Occurrence Of Peripheral Neuropathy Research Articles

Association between response to enfortumab vedotin and peripheral neuropathy in urothelial carcinoma patients: a multicenter retrospective study.

Enfortumab vedotin (EV) was approved for patients with metastatic urothelial carcinoma (mUC) who progressed after anticancer therapy on September 2021 in Japan. The association between the occurrence of EV-related side effects and clinical outcome remains to be elucidated. We identified 97 mUC patients treated with EV therapy at our five institutions from the date of approval to March 2023. The median follow-up period was 7.0months. We retrospectively analyzed the efficacy and safety of EV. The median age of the patients was 71years old, 39% had PS of 1 or more, and 56.7% had primary tumor in upper urinary tract. Overall response rate (ORR) to EV therapy, median progression-free survival (PFS), and overall survival (OS) were 43.3%, 7.52months, and 12.78months, respectively. Any grade of treatment-related skin disorder, dysgeusia, peripheral neuropathy, gastrointestinal disorder, and hyperglycemia occurred in 61 (62.9%), 36 (37.1%), 34 (35.1%), 29 (29.9%), and 18 (18.6%) patients, respectively. The patients with EV-associated peripheral neuropathy had significantly higher ORR (58.8% vs. 34.9%, P=.032) and longer median PFS (8.05 vs. 6.31months, P=.017) and OS (not reached vs. 11.57months, P=.008, respectively) than those without. The occurrence of peripheral neuropathy after EV treatment and the presence of peritoneal dissemination were factors independently associated with PFS (hazard ratio=0.46, P=.008 and hazard raito = 3.83, P = .004, respectively) and OS (hazard ratio=0.30, P=.005 and hazard raito = 4.53, P = .002, respectively). The occurrence of EV-related peripheral neuropathy might be associated with the efficacy of EV therapy in mUC patients.

Correlation study of renal function indices with diabetic peripheral neuropathy and diabetic retinopathy in T2DM patients with normal renal function.

The anticipation of diabetes-related complications remains a challenge for numerous T2DM patients, as there is presently no effective method for early prediction of these complications. This study aims to investigate the association between renal function-related indicators and the occurrence of peripheral neuropathy and retinopathy in individuals diagnosed with type 2 diabetes mellitus (T2DM) who currently have normal renal function. Patients with T2DM who met the criteria were selected from the MMC database and divided into diabetic peripheral neuropathy (DPN) and diabetic retinopathy (DR) groups, with a total of 859 and 487 patients included, respectively. Multivariate logistic regression was used to analyze the relationship between blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), urine albumin(ALB), albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and diabetic peripheral neuropathy and retinopathy. Spearman correlation analysis was used to determine the correlation between these indicators and peripheral neuropathy and retinopathy in diabetes. In a total of 221 patients diagnosed with DPN, we found positive correlation between the prevalence of DPN and eGFR (18.2, 23.3, 35.7%, p < 0.05). Specifically, as BUN (T1: references; T2:OR:0.598, 95%CI: 0.403, 0.886; T3:OR:1.017, 95%CI: 0.702, 1.473; p < 0.05) and eGFR (T1: references; T2:OR:1.294, 95%CI: 0.857, 1.953; T3:OR:2.142, 95%CI: 1.425, 3.222; p < 0.05) increased, the odds ratio of DPN also increased. Conversely, with an increase in Cr(T1: references; T2:OR:0.86, 95%CI: 0.56, 1.33; T3:OR:0.57, 95%CI: 0.36, 0.91; p < 0.05), the odds ratio of DPN decreased. Furthermore, when considering sensitivity and specificity, eGFR exhibited a sensitivity of 65.2% and specificity of 54.4%, with a 95% confidence interval of 0.568-0.656. In this experimental sample, we found a clear positive correlation between eGFR and DPN prevalence.

Vitamin D and Multiple Myeloma: A Scoping Review

As the global incidence of multiple myeloma (MM) increases, the identification of modifiable risk factors for disease prevention becomes paramount. Maintaining optimal vitamin D status is a candidate for prevention efforts, based on pre-clinical evidence of a possible role in disease activity and progression. A structured scoping review was performed to identify and describe human-level research regarding the association between vitamin D and MM risk and/or prognosis. Searches of three databases (OVID-Medline, OVID-Embase, and OVID-Cochrane Library) yielded 15 included publications. Vitamin D deficiency is fairly common among patients with MM, with 42.3% of participants in the studies identified as having a vitamin D deficiency. No included publication reported on vitamin D status and the risk of developing or being newly diagnosed with MM. Possible associations with vitamin D that warrant future exploration include the incident staging of MM disease, the occurrence of peripheral neuropathy, and survival/prognosis. Vitamin D receptor (VDR) polymorphisms associated with MM also warrant further investigation. Overall, this scoping review was effective in mapping the research regarding vitamin D and MM and may help support new hypotheses to better describe this association and to better address identified knowledge gaps in the literature.

