Effectiveness of Metanx Prescription Medical Food on Small Nerve Fibers and Monofilament Sensation in Patients with Diabetic Peripheral Polyneuropathy

Purpose: Diabetic peripheral neuropathy (DPN) is prevalent among the population with type 2 diabetes, and treatment approaches are limited. The combination of L-methylfolate-methylcobalamin-pyridoxal-5-phospate (LMF-MC-PP, Metanx?) is a prescription medical food that has demonstrated significant improvements in sensory perception and quality of life as well as reduced neuropathic pain in patients with DPN. The present study examined the effects of LMF-MC-PP on sensory perception and epidermal nerve fiber density (ENFD) among patients with confirmed DPN. Methods: Patients with type 2 diabetes and diagnosed with diabetic peripheral polyneuropathy, based on loss of vibratory perception, warm-cold discrimination or monofilament sensation, underwent bilateral lower extremity ENFD assessments via skin punch biopsy and were started on LMF-MC-PP. ENFD and monofilament testing were repeated at 6 months. Findings: Of 123 patients evaluated, all had monofilament testing at baseline and 6 months and 122 had assessments at both time points. A significant (p < 0.05) improvement in ENFD from baseline to 6 months was observed. A significant (p = 0.0001) improvement in monofilament testing also was observed. Overall, more patients had intact sensation after 6 months, with 60 (48.8%) of 123 patients having positive monofilament test at baseline as compared to 95 (77.2%) positive after 6 months. An analysis of the association between improvements in ENFD and monofilament testing found that the two tended to occur together, and this was significant (p < 0.05) for the right limb. Implications: Clinically important and statistically significant improvements in ENFD and monofilament sensation were associated with LMF-MC-PP in patients with DPN. When compared to the decrease in ENFD expected among DPN patients, the improvements are even more clinically significant. These findings should be validated in a larger, placebo-controlled study.

Bendable tube-shaped supercapacitor based on reduced graphene oxide and Prussian blue coated carbon fiber yarns for energy storage

Carbon fiber yarns（CFY） are promising as a new type of flexible building blocks for the construction of flexible architectures for the energy storage applications. The main hurdle with CFY is how to make them high energy and power capable by using economically and environmentally viable materials. Here,we report reduced graphene oxide（r GO） and Prussian blue（PB） coated CFY, derived from a facile electrochemical process at room temperature for supercapacitor electrodes. The PB coated CFY and r GO coated CFY electrodes exhibit the excellent gravimetric capacitance of 339 F/g and 160.2 F/g, respectively, in aqueous KCl electrolyte in three-electrode cell configuration. When we coupled these electrodes inside the flexible plastic tube and separated by the electrolyte wet filter paper in order to construct flexible architecture, the resulting device delivers excellent specific energy of 52.1 Wh/kg and 26.5 Wh/kg with offering specific power of 3100 W/kg and 14400 W/kg respectively, under a wide operating potential of1.8 V with excellent rate capability. The device shows high tolerance towards bending, and retained its efficiency to the capacitance after being bent at an angle of 360° for 200 bending cycles.

Single fiber electromyography in 78 patients with amyotrophic lateral sclerosis

Background Single fiber electromyography (SFEMG) is a sensitive technique for detecting abnormalities in neuromuscular transmission and is mainly used in the diagnosis of neuromuscular junction disorders, such as myasthenia gravis While the process of denervation reinnervation in amyotrophic lateral sclerosis (ALS) can also result in immature collateral nerve terminals and instability of neuromuscular transmission, the purpose of this study was to investigate the changes and clinical values of SFEMG in patients with ALS Methods Volitional SFEMG was performed on the extensor digitorum communis (EDC) of 78 patients with ALS (men 52, women 26) who had been previously diagnosed by history, clinical features, and neurophysiological studies The mean jitter, the percentage of jitter >55 μs, the impulse blocking percentage, and fiber density (FD) were determined These results were compared to normal controls In addition, the SFEMG indices were analyzed for correlations with the duration of ALS, the EDC strength score on the Medical Research Council (MRC) scale, and spontaneous activity detected by EMG studies Results SFEMG indices were abnormal in all patients with ALS Mean jitter ranged from 30 to 178 μs (mean 80 2 μs); the percentage of jitter >55 μs ranged from 5% to 100% (mean 60 5%) In addition, the impulse blocking percentage ranged from 0% to 90% (mean 28 1%) and FD ranged from 1 4 to 4 1 (mean 2 6) Mean jitter, the percentage of jitter >55 μs, and the blocking percentage in 57 patients with definite or probable ALS were significantly higher than in patients with possible or suspected ALS MRC scores of the EDC negatively correlated with mean jitter, the percentage of jitter >55 μs, blocking percentage, and FD Conclusions SFEMG is the most sensitive tool for diagnosing definite or probable ALS Increased jitter, blocking percentage, and FD can indicate the degree of immature collateral sprouts and motor end plates resulting from the progressive denervation and reinnervation associated with ALS, and may be helpful in evaluating prognosis

Clinical Characteristics, Electrophysiology, and Skin Biopsy of 38 Peripheral Neuropathy Cases with Small Fiber Involvement of Various Etiologies

Background：In small fiber neuropathy （SFN）,thinly myelinated Aδ and unmyelinated C fibers are primarily affected,resulting in sensory and/or autonomic symptoms.Various etiologies have been shown to be associated with SFN.This study was aimed to analyze a variety of features in peripheral neuropathy （PN） with small fiber involvement.and to compare disease severity among patients with idiopathic PN,PN associated with impaired glucose tolerance （IGT）,and metabolic syndrome （MS） PN.Methods：Thirty-eight PN patients with small fiber involvement were enrolled from December 20,2013 to May 31,2016.Patients were divided into idiopathic PN,IGT-related PN,and MS-related PN groups.Detailed medical history and small fiber neuropathy were investigated,and symptom inventory questionnaire was conducted,as well as the visual analog scale.Nerve conduction studies and skin biopsies were also performed.The differences among the groups were analyzed using analysis of variance and Kruskal-Wallis test.Results：Eight patients were diagnosed with pure SFN.lntraepidermal nerve fiber density （I ENFD） weakly correlated with motor conduction velocity （MCV） （r =0.372,P =0.025）,and proximal （r =0.383,P =0.021） and distal （r =0.358,P 0.032） compound muscle action potential （CMAP） of the tibial nerve.IENFD also weakly correlated with MCV of the peroneal nerve （r=0.399,P =0.016）.IENFD was shown to be significantly different among all groups （x2 =9.901,P-0.007）.IENFD was significantly decreased （x2 =23.000,P=0.003） in the MS-related PN group compared to the idiopathic PN group.The MCV of the tibial nerve was significantly different among all groups （x2 =8.172,P 〈 0.017）.The proximal （F =4.336,P =0.021） and distal （F =3.262,P =0.049） CMAP of the tibial nerve was also significantly different among all groups.Conclusions：IENFD of patients included in the present study weakly correlated with various electrophysiological parameters.Small and large fibers are more involved in patients with MS-related PN than in patients with idiopathic PN.