Left ventricular dysfunction in normotensive Type 1 diabetic patients: the impact of autonomic neuropathy.

AIMS: The pathophysiological mechanisms responsible for increased cardiovascular mortality in diabetic autonomic neuropathy (AN) are largely unknown. The aim was to determine the relative role of AN in the pathogenesis of cardiac diastolic dysfunction and left ventricular hypertrophy in Type 1 diabetes. METHODS: Ten Type 1 diabetic patients with AN, defined by cardiovascular tests (AN+) and 10 age- and sex-matched patients without neuropathy (AN-) as well as 10 healthy subjects (C) participated in the study. Left ventricular diastolic function was assessed by Doppler echocardiography, whilst systolic function was evaluated by cine magnetic resonance (MR) imaging. RESULTS: Doppler echocardiography showed a significant decrease in E/A ratio, i.e. the ratio between peak Early transmitral filling velocity during early diastole (E-wave) and peak transmitral Atrial filling velocity during late diastole (A-wave), in AN+ compared with C (P < 0.01) [0.95 +/- 0.08 (mean +/- sem) (AN+); 1.19 +/- 0.09 (AN-); 1.33 +/- 0.10 (C)]. The E-wave deceleration time was significantly shorter in AN+ compared with AN- and C (P < 0.02) [178 +/- 7 ms (AN+); 203 +/- 9 ms (AN-); 205 +/- 9 ms (C)]. Cine MR imaging showed a significantly greater left ventricular mass index in AN+ compared with C [103 +/- 4 g/m(2) (AN+) vs. 98 +/- 7 (AN-) and 92 +/- 4 g/m(2) (C), P < 0.05]. CONCLUSION: Autonomic neuropathy is associated with left ventricular hypertrophy and diastolic dysfunction in Type 1 diabetic patients.     

Fulminant myasthenia gravis and polymyositis after thymectomy for thymoma

Two days after thymectomy for thymoma a patient developed myasthenia gravis and polymyositis; these rapidly progressed to a near total paralysis.     

Motor unit number estimation in the rat tail using a modified multipoint stimulation technique

Motor unit number estimation (MUNE) of the rodent hindlimb has been used mainly for following the progression of motor neuron disorders. By performing MUNE in the tail, however, progression of axonal neuropathy could also be assessed, as both proximal and distal regions would be available for study. In this investigation, three raters performed a modified multipoint stimulation MUNE technique in the tails of 14 healthy adult rats. The technique was straightforward to perform, with a relatively narrow range of motor unit number estimates of 40 ± 16 (standard deviation) for the proximal tail and 21 ± 11 for the distal tail. Intrarater reliability coefficients were 0.31 (P = 0.033) and 0.32 (P = 0.028) for the proximal and distal tail, respectively. Interrater reliability coefficients were 0.22 (P = 0.086) and 0.44 (P = 0.004). These reliability assessments, along with the relatively low motor unit estimates and narrow range of values, support the idea that rat tail MUNE may have utility in the evaluation of rodent models of neuromuscular disease, including length‐dependent neuropathy. Muscle Nerve 40: 115–121, 2009     

Ultrasound of the posterior circumflex humeral artery

Quadrilateral space syndrome (QSS) is described as compression neuropathy of the axillary neurovascular bundle in the quadrilateral space of the shoulder. This neurovascular bundle includes the posterior circumflex humeral artery (PCHA). Historically, angiography and more recently magnetic resonance angiography have been used to assess occlusion and stenosis of the PCHA in cases of suspected QSS. These traditional imaging techniques have a number of disadvantages in terms of cost, availability, invasiveness and patient comfort. We undertook to examine the ability of ultrasound to reliably visualise the PCHA. Asymptomatic adult volunteers were recruited from staff, and patients attending the radiology department who presented for pathologies unrelated to the shoulder. We used a new technique to assess blood flow in the PCHA, performing the scan from a posterolateral approach on the upper arm just above the level of the surgical neck of the humerus. This technique enabled the scan to be undertaken with the patient seated comfortably. Fifty volunteers were recruited into the study. The mean (±SD) age was 35 (±14 years). The PCHA was visualised in all patients. Our method was able to maximise Doppler sensitivity and visualisation of the artery without discomfort to the patient in less than 10 min. Ultrasound can be used to reliably visualise the PCHA. Ultrasound has potential to be used in the assessment of the PCHA in cases of QSS.     