The protective effect of chemical and natural compounds against vincristine-induced peripheral neuropathy (VIPN).

Vincristine, an alkaloid extracted from Catharanthus rosea, is a class of chemotherapy drugs that act by altering the function of the microtubules and by inhibiting mitosis. Despite its widespread application, a major adverse effect of vincristine that limits treatment duration is the occurrence of peripheral neuropathy (PN). PN presents with several symptoms including numbness, painful sensation, tingling, and muscle weakness. Vincristine-induced PN involves impaired calcium homeostasis, an increase of reactive oxygen species (ROS), and the upregulation of tumor necrosis factor-alpha (TNF-α), and interleukin 1 beta (IL-1β) expression. Several potential approaches to attenuate the vincristine-induced PN including the concomitant administration of chemicals with vincristine have been reported. These chemicals have a variety of pharmaceutical properties including anti-inflammation, antioxidant, and inhibition of calcium channels and calcineurin signaling pathways and increased expression of nerve growth factor (NGF). This review summarized several of these compounds and the mechanisms of action that could lead to effective options in improving vincristine-induced peripheral neuropathy (VIPN).

Frequency of Peripheral Neuropathy in Newly Diagnosed Type 2 Diabetes Presenting in a Tertiary Care Hospital of Lahore

Background: Among the common complications of diabetes, neuropathy has its place. About 50% of diabetics suffer from this complication. It is one of the most common cause of elevated morbidity mortality in diabetics. Duration of diabetes, its control and association with other micro vascular complications can result in an raised incidence of neuropathy in patients. Aim: To find frequency of peripheral neuropathy in newly diagnosed type 2 diabetes in a tertiary care hospital. Methods: Cross sectional study carried out in newly diagnosed patients with type II Diabetes Mellitus presented at department of Medicine, Fatima Memorial hospital, Lahore. 200 newly diagnosed type II diabetes patients who met the inclusion criteria were selected. Information was recorded on predesigned questionnaire regarding peripheral neuropathy and socio-demographic variables. Results: The mean age among peripheral neuropathy respondents was 47.05±6.37 years while it was 45.19±6.50 years among not having peripheral neuropathy. Peripheral neuropathy was seen in 42 (21%) respondents while in 158 (79%) there was no peripheral neuropathy. Gender among peripheral neuropathy showed that males were 36 and females were 06 in number; and among non-peripheral neuropathy group there were 135 males and 23 females. Most of the low income respondents were suffering from peripheral neuropathy as compared to other income groups. Post stratification regarding age and gender yields significant results within income groups while the later showed only male respondents were significant. Conclusion: This study reports that in type 2 diabetic patients diagnosed less than one year back, there is an increased prevalence of peripheral neuropathy. Male respondents were more in number than females but both had shown almost having same occurrence of peripheral neuropathy. Keywords: Peripheral Neuropathy, Type II Diabetes, Neuropathy

Peripheral Neuropathy Is an Under-Recognized Feature of Monoclonal Gammopathy of Undetermined Significance: A Population-Based Study of 18,668 MGUS Patients and Their 97,641 Matched Controls

