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For: Pitei DL, Watkins PJ, Stevens MJ, Edmonds ME. The value of the Neurometer in assessing diabetic neuropathy by measurement of the current perception threshold. Diabet Med 1994;11:872-6. [PMID: 7705025 DOI: 10.1111/j.1464-5491.1994.tb00371.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

For:	Pitei DL, Watkins PJ, Stevens MJ, Edmonds ME. The value of the Neurometer in assessing diabetic neuropathy by measurement of the current perception threshold. Diabet Med 1994;11:872-6. [PMID: 7705025 DOI: 10.1111/j.1464-5491.1994.tb00371.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

Number

Cited by Other Article(s)

Liu XH, Lin W, Xu HL, Cui ML, Huang ZY, Li Y, Zhang NN, Wang N, Wang ZY, Gan SR. Assessment of Peripheral Neuropathy Using Current Perception Threshold Measurement in Patients with Spinocerebellar Ataxia Type 3. CEREBELLUM (LONDON, ENGLAND) 2025;24:37. [PMID: 39856266 DOI: 10.1007/s12311-024-01769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2024] [Indexed: 01/27/2025]

Affiliation(s)

Xia-Hua Liu Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, China Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Wei Lin Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Key Laboratory of Brain Aging and Neurodegenerative Diseases of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China Department of Neurology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
Hao-Ling Xu Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
Mao-Lin Cui School of Special Education and Rehabilitation, Binzhou Medical University, Yantai, 264003, People's Republic of China
Zhuo-Ying Huang Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Key Laboratory of Brain Aging and Neurodegenerative Diseases of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China Department of Neurology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
Ying Li Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China
Nan-Nan Zhang Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, China Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Ning Wang Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Key Laboratory of Brain Aging and Neurodegenerative Diseases of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China. Department of Neurology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China. Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China.
Zhi-Yong Wang Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, China. Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Shi-Rui Gan Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Key Laboratory of Brain Aging and Neurodegenerative Diseases of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China. Department of Neurology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China. Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China.

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Magony S, Nyiraty S, Tóth B, Pesei F, Orosz A, Ábrahám G, Kempler P, Lengyel C, Várkonyi T. Peripheral sensory nerve hyperesthesia in women with polycystic ovary syndrome. Minerva Endocrinol (Torino) 2024;49:381-388. [PMID: 33880894 DOI: 10.23736/s2724-6507.21.03418-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Esze R, Barna S, Fülöp P, Kempler P, Mikó M, Páll D, Paragh G, Somodi S, Emri M, Képes Z, Garai I, Káplár M. C-peptide: an essential ally in microvascular complications of type 2 diabetes mellitus and obesity. Diabetol Metab Syndr 2024;16:211. [PMID: 39210480 PMCID: PMC11361105 DOI: 10.1186/s13098-024-01454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open

Abstract

BACKGROUND

In order to investigate microvascular complications in metabolic diseases, we aimed to investigate cerebral and peripheral microcirculation in relation to peripheral neuropathy and laboratory biomarkers in type 2 diabetes mellitus (T2DM) and obesity.

METHODS

Based on the degree of neuropathy (NP), study participants (40 T2DM and 30 obese individuals) were classified into no-NP, mild-NP and severe-NP subgroups. After the injection of Technetium-99 m hexamethylpropylene amine oxime, both T2DM and obese participants underwent single-photon emission computed tomography/computed tomography ([99mTc]Tc-HMPAO SPECT/CT) and SPECT-only examinations to assess lower limb and brain perfusion; respectively. Peripheral nerve function was evaluated with a neurometer and glycaemic markers were measured from plasma in both groups.

RESULTS

Compared to the obese individuals, lower extremity perfusion was significantly reduced in the diabetic subjects (p < 0.005), while it showed a positive correlation with C-peptide levels and negative association with HbA1c values. A U-shape pattern of peripheral microcirculation was observed between the NP groups, indicating a surprisingly better perfusion in the severe-NP group than in the mild one, with the highest levels in obese patients. Since changes in the C-peptide levels exhibited a similar U-shaped trend across the NP subgroups, we suggest a positive correlation between C-peptide levels and the extent of peripheral perfusion. Although, C-peptide values and cerebral microcirculation correlated positively (rho = 0.27), brain perfusion did not show any differences neither between the diabetic and the obese patients, nor between the NP subgroups (at p < 0.05).

CONCLUSIONS

Establishing the link between neuropathy and peripheral microcirculation, C-peptide seems to be a promising biomarker for the prediction of microvascular alterations in metabolic diseases. Of note, the dominance of metabolic factors over microvascular damage in the development of obesity-related neuropathy should be emphasized as well.

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Affiliation(s)

Regina Esze Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary. Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary.
Sándor Barna Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Péter Fülöp Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Péter Kempler Department of Medicine and Oncology, Semmelweis University, Korányi Sándor U. 2/a, Budapest, 1083, Hungary
Márton Mikó Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Dénes Páll Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary Department of Medical Clinical Pharmacology, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
György Paragh Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Sándor Somodi Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Miklós Emri Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Zita Képes Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Ildikó Garai Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
Miklós Káplár Division of Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, Debrecen, 4032, Hungary

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Tordai DZ, Hajdú N, Rácz R, Istenes I, Békeffy M, Vági OE, Kempler M, Körei AE, Tóbiás B, Illés A, Pikó H, Kósa JP, Árvai K, Papp M, Lakatos PA, Kempler P, Putz Z. Genetic Factors Associated with the Development of Neuropathy in Type 2 Diabetes. Int J Mol Sci 2024;25:1815. [PMID: 38339094 PMCID: PMC10855482 DOI: 10.3390/ijms25031815] [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: 12/19/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open

