Sensory deficits of the paretic and non-paretic upper limbs relate with the motor recovery of the poststroke subjects

BACKGROUND

Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role.

OBJECTIVE

To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects.

METHODS

The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA).

RESULTS

The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side.

CONCLUSION

In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.

Onset of an Active Charcot Foot in a Person with Longstanding Type 1 Diabetes and Normal Vibration Perception Threshold-A Case Report

Charcot neuro-osteoarthropathy (CNO), or Charcot foot, is a disabling complication of diabetes, which is poorly understood and frequently overlooked. We describe an atypical presentation of an active Charcot foot in a woman with a long-standing type 1 diabetes who did not exhibit loss of protective sensation (sensate to a 10-gram monofilament) or loss of vibration sensation. These standard measures of large nerve fibre function ruled out "classical" neuropathy. However, additional testing showed reduced sweat gland function most likely related to degeneration of c-fibres (small fibre neuropathy). This case raises the awareness that in addition to the "textbook" description, in diabetes, Charcot foot can develop in individuals with "minimal" or "no signs" of clinical neuropathy. The onset of active Charcot foot should be suspected in every person with diabetes and history of trauma even when foot and ankle x-rays are normal. Offloading should be initiated until the diagnosis is proven otherwise.

Comparative Analysis of Mechanical Properties and Microbiological Resistance of Polyfilament and Monofilament Suture Materials Used in the Operation "Tooth Extraction"

In surgical dentistry, suture material is the only foreign body that remains in the tissues after surgery, and it can lead to several negative reactions, for example, infection of the wound. The purpose of this study was to compare the mechanical properties and microbiological resistance of mono- and polyfilament suture materials used in tooth extraction operations. The study of elongation and knot force was carried out on an Instron 5969 Dual Column Testing System device. The capillarity of the materials was studied on a setup assembled by the authors manually by immersing the ends of the filaments in a colored manganese solution. A microbiological study was carried out on the threads taken for the experiment immediately after wound suturing, and on day 7, at which time they were removed. The comparison was made according to Rothia mucilaginosa, Streptococcus sanguinis, Staphylococcus epidermidis. Results: monofilament suture materials (Prolene and Glycolon), after calculating the Kruskal-Wallis and Mann-Whitney indices, showed better performance in all experiments compared to polyfilament sutures (Vicryl and PGA). In capillarity comparison, there was a significant difference between groups (p = 0.00018). According to the sum of the results of three microbiological studies on day 7, monofilament suture materials absorbed less of the studied bacteria on their surface compared to the polyfilament ones (p < 0.05). Conclusions: Of the studied suture materials, Prolene had the best microbiological resistance and good mechanical properties.

Suture type for hysterotomy closure: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term operative outcomes with varied results. This systematic review and meta-analysis aimed to examine types of suture material used for cesarean delivery.

DATA SOURCES

Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid, and ClinicalTrials.gov were searched from inception of each database to October 2021.

STUDY ELIGIBILITY CRITERIA

All randomized controlled trials that compared types of suture materials used for hysterotomy closure during low-transverse cesarean delivery at ≥24 weeks' gestation and examined maternal outcomes were included for this review. The primary outcome was estimated blood loss. Secondary outcomes included additional surgical complications.

METHODS

Results were summarized as mean difference or risk ratio with associated 95% confidence intervals. The quality of studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I2).

RESULTS

This review included 7 randomized controlled trials, of which 3 compared multifilament with barbed suture (136 vs 136 participants), 3 compared multifilament with conventional monofilament suture (245 vs 244 participants), and 1 trial compared multifilament with chromic suture (4590 vs 4595 participants). Primary analysis showed no difference in estimated blood loss between the multifilament and the barbed suture group (mean difference, 46.2 mL; 95% confidence interval, -13.6 to 105.9), nor in change in hemoglobin concentration between the multifilament and the conventional monofilament group (mean difference, -0.1%; 95% confidence interval, -0.5 to 0.3). Secondary outcomes showed a reduction in operative time with barbed vs multifilament suture (mean difference, 1.9 minutes; 95% confidence interval, 0.03-3.8). Analysis also demonstrated an increased uterine scar thickness with use of conventional monofilament vs multifilament suture (mean difference, -1.05 mm; 95% confidence interval, -1.9 to -0.2).