IntroductionMonoclonal gammopathy of undetermined significance (MGUS) is the precursor state of multiple myeloma (MM) and related disorders with a prevalence of 4.2%. Peripheral neuropathy (PN) is a reported complication of MGUS and 20% of newly diagnosed MM patients present with PN. These MM patients are more likely to develop more severe PN during treatment with certain drugs used to treat MM (e.g. bortezomib and thalidomide). Previous studies have been inconsistent regarding the rate of PN in the MGUS population with estimates ranging from 3-70%. A rate of 15-20% is however the most widely cited. Studies have also been inconsistent regarding the implications of PN for progression of MGUS to MM and related disorders and even whether MGUS confers any increased risk of PN at all.These inconsistencies can mostly be attributed to the small sample sizes and retrospective nature of previous studies, the lack of standardized methods for PN diagnosis in this patient group, and the high rate of undiagnosed PN in the general population.PN has been reported to be relatively common in this patient group, and can be debilitating, significantly reducing quality of life and raising health-care costs for MGUS and MM patients. Therefore, we were motivated to conduct a large population-based study with the primary objective assessing the recognition and risk of PN. To avoid the potential surveillance bias associated with a diagnosis of MGUS we also performed a comparison with patients with diabetes mellitus (DM), a population routinely examined for PN because of their well-recognized and high risk of PN. Additionally, as a secondary objective, we assessed the potential effect of PN on the rate of progression of MGUS to MM and related disorders.MethodsSubjects diagnosed with MGUS in the years 1986 to 2013 were obtained from a registry of a network of Swedish hematology/oncology centers and from the Swedish Patient Registry. Four controls were matched to each case through the Swedish Population Registry by sex, year of birth, and county of residence. Diagnoses of PN and DM were acquired from the Swedish Patient Registry. Data on the date of death was acquired from the Swedish Cause of Death Registry. Information on MGUS progression was obtained from the Swedish Cancer RegistryExposure was having MGUS, DM, or MGUS and DM. Having DM was defined as a diagnosis of DM at any time. The outcome was the occurrence of PN while censoring at progression to MM and related disorders. Cox proportional hazard regression was performed adjusting for age, sex, and year of MGUS diagnosis. For this analysis, participants with previous PN or censoring event before the date of MGUS diagnosis were excluded.Additionally we performed analysis of the rate of progression of MGUS with and without PN to MM and related disorders. For this analysis we used a multi-state Cox proportional hazard regression model adjusting for age, sex, and the year of MGUS diagnosis.ResultsA total of 18,668 subjects with MGUS were identified and 97,641 matched controls enrolled, a total of 2,685 individuals were excluded. A total 13,899 of subjects had DM of whom 2,438 also had MGUS. All exposed groups had a higher rate of PN than controls (controls: 1.2%, MGUS: 2.8%, DM: 2.3%, MGUS+DM: 4.8%) as well as a significantly increased hazard of PN as compared to controls (MGUS: hazard ratio (HR)=4.0; 95% confidence interval (CI) 3.6-4.4, DM: HR=1.8; 95% CI 1.6-2.1, MGUS+DM: HR=6.0; 95% CI 5.0-7.3). Progression to MM or related disorder was not different in MGUS individuals with PN (HR=0.85; 95% CI 0.68-1.07). The proportion of the total MGUS cohort that progressed was 12.4% and 15.5% for individuals with MGUS with and without PN, respectively.DiscussionIn this large population-based real-world cohort study on more than 18,000 MGUS individuals and their almost 100,000 matched controls, we found that individuals with MGUS are at a 4-fold risk of PN when compared to controls. Interestingly, we found that MGUS individuals are at a higher risk of PN than patients with DM, a population routinely screened for PN because of its well-recognized risk of PN. Additionally, the rates of PN diagnosis in this real-world patient care setting are far below the rate of PN most widely reported in non-registry based studies. This suggests serious under-recognition of this important complication in the real world care of individuals with MGUS. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

体重指数对评估硼替佐米治疗多发性骨髓瘤周围神经病变发生的价值

体重指数对评估硼替佐米治疗多发性骨髓瘤周围神经病变发生的价值

Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson's Disease: A Systematic Review.

The occurrence of peripheral neuropathy (PNP) is often observed in Parkinson’s disease (PD) patients with a prevalence up to 55%, leading to more prominent functional deficits. Motor assessment with mobile health technologies allows high sensitivity and accuracy and is widely adopted in PD, but scarcely used for PNP assessments. This review provides a comprehensive overview of the methodologies and the most relevant features to investigate PNP and PD motor deficits with wearables. Because of the lack of studies investigating motor impairments in this specific subset of PNP-PD patients, Pubmed, Scopus, and Web of Science electronic databases were used to summarize the state of the art on PNP motor assessment with wearable technology and compare it with the existing evidence on PD. A total of 24 papers on PNP and 13 on PD were selected for data extraction: The main characteristics were described, highlighting major findings, clinical applications, and the most relevant features. The information from both groups (PNP and PD) was merged for defining future directions for the assessment of PNP-PD patients with wearable technology. We established suggestions on the assessment protocol aiming at accurate patient monitoring, targeting personalized treatments and strategies to prevent falls and to investigate PD and PNP motor characteristics.

