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Intestinal pseudo-obstruction caused by herpes zoster:Case report and pathophysiology

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World Journal of Clinical Cases 2018年第6期6卷 132-138页

作者： Roberto Anaya-Prado José V Pérez-Navarro Ana Corona-Nakamura Michelle M Anaya-Fernández Roberto Anaya-Fernández Marian Eliza Izaguirre-Pérez Department of Surgery at Western Medical Center the Mexican Institute of Social Security Division of Research at Autonomous University of Guadalajara Department of Infectious Diseases at Western Medical Center the Mexican Institute of Social Security Division of Research at University of Guadalajara

Herpes zoster(HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be consideredwhen dealing with non-obstructive(adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.

关键词： Ogilvie’s symdrome Herpes zoster virus neuropathies Intestinal pseudo-obstruction

Impacts of statin and metformin on neuropathy in patients with type 2 diabetes mellitus: Korean Health Insurance data

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World Journal of Clinical Cases 2021年第33期9卷 10198-10207页

作者： Hong Ki Min Se Hee Kim Jong Han Choi Kyomin Choi Hae-Rim Kim Sang-Heon Lee Department of Internal Medicine Konkuk University Medical CenterSeoul KS013South Korea Department of Neurology Konkuk University Medical CenterSeoul KS013South Korea Division of Rheumatology Department of Internal MedicineKonkuk University School of MedicineSeoul KS013South Korea

BACKGROUND Neuropathy is a common chronic complication in type 2 diabetes mellitus(T2DM).Statin and metformin are commonly used medications in T2DM patients,and some studies showed statin-or metformin-induced neuropathy.AIM To evaluate the incidence of neuropathy among patients with T2DM associated with statin and metformin therapies.METHODS Korean Health Insurance Review and Assessment national patient sample data from 2016 and 2017 were used.Patients with T2DM and no complications were divided into statin/metformin/statin+metformin users and non-users.Neuropathy incidence was defined by International Statistical Classification of Diseases and Related Health Problems,10th revision codes and concomitant prescriptions for anticonvulsants or antidepressants.Logistic regression analyses were conducted to examine the associations between statin/metformin/statin+metformin therapies and the incidence of neuropathy.Propensity score(PS)matching was performed on the basis of age,sex and comorbidities.RESULTS Overall,34964 and 35887 patients with T2DM and no complications were included in the Korean Health Insurance Review and Assessment national patient sample datasets from 2016 and 2017,respectively.Statin therapy was associated with increased risks of neuropathy in 2016 and 2017[PS-matched odds ratio(OR)=1.22,95%confidence interval(CI):1.08-1.38;PS-matched OR=1.17,95%CI:1.03-1.33,respectively].Metformin therapy was associated with reduced risks of neuropathy in 2016 and 2017(PS-matched OR=0.30,95%CI:0.21-0.42;PSmatched OR=0.44,95%CI:0.32-0.60,respectively).Combined statin+metformin therapy was not significantly associated with neuropathy in 2016 or 2017(PSmatched OR=0.85,95%CI:0.61-1.19;PS-matched OR=0.95,95%CI:0.66-1.38,respectively).CONCLUSION Statin therapy was associated with enhanced risk of new-onset neuropathy in patients with T2DM,but metformin therapy showed the opposite association.

关键词： Diabetes mellitus neuropathies Hydroxymethylglutaryl-CoA reductase inhibitors Metformin

Recurrent carpal tunnel syndrome: Evaluation and treatment of the possible causes

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World Journal of Clinical Cases 2018年第10期6卷 365-372页

作者： Ahmet Ero?lu Enes Sar? Ali K?van? Topuz Hakan ?im?ek Serhat Pusat Department of Neurosurgery Haydarpa?a Sultan Abdülhamid Education and Research Hospital Department of Orthopaedics and Traumatology Near East University Hospital Department of Neurosurgery Baypark Hospital

