undergone orthognathic surgery. After surgery, patients were assigned to the SGB group or the XLI group. CPT and R-CPT of the 2 groups were measured at stimulation frequencies of 2,000, 250, and 5 Hz before surgery, 1 week after surgery, and after 10 treatment sessions. Furthermore, the influence of surgical factors, such as genioplasty and a surgically exposed inferior alveolar nerve (IAN), was examined in the 2 groups. RESULTS Patients' CPT and R-CPT values indicated a considerable amount of sensory disturbance in most cases after surgery. The change in magnitude of all CPT and R-CPT values for the SGB group decreased considerably compared with that for the XLI group after treatment. There was no correlation between CPT or R-CPT values and surgical factors (eg, genioplasty and exposure of the IAN). CONCLUSION SGB of the IAN could be an effective method for treating neurosensory deficits after orthognathic surgery on the IAN.
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Affiliation(s)
- Kentaro Nogami
- Lecturer, Section of Anesthesiology, Department of Diagnostics and General Care, Fukuoka Dental College, Fukuoka, Japan.
| | - Shogo Taniguchi
- Professor, Section of Anesthesiology, Department of Diagnostics and General Care, Fukuoka Dental College, Fukuoka, Japan
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Himeno T, Kamiya H, Naruse K, Cheng Z, Ito S, Shibata T, Kondo M, Kato J, Okawa T, Fujiya A, Suzuki H, Kito T, Hamada Y, Oiso Y, Isobe K, Nakamura J. Angioblast Derived from ES Cells Construct Blood Vessels and Ameliorate Diabetic Polyneuropathy in Mice. J Diabetes Res 2015; 2015:257230. [PMID: 25977928 PMCID: PMC4419216 DOI: 10.1155/2015/257230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although numerous reports addressing pathological involvements of diabetic polyneuropathy have been conducted, a universally effective treatment of diabetic polyneuropathy has not yet been established. Recently, regenerative medicine studies in diabetic polyneuropathy using somatic stem/progenitor cell have been reported. However, the effectiveness of these cell transplantations was restricted because of their functional and numerical impairment in diabetic objects. Here, we investigated the efficacy of treatment for diabetic polyneuropathy using angioblast-like cells derived from mouse embryonic stem cells. METHODS AND RESULTS Angioblast-like cells were obtained from mouse embryonic stem cells and transplantation of these cells improved several physiological impairments in diabetic polyneuropathy: hypoalgesia, delayed nerve conduction velocities, and reduced blood flow in sciatic nerve and plantar skin. Furthermore, pathologically, the capillary number to muscle fiber ratios were increased in skeletal muscles of transplanted hindlimbs, and intraepidermal nerve fiber densities were ameliorated in transplanted plantar skin. Transplanted cells maintained their viabilities and differentiated to endothelial cells and smooth muscle cells around the injection sites. Moreover, several transplanted cells constructed chimeric blood vessels with recipient cells. CONCLUSIONS These results suggest that transplantation of angioblast like cells induced from embryonic stem cells appears to be a novel therapeutic strategy for diabetic polyneuropathy.
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Affiliation(s)
- Tatsuhito Himeno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hideki Kamiya
- Department of Chronic Kidney Disease Initiatives, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, 21 Karimata, Yazako, Nagakute, Aichi 480-1195, Japan
- *Hideki Kamiya:
| | - Keiko Naruse
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, 1-100 Kusumoto-cho, Chikusa-ku, Nagoya 464-8650, Japan
| | - Zhao Cheng
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Sachiko Ito
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Taiga Shibata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Masaki Kondo
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Jiro Kato
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tetsuji Okawa
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Atsushi Fujiya
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Department of Metabolic Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hirohiko Suzuki
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tetsutaro Kito
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yoji Hamada
- Department of Metabolic Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yutaka Oiso
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kenichi Isobe
- Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Jiro Nakamura
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, 21 Karimata, Yazako, Nagakute, Aichi 480-1195, Japan
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Koo BK, Ohn JH, Kwak SH, Moon MK. Assessment of diabetic polyneuropathy and autonomic neuropathy using current perception threshold in korean patients with diabetes mellitus. Diabetes Metab J 2014; 38:285-93. [PMID: 25215275 PMCID: PMC4160582 DOI: 10.4093/dmj.2014.38.4.285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The current perception threshold (CPT) could be quantified by stimulating Aβ and C fibers at 2,000 and 5 Hz, respectively. C fibers play a role in the autonomic nervous system and are involved in temperature and pain sensation. We evaluated the usefulness of CPT for diagnosing distal polyneuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in diabetic patients. METHODS The CPT was measured in the index finger (C7 level) and in the third toe (L5 level) in diabetic patients aged 30 to 69 years. We assessed DPN according to the neuropathy total symptom score-6 (NTSS-6) and 10-g monofilament pressure sensation. Subjects with a NTSS-6 >6 or with abnormal 10-g monofilament sensation were defined to have DPN. CAN was evaluated by spectral analysis of heart rate variability and by Ewing's traditional tests. RESULTS The subjects with DPN had significantly higher CPT at all of the frequencies than the subjects without DPN (P<0.05). Abnormal 10-g monofilament sensation and NTSS-6 >6 could be most precisely predicted by CPT at 2,000 and 5 Hz, respectively. However, only 6.5% and 19.6% of subjects with DPN had an abnormal CPT at 2,000 Hz at the C7 and L5 levels. Although CPT at 5 Hz showed a negative correlation with the power of low and high frequency in the spectral analysis (P<0.05), only 16.7% of subjects with CAN exhibited an abnormal CPT at the same frequency. CONCLUSION Although the CPT is significantly associated with neuropathic symptoms or signs corresponding to the nerve fiber stimulated, it provides little additional information compared with conventional evaluations.
