Severity Of Neuropathy Research Articles

Features characterising cardiac autonomic neuropathy in diabetes using ensembled classification

ObjectiveUsing supervised machine learning to classify the severity of cardiovascular autonomic neuropathy (CAN). The aims were 1) to investigate which features contribute to characterising CAN 2) to generate an ensembled set of features that best describes the variation in CAN classification. MethodsEighty-two features from demographic, beat-to-beat, biochemical, and inflammation were obtained from 204 people with diabetes and used in three machine-learning-classifiers, these are: support vector machine, decision tree, and random forest. All data were ensembled using a weighted mean of the features from each classifier. ResultsThe 10 most important features derived from the domains: Beat-to-beat, inflammation markers, disease-duration, and age. ConclusionsBeat-to-beat measures associate with CAN as diagnosis is mainly based on cardiac reflex responses, disease-duration and age are also related to CAN development throughout disease progression. The inflammation markers may reflect the underlying disease process, and therefore, new treatment modalities targeting systemic low-grade inflammation should potentially be tested to prevent the development of CAN. SignificanceCardiac reflex responses should be monitored closely to diagnose and classify severity levels of CAN accurately. Standard clinical biochemical analytes, such as glycaemic level, lipidic level, or kidney function were not included in the ten most important features. Beat-to-beat measures accounted for approximately 60% of the features in the ensembled data.

Correspondence of the Boston Carpal Tunnel Questionnaire with severity of median neuropathy.

The Boston Carpal Tunnel Questionnaire is one of the most popular patient-reported outcome measures designed specifically for people with idiopathic median neuropathy at the carpal tunnel. We used electrophysiological and ultrasound measures of median neuropathy from one hand in 185 people to create a single measure of median neuropathy severity as a continuum (through exploratory factor analysis). We assessed if our single measure of median neuropathy severity is independently associated with Boston Carpal Tunnel Questionnaire item groupings. Median neuropathy severity measured as a continuum had modest independent associations with Boston Carpal Tunnel Questionnaire magnitude of capability (adjusted R2 0.063) and paraesthesia intensity (adjusted R2 0.12) items but not with items related to pain intensity. Considering the lack of association of Boston Carpal Tunnel Questionnaire pain items with objective pathophysiology, combined with their notable association with mental health measures in previous studies, it is probably best to omit items related to pain.Level of evidence: III.

Association of Paclitaxel Induced Neuropathy with Quality of Life of Patients with Non-Metastatic Breast Cancer

Objective: To look for an association of Paclitaxel induced neuropathy with the quality of Life of patients with non-metastatic breast cancer.
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Feb 2022.
 Methodology: The study included one hundred and twenty patients with diagnosed non-metastatic breast cancer taking Paclitaxel chemotherapy for more than one month. Peripheral neurotoxicity was assessed by a consultant oncologist based on the Eastern Cooperative Oncology Group (ECOG) score. In addition, quality of Life was recorded with the help of the World Health Organization Quality of Life (WHOQOL)-BREF scale in all the study participants and associated with the presence and severity of neuropathy.
 Results: Out of 120 non-metastatic breast cancer patients using Paclitaxel for more than one month included in the study, 113 (94.2%) were female, while 7(5.8%) were male. 52(48.3%) had good quality of Life, while 68(51.7%) had poor quality of Life. 34(28.3%) had Grade-0 neuropathy, 54 (45%) had Grade-I, 30(25%) had Grade-II, and 2(1.6%) had Grade-III neuropathy.Statistical analysis showed that the presence and severity of neurotoxicity had a statistically significant relationship with poor quality of Life (p-value=0.001).
 Conclusion: Many patients having breast cancer using Paclitaxel had the presence of neuropathy. The presence and severity of neuropathy are strongly associated with poor quality of Life in patients included in our study.Keywords: Breast cancer, Neurotoxicity, Paclitaxel, Quality of life.

Predictive value of ultrasonography in polyneuropathy diagnosis: electrophysiological and ultrasonographic analysis.

