THE ROLE OF IGF-1 GENE EXPRESSION ABNORMALITY IN PATHOGENESIS OF DIABETIC PERIPHERAL NEUROPATHY

Objective. To explore the role of insulin-like growth factor 1 (IGF-1)gene expression abnormality in neurotrophic causes of diabetic peripheral neurophathy.Methods. Diabetes was induced in Sprague Dawley rats by alloxan. The parameters were measured as follows: IGF-1 mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR); IGF-1 peptide by enzyme-linked immunosorbent assay (ELISA); electrophysiological parameters of nerves by evoked electromyogram; morphometric evaluation of sciatic nerves under light microscope and transmission electron microscope.Results. During early diabetic stage, IGF-1 mRNA [(0.430±0.031)vs. (0.370±0.016), P ＜0.01,(0.430 ± 0.031 ) vs. (0.280 ± 0.010) , P ＜0.001, respectively], IGF - 1 peptide contents [ (38.44 ± 3.60)ng/mgvs. (30.06±2.41) ng/mg, P ＜0.01, (38.44±3.6) ng/mgvs. (3.71 +2.70) ng/mg, P ＜0.001,respectively] in sciatic nerve tissue reduced in diabetic rats with hyperglycemia and varied with severity of diabetic state when compared with non-diabetic control rats, and further gradually down-regulated in the diabetic rats with duration of diabetes [IGF-1 mRNA (0. 320 ± 0. 021) ～ (0. 230 + 0. 060); IGF-1 peptide (28.80 ± 3.30) ～(19. 51 + 1.80)ng/mg]. Furthermore, they correlated with nerve functional (sensory nerve conduction velocity:r = 0. 741, P ＜0. 001; amplitude ofevokedpotential: r = 0. 716, P ＜0. 001, respectively)andstructuralabnormality (axonal areas r = 0. 81, P ＜ 0. 001 ) of sciatic nerve. No difference was found in the above parameters between diabetic rats with euglycemia and non-diabetic control group.Conclusion. IGF-1 gene expression in tissues was down-regulated from early diabetic stage, and varied with the severity and duration of diabetic state. The decrement in IGF-1 level might contribute to the initiation and development of diabetic neuropathy via autocrine or paracrine pathway.

The effect of foot bath of Chinese medicine combined with acupoint injection for diabetic peripheral neuropathy:a meta analysis

Objective:The aim of this systematic review was to assess the effect of foot bath of Chinese medicine combined with acupoint injection(FBCMCAI)on patients with diabetic peripheral neuropathy(DPN).Methods:Databases such as Cochrane Library,Pubmed,Web Of Science,China Biology Medicine(CBM),CNKI,VIP and WANFANG DATA were electronically searched to collect the randomized controlled trials(RCTs)(up to October 2016).According to the inclusion and exclusion criteria,literature about effects of FBCMCAI in the treatment of DPN were screened and data were extracted.Literature quality evaluation was appliced by Cochrane Reviewer Handbook 5.1.0.A random or a fixed effects model was used to analyze outcomes by RevMan 5.3 software.Subgroup analysis,sensitivity analysis,and orientation description were performed if necessary.Results:11 randomized controlled trials with a total of 927 patients were included.Meta analysis results revealed that the efficacy of FBCMCAI for DPN was significantly superior to the control treatment(OR=5.07,95%CI:3.23-7.94,Z=7.08,P<0.00001).Besides,there was an increase in motor conduction velocity of peroneal nerve(SMD=1.08,95%CI:0.66-1.48,Z=5.30,P<0.00001),motor conduction velocity of tibial nerve(SMD=1.08,95%CI:0.58-1.58,Z=4.22,P<0.0001)and motor conduction velocity of median nerve(SMD=0.46,95%CI:0.23-0.68,Z=3.96,P<0.0001)in FBCMCAI groups.For another,there was also an increase in sensory motor conduction velocity of the motor nerve(SMD=0.80,95%CI:0.54-1.05,Z=6.06,P<0.00001)and sensory motor conduction velocity of median nerve(SMD=0.66,95%CI:0.38-0.93,Z=4.73,P<0.00001)in the FBCMCAI groups.Symptoms score was significantly reduced after FBCMCAI treatment(WMD=-4.21,95%CI[-4.95,-3.48],Z=11.25,P<0.00001).Conclusion:FBCMCAI may have significant therapeutic efficacy for the treatment of DPN.Diabetic neurologic symptoms and nerve conduction velocities can be improved under FBCMCAI treatment.In-depth research and high quality randomized controlled trials on the efficacy of FBCMCAI are necessary.