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hun Ohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Soo-Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Bicer F, Kim JY, Horowitz A, Daneshgari F, Liu G. Assessment of bladder sensation in mice with a novel device. Urology 2014; 84:490.e1-6. [PMID: 24958485 DOI: 10.1016/j.urology.2014.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/02/2014] [Accepted: 04/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop and test the efficacy of an implantable bladder electrode device that can be used with the Neurometer electrodiagnostic stimulator to assess fiber-specific afferent bladder sensation in the mouse. METHODS We constructed a ball-tipped platinum electrode and surgically implanted it into the mouse bladder. The Neurometer was connected to the electrode to apply selective nerve fiber stimuli (250 Hz for Aδ fibers and 5 Hz for C fibers) of increasing intensities to the bladder mucosa in the mouse to determine bladder sensory threshold (BST) values. Using 58 female C57BL/6J mice, we measured the temporal and interobserver consistency of BST measurements, the effects of intravesical administration of lidocaine and resiniferatoxin on the BST, and the effects of our device on voiding behavior and bladder mucosal integrity. RESULTS BST values at 250 and 5 Hz did not vary significantly when measured 2, 4, and 6 days after device implantation, or when obtained by 2 blinded independent observers. Intravesical lidocaine yielded a transient increase in BST values at both 250 Hz and 5 Hz, whereas resiniferatoxin yielded a significant increase only at the 5 Hz stimulus frequency after 24 hours. Moderately increased micturition frequency and decreased volume per void were observed 4 and 6 days after device implantation. Histology revealed mild inflammatory changes in the area of the bladder adjacent to the implanted BST device. CONCLUSION Assessment of neuroselective bladder sensation in mice is feasible with our device, which provides reproducible BST values for autonomic bladder afferent nerve fibers.
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Affiliation(s)
- Fuat Bicer
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jin Young Kim
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Andrew Horowitz
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Firouz Daneshgari
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Guiming Liu
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH.
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Lee WC, Wu HC, Huang KH, Wu HP, Yu HJ, Wu CC. Hyposensitivity of C-fiber afferents at the distal extremities as an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. PLoS One 2014; 9:e86463. [PMID: 24466107 PMCID: PMC3900526 DOI: 10.1371/journal.pone.0086463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/10/2013] [Indexed: 12/01/2022] Open
Abstract
Purpose To investigate the relationship between distal symmetric peripheral neuropathy and early stages of autonomic bladder dysfunction in type 2 diabetic women. Materials and Methods A total of 137 diabetic women with minimal coexisting confounders of voiding dysfunction followed at a diabetes clinic were subject to the following evaluations: current perception threshold (CPT) tests on myelinated and unmyelinated nerves at the big toe for peroneal nerve and middle finger for median nerve, uroflowmetry, post-void residual urine volume, and overactive bladder (OAB) symptom score questionnaire. Patients presenting with voiding difficulty also underwent urodynamic studies and intravesical CPT tests. Results Based on the OAB symptom score and urodynamic studies, 19% of diabetic women had the OAB syndrome while 24.8% had unrecognized urodynamic bladder dysfunction (UBD). The OAB group had a significantly greater mean 5 Hz CPT test value at the big toe by comparison to those without OAB. When compared to diabetic women without UBD, those with UBD showed greater mean 5 Hz CPT test values at the middle finger and big toe. The diabetic women categorized as C-fiber hyposensitivity at the middle finger or big toe by using CPT test also had higher odds ratios of UBD. Among diabetic women with UBD, the 5 Hz CPT test values at the big toe and middle finger were significantly associated with intravesical 5 Hz CPT test values. Conclusions Using electrophysiological evidence, our study revealed that hyposensitivity of unmyelinated C fiber afferents at the distal extremities is an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. The C fiber dysfunction at the distal extremities seems concurrent with vesical C-fiber neuropathy and may be a sentinel for developing early diabetic bladder dysfunction among female patients.