Peripheral neuropathy may cause serious complications such as foot ulcers and Charcot joint which can prevent by early diagnosis. We aimed to analyze the diagnostic value of ultrasonographic measurements of nerves and muscles in distal symmetric axonal polyneuropathy (DSAP). Study included 51 DSAP patients and 51 controls. Nerve conduction studies were performed. Median, ulnar, tibial, superficial peroneal, and sural nerves and the abductor pollicis brevis (APB), abductor digiti minimi (ADM), first dorsal interosseous (FDI), extensor digitorum brevis (EDB), abductor hallucis (AH) and tibialis anterior (TA) muscles were evaluated with ultrasound. The Toronto clinical scoring system (TCSS) was used to assess the severity of neuropathy. The median, ulnar, and tibial nerve cross-sectional areas (CSA) were higher in the DSAP group (p = 0.025, p = 0.011, p < 0.001 respectively) while superficial peroneal and sural nerve CSAs were not differed. Only AH and EDB ultrasonographic findings from the muscles differed between the two groups. Effect of diabetes and DSAP on sonographic findings were assessed with two-way ANOVA. Results indicated that only DSAP had a significant effect on sonographic nerve and muscle examination. The area under the ROC curve was 0.831 ± 0.042 for tibial nerve CSA (p < 0.001) with a cut-off value of 15.5 mm2 (sensitivity 74% and specificity 83%). Median, ulnar and tibial nerve CSAs were found to be larger in polyneuropathy patients and they were associated with the clinical and electrophysiological severity of polyneuropathy. ROC analysis showed that tibial nerve CSA may have a predictive value in the diagnosis of DSAP.

Prevalence of Hearing Loss in Type 2 Diabetes Mellitus and Its Association with Severity of Diabetic Neuropathy and Glycemic Control.

This study assessed the prevalence of hearing loss (HL) in patients with type 2 diabetes mellitus (T2DM) and its relationship with the presence and severity of diabetic neuropathy. Patients between the ages of 30 and 60 years (both ages inclusive) with T2DM were recruited and divided into three groups. Group I included patients without neuropathy. Group II had patients with mild neuropathy. Group III had patients with moderate and severe neuropathy. After informed consent hearing threshold was assessed using pure tone audiometry (PTA). Of the 200 patients recruited, the prevalence of HL was overall 81%. The prevalence was 66.7% in group I, 80.9% in group II, and 87.6% in group III (p = 0.009). Among patients with moderate to severe neuropathy (group III), 33.3% had clinically significant HL (CSHL) (p = 0.015). Age, gender, presence of neuropathy, and severity of neuropathy were associated with an increased risk of developing HL. Among patients with diabetes, age, nephropathy, and neuropathy were associated with HL. The severity of HL worsened with the worsening severity of neuropathy and increase in glycated hemoglobin (Hba1c) levels. Patients with moderate to severe neuropathy might benefit from screening for HL.

Neuropathy and Serum Vitamin B 12 Level in Metformin Treated Type2 Diabetic Patients of North India: A Single Centre Observational Study

Abstract: Aim: To determine the prevalence of neuropathy with the help of MNSI questionnaire (Michigan neuropathy screening instrument) Method: A single Centre observational study was completed in a tertiary care hospital between jan 2020 to april 2021. .In our study, 95 type 2 diabetes patients who had been taking metformin for a minimum of three months were included in a row. The severity of peripheral neuropathy (as measured by MNSI) and severe characteristics were compared. The length of diabetes, the length of metformin medication, dietary history, and HbA1c levels were some of these. B12 15 pg/ml was considered a definitive B12 deficit, while 220pg/ml was considered a potential B12 insufficiency. Result: In our research, we discovered a weak negative relationship (r=0.19) between the duration of metformin administration and vitamin B12 levels. In our investigation, the average vitamin B12 concentration was 99.22 pg/mL. Peripheral neuropathy and metformin medication duration had a favourable connection (r=1). The typical MNSI result was 11.2. Patients without peripheral neuropathy took metformin for an average of 3.5 years, whereas those with the condition took the drug for an average of 8.04 years.