A Meta analysis of characteristics of median nerve and sural nerve injury inpatients with diabetic peripheral neuropathy

Objective： A meta-analysis of randomized trials was performed to assess the injured degree of median nerve andsural nerve in patients with diabetic peripheral neuropathy （DPN）. Methods： we searched Pubmed Database, ChinaBiomedical Literature Database, VIP Database, ChinaNet for studies. Then evaluated these studies in order to findthe researches in line with the requirements of the study; Each relevant research was carefully read to extractrelevant data; The current perception threshold （CPT） value of median nerve and sural nerve were compared at2000Hz, 250Hz and 5Hz between patients with DPN and the normal control group. Results： Finally 10 articles thatmeet the standards were included, with 1054 cases in the patient group and 719 cases in the normal group. The CPTvalues of median nerve and sural nerve at 2000 Hz, 250 Hz and 5 Hz of patients group were higher than those ofnormal control group （P 〈0.05 for all）. Conclusion： Systematic reviews showed that the sensitivity of the mediannerve and sural nerve in DPN patients was generally reduced. Sensory nerve quantitative detector could detectnerve damage early, accurately and monitor the effect treatment in patients with DPN.

Traditional Chinese Medicine Nursing in Diabetic Peripheral Neuropathy： A literature review

At present, unified and effective treatment for diabetic peripheral neuropathy （DPN） is still lacking, however Chinese medicine techniques characterized by syndrome differentiation and treatment, for example traditional Chinese medicine preparations, acupuncture, and fumigation, have been considered the promising alternative for DPN. Traditional Chinese medicine nursing, which is development on the basis of traditional Chinese medicine （TCM） theory, uses not only acupuncture, acupoint application and other treatments but also cares for the patient＇s diet and emotions in order to promote the recovery of skin and nerve endings in patients with DPN. Vast amounts of studies have explored the efficacies of various TCM nursing techniques in managing DPN, however, the article, which comprehensively documented these TCM nursing techniques in DNP patients, cannot be cap- tured. In the present article, we summarized the latest findings of TCM research on DPN in recent years in order to provide a reference for DPN.

消渴通痹颗粒对DM大鼠周围神经缺血状态新生血管的影响

目的:观察复方中药消渴通痹颗粒对DM大鼠周围神经缺血状态新生血管的影响。方法:建立DM大鼠缺血性周围神经病的实验模型并分组。灌胃给药2月后,检测缺血肢体坐骨神经血管内皮细胞CD_(34)及新生微血管面密度(MVD)。结果:与正常组比较,模型组CD_(34)、MVD明显升高(P<0.05,P<0.01),中药组、西洛他唑组CD_(34)、MVD均有明显升高(P<0.05,P<0.01);与模型组比较,中药组CD_(34)、MVD均升高(P<0.05,P<0.01),其中中药大剂量组显著增加(P<0.01)。结论:消渴通痹颗粒能促进缺血组织的微血管再生,从而改善局部微循环障碍,减轻或改善糖尿病周围神经病变。

Observation on clinical therapeutic efficacy of moxibustion combined with mecobalamin on diabetic perineuropathy and effects on patients' blood homocysteine