AIM To investigate the causes of the recurrent carpal tunnel syndrome(CTS) and implemented surgical interventions.METHODS Four hundred and eighty-seven patients, who were diagnosed with CTS and underwent surgical intervention between October 2016 and September 2007, were evaluated in this retrospective study. The age, gender, physical evaluation findings, electrophysiological examination reports and implemented surgical treatment methods were analyzed.RESULTS Thirty-nine of the cases were operated due to recurrent CTS. Further examination of the patients with recurrent CTS revealed that ten cases had diabetic polyneuropathy, three cases had hypothyroidism, two cases had rheumatoid arthritis and one case had systemic amyloidosis. Postoperative electromyography confirmed the neuropathy was due to systemic diseases. The remaining 23 patients with recurrent CTS did not have any systemic disease and all of them had applied previously to another health center. CONCLUSION We concluded that the recurrence rates in CTS might be decreased with exploration and incision of the entire transverse ligament. Damage to the motor and sensory branches of the median nerve could be avoided with an incision on the ulnar side.

关键词： Carpal tunnel Electromyography Median nerve retrospective study Entrapment neuropathies

Ginsenoside Rb1 prevents high glucose-induced Schwann cell injury through the mitochondrial apoptosis pathway

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Journal of Traditional Chinese Medicine 2017年第6期37卷 746-755页

作者： Li Xiaogang Zhang Zhe Wang Rui Xia Xinxin Liu Yonghui Sun Lianqing Li Xiaogang Department of Anesthesiologythe First Affili-ated Hospital of Xi'an Jiaotong UniversityXi'an 710061China Department of Traditional Chinese Medicine the First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061China

OBJECTIVE: To investigate the effects of ginsenoside Rb1 on high glucose-induced neurotoxicity and the underlying molecular mechanism in primary cultured Schwann cells(SCs).METHODS: Cultured SCs were divided into six groups that received(a) normal glucose,(b) osmotic control,(c) high glucose,(d) high glucose plus 1μM ginsenoside Rb1,(e) high glucose plus 10 μM ginsenoside Rb1, or(f) high glucose plus 100 μM alpha lipoic acid(ALA). Intracellular reactive oxygen species(ROS) generation and mitochondrial transmembrane potential(ΔΨm) were detected by flow cytometric analyses. Apoptosis was confirmed by the annexin V-FITC/propidium iodide(PI) method,and the concentration of 8-hydroxy-2-deoxy guanosine(8-OHd G) was detected by an enzyme-linked immunosorbent assay. Western blotting was performed to analyze the expression levels of important transcription factors such as cytochrome c, bcl-2, bax, activated caspase-3, and activated poly(ADP-ribose) polymerase(PARP).RESULTS: Ginsenoside Rb1 inhibited high glucose-induced oxidative stress by decreasing ROS and 8-OHd G levels as well as mitochondrial depolarization in SCs. 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide and annexin V-FITC/PI assays showed that incubating SCs with high glucose decreased cell viability and increased the number of apoptotic cells, whereas treatment with ginsenoside Rb1 protected SCs against high glucose-induced cell damage. Furthermore, ginsenoside Rb1 down-regulated the expression of high glucose-induced bax and cytochrome c release but up-regulated bcl-2 expression. In addition, ginsenoside Rb1 attenuated high glucose-induced activation of caspase-3 and minimized cleavage of PARP in SCs.CONCLUSION: These results suggest that ginsenoside Rb1 antagonizes high glucose-induced oxidative stress and activation of the mitochondrial apoptosis pathway in SCs.

关键词： Diabetic neuropathies Oxidative stress Ginsenosides, Apoptosis inducing factor Schwanncells

Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy

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World Journal of Orthopedics 2018年第12期9卷 292-299页

作者： Fabian van de Bunt Michael L Pearl Tom van Essen Johannes A van der Sluijs Department of Orthopedics Amsterdam UMCVU University Medical Center Department of Shoulder and Elbow Surgery Kaiser Permanente Medical Cente

AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy(BPBI) and suffered from an internal rotation contracture. Additionally, the role of the infraspinatus(IS) and subscapularis(SSc) muscles in the genesis of this bony deformation is explored.METHODS Bilateral magnetic resonance imaging(MRI) scans of 35 infants(age range: 2-7 mo old) with BPBI were retrospectively analyzed. Retroversion was measured according to two proximal axes and one distal axis(transepicondylar axis). The proximal axes were:(1) the perpendicular line to the borders of the articular surface(humeral centerline); and(2) the longest diameter through the humeral head. Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements.RESULTS Retroversion on the involved side was significantly decreased, 1.0° vs 27.6°(1) and 8.5° vs 27.2°(2),(P < 0.01), as compared to the uninvolved side. The size of the SSc and IS muscles on the involved side was significantly decreased, 2.26 cm2 vs 2.79 cm2 and 1.53 cm2 vs 2.19 cm2, respectively(P < 0.05). Furthermore, the muscle ratio(SSc/IS) at the involved side was significantly smaller compared to the uninvolved side(P = 0.007).CONCLUSION Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture.