Study on autonomic neuropathy of the digestive system caused by bortezomib in the treatment of multiple myeloma

ABSTRACTObjectiveTo research the effects of autonomic neuropathy of the digestive system induced by bortezomib on clinical efficacy and quality of life.MethodsA total of 150 patients with newly diagnosed multiple myeloma (MM) were hospitalized in our department from January 2018 to December 2021, and treated with bortezomib-based combination regimens. To observe the incidence of autonomic neuropathy of the digestive system and analyse the correlations between the severity of autonomic neuropathy and the efficacy, survival, age, underlying diseases and personal history.ResultsThe incidence of autonomic neuropathy of the digestive system was 60.0%. The overall response rate (ORR), 2-year progression-free survival (PFS) rate and 2-year overall survival (OS) rate in the grade 3 group of autonomic neuropathy were significantly lower than those in the grade 1–2 group, and the differences were statistically significant (P < 0.05). Age, constipation, diabetes, fracture/spinal cord compression in bed and history of alcoholism were positively correlated with the risk of autonomic neuropathy of the digestive system (P < 0.05). The autonomic neuropathy of the digestive system was significantly alleviated in most patients after the timely adjustment of the treatment regimen, and bortezomib could continue to be administered.ConclusionsThe incidence of autonomic neuropathy of the digestive system induced by bortezomib is high, and its severity is closely related to efficacy, advanced age, constipation, diabetes, fracture/spinal cord compression in bed and history of alcoholism. Early detection and early treatment are necessary to better treat the disease and reverse the autonomic neuropathy.

Mutational Profile in 75 Patients With Anti-Myelin-Associated Glycoprotein Neuropathy: Clinical and Hematologic Therapy Response and Hints on New Therapeutic Targets.

Neuropathy with antibodies to myelin-associated glycoprotein (MAG) is the most common paraproteinemic IgM neuropathy. Recently, the mutational profile of the MYD88 and CXCR4 genes has been included in the diagnostic workup of IgM monoclonal gammopathies. The objective of our study was to assess the prevalence of MYD88 L265P and CXCR4 S338X gene variants in patients with anti-MAG antibody neuropathy. Secondary aims were to evaluate possible correlations between the mutational profile and neuropathy severity, antibody titers, and treatment response. Seventy-five patients (47 men, mean age at molecular analysis 70.8 ± 10.2 years; mean disease duration 5.1 ± 4.9 years) with anti-MAG antibody neuropathy were recruited. Among them, 38 (50.7%) had IgM monoclonal gammopathy of undetermined significance, 29 (38.7%) Waldenstrom macroglobulinemia (WM), and 8 (10.6%) chronic lymphocytic leukemia/marginal zone lymphoma/hairy cell leukemia variant. Molecular analysis was performed on DNA from the bone marrow mononuclear cells in 55 of 75 patients and from peripheral mononuclear cells in 18 of 75 patients. Forty-five patients were treated with rituximab, 6 with ibrutinib, 2 with obinutuzumab-chlorambucil, and 3 with venetoclax-based therapy. All the patients were assessed with the Inflammatory Neuropathy Cause and Treatment (INCAT) Disability Scale, INCAT Sensory Sum Score, and MRC Sum Score at baseline and follow-up. We considered as responders, patients who improved by at least 1 point in 2 clinical scales. Fifty patients (66.7%) carried the MYD88L265P variant, with a higher frequency in WM and naive patients (77.2% vs 33.3%, p = 0.0012). No patients harbored the CXCR4S338X variant. There were no significant differences in hematologic data (IgM levels, M protein, and anti-MAG antibody titers), neuropathy severity, or response to rituximab in MYD88-altered and MYD88 wild-type patients. Nine of 11 (81.8%) patients treated with novel targeted drug, according to the MYD88 status, responded to treatments. MYD88L265P variant has a high prevalence (66.7%) in anti-MAG antibody neuropathy representing a potential effective mutational target for Bruton tyrosine kinase inhibitors. MYD88L265P variant, however, does not seem to be a prognostic factor of neuropathy severity or response to rituximab. In patients not responding or becoming refractory to rituximab, a tailored therapy with new effective target therapies should be considered.