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Affiliation(s)
- Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institution of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Ching Wu
- Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huey-Peir Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Jeng Yu
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Chia-Ching Wu
- Department of International Business, College of Commerce and Management, Cheng Shiu University, Kaohsiung, Taiwan
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25
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Ino S, Chikai M, Takahashi N, Ohnishi T, Doi K, Nunokawa K. A pilot study of a plantar sensory evaluation system for early screening of diabetic neuropathy in a weight-bearing position. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:3508-3511. [PMID: 25570747 DOI: 10.1109/embc.2014.6944379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to develop smart equipment to quantify plantar tactile sensibility for the early diagnosis and tracking of peripheral neuropathy caused by diabetes mellitus. In this paper, we offer a new testing system that is composed of a plantar tactile stimulation platform with a small moving contactor to stretch the skin tangentially, a response switch for each tactile stimulus, a motor control box, and a personal computer (PC) for psychophysical data processing. This quantitative sensory testing system has detailed measurements available and is easy to use compared with the conventional testing devices, such as von Frey monofilaments, pin-prick testing devices, and current perception threshold testers. When using our testing system in a weight-bearing position, we observed that the plantar tactile thresholds for the tangential stretching stimulus on the plantar surface of the foot ranged from approximately 10 um to 30 um for healthy subjects. However, the threshold for a subject with diabetes was nearly three times higher than that for healthy subjects. The significant difference between these values suggests that the plantar sensory evaluation system using the lateral skin stretch stimulation can be used for early diagnosis, for the accurate staging of diabetic neuropathy, and for evaluating its progression noninvasively in a clinic and at home.
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Okawa T, Kamiya H, Himeno T, Kato J, Seino Y, Fujiya A, Kondo M, Tsunekawa S, Naruse K, Hamada Y, Ozaki N, Cheng Z, Kito T, Suzuki H, Ito S, Oiso Y, Nakamura J, Isobe KI. Transplantation of Neural Crest-Like Cells Derived from Induced Pluripotent Stem Cells Improves Diabetic Polyneuropathy in Mice. Cell Transplant 2013; 22:1767-83. [DOI: 10.3727/096368912x657710] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Impaired vascularity and nerve degeneration are the most important pathophysiological abnormalities of diabetic polyneuropathy (DPN). Therefore, regeneration of both the vascular and nervous systems is required for the treatment of DPN. The neural crest (NC) is a transient embryonic structure in vertebrates that differentiates into a vast range of cells, including peripheral neurons, Schwann cells, and vascular smooth muscle cells. In this study, we investigated the ability of transplantation of NC-like (NCL) cells derived from aged mouse induced pluripotent stem (iPS) cells in the treatment of DPN. iPS cells were induced to differentiate into neural cells by stromal cell-derived inducing activity (SDIA) and subsequently supplemented with bone morphogenetic protein 4 to promote differentiation of NC lineage. After the induction, p75 neurotrophin receptor-positive NCL cells were purified using magnetic-activated cell sorting. Sorted NCL cells differentiated to peripheral neurons, glial cells, and smooth muscle cells by additional SDIA. NCL cells were transplanted into hind limb skeletal muscles of 16-week streptozotocin-diabetic mice. Nerve conduction velocity, current perception threshold, intraepidermal nerve fiber density, sensitivity to thermal stimuli, sciatic nerve blood flow, plantar skin blood flow, and capillary number-to-muscle fiber ratio were evaluated. Four weeks after transplantation, the engrafted cells produced growth factors: nerve growth factor, neurotrophin 3, vascular endothelial growth factor, and basic fibroblast growth factor. It was also confirmed that some engrafted cells differentiated into vascular smooth muscle cells or Schwann cell-like cells at each intrinsic site. The transplantation improved the impaired nerve and vascular functions. These results suggest that transplantation of NCL cells derived from iPS cells could have therapeutic effects on DPN through paracrine actions of growth factors and differentiation into Schwann cell-like cells and vascular smooth muscle cells.
