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Prospects for the application of transcranial magnetic stimulation in diabetic neuropathy

Neural Regeneration Research 2021年第5期16卷 955-962页

作者： Xi Xu Dong-Sheng Xu Department of Rehabilitation Medicine Affiliated Hospital of Nantong UniversityNantongJiangsu ProvinceChina Department of Rehabilitation Medicine Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghaiChina School of Rehabilitation Science Shanghai University of Traditional Chinese MedicineShanghaiChina

Encouraging results have been reported for the use of transcranial magnetic stimulationbased nerve stimulation in studies of the mechanisms of neurological regulation,nerve injury repair,and nerve ***,to date,there are only a few reviews on the use of transcranial magnetic stimulation for diabetic *** with diabetic neuropathy vary in disease progression and show neuropathy in the early stage of the disease with mild symptoms,making it difficult to screen and *** the later stage of the disease,irreversible neurological damage occurs,resulting in treatment *** this review,we summarize the current state of diabetic neuropathy research and the prospects for the application of transcranial magnetic stimulation in diabetic *** review significant studies on the beneficial effects of transcranial magnetic stimulation in diabetic neuropathy treatment,based on the outcomes of its use to treat neurodegeneration,pain,blood flow change,autonomic nervous disorders,vascular endothelial injury,and ***,the studies suggest that transcranial magnetic stimulation can produce excitatory/inhibitory stimulation of the cerebral cortex or local areas,promote the remodeling of the nervous system,and that it has good application prospects for the localization of the injury,neuroprotection,and the promotion of nerve ***,transcranial magnetic stimulation is useful for the screening and early treatment of diabetic *** magnetic stimulation can also alleviate pain symptoms by changing the cortical threshold and inhibiting the conduction of sensory information in the thalamo-spinal pathway,and therefore it has therapeutic potential for the treatment of pain and pain-related depressive symptoms in patients with diabetic ***,based on the effect of transcranial magnetic stimulation on local blood flow and its ability to change heart rate and urine protein conten

关键词： autonomic neuropathy central nervous system depression inflammation oxidative stress pain peripheral nerve plasticity recovery regeneration vascular

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Prevalence and determinants of delayed gastric emptying in hospitalised Type 2 diabetic patients

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World Journal of Gastroenterology 2008年第10期14卷 1564-1569页

作者： Vladimir Kojecky Jaromir Bernatek Michael Horowitz Stanislav Zemek Jiri Bakala Ales Hep Internal clinic of the Postgraduate Medical School Zlin Bata Regional Hospital Zlin 76000 Czech Republic Department of Nuclear medicine Bata Regional Hospital Zlin 76000 Czech Republic Department of Medicine Royal Adelaide Hospital University of Adelaide Adelaide Australia Endoscopy center Masaryk University Hospital Brno Czech Republic

AIM: To determine the prevalence of delayed gastric emptying (GE) in older patients with Type 2 diabetes mellitus. METHODS: One hundred and forty seven patients with Type 2 diabetes, of whom 140 had been hospitalised, mean age 62.3 ± 8.0 years, HbA1c 9.1% ± 1.9%, treated with either oral hypoglycemic drugs or insulin were studied. GE of a solid meal (scintigraphy), autonomic nerve function, upper gastrointestinal symptoms, acute and chronic glycemic control were evaluated. Gastric emptying results were compared to a control range of hospitalised patients who did not have diabetes. RESULTS: Gastric emptying was delayed (T50 > 85 min) in 17.7% patients. Mean gastric emptying was slower in females (T50 72.1 ± 72.1 min vs 56.9 ± 68.1 min, P = 0.02) and in those reporting nausea (112.3 ± 67.3 vs 62.7 ± 70.0 min, P neuropathy, current glycemia or the total score for upper gastrointestinal symptoms. CONCLUSION: Prolonged GE occurs in about 20% of hospitalised elderly patients with Type 2 diabetes when compared to hospitalised patients who do not have diabetes. Female gender, nausea and early satiety areassociated with higher probability of delayed GE.

关键词： autonomic neuropathy Diabetes mellitus Gastric emptying Gastrointestinal symptoms Glycemic control

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Impaired contractility and remodeling of the upper gastrointestinal tract in diabetes mellitus type-1

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World Journal of Gastroenterology 2007年第36期13卷 4881-4890页

作者： Jens BrΦndum FrΦkjΦr SΦren Due Andersen Niels EjskjΦr Peter Funch-Jensen AsbjΦrn Mohr Drewes Hans Gregersen Center for Visceral Biomechanics and Pain Aalborg Hospital Aalborg Denmark Department of Radiology Aalborg Hospital Aalborg Denmark Department of Endocrinology M Aarhus University Hospital Aarhus Denmark Department of Surgical Gastroenterology L Aarhus University Hospital Aarhus Denmark Center for Sensory-Motor Interaction Department of Health Science and Technology Aalborg University Denmark Center for Sensory-Motor Interaction Department of Health Science and Technology Aalborg University Denmark National Center for Ultrasound in Gastro-enterology Haukeland University Hospital Bergen Norway