Abstract

Neuropathy is a serious and frequent complication of type 2 diabetes (T2DM). This study was carried out to search for genetic factors associated with the development of diabetic neuropathy by whole exome sequencing. For this study, 24 patients with long-term type 2 diabetes with neuropathy and 24 without underwent detailed neurological assessment and whole exome sequencing. Cardiovascular autonomic function was evaluated by cardiovascular reflex tests. Heart rate variability was measured by the triangle index. Sensory nerve function was estimated by Neurometer and Medoc devices. Neuropathic symptoms were characterized by the neuropathy total symptom score (NTSS). Whole exome sequencing (WES) was performed on a Thermo Ion GeneStudio S5 system determining the coding sequences of approximately 32,000 genes comprising 50 million base pairs. Variants were detected by Ion Reporter software and annotated using ANNOVAR, integrating database information from dbSNP, ClinVar, gnomAD, and OMIM. Integrative genomics viewer (IGV) was used for visualization of the mapped reads. We have identified genetic variants that were significantly associated with increased (22-49-fold) risk of neuropathy (rs2032930 and rs2032931 of recQ-mediated genome instability protein 2 (RMI2) gene), rs604349 of myosin binding protein H like (MYBPHL) gene and with reduced (0.07-0.08-fold) risk (rs917778 of multivesicular body subunit 12B (MVB12B) and rs2234753 of retinoic acid X receptor alpha (RXRA) genes). The rs2032930 showed a significant correlation with current perception thresholds measured at 5 Hz and 250 Hz for n. medianus (p = 0.042 and p = 0.003, respectively) and at 5 Hz for n. peroneus (p = 0.037), as well as the deep breath test (p = 0.022) and the NTSS (p = 0.023). The rs2032931 was associated with current perception thresholds (p = 0.003 and p = 0.037, respectively), deep breath test (p = 0.022), and NTSS (p = 0.023). The rs604349 correlated with values measured at 2000 (p = 0.049), 250 (p = 0.018), and 5 Hz (p = 0.005) for n. medianus, as well as warm perception threshold measured by Medoc device (p = 0.042). The rs2234753 showed correlations with a current perception threshold measured at 2000 Hz for n. medianus (p = 0.020), deep breath test (p = 0.040), and NTSS (p = 0.003). There was a significant relationship between rs91778 and cold perception threshold (p = 0.013). In our study, genetic variants have been identified that may have an impact on the risk of neuropathy developing in type 2 diabetic patients. These results could open up new opportunities for early preventive measures and might provide targets for new drug developments in the future.

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Affiliation(s)

Dóra Zsuszanna Tordai Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Noémi Hajdú Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Ramóna Rácz Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Ildikó Istenes Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Magdolna Békeffy Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Orsolya Erzsébet Vági Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Miklós Kempler Department of Internal Medicine and Hematology, Semmelweis University, 1085 Budapest, Hungary;
Anna Erzsébet Körei Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Bálint Tóbiás Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.) PentaCore Laboratory, 1134 Budapest, Hungary; Vascular Diagnostics Ltd., 1026 Budapest, Hungary Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
Anett Illés Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.) PentaCore Laboratory, 1134 Budapest, Hungary; Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
Henriett Pikó Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.) PentaCore Laboratory, 1134 Budapest, Hungary; Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
János Pál Kósa Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.) PentaCore Laboratory, 1134 Budapest, Hungary; Vascular Diagnostics Ltd., 1026 Budapest, Hungary Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
Kristóf Árvai PentaCore Laboratory, 1134 Budapest, Hungary; Vascular Diagnostics Ltd., 1026 Budapest, Hungary
Márton Papp Centre for Bioinformatics, University of Veterinary Medicine, 1078 Budapest, Hungary;
Péter András Lakatos Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.) PentaCore Laboratory, 1134 Budapest, Hungary; Vascular Diagnostics Ltd., 1026 Budapest, Hungary Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
Péter Kempler Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
Zsuzsanna Putz Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.) Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary

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Körei AE, Békeffy M, Menyhárt A, Osgyán K, Istenes I, Horváth VJ, Kempler P. No clear evidence of neuropathy among patients with high risk for the development of prediabetes/diabetes-a pilot study. Front Endocrinol (Lausanne) 2024;15:1302013. [PMID: 38352713 PMCID: PMC10863448 DOI: 10.3389/fendo.2024.1302013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open

Abstract

Introduction

Autonomic and sensory neuropathy have been observed in both prediabetes and manifest diabetes mellitus. However, there is a lack of available data regarding whether patients at a moderate or high risk of developing diabetes, yet without a current diagnosis of prediabetes or diabetes, exhibit an increased prevalence of neuropathy.

Methods

FINDRISC (Finnish Diabetes Risk Score) was used to classify individuals at risk (≥12 points, n = 44; control <12 points, n = 28). HbA1c levels >5.6% served as exclusion criteria, and patients with known medical conditions predisposing to neuropathy were also excluded. Cardiac autonomic function (Ewing tests) and peripheral sensory neuropathy (Neurometer and Q-sense) were assessed by standardized protocols, and their potential association with increased FINDRISC points was analyzed using a regression model.

Results

Mean age was 46.7 ± 14.3 years in the control and 55.7 ± 14.1 years in the increased risk group. Male/female ratio did not differ. Individuals with increased risk of diabetes were more obese (BMI: 29.9 ± 12.5 kg/m2 vs. 25.9 ± 8.9 kg/m2). Additionally, hypertension was more frequent among them (68.2% vs. 17.9%), and their lipid parameters were also less favorable. Parasympathetic neuropathy was present in both groups (56.8% vs. 32.1%, respectively). Sympathetic neuropathy was not found. Sensory nerve dysfunction was of low prevalence in the high-risk group and did not occur in healthy controls. In multiple logistic regression analysis, HbA1c exhibited an independent association with parasympathetic neuropathy (OR: 5.9; 95% CI: 1.08-32.68; p < 0.041).