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Affiliation(s)
- Tetsuji Okawa
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Kamiya
- Department of Chronic Kidney Disease Initiatives, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuhito Himeno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jiro Kato
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Seino
- Department of Metabolic Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Atsushi Fujiya
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Metabolic Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Masaki Kondo
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Tsunekawa
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Naruse
- Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yoji Hamada
- Department of Metabolic Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Nobuaki Ozaki
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | - Zhao Cheng
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsutaro Kito
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohiko Suzuki
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachiko Ito
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yutaka Oiso
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jiro Nakamura
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ken-Ichi Isobe
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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27
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Tsui BCH, Shakespeare TJ, Leung DH, Tsui JH, Corry GN. Reproducibility of current perception threshold with the Neurometer(®) vs the Stimpod NMS450 peripheral nerve stimulator in healthy volunteers: an observational study. Can J Anaesth 2013; 60:753-60. [PMID: 23690134 DOI: 10.1007/s12630-013-9965-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 05/02/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Current methods of assessing nerve blocks, such as loss of perception to cold sensation, are subjective at best. Transcutaneous nerve stimulation is an alternative method that has previously been used to measure the current perception threshold (CPT) in individuals with neuropathic conditions, and various devices to measure CPT are commercially available. Nevertheless, the device must provide reproducible results to be used as an objective tool for assessing nerve blocks. METHODS We recruited ten healthy volunteers to examine CPT reproducibility using the Neurometer(®) and the Stimpod NMS450 peripheral nerve stimulator. Each subject's CPT was determined for the median (second digit) and ulnar (fifth digit) nerve sensory distributions on both hands - with the Neurometer at 5 Hz, 250 Hz, and 2000 Hz and with the Stimpod at pulse widths of 0.1 msec, 0.3 msec, 0.5 msec, and 1.0 msec, both at 5 Hz and 2 Hz. Intraclass correlation coefficients (ICC) were also calculated to assess reproducibility; acceptable ICCs were defined as ≥ 0.4. RESULTS The ICC values for the Stimpod ranged from 0.425-0.79, depending on pulse width, digit, and stimulation; ICCs for the Neurometer were 0.615 and 0.735 at 250 and 2,000 Hz, respectively. These values were considered acceptable; however, the Neurometer performed less efficiently at 5 Hz (ICCs for the second and fifth digits were 0.292 and 0.318, respectively). CONCLUSION Overall, the Stimpod device displayed good to excellent reproducibility in measuring CPT in healthy volunteers. The Neurometer displayed poor reproducibility at low frequency (5 Hz). These results suggest that peripheral nerve stimulators may be potential devices for measuring CPT to assess nerve blocks.
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Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada.
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Aoki M, Goh AC, Hata Y, Tensho K. A Descriptive Study Investigating the Feasibility and Selectivity of Current Perception Threshold in the Objective Assessment of Post-operative Sub-acute Knee Pain. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mikimasa Aoki
- Department of Rehabilitation, Shinshu University Hospital: 3-1-1 Asahi, Matsumoto, Nagano 390-8121, Japan
- Department of Health Sciences, Graduate School of Medicine, Shinshu University
| | - Ah-Cheng Goh
- Department of Health Sciences, Graduate School of Medicine, Shinshu University
- Department of Physical Therapy, School of Health Sciences, Shinshu University
| | - Yukihiko Hata
- Department of Rehabilitation, Shinshu University Hospital: 3-1-1 Asahi, Matsumoto, Nagano 390-8121, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, School of Medicine, Shinshu University
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29
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de Bruin ED, Hubli M, Hofer P, Wolf P, Murer K, Zijlstra W. Validity and reliability of accelerometer-based gait assessment in patients with diabetes on challenging surfaces. J Aging Res 2012; 2012:954378. [PMID: 22900182 PMCID: PMC3415100 DOI: 10.1155/2012/954378] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/17/2012] [Accepted: 06/25/2012] [Indexed: 11/17/2022] Open
Abstract
Walking on irregular terrain influences gait of diabetic patients. We investigate the test-retest reliability and construct validity of gait measured with the DynaPort MiniMod under single and dual task conditions in diabetic patients walking on irregular terrain to identify the measurement error (precision) and minimal clinical detectable change. 29 patients with Type 2 diabetes were measured once, and 25 repeated the measurement within 7 days. Patients walked on a therapy garden walkway. Differences between three groups of diabetics with various levels of lower extremity neuropathy were analyzed with planned contrasts. ICC was excellent for intervisit measurements with ICC's >0.824. Bland and Altman Plots, SEM, and SDD showed precise values, distributed around zero for both test conditions. A significant effect of grouping on step length performance hints at possible construct validity of the device. Good reliability of DynaPort MiniMod measurements on a therapy garden walkway and an indication for discriminatory capability suggests that DynaPort MiniMod could facilitate the study of gait in diabetic patients in conditions close to real-life situations. Good reliability, small measurement error, and values of minimal clinical detectable change recommend the further utilization of DynaPort MiniMod for the evaluation of gait parameters in diabetic patients.