CONCLUSION

This meta-analysis does not support a specific type of suture material for uterine closure at cesarean delivery because of insufficient data. Although barbed suture was associated with an overall decrease in operative time, and use of conventional monofilament suture was associated with an increase in uterine scar thickness, the clinical utility of these differences is not clear. Further adequate randomized controlled trials are warranted for evaluation of different suture materials for hysterotomy closure.

Burden of diabetic foot syndrome in rural community: Need for screening and health promotion

Context

Living with diabetes can be difficult since it can affect the patient in many ways. Diabetic foot syndrome (DFS) is described as a group of symptoms where neuropathy reduced blood supply and infection leads to tissue breakdown and morbidity.

Aim

This study aims to determine the prevalence of DFS and associated sociodemographic and treatment-related factors among adults living with type 2 diabetes mellitus in a rural community.

Setting and Design

A cross-sectional study was conducted in an area under the rural health training centre of department of Community Medicine.

Methods and Material

The study was conducted to determine DFS by measuring neuropathy, peripheral vascular disease using Michigan neuropathy screening instrument, and clinical examination.

Statistical Analysis Used

The data collected was analyzed using SPSS 25.

Results

The prevalence of DFS among those with type 2 diabetes mellitus was high (51.7%). DFS was associated with advanced age (>75 years), duration of diabetes for more than 5 years and with foot ulcer. Smoking and alcohol consumption were not associated with DFS.

Conclusion

Half of those with diabetes had DFS. People with DFS were more likely to be older and living with diabetes for longer duration. This underscores the need for early identification of DFS by the primary care physicians. Further research on the role of health professionals at the primary care level in educating and screening DFS in people with diabetes are required.

Synthesis of a novel monofilament bioabsorbable suture for biomedical applications

In this research, a novel bioabsorbable suture that is, monofilament and capable of localized drug delivery, was developed from a combination of natural biopolymers that where not previously applied for this purpose. The optimized suture formulation comprised of sodium alginate (6% wt/vol), pectin (0.1% wt/vol), and gelatin (3% wt/vol), in the presence of glycerol (4% vol/vol) which served as a plasticizer. The monofilament bioabsorbable sutures where synthesized via in situ ionic crosslinking in a barium chloride solution (2% wt/vol). The resulting suture was characterized in terms of mechanical properties, morphology, swelling, degradation, drug release, and biocompatibility, in addition to Fourier-transform infrared (FTIR) spectroscopy, Powder X-ray Diffraction (PXRD) and Differential Scanning Calorimetry (DSC) analysis. The drug loaded and non-drug loaded sutures had a maximum breaking strength of 4.18 and 4.08 N, in the straight configuration and 2.44 N and 2.59 N in the knot configuration, respectively. FTIR spectrum of crosslinked sutures depicted Δ9 cm^-1 downward shift for the carboxyl stretching band which was indicative of ionic interactions between barium ions and sodium alginate. In vitro analysis revealed continued drug release for 7 days and gradual degradation by means of surface erosion, which was completed by day 28. Biocompatibility studies revealed excellent hemocompatibility and no cytotoxicity. These results suggest that the newly developed bioabsorbable suture meets the basic requirements of a suture material and provides a viable alternative to the synthetic polymer sutures that are currently on the market.

New Solvent and Coagulating Agent for Development of Chitosan Fibers by Wet Spinning

Adipic acid was evaluated as a novel solvent for wet spinning of chitosan fibers. A solvent with two carboxyl groups could act as a physical crosslinker between the chitosan chains, resulting in improved properties of the fibers. The performance of adipic acid was compared with conventional solvents, i.e., lactic, citric, and acetic acids. Chitosan solutions were injected into a coagulation bath to form monofilaments. Sodium hydroxide (NaOH) and its mixture with ethanol (EtOH) were used as coagulation agents. Scanning electron microscopy confirmed the formation of uniform chitosan monofilaments with an even surface when using adipic acid as solvent. These monofilaments generally showed higher mechanical strength compared to that of monofilaments produced using conventional solvents. The highest Young's modulus, 4.45 GPa, was recorded for adipic acid monofilaments coagulated in NaOH-EtOH. This monofilament also had a high tensile strength of 147.9 MPa. Furthermore, taking advantage of chitosan insolubility in sulfuric acid (H₂SO₄) at room temperature, chitosan fibers were successfully formed upon coagulation in H₂SO₄-EtOH. The dewatering of fibers using EtOH before drying resulted in a larger fiber diameter and lower mechanical strength. Adipic acid fibers made without dehydration illustrated 18% (for NaOH), 46% (for NaOH-EtOH), and 91% (for H₂SO₄-EtOH) higher tensile strength compared to those made with dehydration.