Discussion

An increased risk of developing prediabetes/diabetes does not appear to have a strong correlation with an increased likelihood of developing autonomic or sensory neuropathy. However, the etiology behind the occurrence of parasympathetic autonomic neuropathy in healthy individuals remains unknown.

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Sebők J, Édel Z, Dembrovszky F, Farkas N, Török Z, Balogh G, Péter M, Papp I, Balogi Z, Nusser N, Péter I, Hooper P, Geiger P, Erőss B, Wittmann I, Váncsa S, Vigh L, Hegyi P. Effect of HEAT therapy in patiEnts with type 2 Diabetes mellitus (HEATED): protocol for a randomised controlled trial. BMJ Open 2022;12:e062122. [PMID: 35820741 PMCID: PMC9277369 DOI: 10.1136/bmjopen-2022-062122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open

Abstract

INTRODUCTION

The burden of type 2 diabetes mellitus (T2DM) is increasing worldwide. Heat therapy has been found effective in improving glycaemic control. However, to date, there is a lack of randomised controlled studies investigating the efficacy of heat therapy in T2DM. Therefore, we aim to investigate whether heat therapy with natural thermal mineral water can improve glycaemic control in patients with T2DM.

METHODS AND ANALYSIS

The HEAT therapy in patiEnts with type 2 Diabetes mellitus (HEATED) Study is a single-centre, two-arm randomised controlled trial being conducted at Harkány Thermal Rehabilitation Centre in Hungary. Patients with T2DM will be randomly assigned to group A (bath sessions in 38°C natural thermal mineral water) and group B (baths in thermoneutral water (30°C-32°C)). Both groups will complete a maximum of 5 weekly visits, averaging 50-60 visits over the 12-week study. Each session will last 30 min, with a physical check-up before the bath. At baseline, patients' T2DM status will be investigated thoroughly. Possible microvascular and macrovascular complications of T2DM will be assessed with physical and laboratory examinations. The short form-36 questionnaire will assess the quality of life. Patients will also be evaluated at weeks 4, 8 and 12. The primary endpoint will be the change of glycated haemoglobin from baseline to week 12. An estimated 65 patients will be enrolled per group, with a sample size re-estimation at the enrolment of 50% of the calculated sample size.

ETHICS AND DISSEMINATION

The study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (818-2/2022/EÜIG). Written informed consent is required from all participants. We will disseminate our results to the medical community and will publish our results in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT05237219.

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Affiliation(s)

Judit Sebők 2nd Department of Internal Medicine, University of Pecs Medical School, Pécs, Hungary
Zsófia Édel 2nd Department of Internal Medicine, University of Pecs Medical School, Pécs, Hungary
Fanni Dembrovszky Institute for Translational Medicine, Szentágothai Research Centre, University of Pecs Medical School, Pécs, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
Nelli Farkas Institute for Translational Medicine, Szentágothai Research Centre, University of Pecs Medical School, Pécs, Hungary Institute of Bioanalysis, University of Pecs Medical School, Pécs, Hungary
Zsolt Török LipidArt, Szeged, Hungary
Gábor Balogh LipidArt, Szeged, Hungary
Mária Péter LipidArt, Szeged, Hungary
Ildiko Papp LipidArt, Szeged, Hungary
Zsolt Balogi Institute of Biochemistry and Medical Chemistry, University of Pecs Medical School, Pécs, Hungary
Nóra Nusser Harkány Thermal Rehabilitation Centre, Harkány, Hungary
Iván Péter Harkány Thermal Rehabilitation Centre, Harkány, Hungary
Philip Hooper Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
Paige Geiger Department of Molecular and Integrative Physiology, University of Kansas School of Medicine, Kansas City, Kansas, USA
Bálint Erőss Institute for Translational Medicine, Szentágothai Research Centre, University of Pecs Medical School, Pécs, Hungary Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
István Wittmann 2nd Department of Internal Medicine, University of Pecs Medical School, Pécs, Hungary
Szilárd Váncsa Institute for Translational Medicine, Szentágothai Research Centre, University of Pecs Medical School, Pécs, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
László Vigh LipidArt, Szeged, Hungary
Péter Hegyi Institute for Translational Medicine, Szentágothai Research Centre, University of Pecs Medical School, Pécs, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

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He S, Tripanpitak K, Yoshida Y, Takamatsu S, Huang SY, Yu W. Gate Mechanism and Parameter Analysis of Anodal-First Waveforms for Improving Selectivity of C-Fiber Nerves. J Pain Res 2021;14:1785-1807. [PMID: 34163235 PMCID: PMC8215851 DOI: 10.2147/jpr.s311559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open

Zhang R, Zhang X, Chen Y, Song W. Current perception threshold testing in chronic ankle instability. BMC Musculoskelet Disord 2021;22:453. [PMID: 34006258 PMCID: PMC8132381 DOI: 10.1186/s12891-021-04345-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

Damage to sensory input is an underlying pathology of chronic ankle instability (CAI). Therefore, it is necessary to evaluate the sensory function of patients with CAI. The present study quantitatively evaluated sensory nerve function in patients with CAI and healthy controls using current perception threshold (CPT) measurements, as well as the influence of sex, age, and body mass index (BMI) on CPT values and the relations between CPT frequencies.