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Affiliation(s)
- Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, ETH, 8093 Zurich, Switzerland
| | - Michèle Hubli
- Institute of Human Movement Sciences and Sport, ETH, 8093 Zurich, Switzerland
| | - Pamela Hofer
- Institute of Human Movement Sciences and Sport, ETH, 8093 Zurich, Switzerland
| | - Peter Wolf
- Sensory-Motor Systems Lab, ETH, Zurich, Switzerland
| | - Kurt Murer
- Institute of Human Movement Sciences and Sport, ETH, 8093 Zurich, Switzerland
| | - Wiebren Zijlstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Institut für Bewegungs- und Sportgerontologie, Deutsche Sporthochschule Köln, Köln, Germany
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30
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Zheng W, He Y, Chen L. Correlation of current perception threshold and somatosensory evoked potential in diabetes. Neurophysiol Clin 2012; 42:241-7. [PMID: 22632872 DOI: 10.1016/j.neucli.2012.02.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 02/17/2012] [Accepted: 02/26/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the relationship between current perception threshold (CPT) and somatosensory evoked potential (SEP) in diabetes. METHODS Both CPT and SEP were recorded in 66 diabetic patients. Both the CPT scores (measured at 2000 Hz, 250 Hz, and 5 Hz stimulations) and SEP (peak latency at ERB's point [Lat (ERB)] and popliteal fossa [Lat (PF)]; interpeak latency of "ERB to 7th cervical vertebra" [Δlat (ERB-C7)] and "popliteal fossa to lumbar vertebra" [Δlat (PF-FO)]) were recorded in both upper and both lower limbs, separately. t-tests and correlation analyses were performed to assess relationships between CPT and SEP tests. RESULTS After adjustment for height and/or age, CPT scores at 2000 Hz were significantly correlated with Lat (ERB) (left: ρ=0.408, P<0.05; right: ρ=0.297, P<0.05), Δlat (ERB-C7) (left: ρ=0.238, P<0.05; right: ρ=0.385, P<0.05), and Lat (PF) (ρ=0.216, P<0.05), and those at 250 Hz were moderately correlated with Lat (ERB) (left: ρ=0.234, P<0.05; right: ρ=0.306, P<0.05). CPT scores at 5 Hz were not significantly correlated with any SEP measurements (P>0.05). CONCLUSIONS Both CPT scores at 2000 Hz and SEP may reliably determine large-fiber function in diabetic neuropathy.
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Affiliation(s)
- W Zheng
- Department of Emergency, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing 100044, China.
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Himeno T, Kamiya H, Naruse K, Harada N, Ozaki N, Seino Y, Shibata T, Kondo M, Kato J, Okawa T, Fukami A, Hamada Y, Inagaki N, Seino Y, Drucker DJ, Oiso Y, Nakamura J. Beneficial effects of exendin-4 on experimental polyneuropathy in diabetic mice. Diabetes 2011; 60:2397-406. [PMID: 21810596 PMCID: PMC3161330 DOI: 10.2337/db10-1462] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The therapeutic potential of exendin-4, an agonist of the glucagon-like peptide-1 receptor (GLP-1R), on diabetic polyneuropathy (DPN) in streptozotocin (STZ)-induced diabetic mice was investigated. RESEARCH DESIGN AND METHODS The presence of the GLP-1R in lumbar dorsal root ganglion (DRG) was evaluated by immunohistochemical analyses. DRG neurons were dissected from C57BL6/J mice and cultured with or without Schwann cell-conditioned media in the presence or absence of GLP-1 (7-37) or exendin-4. Then neurite outgrowth was determined. In animal-model experiments, mice were made diabetic by STZ administration, and after 12 weeks of diabetes, exendin-4 (10 nmol/kg) was intraperitoneally administered once daily for 4 weeks. Peripheral nerve function was determined by the current perception threshold and motor and sensory nerve conduction velocity (MNCV and SNCV, respectively). Sciatic nerve blood flow (SNBF) and intraepidermal nerve fiber densities (IENFDs) also were evaluated. RESULTS The expression of the GLP-1R in DRG neurons was confirmed. GLP-1 (7-37) and exendin-4 significantly promoted neurite outgrowth of DRG neurons. Both GLP-1R agonists accelerated the impaired neurite outgrowth of DRG neurons cultured with Schwann cell-conditioned media that mimicked the diabetic condition. At the doses used, exendin-4 had no effect on blood glucose or HbA(1c) levels. Hypoalgesia and delayed MNCV and SNCV in diabetic mice were improved by exendin-4 without affecting the reduced SNBF. The decreased IENFDs in sole skins of diabetic mice were ameliorated by exendin-4. CONCLUSIONS Our findings indicate that exendin-4 ameliorates the severity of DPN, which may be achieved by its direct actions on DRG neurons and their axons.