AIM: To investigate that both the neuronal function of the contractile system and structural apparatus of the gastrointestinal tract are affected in patients with longstanding diabetes and auto mic neuropathy. METHODS: The evoked esophageal and duodenal contractile activity to standardized bag distension was assessed using a specialized ultrasound-based probe. Twelve type-1 diabetic patients with autonomic neuropathy and severe gastrointestinal symptoms and 12 healthy controls were studied. The geometry and biomechanical parameters (strain, tension/stress, and stiffness) were assessed. RESULTS: The diabetic patients had increased frequency of distension-induced contractions (6.0 ± 0.6 vs 3.3 ± 0.5, P 0.14). CONCLUSION: The impaired contractile activity with an imbalance in the distension-induced contractions likely reflects neuronal abnormalities due to autonomic neuropathy. However, structural changes and remodeling of the gastrointestinal tract are also evident and may add to the neuronal changes. This may contribute to the pathophysiology of diabetic gut dysfunction and impact on future management of diabetic patients with gastrointestinal symptoms.

关键词： Diabetes autonomic neuropathy Bio- mechanics Contractility Ultrasound Esophagus Duodenum Deformation Stress

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Holmes-Adie syndrome, autoimmune hepatitis and celiac disease: A case report

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World Journal of Gastroenterology 2006年第9期12卷 1485-1487页

作者： Timea Csak Aniko Folhoffer Andrea Horvath Judit Halász Csaba Diczházi Zsuzsa Schaff Ferenc Szalay Department of Medicine Semmelweis University BudapestHungary Department of Pathology Semmelweis University BudapestHungary

A 35-year-old female patient presented with the following symptoms of Holmes-Adie syndrome： photophobia, enlargement of the left pupil unresponsive to light, Achilles areflexia. The pilocarpine test was positive. No tumor or other neurological abnormality was found. She had a 19-year history of autoimmune hepatitis. Flares up were observed following each 3 deliveries. At age of 31 she presented with diarrhea and weight loss. Abdominal tumor was detected by ultrasound. The surgically removed tumor was histologically a benign mesenteric multicystic lymphangioma. Simultaneously, celiac disease was diagnosed. Gluten-free diet resulted in a significant improvement of celiac disease, but not of autoimmune hepatitis. autonomic neuropathy was proven by standard cardiovascular tests. The patient was a homozygous carrier for HLA DQ2 antigen characteristic for celiac disease and heterozygous for HLA DR3 B8 frequent in autoimmune liver diseases. Our novel observation on association of Holmes-Adie syndrome with autoimmune hepatitis and celiac disease is suggestive for a common immunological background for all three entities present in a patient with mesenteric multicystic lymphangioma.

关键词： Holmes-Adie syndrome Autoimmune hepatitis Celiac disease Mesenteric lymphangioma autonomic neuropathy

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Influence of cardiac nerve status on cardiovascular regulation and cardioprotection

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World Journal of Cardiology 2017年第6期9卷 508-520页

作者： John G Kingma Denys Simard Jacques R Rouleau Department of Medicine Faculty of MedicineLaval University Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec-UniversitéLaval

Neural elements of the intrinsic cardiac nervous system transduce sensory inputs from the heart, blood vessels and other organs to ensure adequate cardiac function on a beat-to-beat basis. This inter-organ crosstalk is critical for normal function of the heart and other organs; derangements within the nervous system hierarchy contribute to pathogenesis of organ dysfunction. The role of intact cardiac nerves in development of, as well as protection against, ischemic injury is of current interest since it may involve recruitment of intrinsic cardiac ganglia. For instance, ischemic conditioning, a novel protection strategy against organ injury, and in particular remote conditioning, is likely mediated by activation of neural pathways or by endogenous cytoprotective bloodborne substances that stimulate different signalling pathways. This discovery reinforces the concept that inter-organ communication, and maintenance thereof, is key. As such, greater understanding of mechanisms and elucidation of treatment strategies is imperative to improve clinical outcomes particularly in patients with comorbidities. For instance, autonomic imbalance between sympathetic and parasympathetic nervous system regulation can initiate cardiovascular autonomic neuropathy that compromises cardiac stability and function. Neuromodulation therapies that directly target the intrinsic cardiac nervous system or other elements of the nervous system hierarchy are currently being investigated for treatment of different maladies in animal and human studies.