METHODS

Fifty-nine subjects with CAI and 30 healthy controls participated in this study. CPT values at the anterior talofibular ligament region were recorded on the injured and uninjured sides in CAI patients and on both sides in the healthy control group. Between group differences were compared. The influence of sex, age and BMI on CPT values was evaluated. Correlations between different frequencies were also studied.

RESULTS

There were no significant differences in age, sex, height, weight or BMI between the CAI and healthy control groups. The CPT values did not show a significant difference by sex. The CPT values did not significantly correlate with age or BMI. Compared to the control group, the CAI group had significantly higher CPT values on the injured and uninjured sides under 250-Hz and 5-Hz electrical stimuli; the difference between the groups was significant (p < 0.01), and the effect size were large. No significant difference was observed under 2000-Hz stimuli. There were correlations between CPT values at different frequencies (p < 0.01), especially 250 Hz and 5 Hz.

CONCLUSION

The present study revealed increased sensory thresholds in 250-Hz- and 5-Hz-related sensory nerve fibres in the injured and uninjured ankles of patients with CAI. This increase may indicate dysfunction of A-delta and C fibres. Sex, age and BMI did not significantly impact CPT values. There were correlations between CPT values at different frequencies, especially 250 Hz and 5 Hz.

LEVEL OF EVIDENCE

Level III, case-control study.

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A test-retest reliability study of assessing small cutaneous fibers by measuring current perception threshold with pin electrodes. PLoS One 2020;15:e0242490. [PMID: 33201884 PMCID: PMC7671533 DOI: 10.1371/journal.pone.0242490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022] Open

Efficacy of nonviral gene transfer of human hepatocyte growth factor (HGF) against ischemic-reperfusion nerve injury in rats. PLoS One 2020;15:e0237156. [PMID: 32780756 PMCID: PMC7418984 DOI: 10.1371/journal.pone.0237156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023] Open

An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2019;15:1347-1353. [PMID: 31538606 PMCID: PMC6760391 DOI: 10.5664/jcsm.7756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/20/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022]

Abstract

STUDY OBJECTIVES

To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system.

METHODS

A total of 32 patients with OSA and 18 healthy control patients were included in the study. All participants were selected based on medical history, physical examination, and nocturnal polysomnography (PSG) and divided into two groups. The palatal sensory status of participants was examined with a Neurometer current perception threshold (CPT) system. The system was used to deliver an electrical stimulus at three different frequencies (2,000 Hz, 250 Hz, and 5 Hz) by an investigator blinded to the PSG results.

RESULTS

There were no significant differences in the CPT values of the hard palate between the patients with OSA and control patients at any of the three stimulation frequencies. The differences in the CPT values of the soft palate between these groups failed to show any statistical significance at 250 Hz and 5 Hz. However, the patients with OSA showed significantly higher CPT values of the soft palate at 2,000 Hz than the age-matched healthy control patients (256.56 ± 129.34 versus 372.13 ± 152.06; P = .009).

CONCLUSIONS

Our study revealed an impairment of 2,000 Hz-related sensory nerve function of the soft palate among patients with OSA. The CPT test could be a useful tool for the quantitative and selective assessment of the sensory nerve function in patients with OSA. Additional research is required to evaluate the different types of sensory nerve dysfunctions among such patients.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Title: The Effects of Nasal Airflow on Upper Airway Dilator Muscles During Sleep; Identifier: NCT03506178; URL: https://clinicaltrials.gov/ct2/show/NCT03506178.

CITATION

An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative evaluation of the function of the sensory nerve fibers of the palate in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(9):1347-1353.

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Michelle Welman FHS, Smit AE, Jongen JLM, Tibboel D, van der Geest JN, Holstege JC. Pain Experience is Somatotopically Organized and Overlaps with Pain Anticipation in the Human Cerebellum. THE CEREBELLUM 2019;17:447-460. [PMID: 29480507 PMCID: PMC6028829 DOI: 10.1007/s12311-018-0930-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Furuse N, Kimoto S, Nakashima Y, Ogawa T, Furokawa S, Okubo M, Yamaguchi H, Kawai Y. Verification of the reliability of current perception threshold and pain threshold testing by application of an electrical current stimulus to mandibular mucosa in young adults. J Oral Rehabil 2019;46:556-562. [PMID: 30762250 DOI: 10.1111/joor.12777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/03/2019] [Accepted: 02/07/2019] [Indexed: 11/30/2022]

Ogawa T, Kimoto S, Nakashima Y, Furuse N, Ono M, Furokawa S, Okubo M, Yamaguchi H, Kawai Y. Differences in pain thresholds elicited by intraoral electrical stimuli between individuals with and without diabetes mellitus. J Oral Rehabil 2018;45:235-239. [DOI: 10.1111/joor.12601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]

Ogawa T, Kimoto S, Nakashima Y, Furuse N, Ono M, Furokawa S, Okubo M, Yazaki T, Kawai Y. Measurement reliability of current perception threshold and pain threshold in parallel with blood sampling. Clin Exp Dent Res 2017;3:154-159. [PMID: 29744194 PMCID: PMC5839228 DOI: 10.1002/cre2.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022] Open

Németh N, Putz Z, Istenes I, Körei AE, Vági OE, Kempler M, Gandhi R, Jermendy G, Tesfaye S, Tabák ÁG, Kempler P. Is there a connection between postprandial hyperglycemia and IGT related sensory nerve dysfunction? Nutr Metab Cardiovasc Dis 2017;27:609-614. [PMID: 28676377 DOI: 10.1016/j.numecd.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 01/24/2023]

Abstract

BACKGROUND AND AIMS

To assess the risk factors for sensory nerve dysfunction in subjects with isolated impaired glucose tolerance (IGT).