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Affiliation(s)
- Tatsuhito Himeno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Kamiya
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Chronic Kidney Disease Initiatives, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Corresponding author: Hideki Kamiya,
| | - Keiko Naruse
- Department of Internal Medicine, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Norio Harada
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuaki Ozaki
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Seino
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taiga Shibata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Kondo
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jiro Kato
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuji Okawa
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayako Fukami
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Hamada
- Department of Metabolic Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuya Inagaki
- Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Seino
- Division of Diabetes, Clinical Nutrition, and Endocrinology, Department of Medicine, Kansai Electric Power Hospital, Osaka, Japan
| | - Daniel J. Drucker
- Department of Medicine, Mt. Sinai Hospital, Samuel Lunenfeld Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Yutaka Oiso
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jiro Nakamura
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Dahlin LB, Granberg V, Rolandsson O, Rosén I, Dahlin E, Sundkvist G. Disturbed vibrotactile sense in finger pulps in patients with Type 1 diabetes--correlations with glycaemic level, clinical examination and electrophysiology. Diabet Med 2011; 28:1045-52. [PMID: 21843302 DOI: 10.1111/j.1464-5491.2011.03328.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS In a cohort of men and women with Type 1 diabetes, prospectively followed for > 20 years, vibrotactile sense in fingers was investigated and related to neurophysiological tests, glycaemic level and clinical score. METHODS Out of 58 patients, diagnosed at the age of 15-25 years and recruited 1984-1985, 32 patients (13 women, median age 52 years, range 44-75 years; 19 men, median age 52 years, range 39-69 years; median duration 33.5 years, range 21-52 years) accepted follow-up in 2006. Vibration thresholds were measured in finger pulps of index and little fingers bilaterally at seven frequencies and related to results of touch (monofilaments), tactile discrimination (two-point discrimination test), electrophysiology (median nerve function), glycaemic level (HbA(1c) levels since 1984-1985) and a clinical score. RESULTS Vibrotactile sense was reduced in finger pulps, mainly in men, compared with an age- and gender-matched healthy control group with normal HbA(1c) . Vibration thresholds were increased, particularly at 250 and 500 Hz, in both index and little finger pulps. Touch and tactile discrimination correlated with vibration thresholds, but not with each other or with electrophysiology. HbA(1c) levels (at follow-up or mean values from five follow-ups since recruitment) did not correlate with any nerve function variables. Clinical scores correlated with vibrotactile sense, particularly at higher frequencies (> 125 Hz), but not with total Z-scores of electrophysiology. Duration of disease did not correlate with any variables. CONCLUSIONS Examination of vibration thresholds in index and little finger pulps may be valuable to detect neuropathy, where thresholds correlate with symptoms and tests.
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Affiliation(s)
- L B Dahlin
- Department of Hand Surgery , Skåne University Hospital, Malmö, Sweden.
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Spornick N, Guptill V, Koziol D, Wesley R, Finkel J, Quezado ZMN. Mouse current vocalization threshold measured with a neurospecific nociception assay: the effect of sex, morphine, and isoflurane. J Neurosci Methods 2011; 201:390-8. [PMID: 21864576 DOI: 10.1016/j.jneumeth.2011.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/03/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
Sine-wave electrical stimulation at frequencies 2000, 250, and 5Hz to respectively evaluate Aβ, Aδ, and C sensory neurons has recently been added to the armamentarium used to evaluate sensory neurons. We developed an automated nociception assay using sine-wave stimulation methodology to determine current vocalization threshold in response to 2000, 250, and 5Hz and examine the effects of sex, analgesics, and anesthetics in mice. At baseline, males had significantly higher mean current vocalization thresholds compared with female mice at 2000, 250, and 5Hz (p≤0.019). By 1h after intrathecal injections of morphine there were significant increases in current vocalization threshold percent changes from baseline that varied with doses (p=0.0001) and frequency used (p<0.0001). Specifically, with increasing doses of morphine, there were significantly greater increases in current vocalization threshold percent changes from baseline in response to 5Hz compared with 250 and 2000Hz stimulation in a significantly ordered pattern: 5Hz>250Hz (p<0.0001) and 250Hz>2000Hz (p=0.0002). Forty-five minutes after exposure, there were no effects of isoflurane on current vocalization thresholds at any frequency. Therefore, our findings suggest that this automated nociception assay using sine-wave stimulation in mice, can be valuable for measurements of the effects of sex, opioids, and anesthetics on the response to electrical stimuli that preferentially stimulate Aβ, Aδ, and C-sensory fibers in vivo. This investigation suggests the validation of this assay and supports its use to examine mechanisms of nociception in mice.