关键词： Humeral retroversion Infants Brachial plexus Brachial plexus neuropathies Shoulder Humerus

High-Intensity Interval Training v/s Steady-State Cardio in Rehabilitation of Neurological Patients

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Open Journal of Therapy and Rehabilitation 2023年第2期11卷 35-44页

作者： Thorin Thorbjørnssønn Birkeland Independent Researcher Oslo Norway

Neuropathy is nerve damage that can cause chronic neuropathic pain, which is challenging to cure and has a significant financial burden. Exercise therapies, including High-Intensity Interval Training (HIIT) and steady-state cardio, are being explored as potential treatments for neuropathic pain. This systematic review compares the effectiveness of HIIT and steady-state cardio for improving function in neurological patients. This article provides an overview of the systematic review conducted on the effects of exercise on neuropathic patients, with a focus on high-intensity interval training (HIIT) and steady-state cardio. The authors conducted a comprehensive search of various databases, identified relevant studies based on predetermined inclusion criteria, and used the EPPI automation application to process the data. The final selection of studies was based on validity and relevance, with redundant articles removed. The article reviews four studies that compare high-intensity interval training (HIIT) to moderate-intensity continuous training (MICT) on various health outcomes. The studies found that HIIT can improve aerobic fitness, cerebral blood flow, and brain function in stroke patients;lower diastolic blood pressure more than MICT and improve insulin sensitivity and skeletal muscle mitochondrial content in obese individuals, potentially helping with the prevention and management of type 2 diabetes. In people with multiple sclerosis, acute exercise can decrease the plasma neurofilament light chain while increasing the flow of the kynurenine pathway. The available clinical and preclinical data suggest that further study on high-intensity interval training (HIIT) and its potential to alleviate neuropathic pain is justified. Randomized controlled trials are needed to investigate the type, intensity, frequency, and duration of exercise, which could lead to consensus and specific HIIT-based advice for patients with neuropathies.

关键词： Neurological Diseases neuropathies High-Intensity Interval Training (HIIT) Steady-State Cardio Exercise

The Role of Orthotic Service in Modern Rehabilitation of Patients with Charcot-Marie-Tooth Disease

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Journal of Biosciences and Medicines 2018年第7期6卷 23-34页

作者： Olga V. Petryaeva Natalia A. Shnayder Ivan P. Artyukhov Margarita R. Sapronova Irina O. Loginova V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University Krasnoyarsk Russia V.M. Bechterev National Medical Research Center of Psychiatry and Neurology Sankt-Petersburg Russia

Charcot-Marie-Tooth (CMT) disease, which encompasses several hereditary motor and sensory neuropathies, is one of the most common neuro-muscular disorders. 80% of patients having CMT disease are diagnosed with per cavus deformity. Orthosis is widespread and varies widely in forms. The paper arises the necessity of habilitation at the earliest possible stage as only a few patients use it. The meta-analysis of 412 scientific papers concerning this problem demonstrates the getting better gate, balance and the stopping CMT progression which is scientifically proven. It is also shown that patients with CMT use low prevalence of orthotics, and demonstrate low compliance of patients (for various reasons), high expectations from this habilitation technique.