A Novel Diagnostic Test for End-Stage Sensory Failure Associated With Diabetic Foot Ulceration: Proof-of-Principle Study

BACKGROUND

Diabetic foot ulceration (DFU) affects only a subgroup of patients with diabetic neuropathy, that is, those with pain-insensitivity due to end-stage sensory failure. Pain perception failure develops insidiously and remains asymptomatic until first DFU. As loss of pain perception is clinically significant, timely detection is mandatory.

OBJECTIVES

A novel suprathreshold pinprick pain stimulus of 512 mN force made from optical glass-fiber was explored in a prospective cross-sectional diagnostic accuracy study to detect DFU-related end-stage sensory failure.

METHODS

A total of 116 participants were studied (25 healthy people, 22 patients with diabetes without relevant complications, 19 patients with previous painful foot or leg injuries, and 50 patients with previous or active painless DFU [reference standard]). Palmar and plantar surfaces were stimulated in a standardized fashion. At the feet, the second and third toe skinfolds and the middle of the plantar arch were stimulated. Participants scored stimulated pricking discomfort or pain intensity 0 to 10 on a numerical rating scale.

RESULTS

At hands, intensity was rated on average 5 (1-10) [median (range)] by 114/116 participants. Per foot, participants without DFU scored 5 (1-10), while those with DFU scored 0 (0-3) (P < .0001). At plantar toe skinfolds, the absence of pinprick pain perception detected DFU-associated sensory failure with an accuracy of 99.5% (sensitivity 99.5%, specificity 99.4%, positive likelihood ratio 248, and negative likelihood ratio 0.005).

CONCLUSION

In this pilot study, nociceptive stimulation of a plantar toe skinfold with a 512 mN optical glass-fiber pinprick accurately identified DFU-associated end-stage sensory failure.

Comparison between quantitative and subjective assessments of chemotherapy-induced peripheral neuropathy in cancer patients: A prospective cohort study

OBJECTIVE

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event experienced by cancer patients. In general, CIPN is evaluated subjectively based on patient self-assessment or clinician-reported scales; evidence supporting the utility and validity of quantitative sensory tests (QST) is lacking in this patient population. The aim of this study was to objectively assess CIPN of lower extremities by QSTs, and to evaluate the concordance between QSTs and subjective assessments.

METHODS

In this prospective cohort study, outpatients with cancer receiving chemotherapy were recruited at a single university hospital. We assessed CIPN at the lower extremities at baseline and three months after baseline. The QSTs were performed by applying a monofilament and a tuning fork to determine touch and vibration thresholds, respectively, at the affected site. Subjective assessments were performed based on the visual analog scale (VAS) and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) toxicity grade. Kappa coefficients were calculated to evaluate the concordance between QSTs and subjective assessments.

RESULTS

After exclusion and drop-outs during follow-up, nineteen patients were included in the analysis. The prevalence of patients with abnormal sensation was 37% based on QSTs, 32% based on the VAS, and 14% based on CTCAE grading, respectively. Kappa coefficients were 0.32 between QSTs and VAS, and 0.28 between QSTs and CTCAE.

CONCLUSIONS

The concordance rates between quantitative and subjective assessments were low. CIPN should be assessed using both quantitative and subjective assessments.

Efficacy of different cerclage suture materials in reducing preterm birth

Objective: To compare the efficacy of monofilament suture, braided polyester thread, and 5 mm tape suture in reducing preterm birth (PTB).Study design: Women who received a cerclage at Touro Infirmary, New Orleans, LA, USA, between 1 January, 2011 and 31 December, 2016 were identified using ICD-9/10 codes. All charts were reviewed for demographic and obstetrical variables including gestational age (GA) at delivery.Results: Of 145 women who received a cerclage, 36 were excluded due to incomplete charts leaving 109 for analysis. There was no significant difference in gestational age at cerclage placement or delivery among women with monofilament, braided, or 5 mm tape cerclages (p = .936 and p = .919, respectively) nor was there a difference in the proportion who delivered at ≥32, 34, or 37 weeks across groups with differing cerclage material (p = .270, p = .275, and p = .419, respectively). There was no difference in GA at delivery for patients who received 17-OHP compared to those who did not (p = .362). There were also no differences with respect to birth outcomes such as birthweight (p = .938), Apgar scores (p = .477, p = .430) or neonatal intensive care admission rates (NICU) (p = .304). Analysis revealed no difference in characteristics between groups including history of PTB or indication for removal (p = .371, p = .317).Conclusion: We found no difference in pregnancy prolongation when comparing different suture material used for indicated cerclages. We also found no differences with respect to rates of maternal infection or adverse neonatal outcomes among groups.RationaleThis study was conducted to evaluate the efficacy of different suture materials in increasing gestational age at delivery and reducing preterm birth.