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Affiliation(s)
- Nicholas Spornick
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Avenue, Washington, DC 20010, USA
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A comparison of neurosensory alteration and recovery pattern among different types of orthognathic surgeries using the current perception threshold. ACTA ACUST UNITED AC 2011; 111:24-33. [DOI: 10.1016/j.tripleo.2010.03.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 03/19/2010] [Accepted: 03/30/2010] [Indexed: 11/18/2022]
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Shibata T, Naruse K, Kamiya H, Kozakae M, Kondo M, Yasuda Y, Nakamura N, Ota K, Tosaki T, Matsuki T, Nakashima E, Hamada Y, Oiso Y, Nakamura J. Transplantation of bone marrow-derived mesenchymal stem cells improves diabetic polyneuropathy in rats. Diabetes 2008; 57:3099-107. [PMID: 18728233 PMCID: PMC2570407 DOI: 10.2337/db08-0031] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Mesenchymal stem cells (MSCs) have been reported to secrete various cytokines that exhibit angiogenic and neurosupportive effects. This study was conducted to investigate the effects of MSC transplantation on diabetic polyneuropathy (DPN) in rats. RESEARCH DESIGN AND METHODS MSCs were isolated from bone marrow of adult rats and transplanted into hind limb skeletal muscles of rats with an 8-week duration of streptozotocin (STZ)-induced diabetes or age-matched normal rats by unilateral intramuscular injection. Four weeks after transplantation, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) productions in transplanted sites, current perception threshold, nerve conduction velocity (NCV), sciatic nerve blood flow (SNBF), capillary number-to-muscle fiber ratio in soleus muscles, and sural nerve morphometry were evaluated. RESULTS VEGF and bFGF mRNA expression were significantly increased in MSC-injected thigh muscles of STZ-induced diabetic rats. Furthermore, colocalization of MSCs with VEGF and bFGF in the transplanted sites was confirmed. STZ-induced diabetic rats showed hypoalgesia, delayed NCV, decreased SNBF, and decreased capillary number-to-muscle fiber ratio in soleus muscles, which were all ameliorated by MSC transplantation. Sural nerve morphometry showed decreased axonal circularity in STZ-induced diabetic rats, which was normalized by MSC transplantation. CONCLUSIONS These results suggest that MSC transplantation could have therapeutic effects on DPN through paracrine actions of growth factors secreted by MSCs.
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Affiliation(s)
- Taiga Shibata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Nagakura Y, Jones TL, Malkmus SA, Sorkin L, Yaksh TL. The sensitization of a broad spectrum of sensory nerve fibers in a rat model of acute postoperative pain and its response to intrathecal pharmacotherapy. Pain 2008; 139:569-577. [PMID: 18692315 DOI: 10.1016/j.pain.2008.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 04/24/2008] [Accepted: 06/06/2008] [Indexed: 11/28/2022]
Abstract
Further understanding of pathophysiology of postoperative acute pain is necessary for its better management. The methodology of current threshold (CT) determination by using sine-wave stimuli at 3 frequencies has been used to selectively and quantitatively analyze the function of the subsets of fibers (i.e., frequency of 5, 250, and 2000Hz recruits C-, Adelta-, and Abeta-fibers, respectively). This study investigated how surgical incision would affect the CTs, and then assessed the efficacy of intrathecal pharmacotherapy. The CT required to evoke a paw withdrawal response was assessed over time at stimulus frequencies of 5Hz (CT5), 250Hz (CT250), and 2000Hz (CT2000) in rats that had undergone surgical incision of the plantar skin and muscle. The CTs at all frequencies significantly decreased immediately after the incision. The decreased thresholds gradually recovered during the first week post-surgery. CT5 and CT250 (but not CT2000) remained significantly low even on day 7 post-surgery. Morphine at 5microg/10microL i.t. significantly reversed CT5 and CT250. NBQX (alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid [AMPA]/kainate receptor antagonist) at 1.9 or 3.8microg/10microL i.t. significantly increased the thresholds over the pre-surgery threshold levels at all frequencies. MK-801 (N-methyl d-aspartate [NMDA] receptor antagonist) up to 13.5microg/10microL i.t. did not significantly affect CTs at any frequencies. In conclusion, a broad spectrum of sensory fibers (Abeta, Adelta, and C) is sensitized at the spinal and/or peripheral level in the postoperative acute pain state. Spinal AMPA/kainate receptors but not NMDA receptors play a significant role in this sensitization.
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Affiliation(s)
- Yukinori Nagakura
- Department of Anesthesiology, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0818, USA
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Nather A, Neo SH, Chionh SB, Liew SCF, Sim EY, Chew JLL. Assessment of sensory neuropathy in diabetic patients without diabetic foot problems. J Diabetes Complications 2008; 22:126-31. [PMID: 18280443 DOI: 10.1016/j.jdiacomp.2006.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 10/12/2006] [Accepted: 10/16/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the incidence and extent of peripheral sensory neuropathy in diabetic patients without diabetic foot problems (DFPs) with <5, 5-10 and >10 years duration of diabetes using three different modalities of testing: Pin-Prick Testing, 5.07 Semmes-Weinstein Monofilament Testing (SWMT) and Rapid-Current Perception Threshold (R-CPT) measurements using the Neurometer. METHODS Our study population consisted of 60 patients (120 feet) treated for diabetes mellitus in the Division of Endocrinology at the National University Hospital. No patient had any DFPs. Twenty-two, 21 and 17 patients had duration of diabetes of <5, 5-10 and >10 years, respectively. All patients were tested for sensory neuropathy using Pin-Prick Testing using a standardized protocol, SWMT and the Neurometer. RESULTS There was a significantly higher incidence of sensory neuropathy detected by both the Pin-Prick Test and the Neurometer as compared to the SWMT. Also, in all three modalities, there was a significant increase in incidence of sensory neuropathy detected in diabetics with >5 years duration of diabetes. In addition, the Pin-Prick Test showed an increase in extent of sensory neuropathy with a longer duration of diabetes. CONCLUSIONS The Pin-Prick Test was found to be a simple, cheap and useful diagnostic tool for detection of sensory neuropathy in diabetics without DFPs. In addition, it could accurately delineate the extent of neuropathy in the lower limb - additional useful information not obtainable with SWMT or Neurometer. Even for patients with <5 years duration of diabetes, the incidence of sensory neuropathy detected was considerable. The incidence of neuropathy detected continued to increase with length of duration of diabetes. Hence, we recommend screening of patients for neuropathy as soon as they are diagnosed with diabetes.