The Effect of Metformin on Chemotherapy-Induced Toxicities in Non-diabetic Breast Cancer Patients: A Randomised Controlled Study

Breast cancer patients treated with adriamycin-cyclophosphamide plus paclitaxel (AC-T) are often challenged with serious adverse effects for which no effective therapies are available. Here, we investigated whether metformin, an antidiabetic drug with additional pleiotropic effects could favourably offset AC-T induced toxicities. Seventy non-diabetic breast cancer patients were randomised to receive either AC-T (adriamycin 60 mg/m2 + cyclophosphamide 600 mg/m2 × 4 cycles Q21 days, followed by weekly paclitaxel 80 mg/m2 × 12 cycles) alone or AC-T plus metformin (1700 mg/day). Patients were assessed regularly after each cycle to record the incidence and severity of adverse events based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0. Moreover, baseline echocardiography and ultrasonography were done and repeated after the end of neoadjuvant therapy. Addition of metformin to AC-T resulted in significantly less incidence and severity of peripheral neuropathy, oral mucositis, and fatigue (p < 0.05) compared to control arm. Moreover, the left ventricular ejection fraction (LVEF%) in the control arm dropped from a mean of 66.69 ± 4.57 to 62.2 ± 5.22% (p = 0.0004) versus a preserved cardiac function in the metformin arm (64.87 ± 4.84to65.94 ± 3.44%, p = 0.2667). Furthermore, fatty liver incidence was significantly lower in metformin compared with control arm (8.33% vs 51.85%, p = 0.001). By contrast, haematological disturbances caused by AC-T were preserved after concurrent metformin administration (p > 0.05). Metformin offers a therapeutic opportunity for controlling toxicities caused by neoadjuvant chemotherapy in non-diabetic breast cancer patients. This randomised controlled trial was registered on November 20, 2019 in ClinicalTrials.gov under registration number: NCT04170465.

The Association between Waist Hip Ratio and Severity of Diabetic Peripheral Neuropaty in Diabetes Melitus Type 2 by Using Toronto Clinical Scoring System

Introduction: Diabetic neuropathy is a common and progressive microvascular complication of diabetes, so early detection and prevention is very important. Other modifiable risk factors such as hypertension, dyslipidemia, or central obesity can be managed. Central obesity with insulin resistance is a key pathophysiological factor in the metabolic syndrome. Waist hip ratio (WHR) has been proposed as a tool for detecting central obesity. Toronto Clinical Scoring System (TCSS) is a diabetic neuropathy scoring system that has high sensitivity and specificity. The aim of this study was to determine the relationship between waist hip ratio and the severity of peripheral diabetic neuropathy in type 2 Diabetes Melitus (DM) according to the Toronto Clinical Scoring System (TCSS). Method: This study used a cross-sectional design. Sampling was conducted at the Endocrinology Polyclinic and Neurology Polyclinic Hospital H. Adam Malik Medan. The research sample was taken as many as 45 subjects consecutively. TCSS examination is performed to diagnose and determine the severity of diabetic neuropathy Therefore, waist hip ratio was calculated to assess central obesity. Data analysis using Chi Square test. Results: On the demographic characteristics of the research subjects were male, age range 51-60 years, high school education level, not working, history of DM 5-10 years. The mean value of WHR is 0.87±0.051. Median TCSS Score 10 (6-16). The majority of subjects had mild diabetic peripheral neuropathy. Patients with central obesity had a grading of neuropathy that was classified as severe as many as 13 people (56.5%), moderate as many as 7 people (30.4%), and mild as many as 3 people (13.0%). While patients who are not obese have a grading of neuropathy that is classified as severe as many as 1 person (4.5%), moderate as many as 5 people (22.7%), mild as many as 16 people (72.7%). Based on the Chi Square test, it was found that there was a significant association between the waist hip ratio and the severity of diabetic peripheral neuropathy in type 2 DM patients with p&lt;0.01. Conclusion: There is a statistically significant association between waist hip ratio and the severity of diabetic neuropathy in type 2 DM with p &lt; 0.01.