Successful transition from bortezomib subcutaneous to generic intravenous bortezomib: Cost savings initiative with global economic impact.

e19375 Background: It is estimated that the U.S. will spend $370 billion in 2019 on pharmaceuticals and by 2020 the cost of cancer care will be approximately 158 billion. Cost containment strategies for high cost drugs are needed. There exists an opportunity to decrease overall cost related to bortezomib by switching patients to generic bortezomib. Generic bortezomib was first approved by the FDA in January 2018 but it can only be administered intravenously. Based on previous studies on occurrence of peripheral neuropathy we hypothesized that patients who have not developed bortezomib induced peripheral neuropathy (BIPN) after or during 4 cycles of subcutaneous (subQ) bortezomib could be switched to IV bortezomib without greatly increasing neuropathy. Methods: A protocol was implemented to switch patients from SubQ to IV bortezomib at our hematology outpatient clinic. Patients had to complete 4 cycles of SubQ bortezomib and have either Grade 1 or no BIPN to qualify to switch to IV bortezomib generic formulation. After approval from the hematology/oncology providers and nursing department, this protocol was implemented to start accrual in November 2018. After provider approval for eligible patients, pharmacists would update the treatment plan orders and also notify nursing and patients of the change. Results: Fifteen patients have received at least 1 cycle of IV generic bortezomib for various indications from Nov 2018 to Nov 2019, ranging from 1 cycle to 12 cycles. The diseases for which bortezomib was being used included multiple myeloma (n = 8) and AL amyloidosis (n = 2), renal transplant rejection and thrombotic thrombocytopenic purpura (TTP). Two of the 15 patients had Grade 1 BIPN prior to switching, while all others reported no neuropathy prior to the switch. None of the patients have developed new neuropathy after making the switch from subQ to IV bortezomib. Nursing and patient satisfaction surveys showed that majority of both groups did not have a preference for IV versus subQ administration. Conclusions: We describe a method to switch from subcutaneous bortezomib to generic IV bortezomib instituted at a large academic medical center as a cost containment strategy. This has resulted in no new cases of neuropathy in our growing data set.

Association of CEP72 rs924607 with vincristine-induced peripheral neuropathy (PN) in patients with diffuse large B-cell lymphoma on CALGB 50303 (Alliance).

e13535 Background: Pediatric patients (pts) receiving long-term vincristine treatment for acute lymphoblastic leukemia (ALL) who carry two variant alleles of CEP72 rs924607 experience more severe peripheral neuropathy (PN) at lower cumulative vincristine doses. The objective of this retrospective pharmacogenetic analysis was to determine if pts homozygous for rs924607 have increased PN risk when receiving short-term vincristine treatment for diffuse large B-cell lymphoma (DLBCL). Methods: Caucasian pts with DLBCL randomized to either of two vincristine-containing regimens (R-CHOP or DA-EPOCH-R) on the CALGB 50303 (Alliance) trial were genotyped for germline rs924607 via TaqMan. Vincristine was administered intravenously 1.4 mg/m2 (2 mg cap) on day 1 of each R-CHOP cycle (1.4 mg/m2/cycle) or 0.4 mg/m2/day (no cap) on days 1-4 of each DA-EPOCH-R cycle (1.6 mg/m2/cycle). Dosing was repeated every 21 days for 6 treatment cycles, for a maximum cumulative vincristine dose of 8.4 (R-CHOP) or 9.6 (DA-EPOCH-R) mg/m2 over 18 weeks. The primary analysis compared risk of NCI CTCAE grade 3 or higher PN in rs924607 homozygous variant pts versus wild-type allele carriers using multivariable Cox proportional hazards regression adjusted for treatment received (R-CHOP vs. DA-EPOCH-R), age (continuous), and sex (male vs. female). A secondary analysis was conducted only in pts assigned to the DA-EPOCH-R arm. Results: Of 307 pts included in the analysis, 32 (10.4%) experienced grade 3+ PN. PN occurrence was nominally lower in homozygous pts (5/59 = 8.5%) than wild-type carriers (27/248 = 10.9%). In the primary analysis, homozygous pts did not experience PN earlier in treatment (Hazard ratio (HR) = 1.04, (95% confidence interval: 0.39-2.75), one-sided p-value = 0.47). There was no significant difference between groups in dose-at-PN occurrence (homozygous (n = 5): 8.81 mg/m2 vs. wild-type carrier (n = 27):6.74 mg/m2, p &gt; 0.05). The secondary analysis in pts on the DA-EPOCH-R arm (n = 147), in which the majority of PN events occurred (n = 27/32 = 84%), homozygous pts (n = 26) did not have significantly increased PN risk (HR = 1.30, p = 0.56). Conclusions: This retrospective analysis of the prospective CALGB 50303 trial did not find that pts homozygous for CEP72 rs924607 had increased PN risk during short-term vincristine treatment for DLBCL. Support: U10CA180821, U10CA180882, U24CA196171; https://acknowledgments.alliancefound.org . ClinicalTrials.gov Id: NCT00118209.