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Affiliation(s)
- Aziz Nather
- Department of Orthopaedic Surgery, National University Hospital, Singapore.
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Nagakura Y, Malkmus S, Yaksh TL. Determination of current threshold for paw withdrawal with sine-wave electrical stimulation in rats: Effect of drugs and alteration in acute inflammation. Pain 2008; 134:293-301. [PMID: 17583428 DOI: 10.1016/j.pain.2007.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 03/19/2007] [Accepted: 04/23/2007] [Indexed: 11/24/2022]
Abstract
Electrical stimulation is widely used to assess the function of sensory nerves in humans. In the present study, the threshold current (CT) required to evoke a paw withdrawal response in rats was assessed with stepwise increases in current delivered as sinusoidal stimulation at frequencies of 2000 Hz (CT2000), 250 Hz (CT250) and 5 Hz (CT5). Baseline CT was 840+/-3 microA for CT2000, 267+/-2 microA for CT250 and 165+/-1 microA for CT5 (n=59). Intrathecal administration (1-10 microg/rat) of morphine selectively increased CT5 and CT250 (efficacy order was CT5>CT250>>CT2000=0), although systemic morphine (1-5mg/kg, S.C.) affected all three CTs (CT5>CT250>CT2000>0). Intrathecal pretreatment at day -3 of capsaicin (75 microg/rat) increased the thermal nociceptive threshold and selectively increased CT5 (CT5>>CT250, CT2000=0). Intraplantar carrageenan injection progressively decreased CT250 and CT5, but increased CT2000 for a 3h period. Intraperitoneal pretreatment with indomethacin (20mg/kg) attenuated carrageenan evoked CT alterations as well as progression of paw swelling and thermal hyperalgesia. In conclusion, low, but not high, frequency stimulation activated a withdrawal response which appears mediated by morphine and capsaicin sensitive primary afferents and this threshold was reduced in the presence of inflammation. These data suggest the validity of such stimulation in defining drug action in a nontissue injurious fashion.
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Affiliation(s)
- Yukinori Nagakura
- Department of Anesthesiology, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0818, USA
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Ozawa M, Tsuchiyama K, Gomi R, Kurosaki F, Kawamoto Y, Aiba S. Neuroselective transcutaneous electric stimulation reveals body area–specific differences in itch perception. J Am Acad Dermatol 2006; 55:996-1002. [PMID: 17097397 DOI: 10.1016/j.jaad.2006.08.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 07/09/2006] [Accepted: 08/10/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Electrically evoked itch has been reported, although the electrodes, the frequency, and the pulse duration used were not standardized. OBJECTIVE To examine whether a neuroselective transcutaneous electrical stimulator (NTES; Neurometer; Neurotron, Inc, Baltimore, Md) can evoke itch and whether it can provoke itch on any body area. METHODS Twelve healthy subjects were stimulated on 30 body sites by 5 Hz alternating current produced by the NTES. We classified the evoked perceptions into two sensations (with and without itch) and divided the examined sites into 7 groups: G1, head and neck; G2, arm; G3, palm; G4, the dorsal surface of the hand; G5, knee and leg; G6, dorsal foot; and G7, ankle. The data were then statistically analyzed. RESULTS The NTES preferentially evoked itch at the G4 and G7 sites, and a sensation without itch at the G1 site. LIMITATION Tests were performed on limited body areas. CONCLUSION The NTES can provoke itch, it was discovered that there are body area-specific differences in itch sensation.
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Affiliation(s)
- Maki Ozawa
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Moghtaderi A, . RAN, . MM, . HR. Diabetic Neuropathy: Determining the Sensitivity of Peripheral Nerves During a Short Course of Glycemic Control. JOURNAL OF MEDICAL SCIENCES 2006. [DOI: 10.3923/jms.2006.818.822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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