Correlation Between the Peripheral Neuropathy and Levels of hs-CRP, IL-1β and IL-6 in Senile Parkinson's Disease Patients.

This study was carried out to investigate the correlation between the onset of peripheral neuropathy and levels of hypersensitive C-reactive protein (hs-CRP), interleukin 1β (IL-1β) and IL-6 in senile Parkinson's disease (PD) patients. For this purpose, a total of 60 PD patients and 60 age-matched healthy subjects were enrolled in this study and received the assessment for peripheral nerves by using the quantified method. Besides, levels of hs-CRP, IL-1β and IL-6 in serum were determined to analyze the correlation between the clinical features, including the severity of PD and cognitive decline, and the levels of hs-CRP, IL-1β and IL-6. Results showed that PD patients had more cases of peripheral neuropathy than those in the healthy control group. Levels of hs-CRP, IL-1β and IL-6 in the serum of PD patients were much higher than those in the healthy control (P<0.05). Besides, PD patients had lower scores of MMSE and MoCA but higher CNPI scores when compared to the healthy control group. As a result, we found that the severity of peripheral neuropathy was in a positive correlation with the levels of hs-CRP, IL-1β and IL-6. It was concluded that PD patients generally have peripheral neuropathy that may correlate with the increases in the levels of hs-CRP, IL-1β and IL-6, and early intervention may mitigate the development and progression of peripheral neuropathy.

The Relationship between Hba1c Levels and Body Mass Index with Severity of Diabetic Neuropathy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Diabetic neuropathy is the most common microvascular complication in diabetes mellitus patients. Diabetic neuropathy is known to be associated with conditions of hyperglycemia and obesity that occur in diabetic patients. Hyperglycemia in diabetic patients can be monitored through HbA1c levels. This study aimed to assess the relationship between HbA1C values and body mass index with the severity of diabetic neuropathy based on nerve conduction velocity examination.&#x0D; Methods: A study with a cross-sectional design with a total of 25 subjects with diabetes mellitus. The severity of diabetic neuropathy was determined based on Baba's diabetic neuropathy classification (BDC), degrees 0 to 4. In all study subjects, plasma HbA1c levels were examined, and body mass index was assessed. The relationship between categorical variables was tested with the chi-square test, and the relationship between numerical and categorical variables with a one-way ANOVA test, the value was considered statistically significant if the p-value &lt;0.05.&#x0D; Results: The 25 subjects with diabetes found a mean age of 54.88 (±SD 8.918) years, with a gender distribution of 46.4% for women and 42.9% for men. The average HbA1c level was 8.9560 (± 2.21850), and the highest body mass index was obese (50%). There was a significant relationship between HbA1c levels and the severity of diabetic neuropathy based on electrophysiological examination (p&lt;0.05), but there was no significant relationship between the value of body mass index and the severity of diabetic neuropathy.&#x0D; Conclusion: Increased HbA1c levels are associated with increased severity of peripheral neuropathy in patients with diabetes mellitus.

An evaluation of the effect of lithium on taxane-induced neuropathy.