Objective To observe the therapeutic efficacy of moxibustion combined with mecobalamin on diabetic perineuropathy and the effects on blood homocysteine in pa ents with diabe c perineuropathy. Methods One hundred and fifty patients with diabetic perineuropathy meeting with the inclusive criteria were randomized into a moxibus on group,a mecobalamin group and a therapeutic alliance group by using random digits table. Moxibustion was carried out on Tàixī（太溪 KI 3）,Sānyīnjiāo（三阴交 SP 6）,Zúsānl？（足三里 ST 36）,Hég？（合谷 LI 4） and Qūchí（曲池 LI 11） for the patients in the moxibustion group,the treatments were carried out once every other day,treatments for ten mes were considered as a treatment course,and totally three treatment courses were carried out. The pa ents in the mecobalamin group were orally administered with mecobalamin tablet 500 μg once,three times a day,20 days were considered as a treatment course,and totally three treatment courses were carried out. Moxibustion was carried out on the basis of oral administration with mecobalamin tablet in the therapeutic alliance group. The clinical symptoms,nerve conductive velocities and changes in blood homocysteine were observed before and after the treatments in the three groups. Results The total eff ec ve rate in the moxibus on group was 74.0%（37/50）,82.0%（41/50） in the mecobalamin group,94.0%（47/50） in the therapeutic alliance group,and the total effective rate in the therapeutic alliance group was significantly be er than the other two groups（P0.01）. The nerve conductive velocities in the mecobalamin group and the therapeutic alliance group after the treatments were significantly increased and the blood homocysteine level decreased in comparison to those before the treatments（P0.01）,while the nerve conductive velocity increased and the blood homocysteine level decreased in the therapeutic alliance group after the treatments in comparison to those in the other two groups（P0.01）. Conclusion Treatments on diabe c perineuropathy by therapeu c alliance of moxibustion and mecobalamin can not only improve symptoms of patients,increase nerve conduc ve velocity in aff ected limbs,but also decrease blood homocysteine level. The method is simple,economical and safe,and it deserves being generalized in clinical prac ces.

Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for diabetic peripheral neuropathy and the effect on HIF-1α and VEGF levels

Objective： To observe the clinical efficacy of electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for treatment of diabetic peripheral neuropathy, and the effect on serum VEGF and HIF-lα levels of patients. Methods： Ninety-six patients were randomly divided into electroacupuncture treatment group （EA group）, intermittent pneumatic compression treatment group （IPC group）, electroacupuncture combined with intermittent pneumatic compression treatment group （EA ＋ IPC group） and cobamamide group （CM group）, with 24 cases in each group. Electroacupuncture treatment （once a day）, intermittent pneumatic com pression treatment （twice a day） and intramuscular injection with cobamamide （1 rag, once a day） were carried out in EA group, IPC group and CM group, respectively, and intermittent pneumatic compres- sion treatment （twice a day） was conducted on the basis of electroacupuncture treatment （once a day） in EA＋IPC group. After treatment for 2 consecutive weeks, the differences in subjective symptoms, mo- tor nerve conduction velocity, sensory nerve conduction velocity and serum HIF-lα and VEGF levels of patients in the four groups before and after treatment were observed and compared. Results： After treatment for 2 weeks, the differences in total effective rate between EA group and CM group, IPC group and CM group, as well as EA ＋ IPC group and CM group were all significant （all P 〈 0.05）, and the total effective rate in EA＋ IPC group was significantly higher than that in EA group and IPC group （both P 〈 0.05）. After treatment for 2 weeks, the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve of patients in EA group, 1PC group and EA＋IPC group were all higher than that before treatment （all P 〈 0.05）; the motor nerve conduction velocity of median nerve and the sensory nerve conduction velocity of common peroneal nerve in EA group were all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve in IPC group were also all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve in EA＋IPC group were all higher than that in CM group （both P 〈 0.05）; the sensory nerve conduction velocity of common peroneal nerve in EA ＋ 1PC group was higher than that in EA group and IPC group （both P 〈 0.05）, and the motor nerve conduction velocity of median nerve in EA＋IPC group was higher than that in IPC group （P 〈 0.05）. The serum HIF-1α and VEGF levels of patients in EA group, IPC group and EA ＋ IPC group after treatment significantly reduced （all P 〈 0.05）. and were lower than that in CM group after treatment （all P 〈 0.05）; the serum HIF-lα and VEGF levels of patients in EA ＋ IPC group after treatment were lower than that in EA group and IPC group, and the difference in serum HIF-lα level was statistically significant （both P 〈 0.05）. Conclusion： Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus can effectively improve the clinical symptoms of patients with diabetic peripheral neuropathy, the efficacy were better than electroacupuncture, intermittent pneumatic compression treatment and cobamamide.