METHODS AND RESULTS

Seventy-two people with isolated IGT (WHO 1999 criteria) and 39 gender and age-matched healthy volunteers underwent detailed clinical and neurological assessment including quantitative sensory testing using the Neurometer device (current perception threshold measurement on four limbs at three different frequencies). Sensory nerve dysfunction was defined as at least two abnormalities on any frequencies on the upper or lower limbs. Sensory nerve dysfunction was more prevalent among subjects with IGT compared to controls (58.3 vs. 10.3%, OR: 11.23, 95%CI: 3.57-35.35). This association was not influenced by BMI, systolic and diastolic blood pressure, heart rate and autonomic neuropathy (multiple adjusted OR: 13.87, 95%CI: 3.18-60.58), but further adjustment for glycaemic measures abolished the association (OR: 1.58, 95%CI: 0.07-35.68). Assessing the components of glycaemic measures separately, the association between sensory nerve dysfunction and IGT was not affected by HbA1c (OR: 13.94, 95%CI: 1.84-105.5). It was, however, substantially attenuated by fasting plasma glucose (OR: 6.75, 95%CI: 1.33-34.27) while the significance was lost after adjustment for 120 min postload glucose level (OR: 3.76, 95%CI: 0.26-54.10). In the pooled population assessed, independent determinants of sensory nerve dysfunction were older age, 120 min glucose, higher height and cardiovascular autonomic neuropathy at near significance.

CONCLUSIONS

Sensory nerve dysfunction amongst subjects with IGT was not explained by cardiovascular covariates, only by glycaemic measures. In addition to 120 min glucose, cardiovascular autonomic neuropathy at borderline significance, age, and height were the independent determinants of sensory nerve dysfunction.

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Uddin Z, MacDermid JC, Moro J, Galea V, Gross AR. Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders. Open Orthop J 2016;10:466-480. [PMID: 29399220 PMCID: PMC5765212 DOI: 10.2174/1874325001610010466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/04/2016] [Accepted: 08/16/2016] [Indexed: 12/15/2022] Open

Abstract

Objective:

To estimate the extent to which psychophysical quantitative sensory test (QST) and patient factors (gender, age and comorbidity) predict pain, function and health status in people with shoulder disorders. To determine if there are gender differences for QST measures in current perception threshold (CPT), vibration threshold (VT) and pressure pain (PP) threshold and tolerance.

Design:

A cross-sectional study design.

Setting:

MacHAND Clinical Research Lab at McMaster University.

Subjects:

34 surgical and 10 nonsurgical participants with shoulder pain were recruited.

Method:

Participants completed the following patient reported outcomes: pain (Numeric Pain Rating, Pain Catastrophizing Scale, Shoulder Pain and Disability Index) and health status (Short Form-12). Participants completed QST at 4 standardized locations and then an upper extremity performance-based endurance test (FIT-HaNSA). Pearson r’s were computed to determine the relationships between QST variables and patient factors with either pain, function or health status. Eight regression models were built to analysis QST’s and patient factors separately as predictors of either pain, function or health status. An independent sample t-test was done to evaluate the gender effect on QST.

Results:

Greater PP threshold and PP tolerance was significantly correlated with higher shoulder functional performance on the FIT-HANSA (r =0.31-0.44) and lower self-reported shoulder disability (r = -0.32 to -0.36). Higher comorbidity was consistently correlated (r =0.31-0.46) with more pain, and less function and health status. Older age was correlated to more pain intensity and less function (r =0.31-0.57). In multivariate models, patient factors contributed significantly to pain, function or health status models (r² =0.19-0.36); whereas QST did not. QST was significantly different between males and females [in PP threshold (3.9 vs. 6.2, p < .001) and PP tolerance (7.6 vs. 2.6, p < .001) and CPT (1.6 vs. 2.3, p =.02)].

Conclusion:

Psychophysical dimensions and patient factors (gender, age and comorbidity) affect self-reported and performance-based outcome measures in people with shoulder disorders.

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Lötsch J, Dimova V, Ultsch A, Lieb I, Zimmermann M, Geisslinger G, Oertel BG. A small yet comprehensive subset of human experimental pain models emerging from correlation analysis with a clinical quantitative sensory testing protocol in healthy subjects. Eur J Pain 2015;20:777-89. [PMID: 26492152 DOI: 10.1002/ejp.803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2015] [Indexed: 11/11/2022]

Lv SL, Fang C, Hu J, Huang Y, Yang B, Zou R, Wang FY, Zhao HQ. Assessment of Peripheral Neuropathy Using Measurement of the Current Perception Threshold with the Neurometer® in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract 2015;109:130-4. [PMID: 25981398 DOI: 10.1016/j.diabres.2015.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 11/20/2022]

Abstract

OBJECTIVE

The aim of this study is to evaluate the role of current perception threshold (CPT) measurement in peripheral neuropathy in type 1 diabetic patients by using the Neurometer(®), a nerve measuring instrument.

METHODS

52 patients with type 1 diabetes mellitus with a disease duration of less than five years and normal neuropathy symptom score (NSS), neuropathy disability score (NDS) and sensory nerve conduction velocity (SCV), and 40 healthy controls were enrolled in this study. Measurement of CPT using the Neurometer(®) at 2000, 250 and 5 Hz assesses function in the bilateral median nerve and sural nerve in all studied cases. We also evaluated the glycated hemoglobin, microalbuminuria, urinary albumin/creatinine ratio and other metabolism indexes of all patients.