关键词： Intrinsic cardiac nervous system Myocardial ischemia Ischemic conditioning autonomic neuropathy Coronary blood flow regulation

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Can the change of vasomotor activity in irritable bowel syndrome patients be detected via color Doppler ultrasound?

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World Journal of Radiology 2023年第7期15卷 226-233页

作者： Omer Kazci Fahrettin Ege Huseyin Aydemir Saliha Kazci Sonay Aydin Department of Radiology Ankara Training and Research HospitalAnkara 06600Turkey Department of Neurology VM Medicalpark HospitalAnkara 06600Turkey Department of Radiology Erzincan Binali Yildirim University Mengucek Gazi Training and Research HospitalErzincan 24400Turkey Department of Epidemiology Ankara University Faculty of MedicineAnkara 06600Turkey

BACKGROUND Irritable bowel syndrome(IBS)is one of the most frequently referred conditions to the gastrointestinal outpatient *** pathophysiology of IBS has not been determined with *** hypersensitivity is indicated as one of the *** sympathetic nervous system is primarily in charge of controlling the arteries,and its effect is vasospasm in the medium and large arteries,resulting in decreased blood *** To demonstrate,using Doppler evaluation of the brachial artery,that sympathetic activity impairs vasomotor performance due to autonomic neuropathy,which we believe is associated with *** There were 58 participants in the *** control group consisted of 29 healthy patients,while the remaining 29 patients had been diagnosed with *** who met the Rome IV criteria and had IBS were included in the *** with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial,as were those with essential hypertension,diabetes mellitus,cardiovascular disease,or peripheral arterial disease,and patients diagnosed with anxiety or *** with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial.A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital *** Doppler probe remained stationary throughout the experiment,allowing for continuous ***,to activate the sympathetic fibers,an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level via the bipolar stimulus *** artery diameter and flow rates were measured again immediately following the fifth *** In healthy persons with no history of chronic illness,there was a statistically significant decrease in flow rate after stimulation(P<0.001).In addition,stimulation resulted

关键词： Irritable bowel syndrome Doppler ultrasonography Brachial artery Median nerve Peripheral neuropathy autonomic neuropathy

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Exercise Intolerance and Excessive Chronotropic Response Due to Possible autonomic Dysfunction Post COVID-19 Infection

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International Journal of Clinical Medicine 2023年第12期14卷 540-551页

作者： Stefanos Archontakis Dimitrios Venetsanos Nikias Milaras Eirini Beneki Panagiotis Dourvas Epameinondas Triantafyllou Konstantinos Sideris Konstantina Aggeli Petros Arsenos Athanasios Kordalis Konstantinos Gatzoulis Skevos Sideris Department of Cardiology Hippokration General Hospital Athens Greece First Cardiology Division Hippokration General Hospital Medical School University of Athens Athens Greece

Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.

关键词： COVID-19 autonomic neuropathy Exertional Intolerance Exaggerated Chronotropic Response POTS Dysautonomia

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Studies on the apoptosis of autonomic neuron in streptozotocin-induced diabetic rats

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Journal of Nanjing Medical University 2006年第6期20卷 383-386页

作者： Qinglin Lou Rongwen Bian Tao Peng Xiaojun Ouyang Hui Xia Liubao Gu Yongzhen Mo Department of Endocrinology Jiangsu Provincial Geriatrics Research Institute Nanjing 210024 China Department of Pathology Nanjing Medical University Nanjing 210029China

Objective： The aim of the study was to investigate apoptosis of the autonomic neuron in streptozotocin-induced diabetic rats, and observe the effect of intervention with nerve growth factor （NGF） on the apoptosis. Methods： A total of 29 male Sprague-Dawley rats were divided into three groups, i.e. normal control （NC, n = 12）, untreated diabetic （DM, n = 9） and diabetic treated with NGF daily of 500 μg/kg for 30 days （DM＋NGF, n = 8）. The diabetic rat models were produced by intraperitoneal injection with streptozotocin （65 mg/kg ）. Over 3 months since the diabetes were setup, the superior cervical sympathetic ganglions（SCG） and the celiac ganglions（CG） were removed and fixed with 10% paraformaldchyde. Apoptosis was measured using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling（TUNEL）. Apoptotic index （AI） was calculated by computer image analysis system. Results： The AI of SCG and CG in DM and DM＋NGF group were significant higher than those of NC group （P 〈 0.001） respectively. There was no difference of AI of SCG and CG between DM group and DM＋NGF group （both P 〉 0.05）. Conclusion： Neuron apoptosis may contribute to the pathophysiology of diabetic autonomic neuropathy and NGF can not prevent the apoptosis of autonomic neuron in diabetic rats.

关键词： diabetes melitus autonomic neuropathy apoptosis nerve growth factor

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