Review of systematic reviews of acupuncture for diabetic peripheral neuropathy

Objective:To review the systematic reviews of acupuncture for diabetic peripheral neuropathy(DPN)and to provide evidence for clinical decisions.Methods:Published systematic reviews targeting acupuncture treatment of DPN were searched using computer through both Chinese and English databases till July 1,2019.Two researchers screened the papers based on inclusion and exclusion criteria and conducted report quality evaluation,methodological quality assessment and evidence quality grading using the preferred reporting items for systematic reviews and meta-analyses(PRISMA),assessment of multiple systematic review 2(AMSTAR 2)and grading of recommendations assessment,development and evaluation(GRADE).Results:Ten systematic reviews were included,involving 11 outcome measures.According to PRISMA,6 items were sufficiently reported while 1 item was not;AMSTAR 2 appraised that all the included systematic reviews were of low quality in the methodological evaluation;according to GRADE,of the 30 clinical evidences,only 5 were graded moderate while the remained were graded low or extremely low.Descriptive analysis showed that acupuncture can significantly improve DPN symptoms,accelerate the conduction velocities of sensory and motor nerves,and up-regulate the content of plasma nitric oxide(NO),while the adverse reaction rate was low.Conclusion:Acupuncture can produce satisfactory clinical efficacy in treating DPN,but the existing problems,such as low-quality evidence,unitary outcome measures,poor methodological quality of systematic reviews and nonstandard reporting,need to be treated cautiously;meanwhile,more high-quality clinical trials are required to elevate the level of evidence.

Clinical Effects of Acupuncture for Diabetic Peripheral Neuropathy

Objective:To observe the clinical effects of acupuncture for diabetic peripheral neuropathy.Methods:Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the basis of conventional treatment of diabetes,acupuncture was used in the treatment group,and inositol was orally administered in the control group.During a 3-month treatment,changes in the symptoms were observed.Results:In the treatment group,16 cases were markedly relieved,12 cases improved,and 4 cases failed,with a total effective rate of 87.5%.In the control group,7 cases were markedly relieved,14 cases improved and 12 cases failed,with a total effective rate of 63.6%.There was a significant difference in the total effective rate between the 2 groups(P<0.05) .Conclusion:Acupuncture may show good effects for diabetic peripheral neuropathy.

Diagnostic value of optic disc retinal nerve fiber layer thickness for diabetic peripheral neuropathy

Objective:To investigate the value of optic disc retinal nerve fiber layer(RNFL)thickness in the diagnosis of diabetic peripheral neuropathy(DPN).Methods:Ninety patients with type 2 diabetes,including 60 patients without DPN(NDPN group)and 30 patients with DPN(DPN group),and 30 healthy participants(normal group)were enrolled.Optical coherence tomography(OCT)was used to measure the four quadrants and the overall average RNFL thickness of the optic disc.The receiver operator characteristic curve was drawn and the area under the curve(AUC)was calculated to evaluate the diagnostic value of RNFL thickness in the optic disc area for DPN.Results:The RNFL thickness of the DPN group was thinner than those of the normal and NDPN groups in the overall average((101.07±12.40)μm vs.(111.07±6.99)μm and(109.25±6.90)μm),superior quadrant((123.00±19.04)μm vs.(138.93±14.16)μm and(134.47±14.34)μm),and inferior quadrant((129.37±17.50)μm vs.(143.60±12.22)μm and(144.48±14.10)μm),and the differences were statistically significant.The diagnostic efficiencies of the overall average,superior quadrant,and inferior quadrant RNFL thicknesses,and a combined index of superior and inferior quadrant RNFL thicknesses were similar,and the AUCs were 0.739(95%confidence interval(CI)0.635–0.826),0.683(95%CI 0.576–0.778),0.755(95%CI 0.652–0.840),and 0.773(95%CI 0.672–0.854),respectively.The diagnostic sensitivity of RNFL thickness in the superior quadrant reached 93.33%.Conclusions:The thickness of the RNFL in the optic disc can be used as a diagnostic method for DPN.