Risk Factors and Frequency of Ingrown Nails in Adult Diabetic Patients

The present study evaluated the properties of nails, frequency of ingrown nails in patients with type 2 diabetes mellitus (DM), risk factors for developing ingrown nails, and effect of diabetic polyneuropathy and vasculopathy on the development and outcome of ingrown nails. Our 6-month epidemiologic prospective study included 300 patients with type 2 DM attending a DM outpatient clinic for routine examinations. The general characteristics and foot changes of the study population were investigated. Diabetic polyneuropathy and vasculopathy were evaluated using a biothesiometer, monofilament tests, and arterial Doppler ultrasonography. The frequency of ingrown nails was 13.6%. Multivariate analysis with logistic regression showed that body mass index (odds ratio [OR] 1.077, 95% confidence interval [CI] 1.007 to 1.15; p = .03), previous trauma (OR 2.828, 95% CI 1.017 to 7,867, p = .042), a weak dorsalis pedis pulse (OR 2.72, 95% CI 1.17 to 6.30, p = .02), trimming type (OR 2.3, 95 CI 1.06 to 4.98), p = .35), onychogryphosis (OR 9.036, 95% CI 2.34 to 34.87, p = .001), and subungual hyperkeratosis (OR 4.3, 95% CI 1.99 to 9.3, p = .001) were predictive variables for ingrown nails in our population. The incidence of onychomycosis was significantly greater in patients with ingrown nails (p = .032) than in patients without ingrown nails. The nail curvature ratio was greater in the patients with ingrown nails than in the group with normal nails. Arterial Doppler ultrasound examinations showed peripheral arterial disease in 19 patients (46.9%) with ingrown nails. The prevalence of ingrown nails was greater in the patients with DM than in the healthy population. Our results indicate that nail type, nail morphology, and diabetic vasculopathy affect the formation and evolution of ingrown nails.

SENSITIVITY OF FOUR SIMPLE METHODS TO SCREEN CHINESE PATIENTS FOR DIABETIC PERIPHERAL NEUROPATHY

CONTEXT

Diabetic peripheral neuropathy (DPN) is a common complication associated with long-term type 2 diabetes mellitus, although early diagnosis can improve prognosis.

OBJECTIVE

Our objective was to develop a simple protocol for early diagnosis of DPN in Chinese type 2 diabetic patients.

SUBJECTS AND METHODS

A total of 209 type 2 diabetic patients were included; these patients were categorized as symptomatic and asymptomatic group based on their symptoms. Clinical data of these patients were recorded and they were screened for DPN by vibration perception threshold test (VPT), 10-G nylon monofilament test, temperature identification, and the tendon reflex test.

RESULTS

The total combined rate of patients who were tested positive for DPN with all four screening methods was 68.7%. Patients tested positive for DPN were significantly older and had a longer disease duration than those who were tested negative (p<0.01); however, glycated hemoglobin levels, presence of hypertension, and gender did not differ significantly between them (p>0.05). Among screening methods, the highest positive rate observed among patients screened with the VPT test was 63.64% as compared to other tests. The total positive rate for temperature discrimination, 10-G monofilament and tendon reflex test were 26.79%, 11.96 % and 17.22 % respectively. In asymptomatic group VPT showed the highest positive rate for DPN (48.41%).

CONCLUSIONS

The combination of four simple methods can improve the detection rate of DPN and identify subclinical cases. Abnormal vibration perception was the most common feature of DPN and it was associated with both disease duration and the age of the patient.