Factors Associated with Occurrence of Peripheral Neuropathy among HIV/AIDS Clients at Kombewa Sub County Hospital of Kisumu County, Kenya

Peripheral Neuropathy (PN) commonly arises as HIV related nerve complication. The study made attempts to assess the underlying factors leading to peripheral neuropathy, the disabling effects of peripheral neuropathy on a patient’s life quality and measures which can be implemented to prevent or lessen the burdening effects of these neuropathies. A descriptive design was adopted where cross-sectional data targeting a sample of 100 consenting adult HIV/AIDS clients were collected utilizing structured questionnaires as key instruments of data collection. In this study variables such as age, height, the past and current CD4 lymphocytes, the viral load, the average duration of antiretroviral treatment (ART), use and the presence of certain co-infection, diabetes or alcohol abuse were analyzed to determine their effects of occurrence of peripheral neuropathy. Fifty eight percent (58%) of the clients were classified to be having neuropathic as compared 42% who did not have neuropathic pain. Duration of diagnosis with HIV and previous CD4 count did not significantly determine the occurrence of neuropathic pain. Viral load at time of diagnosis with HIV; nutritional uptake and HAART regimen significantly contribute to occurrence of PN among HIV/AIDS clients. There was no significant association between cases of peripheral neuropathy and demographic factors such as age, gender, height of the respondents and level of education. Clients with peripheral neuropathy were not receiving adequate health talks on peripheral neuropathy. Effect of PN on physical activity was observed. There is need for providing both medical and palliative treatment to HIV/AIDS patients suffering from peripheral neuropathy.

Peripheral Neuropathy and Hypovitaminosis D Are Associated in Multiple Myeloma Patients

Introduction New strategies in the treatment of multiple myeloma (MM) have improved response rates, progression-free survival and overall survival (OS). Despite the advances in treatment, patients frequently experience adverse events such as chemotherapy-induced peripheral neuropathy (CIPN). CIPN decreases quality of life, and requires dose adjustment, delay or premature termination of treatment, resulting in a negative influence on time to progression and survival. In addition, several studies have found that up to 54% of MM patients have peripheral neuropathy (PN) at diagnosis. A possible mechanism of vitamin D deficiency and PN was found in animal trials, where an increase of nerve growth factor was observed in diabetic rats after supplementation of vitamin D. Furthermore, correction of hypovitaminosis D through vitamin D supplementation was found to reduce PN in patients with DM type 2. Objectives The primary objective of this study was to determine the correlation between the 25-hydroxyvitamin D serum levels and PN in patients with smoldering or symptomatic MM. Secondary objectives were to gain insight into the number of patients with inadequate 25-hydroxyvitamin D serum levels (&lt; 75 nmol/L); to evaluate the influence of different vitamin D levels on the severity of CIPN; to determine the correspondence of the ICPNQ results and patients' records; and to search for differences in prevalence of CIPN for each drug. Methods In this multicentre study, performed in the Medical Center Leeuwarden and Deventer Hospital in the Netherlands, smoldering and symptomatic MM patients were included in the study, regardless of stage or previous treatment. Patients had to be older than 18 years, and able to give informed consent. Blood samples were collected to determine vitamin D levels, and hypovitaminosis D was defined as a 25-hydroxyvitamin D level (vitamin D) below 75 nmol/L. The Indication for Common Toxicity Criteria (CTC) Grading Peripheral Neuropathy Questionnaire (ICPNQ), a validated questionnaire to distinguish different PN grades in MM patients, was used to determine the severity of PN. Visual Analog Scale (VAS) scores were used to grade the intensity of PN. Results We included 120 MM patients with a median age of 68 years (min-max; 48-84), and 57,5% were male. The median vitamin D level was 49.5 nmol/L (min-max; 10-138), and 84% had a serum 25-hydroxyvitamin D level &lt;75 nmol/L. The percentage of patients with PN grade 1 or higher was 69%. In the medical records, absence or presence of PN was mentioned in 40% of the patients by clinicians. The percentage of patients with PN categorized in the vitamin D groups &lt;25, 25-49.9, 50-74.9, and ≥75 nmol/L, was 88, 72, 54, and 79%, respectively. However, patients in the vitamin D group ≥75 nmol/L were diagnosed with MM for a shorter period of time, and received more intensive treatment. A trend was found between lower vitamin D levels (grouped &lt;25, 25-49.9, 50-74.9, and ≥75 nmol/L) and higher incidence of PN (p = 0.036). Conclusions PN and hypovitaminosis D are common in MM patients, and low vitamin D levels are possibly associated with the occurrence of PN. In addition, more attention for PN is needed, as PN is underreported by clinicians. Further research is necessary to clarify the relationship between vitamin D and PN, and whether vitamin D supplementation could positively influence PN in MM patients. Disclosures No relevant conflicts of interest to declare.