RESULTS

The CPT of the bilateral median nerve and sural nerve was significantly lower in diabetic patients (P<0.01). Moreover, the number of median nerve injuries in the diabetic group (left side 8/52, right side 8/52) is significantly different from the number of its ipsilateral sural nerve injuries (left side 28/52, right side 22/52) (left side P<0.01, right side P<0.01). By comparing those with DPN and those without DPN in the diabetic group, DPN groups had significantly higher glycated hemoglobin (t=2.518, P<0.05). Using binary logistic regression, high glycated hemoglobin was identified to be an independent risk factor of DPN incidence (OR (95% CI): 1.317 (1.013 -1.712), P<0.05).

CONCLUSION

These data suggest that CPT is useful in early detection of peripheral neuropathy in patients with type 1 diabetes mellitus. Patients with diabetic peripheral neuropathy, the lower limb nerve is more vulnerable than the upper limb nerve. In addition, patients with DPN had higher glycated hemoglobin which is an independent risk factor of DPN.

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Yoshida M, Shiiba S, Sago T, Nunomaki M, Harano N, Watanabe S. Comparison of pain tolerance thresholds of upper limb to identify the most appropriate venipuncture site. J Oral Maxillofac Surg 2015;73:850.e1-5. [PMID: 25883006 DOI: 10.1016/j.joms.2015.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/01/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]

Assessment of the sensory threshold in patients with atopic dermatitis and psoriasis. Postepy Dermatol Alergol 2015;32:94-100. [PMID: 26015778 PMCID: PMC4436235 DOI: 10.5114/pdia.2014.44013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/05/2014] [Accepted: 03/20/2014] [Indexed: 11/17/2022] Open

Gaudreault F, Drolet P, Fallaha M, Varin F. The Reliability of the Current Perception Threshold in Volunteers and Its Applicability in a Clinical Setting. Anesth Analg 2015;120:678-683. [DOI: 10.1213/ane.0000000000000575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Mori T, Kanbara T, Harumiya M, Iwase Y, Masumoto A, Komiya S, Nakamura A, Shibasaki M, Kanemasa T, Sakaguchi G, Suzuki T. Establishment of opioid-induced rewarding effects under oxaliplatin- and Paclitaxel-induced neuropathy in rats. J Pharmacol Sci 2014;126:47-55. [PMID: 25141998 DOI: 10.1254/jphs.14134fp] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open

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: 0.5] [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

The current perception threshold test differentiates categories of mechanical neck disorder. J Orthop Sports Phys Ther 2014;44:532-40, C1. [PMID: 24981222 DOI: 10.2519/jospt.2014.4691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

STUDY DESIGN

Cross-sectional discriminative analysis.

OBJECTIVE

To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs).

BACKGROUND

Neck pain is the third most common musculoskeletal disorder and affects a third of all adults each year. It can present as neck pain without musculoskeletal signs, neck pain with musculoskeletal signs but no neurological signs, or neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes.

METHODS

Patients with MNDs (n = 106) were classified into 3 groups, based on a standardized musculoskeletal examination process performed by an experienced physiotherapist who was blinded to CPT scores. The 3 groups were defined as neck pain without musculoskeletal signs (MND I) (n = 60), neck pain with musculoskeletal signs (MND II) (n = 29), and neck pain with neurological signs (MND III) (n = 17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, and 2000 Hz), using 3 dermatomal locations on the hand. A 1-way analysis of variance with post hoc comparison and effect sizes was calculated to compare the mean CPT scores between the groups. A binary logistic-regression model was used to predict probability of higher CPT in MND III and to create a receiver-operating-characteristic curve.

RESULTS

Mean CPT differed significantly across the 3 MND groups (MND I, 9.7; MND II, 10.6; and MND III, 11.8; P<.001; η(2) = 0.6). Post hoc comparisons indicated differences between MND I and MND II (P = .05) and between MND II and MND III (P = .01) that had large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND III. The predicted probability of abnormal CPT in MND III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P = .001) for the differentiation capacity of CPT between MND II and III, with a cutoff of 11. The area under the receiver-operating-characteristic curve was 0.84 (95% confidence interval: 0.72, 0.96; P<.001).

CONCLUSION

CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther 2014;44(7):532-540. Epub 10 May 2014. doi:10.2519/jospt.2014.4691.

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Quaghebeur J, Wyndaele JJ. Pudendal and median nerve sensory perception threshold: a comparison between normative studies. Somatosens Mot Res 2014;31:186-90. [PMID: 24853666 DOI: 10.3109/08990220.2014.911172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]

Jung C, Kim B, Mok J, Kang S, Kim C. Association between serum adipocytokine levels and microangiopathies in patients with type 2 diabetes mellitus. J Diabetes Investig 2014;5:333-9. [PMID: 24843783 PMCID: PMC4020339 DOI: 10.1111/jdi.12144] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 07/25/2013] [Accepted: 07/30/2013] [Indexed: 02/06/2023] Open

Abstract

AIMS/INTRODUCTION

It is thought that adipocytokines contribute to the increased risk of vascular complications in type 2 diabetes. However, there is still limited information on the relationship between microangiopathies and adipocytokines, such as adiponectin, leptin and tumor necrosis factor-α (TNF-α) in patients with type 2 diabetes.

MATERIALS AND METHODS

The present study examined the relationship between fasting serum adiponectin, leptin, and TNF-α levels and microangiopathies in Korean type 2 diabetes. A total of 153 patients were recruited and evaluated for diabetic nephropathy, retinopathy and neuropathy. Serum adiponectin, TNF-α and leptin levels were measured.