糖尿病周围神经病变患者血小板活化与中医证型分布的关系研究

[目的] 探讨糖尿病周围神经病变(diabetic peripheral neuropathy，DPN)患者血小板活化与中医证型分布的关系。[方法] 收集2020年2月至2022年12月于本院住院确诊的DPN患者188例。中医证型采用指标聚类分析，绘制聚类图。采用简单对应分析中医证型与病变程度的对应性，比较不同中医证型的一般临床资料、血小板参数及血小板活化物，从而探讨血小板活化与中医证型分布的关系。[结果] 截取聚类图的不同位置，证型分型不同，其中D点截取分为5个证型:阳虚证、气虚证、阴虚证、瘀血痹阻证及痰湿阻络证。188例DPN患者中，痰湿阻络证18例(9.57%)、瘀血痹阻证53例(28.19%)、阳虚证28例(14.89%)、阴虚证39例(20.74%)、气虚证50例(26.60%)。DPN病变程度分级为Ⅰ级56例(29.79%)、Ⅱ级76例(40.43%)、Ⅲ级56例(29.79%)。痰湿阻络证和瘀血痹阻证在二维投影图中间，并未偏向DPN病变程度某一分级；阳虚证偏向Ⅲ级，阴虚证偏向Ⅱ级，气虚证偏向Ⅰ级。与气虚证比较，阴虚证、阳虚证患者的血小板(blood platelet ，PLT)计数、平均血小板体积(mean platelet volume，MPV)、血小板分布宽度(platelet distribution width，PDW)、E26转录因子-1(E26 transformation specific-1，ETS-1)、血小板活化因子(platelet activating factor，PAF)及血小板颗粒膜蛋白-140(granular membrane protein-140，GMP-140)均明显升高(P<0.05)；与阴虚证比较，阳虚证患者的PLT、MPV、PDW、GMP-140、PAF、ETS-1均明显升高(P<0.05)。[结论] 临床可常规将DPN分为阳虚、气虚、瘀血痹阻、阴虚和痰湿阻络5个证型。随着DPN进展，中医证型也发生从气虚到阴虚到阳虚的转化，而瘀血痹阻和痰湿阻络伴随DPN患者各阶段。在DPN进展中，血小板活化可能参与中医证型转化过程。     

用多种非创伤性方法检测糖尿病病人心脏功能

本研究对101例糖尿病病人进行多种非创伤性心功能检查。结果显示:合并高血压及/或冠心病的糖尿病人79％心功能异常,无合并冠心病,高血压及微血管病变,但合并心脏植物神经病变病人为56％,而无以上合并症的病人为47％,且心功能损害程度与微血管病变程度呈正相关。3组病人均以舒张功能损害为主,但各组病人心功能改变形式无明显不同。     

Approach to the patient with chronic polyneuropathy

Background –  Chronic polyneuropathy is a common disorder with heterogenic clinical presentation and many different etiologies. Diagnostic investigation is challenging.
Materials and methods –  An algorithm for diagnostic investigation of chronic polyneuropathy is presented. It was designed to secure practical usefulness for general neurologists, identification of the most common causes with an adequate number of laboratory tests, and more focused investigation when necessary. The proposal is based on review of articles found by PubMed search using the terms 'peripheral neuropathy, cause, and investigation', relevant book chapters, and own clinical experience.
Results –  All patients should undergo a routine investigation for the most common causes of polyneuropathy by asking for diabetes, heredity, alcohol abuse, toxic medications and agents, symptoms of Sjögren's syndrome, renal failure, and the following laboratory tests; glucose, haemoglobin, leucocytes, thrombocytes, ESR, creatinin, ALAT, GT, vitamin B12, serum electrophoresis, TSH and thyroxin. If routine investigation is negative, a targeted approach based on clinical type and electrophysiological findings is recommended. The most common type with slowly progressive, symmetric sensory symptoms beginning in the feet can often be classified as cryptogenic without further investigation. Polyneuropathies with subacute onset, progressive weakness, asymmetric symptoms, proximal weakness, selective involvement of sensory fibers or demyelinating pathology, or other organ manifestations, have various etiologies that necessitate individual focused investigation.
Interpretation –  Diagnostic investigation of polyneuropathy can be simplified and systematized.     

Neuropathic Pain: Mechanisms and Treatment Options

Abstract : Neuropathic pain results from damage to the nervous system. The diseases responsible for neuropathic pain are diverse but they may have in common pathophysiological mechanisms. This review will focus on these mechanisms both in the peripheral as well as within the central nervous system. In addition, there will be discussion on the various treatment choices including both pharamcological and interventional options.     

Cuba: response of medical science to a crisis of optic and peripheral neuropathy

We made two trips to Cuba, as part of an invited international delegation, to investigate an epidemic of optic neuropathy-induced blindness. We worked closely with Cuban scientists and clinicians in their efforts to understand and then deal with 50,000 cases of blindness and an entire population at risk. This gave an unparalleled opportunity to understand the Cuban system of ophthalmologic health care and, in particular, to appreciate the responses of the scientific and health care communities to this crisis. Several features of the very different Cuban medical and scientific infrastructure were both problematic and advantageous as they affected the Cuban efforts to understand, contain and treat this remarkable epidemic.