关键词： Charcot-Marie-Tooth Disease (CMT) Habilitation Rehabilitation Heredi-tary Sensori-Motor neuropathies (HSMN) Contractures Orthosis Demye-linating Diseases (DMD) Orthotic Management Ankle-Foot Orthoses (AFOs)

Multicenter Survey of the Isometric Lower Extremity Strength in Patients with Type 2 Diabetes (MUSCLE-std): Design and Study Protocol

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Journal of Diabetes Mellitus 2014年第4期4卷 251-256页

作者： Takuo Nomura Tomoyasu Ishiguro Masayoshi Ohira Yukio Ikeda Masahito Watanabe Department of Rehabilitation Sciences Kansai University of Welfare Sciences Osaka Japan Department of Physical Therapy Health Science University Yamanashi Japan School of Health Sciences Shinshu University Nagano Japan Diabetes Center Kochi Memorial Hospital Kochi Japan

Background: The lower extremity muscle strength has been shown to be weaker in patients with diabetes mellitus, primarily due to the effects of diabetic polyneuropathy, a common diabetic complication. With respect to assessments of the lower extremity muscle strength, reference values for the knee extension force in healthy Japanese subjects have been reported. The clinical significance of applying knee extension force in the assessment of efficacy of exercise therapy and patient education has also been demonstrated, and the use of an individualized approach in physical exercise based on the quantitative assessment of the lower extremity muscle strength is becoming one of the most important strategies for promoting effective rehabilitation. Methods: The study is a multicenter, cross-sectional investigation. We will measure the knee extension force and evaluate the diabetic polyneuropathy in patients with type 2 diabetes using uniform equipment and methodology at all centers. We will compare the knee extension force between the subjects with and without diabetic polyneuropathy and will investigate the associations between the knee extension force and both glycemic control and exercise habits. The trial registration is UMIN CTR (UMIN000002810). Discussion: The lower extremity muscle strength has been insufficiently investigated in Japanese patients with diabetes. This study was designed to establish reference values for the knee extension force in Japanese diabetic patients with and without diabetic polyneuropathy.

关键词： Muscle Strength Knee Joint Diabetes Mellitus Diabetic neuropathies Physical Therapy

Course of Atypical Manifestations of a Case of Charcot-Marie-Tooth Disease over 35 Years of Clinical Observation

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Neuroscience & Medicine 2013年第3期4卷 145-149页

作者： Giuseppe Lanza Luisa Vinciguerra Valentina Puglisi Daniela Modica Alfio Catalano Giuseppe Zelante Riccardo Ricceri Lorenzo Lupo Salvatore Giuffrida Manuela Pennisi Department “G. F. Ingrassia” MED 01 University of Catania Catania Italy Department “G. F. Ingrassia” Section of Neurosciences University of Catania Catania Italy Department of Chemistry University of Catania Catania Italy.

Introduction: Atypical manifestations of peripheral neuropathy are not rare, challenging the differential diagnosis. In the past, the diagnosis of hereditary neuropathy was mainly based on the clinical and electromyographic (EMG) findings and, occasionally, biopsy. Nowadays, the genetic tests allow us to identify more than 40 different genes/loci associated with Charcot-Marie-Tooth (CMT) disease, although some subtypes are clinically indistinguishable. We have followed a patient with a clinical diagnosis of apparent sporadic and atypical CMT and recently diagnosed genetically as distal hereditary motor neuropathy, type V (dHMN-V). Case Report: Thirty-five years ago, a 16 years old patient complained muscular weakness and wasting at the hands small muscles. Sporadic fasciculations were observed whereas deep tendon reflexes and sensation were normal. EMG examination revealed neurogenic muscular denervation in the distribution of C7, C8 and T1 segments bilaterally. Muscular biopsy of the left Biceps Brachii showed rare atrophic fibers and some cellular atypia. The disease has undergone a clinical and EMG progression and diffusion over the years, involving the lower limbs and leading to a bilateral steppage. A more slight diffuse axonal motor neuropathy was also identified in the proband’s son and second cousin. The genetic study found a known missense mutation in BSCL2 gene related to a dHMN-V. Interestingly, there was a remarkable intra-familiar phenotypic variability, especially in the clinical onset and severity. Discussion: Atypical manifestations of hereditary neuropathies often overlap with other conditions. The present case highlights how a comprehensive clinical evaluation and a careful follow-up have led to a correct diagnosis even 35 years later and have allowed to identify other affected family members. The apparent lack of familiarity was probably due to the very soft presentation in the proband’s relatives. Although the genetic study was not available at that time, the first clinical diagnosis was not d

关键词： Hereditary neuropathies Clinical Overlap Genetic Analysis Phenotypic Variability