RESULTS

Serum adiponectin levels were significantly lower in patients with nephropathy than in those without nephropathy (P = 0.017), and were significantly higher in patients with retinopathy or neuropathy than those without retinopathy or neuropathy (P = 0.01 and P = 0.002, respectively). The mean levels of leptin were significantly higher in patients with neuropathy than in those without neuropathy (P = 0.002). The mean levels of TNF-α were not significantly different according to any of the three microangiopathies. Multivariate logistic regression analysis showed that the odds ratio for the presence of neuropathy in the highest tertile of adiponectin was 4.3 (95% confidence interval 1.59-11.62), as compared with the patients in the lowest tertile of adiponectin level.

CONCLUSIONS

Levels of adipocytokines were significantly different according to the presence of each microangiopathy. In particular, higher serum adiponectin was independently associated with increased odds for the presence of neuropathy. Future prospective studies with larger numbers of patients are required to establish a direct relationship between plasma adipocytokine concentrations and the development or severity of diabetic microangiopathies.

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Ohsawa M, Miyabe Y, Katsu H, Yamamoto S, Ono H. Identification of the sensory nerve fiber responsible for lysophosphatidic acid-induced allodynia in mice. Neuroscience 2013;247:65-74. [DOI: 10.1016/j.neuroscience.2013.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/01/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]

Khalil Z, Ogrin R, Darzins PJ. The effect of sensory nerve stimulation on sensory nerve function in people with peripheral neuropathy associated with diabetes. Neurol Res 2013;29:743-8. [PMID: 17588310 DOI: 10.1179/016164107x208095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]

Legrady P, Bajcsi D, Lengyel C, Varkonyi TT, Fejes I, Kempler P, Abraham G. Investigation of cardiac autonomic and peripheral sensory neuropathy in diabetic and nondiabetic patients with hypertension. Clin Exp Hypertens 2013;35:465-9. [PMID: 23302028 DOI: 10.3109/10641963.2012.758272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]

Tamiya S, Yoshida Y, Harada S, Nakamoto K, Tokuyama S. Establishment of a central post-stroke pain model using global cerebral ischaemic mice. J Pharm Pharmacol 2012;65:615-20. [DOI: 10.1111/jphp.12007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/16/2012] [Indexed: 12/23/2022]

Ohta A, Kato H, Nakamura Y, Tenjin A, Sakai K, Tukiyama H, Terashima Y, Nagai Y, Tanaka Y. Cold-loaded pain sensation test and current perception threshold for evaluating diabetic neuropathy. Diabetol Int 2012. [DOI: 10.1007/s13340-012-0090-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]

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

Kim BY, Jung CH, Mok JO, Kang SK, Kim CH. Association between serum C-peptide levels and chronic microvascular complications in Korean type 2 diabetic patients. Acta Diabetol 2012;49:9-15. [PMID: 21212993 DOI: 10.1007/s00592-010-0249-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/20/2010] [Indexed: 12/25/2022]

On the selective activation of unmyelinated C-fibers using sinusoidal electrical stimulation: an ERP study. Clin Neurophysiol 2011;122:1042-7. [PMID: 21353630 DOI: 10.1016/j.clinph.2011.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/07/2011] [Accepted: 01/31/2011] [Indexed: 11/20/2022]

Takami K, Fujita-Hamabe W, Harada S, Tokuyama S. Aβ and Aδ but not C-fibres are involved in stroke related pain and allodynia: an experimental study in mice. J Pharm Pharmacol 2011;63:452-6. [DOI: 10.1111/j.2042-7158.2010.01231.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]

Abstract Abstract Objectives Cerebral ischaemia is a leading cause of death and disability, including severe complications such as memory disturbance, palsy, and spasticity. Central post-stroke pain (CPSP) is a complication of cerebral ischaemia, and is characterized clinically by spontaneous pain and attacks of allodynia and dysaesthesia. However, the detailed mechanisms of CPSP are not well established. Herein, we have examined alterations of the current stimulus threshold of primary afferent neurons or the nociceptive threshold against mechanical stimuli in mice receiving left middle cerebral artery occlusion (MCAO). Methods Alterations of current stimulus threshold and the development of mechanical allodynia in hind paws were measured after MCAO using a Neurometer and the von Frey filament test, respectively. Key findings Development of cerebral infarction was clearly observed on day 1 and day 3 after MCAO. For the estimation of current stimulus threshold measured by the Neurometer, the sensitivity of Aδ and Aβ fibres (at 2000 and 250 Hz stimulation, respectively) was significantly increased on day 3 after MCAO, while that of C fibres (at 5 Hz stimulation) was unaltered. In addition, the paw withdrawal threshold of the left hind paw as measured by the von Frey filament test was significantly decreased on day 1 and day 3 after MCAO when compared with day 0, while that in the right hind paw was not different. Conclusions The data suggested the development of bilateral hyperaesthesia in this model. Further, mechanical allodynia developed in the ipsilateral side to the MCAO. Potentially, myelinated A fibre-specific hypersensitization after stroke may have contributed to these symptoms. Collapse

Beissner F, Brandau A, Henke C, Felden L, Baumgärtner U, Treede RD, Oertel BG, Lötsch J. Quick discrimination of A(delta) and C fiber mediated pain based on three verbal descriptors. PLoS One 2010;5:e12944. [PMID: 20886070 PMCID: PMC2944851 DOI: 10.1371/journal.pone.0012944] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 08/31/2010] [Indexed: 02/02/2023] Open

Suzuki Y, Ogawa K, Shiota H, Kamei S, Oishi M, Mizutani T. Current Perception Threshold in Subacute Myelo-Optico-Neuropathy. Int J Neurosci 2010;120:368-71. [DOI: 10.3109/00207451003668382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]