F34. Effects of impaired glucose regulation on large and small fibers in peripheral nerve

Introduction We use nerve conduct study (NCS) to evaluate the function of large fibers, skin sympathetic response (SSR) and contact heat evoked potential (CHEP) to evaluate the function of small fibers in patients with impaired glucose regulation (IGR), The occurrence of peripheral neuropathy and damage characteristics are analyzed. Methods According to the classification criteria of glucose metabolism proposed by WHO 2006,we selected 120 patients with IGR, and 60 normal subjects as the control group.All subjects received median, ulnar, tibial, peroneal, sural nerve conduction study (NCS), skin sympathetic response (SSR) and contact heat evoked potential (CHEP) were performed using the Keypoint.net (Medoc Ltd) electromyogram device. Results 1.The abnormal rate of NCS in IGR patients were 22.5%; the abnormal rate of SSR was 39.2%, All patients with NCS abnormalities were associated with abnormal SSR 2.Compared with the control group, the tibial, sural nerve sensory nerve action potential (SNAP) amplitude decreased in IGR group, (2.01 ± 1.5) vs (1.51 ± 1.3) uV, t = −3.01, P = 0.003; (10.5 ± 2.0) vs (6.5 ± 1.9) uV, t = −2.82, P = 0.005 respectively; SSR amplitude reduced in upper and lower limbs (2124 ± 1346) vs (1463 ± 1140) uV, t = −3.21, P = 0.002; (892 ± 387) vs (531 ± 501) uV, t = −6.18, P = 0.00 respectively; CHEP amplitude decreased in dorsum hand and peroneal area stimuli respectively (63.0 ± 10.0) vs (52.4 ± 12.6) uV, t = 3.09, P = 0.003; (44.7 ± 12.5) vs (29.3 ± 12.1) uV, t = 5.84, P = 0.00.3.Compared with the control group, CHEP amplitude decreased in peroneal area stimuli in SSRN group [(44.7 ± 12.5) vs (33.1 ± 18.9) uV, t = 2.94, P = 0.00]; In NCSN group, CHEP amplitude decreased in dorsum hand and peroneal area stimuli compared with the control group respectively (44.7 ± 12.5) vs (28.4 ± 17.4) uV, t = 1.88, P = 0.00; (63.0 ± 10.8) vs (52.4 ± 15.3) uV, t = 2.22, P = 0.00. Conclusion The incidence of peripheral neuropathy (PN) in patients with IGR was 39.2%, Neuropathy showed large and small fiber damage, mainly manifested as small fiber and lower limb sensory nerve fiber damage,CHEP can find small fiber damage earlier than SSR and NCS in patients with IGR.

Lipid-lowering drugs (statins) and peripheral neuropathy.

Background and aimPeripheral neuropathy is a disorder with often unknown causes. Some drugs, including statins, are proposed to be among the causes of peripheral neuropathy. This study aimed at evaluating this condition by electrodiagnostic study among patients who had received statins.MethodsThis case-control study was conducted in Shiraz, Iran in 2015, and included 39 patients aged 35–55 who had received statins for at least 6 months, and 39 healthy matched controls. Using electrodiagnosis, the sensory and motor wave features (amplitude, latency and nerve conduction velocity) of the peripheral nerves (Median, Ulnar, Tibial, Sural, and Peroneal) were evaluated among the subjects. Data were analyzed using SPSS software and p<0.05 was considered statistically significant.ResultsRegarding the occurrence of neuropathy, there were no significant differences in any of the definitions presented for peripheral neuropathy. However, the difference was close to significance for one definition [2 abnormalities in 2 nerves (p=0.055)]. Regarding mean values of the features, significant differences were observed in two features: amplitude of the peroneal motor nerve (p=0.048) and amplitude of the sural sensory nerve (p=0.036).ConclusionSince statins are widely used, awareness regarding their side-effects would lead to better treatment. Even though no significant differences were found between the groups regarding the occurrence of peripheral neuropathy, there were significant differences in amplitudes of the sural sensory response and the peroneal motor response. This indicates the involvement of peripheral nerves. Therefore, we recommend that patients and physicians should be informed about the possible symptoms of this condition.