Brachial Plexus Blockade Causes Subclinical Neuropathy: A Prospective Observational Study

Background: The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls. Methods: In total, 115 hand surgery adult patients were prospectively enrolled in this study. All patients undergoing nerve-related procedures were excluded as well as any patients with preoperative clinically apparent nerve deficits. Eighty-four patients underwent brachial plexus blockade preoperatively, and 31 patients underwent general anesthesia (GA). Semmes-Weinstein monofilament testing of the hand was performed preoperatively on both the operative and nonoperative extremities and postoperatively at a mean of 11 days on both hands. Preoperative and postoperative monofilament testing scores were compared between the block hand and the nonoperated hand of the same patient, as well as between the block hands and the GA-operated hands. Results: There were no recorded clinically relevant neurologic complications in the block group or GA group. A statistically significant decrease in sensation in postoperative testing in the operated block hand compared with the nonoperated hand was noted. When comparing the operated block hand with the operated GA hand, there was a decrease in postoperative sensation in the operated block hand that did not reach statistical significance. Conclusions: Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations.

Thresholds of skin sensitivity are partially influenced by mechanical properties of the skin on the foot sole

Across the foot sole, there are vibration and monofilament sensory differences despite an alleged even distribution of cutaneous afferents. Mechanical property differences across foot sole sites have been proposed to account for these differences. Vibration (VPT; 3 Hz, 40 Hz, 250 Hz), and monofilament (MF) perception threshold measurements were compared with skin hardness, epidermal thickness, and stretch response across five foot sole locations in young healthy adults (n = 22). Perceptual thresholds were expected to correlate with all mechanical property measurements to help address sensitivity differences between sites. Following this hypothesis, the MedArch was consistently found to be the thinnest and softest site and demonstrated the greatest sensitivity. Conversely, the Heel was found to be the thickest and hardest site, and was relatively insensitive across perceptual tests. Site differences were not observed for epidermal stretch response measures. Despite an apparent trend of elevated sensory threshold at harder and thicker sites, significant correlations between sensitivity measures and skin mechanical properties were not observed. Skin hardness and epidermal thickness appeared to have a negligible influence on VPT and minor influence on MF within this young healthy population. When normalized (% greater or smaller than subject mean) to the subject mean for each variable, significant positive correlations were observed between MF and skin hardness (R² = 0.422, P < 0.0001) and epidermal thickness (R² = 0.433, P < 0.0001) providing evidence that skin mechanics can influence MF threshold. In young healthy adults, differences in sensitivity are present across the foot sole, but cannot solely be accounted for by differences in the mechanical properties of the skin.

Development of a 0.5-T/240-mm MgB2 MRI Magnet: Assembly Design and Module Coils

This paper presents the latest results from our continued development of a 0.5-T/240-mm MgB₂ MRI magnet at the MIT Francis Bitter Magnet Laboratory. Because we have successfully developed our superconducting joint technique with a monofilament MgB₂ wire, manufactured by Hyper Tech Research, Inc. (Columbus, OH), we have decided to use a monofilament wire to wind our MgB₂ MRI magnet. The magnet, comprising eight module coils, has a winding inner diameter of 276 mm, an outer diameter of 290 mm, and a total height of 460 mm. Each coil has its own persistent-current switch (PCS) and a superconducting joint. In order to guard against a few bad coils forcing the entire magnet to be inoperative, each coil will be heat-treated and tested individually. After eight coils are successfully operated, they will be assembled into an MRI magnet and series-connected with soldering joints between adjacent coils. The PCS in each coil is designed in such way that it will also serve as a detect-and-heat protection absorber when the magnet quenches over a small "localized" region: The conductor volume in the eight switches is designed to absorb the entire magnet energy while still remaining below 200 K. This paper reports 1) the design of the whole magnet and 2) the fabrication and test results of the two real-size test coils, with their PCSs and superconducting joints. The tests were conducted in gas helium in the temperature range of 10-15 K and in the self-field of the coils.

Monofilament MgB2 Wire for a Whole-Body MRI Magnet: Superconducting Joints and Test Coils