Félix EPV, Giuliano LMP, Tierra-Criollo CJ, Gronich G, Braga NIO, Peres CA, Nóbrega JAM, Manzano GM. Sensations and reaction times evoked by electrical sinusoidal stimulation. Neurophysiol Clin 2009;39:283-90. [PMID: 19962656 DOI: 10.1016/j.neucli.2009.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 10/14/2009] [Accepted: 10/25/2009] [Indexed: 10/20/2022] Open

Bladder sensation testing: Where are we? CURRENT BLADDER DYSFUNCTION REPORTS 2009. [DOI: 10.1007/s11884-009-0010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]

Leong GW, Gorrie CA, Ng K, Rutkowski S, Waite PM. Electrical perceptual threshold testing: a validation study. J Spinal Cord Med 2009;32:140-6. [PMID: 19569461 PMCID: PMC2678285 DOI: 10.1080/10790268.2009.11760765] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open

Lowenstein L, Jesse K, Kenton K. Reply to Spielholz. Muscle Nerve 2009. [DOI: 10.1002/mus.21172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]

Putz Z, Tabák AG, Tóth N, Istenes I, Németh N, Gandhi RA, Hermányi Z, Keresztes K, Jermendy G, Tesfaye S, Kempler P. Noninvasive evaluation of neural impairment in subjects with impaired glucose tolerance. Diabetes Care 2009;32:181-3. [PMID: 18835942 PMCID: PMC2606810 DOI: 10.2337/dc08-1406] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

Tegeder I, Adolph J, Schmidt H, Woolf CJ, Geisslinger G, Lötsch J. Reduced hyperalgesia in homozygous carriers of a GTP cyclohydrolase 1 haplotype. Eur J Pain 2008;12:1069-77. [PMID: 18374612 DOI: 10.1016/j.ejpain.2008.02.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 10/29/2007] [Accepted: 02/02/2008] [Indexed: 10/22/2022]

Abstract

BACKGROUND

Carriers of a particular haplotype of the GTP cyclohydrolase gene (GCH1) had less pain after surgery for chronic lumbar radiculopathy and a decreased sensitivity to some experimental mechanical pain stimuli. Ex-vivo, GCH1 upregulation and BH4 production after forskolin stimulation were reduced, while baseline BH4 concentrations were not affected. This suggested that the haplotype may mainly exert its modulating function when the GCH1 system is provoked. The present study aimed at (i) testing this hypothesis and (ii) independently reproducing the pain-decreasing effects of a particular GCH1 haplotype having been previously associated with pain protection.

METHODS

Experimental pain models with sensitization (local skin inflammation, dermal capsaicin application) and without sensitization (punctate pressure, blunt pressure, thermal and electrical pain) were assessed in 10 homozygous and 22 non-carriers of the particular GCH1 haplotype reportedly associated with pain protection. GCH1, iNOS upregulation and BH4 production were assessed ex-vivo in white blood cells after lipopolysaccharide stimulation for 24 h.

RESULTS

Carriers of the particular GCH1 haplotype addressed in this study had higher thresholds to punctate mechanical pain (von Frey hairs) following local skin inflammation (18.1+/-11.3 vs. 9+/-2.8 g; p=0.005) and, to a lesser degree, to heat pain following capsaicin sensitization (35.2+/-0.9 vs. 36.6+/-2.4 degrees C; p=0.026). In contrast, heat and pressure thresholds and tolerance to electrical stimulation in pain models without sensitization did not differ among the genotypes. GCH1, BH4 and iNOS upregulation in white blood cells after lipopolysaccharide stimulation were decreased in carriers of the GCH1 haplotype, which verified that the genotype groups differed with respect to regulation of the biopterin pathway.

CONCLUSIONS

This study verifies previous results that decreased GCH1 function or inducibility as a result of genetic polymorphisms protects against pain. This study extents previous results by showing that this pain protection is mainly conferred under conditions of hyperalgesia resulting from sensitization, supporting specific functions of BH4 in relation to particular aspects of pain.

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Adhesiolysis and targeted steroid/local anesthetic injection during epiduroscopy alleviates pain and reduces sensory nerve dysfunction in patients with chronic sciatica. J Anesth 2008;22:242-7. [PMID: 18685930 DOI: 10.1007/s00540-008-0616-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 02/08/2008] [Indexed: 10/21/2022]

Kramer JL, Moss AJ, Taylor P, Curt A. Assessment of Posterior Spinal Cord Function with Electrical Perception Threshold in Spinal Cord Injury. J Neurotrauma 2008;25:1019-26. [DOI: 10.1089/neu.2007.0503] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open

Lowenstein L, Jesse K, Kenton K. Comparison of perception threshold testing and thermal-vibratory testing. Muscle Nerve 2008;37:514-7. [PMID: 18067137 DOI: 10.1002/mus.20934] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]

Kang E, Lim JY, Shin HI, Gong H, Oh J, Paik NJ. Comparison between nerve conduction studies and current perception threshold test in carpal tunnel syndrome. Neurophysiol Clin 2008;38:127-31. [DOI: 10.1016/j.neucli.2007.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 09/28/2007] [Accepted: 12/29/2007] [Indexed: 11/15/2022] Open

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: 2.0] [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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Neddermeyer TJ, Flühr K, Lötsch J. Principle components analysis of pain thresholds to thermal, electrical, and mechanical stimuli suggests a predominant common source of variance. Pain 2008;138:286-291. [PMID: 18243556 DOI: 10.1016/j.pain.2007.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 12/05/2007] [Accepted: 12/20/2007] [Indexed: 11/27/2022]