Role of microRNAs in senescence and its contribution to peripheral neuropathy in the arsenic exposed population of West Bengal, India

Arsenic induced senescence (AIS) has been identified in the population of West Bengal, India very recently. Also there is a high incidence of arsenic induced peripheral neuropathy (PN) throughout India. However, the epigenetic regulation of AIS and its contribution in arsenic induced PN remains unexplored. We recruited seventy two arsenic exposed and forty unexposed individuals from West Bengal to evaluate the role of senescence associated miRNAs (SA-miRs) in AIS and their involvement if any, in PN. The downstream molecules of the miRNA associated with the disease outcome, was also checked by immuoblotting. Invitro studies were conducted with HEK 293cells and sodium arsenite exposure. Our results show that all the SA-miRs were upregulated in comparison to unexposed controls. miR-29a was the most significantly altered, highest expression being in the arsenic exposed group with PN, suggesting its association with the occurrence of PN. We looked for the expression of peripheral myelin protein 22 (PMP22), a specific target of miR-29a associated with myelination and found that both invitro and invivo results showed over-expression of the protein. Since this was quite contrary to miRNA regulation, we checked for intermediate players β-catenin and GSK-3β upon arsenic exposure which affects PMP22 expression. We found that β-catenin was upregulated invitro and was also highest in the arsenic exposed group with PN while GSK-3β followed the reverse pattern. Our findings suggest that arsenic exposure alters the expression of SA-miRs and the mir-29a/beta catenin/PMP22 axis might be responsible for arsenic induced PN.

Serum Neuroinflammatory Markers’ Levels and Evaluation of Peripheral Large Nerve Fibre Function in Patients with Psoriasis

Objective: Currently, tumor necrosis factoralpha (TNF-α) inhibitors are widely used all over the world, especially in the treatment of severe psoriasis. However, multiple sclerosis (MS) and peripheral neuropathy occurrence associated with TNF-α inhibitors have been reported in the treatment of patients with psoriasis. It is not known whether TNF-α inhibitors reveal underlying neurological disorders in patients with psoriasis. The aim of this study was to investigate whether there is an association between psoriasis and MS or peripheral neuropathy. Methods: In this study, 50 psoriasis patients and 25 healthy controls were enrolled. Neurological examination and needle electromyography test were performed. Serum levels of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), S-100 calcium-binding protein (S100B) and neuron specific enolase (NSE), which are involved in neuroinflammatory process, were measured. Results: Serum MMP-9 levels were higher in psoriasis patients compared to healthy controls. Serum MMP-2 and NSE levels were decreased in psoriasis patients compared to healthy controls. There was no significant difference in S100B levels between two groups. All neurophysiological parameters in each individual patient and control were found to be within normal limits and there was no difference between groups. Conclusion: NSE and MMP-9 might play role in the occurrence of MS in psoriasis patients. Especially, we are in the opinion that it might be useful to measure the serum levels of these markers before the administration of TNF-α inhibitors in psoriasis patients with family history of MS.

Efficacy of neoadjuvant chemotherapy combined with bevacizumab versus neoadjuvant chemotherapy alone for Her2-negative breast cancer: a meta-analysis of randomized controlled clinical trials

Objective: To evaluate the efficacy and safety of neoadjuvant chemotherapy combined with bevacizumab versus neoadjuvant chemotherapy alone for Her2-negative breast cancer.Methods: We searched PubMed, the Cochrane Library, Web of Science, CNKI, Wanfang Database and the abstracts of major international conferences in recent 5 years to identify prospective randomized controlled clinical trials that met the inclusion and exclusion criteria. Study selection and analyses were undertaken according to the Cochrane Handbook. Meta-analysis was performed using RevMan 5.3 software.Results: Six trials were identified with 4440 eligible patients. The results of this meta-analysis showed that the rate of pathological complete response (pCR) was higher in Her-2 negative breast cancer patients receiving bevacizumab combined with neoadjuvant chemotherapy than that in patients with neoadjuvant chemotherapy alone (24.7% vs 20.1%, RR=1.23, 95%CI:1.10-1.37, P<0.01). In addition, the pCR rate rose up when bevacizumab was added to neoadjuvant chemotherapy both in hormone receptor-positive patients (13.1% vs 10.2%,RR=1.28, 95%CI:1.04-1.58,P<0.05) and in hormone receptor-negative patients (46.3% vs 37.1%, RR=1.25, 95%CI:1.12-1.39, P<0.01). Statistical differences were observed in the rate of relevant adverse events such as hypertention (3.2% vs 0.6%, RR=5.292, 95%CI:2.933-9.549, P<0.01) and mucositis (10.5% vs 2.0%, RR=5.340, 95%CI:3.743-7.617, P<0.01) between the combination group and the chemotherapy alone group. Differences in other toxicities such as febrile neutropenia, infection, surgical complications, neutropenia and hand-foot syndrome were also found to be statistically significant between the combination group and the chemotherapy alone group (all P<0.05), while such difference was not found in the occurrence of peripheral neuropathy (P>0.05). Conclusion: The addition of bevacizumab to neoadjuvant chemotherapy in Her2-negative breast cancer can significantly improve pathological complete response, but may bring more grade 3 and 4 toxicities.More neoadjuvant trials need to be done to define subgroups of Her2-negative breast cancer that would have clinically significant long-term benefit from bevacizumab treatment.