This paper presents recent results from our continued development of a 0.5 T whole-body MRI magnet at the Francis Bitter Magnet Laboratory. HyperTech Research Corp. (Columbus, OH) manufactures the MgB₂ conductor for this project. During the past year, we have found that our technique, originally developed successfully to splice unreacted multifilament MgB₂ wires, works much better, i.e., of higher reliability, with unreacted monofilament MgB₂ wires. This has led us to wind the entire coil components in our persistent-mode MRI magnet with unreacted monofilament MgB₂ wire, having a MgB₂ core of 0.4 mm in diameter, an overall diameter of 0.8 mm bare, 1 mm S-glass insulated. To verify that these coils would not suffer from flux jumping, as they would if wound with monofilament NbTi wire, magnetization studies were performed on monofilament wires of MgB₂ and NbTi (as a reference) at 4.2 K. For the monofilament MgB₂ wire, the results were affirmative. To further ensure the absence of flux jumping that may quench these current-carrying coils, two test coils were wound with unreacted monofilament MgB₂ wire. One MgB₂ coil was operated in driven mode, while the other MgB₂ coil, equipped with a persistent current switch and terminated with a superconducting joint, was operated in persistent mode. The operating temperature range was 4.2-15 K for these MgB₂ coils. The driven mode coil was operated in self-field. The persistent mode coil achieved a persistent current of 100 A, corresponding to a self-field of ~1 T in the winding, for 1 hour with no measurable decay. Both test coils were operated quench free.

Validation of bedside methods in evaluation of diabetic peripheral neuropathy

BACKGROUND & OBJECTIVES

Vibration perception threshold (VPT) is considered as a gold standard for diagnosis of diabetic peripheral neuropathy. However, the data are sparse comparing the VPT with commonly used bedside modalities. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy in patients with diabetes mellitus.

METHODS

A total of 1044 patients with diabetes mellitus attending the Diabetes clinic from January 2007 to May 2008, were included in this study. All subjects had a detailed clinical assessment including Diabetic Neuropathy Symptom (DNS) score, Diabetic Neuropathy Examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, 10 g Semmes-Weinstein monofilament and vibration perception threshold (VPT).

RESULTS

The prevalence of peripheral neuropathy was 34.9 per cent with VPT. Foot care practices were followed by only 214 (20.5%) of the study population. When compared with VPT, ankle reflex was the most sensitive (90.7%) but least specific (37.3%). The tuning fork and monofilament tests respectively had lower sensitivity (62.5 and 62.8%) but better specificity (95.3 and 92.9%) and accuracy (78.9 and 77.9%). Significant correlations were observed between the VPT score and the DNE (r = 0.532, P<0.001) and DNS (r = 0.546, P<0.001) scores and absent tuning fork sensation (r = 0.590; P<0.001), monofilament sensation (r = 0.573; P<0.001) and ankle reflex (r = 0.377, P = 0.01).

INTERPRETATION & CONCLUSIONS

The present findings show that simple bed side tests are useful for assessing peripheral diabetic neuropathy, even in those subjects in whom foot care practices are not followed.

The assessment of clinical distal symmetric polyneuropathy in type 1 diabetes: a comparison of methodologies from the Pittsburgh Epidemiology of Diabetes Complications Cohort

Distal symmetrical polyneuropathy (DSP) is the most common type of diabetic neuropathy, but often difficult to diagnose reliably. We evaluated the cross-sectional association between three point-of-care devices, Vibratron II, NC-stat(®), and Neurometer(®), and two clinical protocols, MNSI and monofilament, in identifying those with DSP, and/or amputation/ulcer/neuropathic pain (AUP), the two outcomes of major concern. This report presents data from 195 type 1 diabetic participants of the Epidemiology of Diabetes Complications (EDC) Study attending the 18-year examination (2004-2006). Participants with physician-diagnosed DSP, AUP or who were abnormal on the NC-stat, and the Vibratron II, MNSI, and monofilament were older (p<0.05) and had a longer duration of diabetes (p < 0.05). There was no difference by sex for DSP, AUP, or any testing modality, with the exception of NCstat (motor). The Vibratron II and MNSI showed the highest sensitivity for DSP (>87%) and AUP (>80%), whereas the monofilament had the highest specificity (98% DSP, 94% AUP) and positive predictive value (89% DSP, 47% AUP), but lowest sensitivity (20% DSP, 30% AUP). The MNSI also had the highest negative predictive value (83%) and Youden's Index (37%) and currently presents the single best combination of sensitivity and specificity of DSP in type 1 diabetes.

Risk factor associations with clinical distal symmetrical polyneuropathy and various neuropathy screening instruments and protocols in type 1 diabetes

OBJECTIVE

To determine whether DSP and neuropathy-assessment instruments used by non-physicians have similar risk factors.

RESEARCH DESIGN AND METHODS

analyses were cross-sectional (n=176).

RESULTS

risk factors were similar for DSP and screening devices.

CONCLUSIONS

these data support the clinical utility of neuropathy screening devices used by non-physician personnel.