HD6610 granules relieve oxaliplatin-induced peripheral neuropathy: study protocol for a multicenter randomized double-blind placebo-controlled trial

Background: Oxaliplatin, a platinum-based cytotoxic agent, is a widely used chemotherapeutic agent. Small-sample clinical trials and animal experiments have shown that Jiawei Huangqi Guizhi Wuwu Tang (a decoction of five components, including Radix Astragali and Ramulus Cinnamomi) effectively reduces peripheral neuropathy caused by oxaliplatin, but no confirmation exists from a prospective, multicenter, randomized, controlled, blinded clinical trial. Methods/Design: We plan to conduct such a trial that will be completed at the Department of Oncology, Jiangsu Provincial Hospital of Integrated Medicine, China, the Center of Oncology of Nanjing Drum Tower Hospital, China, and the Department of Oncology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, China. Sixty-four patients with colorectal cancer stages IIa-IV will be equally randomized into either the HD6610 granule group (oxaliplatin chemotherapy plus HD6610 granules, a granular form for Jiawei Huangqi Guizhi Wuwu Tang) or the HD6610 placebo group (oxaliplatin chemotherapy plus HD6610 placebo made of bitters, food coloring, and starch). Primary outcomes are the scores of the European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy and the National Cancer Institute's Common Terminology Criteria for Adverse Events Version 4.0. Secondary outcomes include the time of peripheral neuropathy occurrence, total neuropathy score, score of the European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire, and survival time. Other outcomes will be evaluated before treatment as well as 1 and 2 weeks and 2, 4, 8, 12, 16, 20, and 24 months after treatment. Discussion: This study will provide evidence that the clinical application of HD6610 can reduce oxaliplatin-induced peripheral neuropathy. Trial registration: ClinicalTrials.gov identifier: NCT02590367; registered on 14 September 2015. Ethical approval: The study protocol was approved by Jiangsu Provincial Hospital of Integrated Medicine in China (approval No. 2014ZX (KT)-010-02).

Clinical Risk Factors for Peripheral Neuropathy in Patients Treated with Subcutaneous or Intravenous Bortezomib for Newly Diagnosed Multiple Myeloma

Clinical Risk Factors for Peripheral Neuropathy in Patients Treated with Subcutaneous or Intravenous Bortezomib for Newly Diagnosed Multiple Myeloma

Screening techniques to identify occurrence of peripheral neuropathy among diabetic patients

Background Neuropathy is the greatest source of morbidity associated with diabetes, affecting up to 50% of those with long-standing disease, and pain as a symptom of neuropathy may be seen in as many as one third of all patients with diabetes. Aim: - The aim of this study was screen the occurrence of peripheral neuropathy among diabetic patients. Subjects and methods The design used for conduction of this study was prospective (cohort) study). Subjects: - A total 300 adults diabetic patients. Tools of data collection:-Tool I Diabetic patient knowledge scaduale, Tool II Diabetic foot examination checklist. It contained two items. General examination Highet , weight , BMI , heart rate , blood pressure, specific foot examination, diagnosis of diabetic peripheral neuropathy using neuropathy symptoms score (NSS),neuropathy disability score (NDS),Pressure perception using 10gm Semmes Winston monofilament on10 sites in two feet and sensory assessment Results: -. The patients who had ≥ 3in total score of neuropathy symptoms score (NSS) were 23%, (10.3%) had total score ≥6 in neuropathy disability score. Loss of protective sensation was common in (11.0%) of patients. The total patients diagnosed with neuropathy (Abnormal with one of these three parameters) were 27 .3 % of studied sample. Also the study reveals that assessment of foot pressure perception using 10gm monofilament had the best sensitivity.Conclusion based on the findings it was concluded that diabetic peripheral neuropathy was diagnosed in one third of studied sample ,10gm monofilament had the best sensitivity Recommendations .All patients with diabetes should be screened at least annually for presence of diabetic peripheral neuropathy. Foot care education must be provided to every diabetic patient with regular confirmation