No medications are known to protect against chemotherapy-induced peripheral neuropathy (CIPN). Pre-clinical models suggest that lithium may lessen taxane-induced neuropathy. Our aim was to use clinical data to assess whether concurrent lithium usage decreased the frequency or severity of CIPN in patients receiving taxane chemotherapy. A retrospective analysis was performed using the electronic health record at Mayo Clinic to identify all patients prescribed concurrent lithium and paclitaxel. Four controls were matched to each case based on clinical variables. Neuropathy severity was graded from available patient and clinician reports. Rates of any neuropathy, dose reduction for CIPN, and treatment discontinuation for CIPN were compared. Conditional regression analysis was performed with propensity score matching. Six patients, receiving concurrent lithium and paclitaxel, were included in the analysis, and compared to 24 control cases. A similar number of paclitaxel cycles were administered to both groups. Any neuropathy was experienced by 33% (2/6) of patients receiving lithium and 38% (9/24) patients who did not receive lithium (p = 1.000). There was no difference in neuropathy severity (p = 0.8565), rate of chemotherapy dose reduction (17% vs. 17%, p = 1.000), or treatment discontinuation (17% vs 4%, p = 0.3655) for CIPN. In the propensity score analysis, the odds ratio for developing any neuropathy was 0.63 (95% confidence interval, 0.06 to 6.96, p = 0.7079). Lithium does not appear to significantly lessen the risk of neuropathy for patients receiving paclitaxel. Targeted approaches for preventing CIPN are desperately needed. Despite sound scientific rationale, the current study did not identify neuroprotective properties of lithium.

Can Endoplasmic Reticulum Stress Responses Predict the Development of CIPN in Patients Receiving Paclitaxel-based Therapy? (P12-13.001)

<h3>Objective:</h3> To determine if XBP1s correlates with the onset and severity of chemotherapy-induced peripheral neuropathy (CIPN) in patients receiving paclitaxel (PTX) therapy for their cancer. <h3>Background:</h3> Neuroinflammation is one proposed mechanism for the development of CIPN. X-box binding protein 1 (XBP1s), a prominent molecule in the IRE1α–XBP1 signaling pathway (which regulates the production of enzymes that mediate inflammation-induced pain), shows promise as a potential biomarker to predict the onset of CIPN. <h3>Design/Methods:</h3> Patients newly diagnosed with gynecologic malignancy receiving PTX-based first-line therapy were recruited before treatment initiation. Once consented, blood samples were drawn before treatment and at each scheduled PTX infusion. Determination of serum PTX levels using mass spectrometry and XBP1s mRNA levels in peripheral blood mononuclear cells (PBMCs) by qPCR were performed. In addition, at every infusion time point, each patient’s level of peripheral neuropathy was graded by a physician or advanced provider based on CTCAE (Common Terminology Criteria for Adverse Events) grading criteria (scored 0–5, with 0 being asymptomatic and higher numbers indicating worse neuropathy). Cellular XBP1s, serum PTX, and neuropathy CTCAE scores were statistically associated. <h3>Results:</h3> The study cohort consisted of 8 patients; all female; mean age 55±17 years. All 8 received PTX/carboplatin. Of these, 7 developed symptomatic CIPN (physician assessment). Median peak neuropathy CTCAE grade was 1 (range 0–2). Mean XBP1s peak value was 0.049±0.032; mean baseline XBP1s value was 0.027±0.015. There was a significant association between rise of XBP1s from baseline to peak and neuropathy CTCAE grade (r=0.830, R₂=0.725, p=0.018). Patients with higher serum PTX also had higher PBMC XBP1s expression relative to baseline (p=0.022). Patients with longer days to peak of XBP1s also had longer days to onset of CIPN (r=0.757, R₂=0.573, p=0.049). <h3>Conclusions:</h3> A greater rise from baseline in XBP1s, a marker of ER stress, correlated with the timing and severity of PTX-induced CIPN. <b>Disclosure:</b> Mr. Limia has nothing to disclose. Dr. Foneca has nothing to disclose. Dr. Gelblung has nothing to disclose. Dr. Shalowitz has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nimble, LLC. The institution of Dr. Shalowitz has received research support from Foundation for Women’s Cancers. The institution of Dr. Shalowitz has received research support from National Cancer Institute. Dr. Kelly has nothing to disclose. Fang-Chi Hsu has nothing to disclose. Dr. Furdui has stock in Xoder Technologies. Dr. Furdui has received intellectual property interests from a discovery or technology relating to health care. Dr. Cubillos-Ruiz has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for NextRNA Therapeutics. The institution of Dr. Cubillos-Ruiz has received research support from Department of Defense. The institution of Dr. Cubillos-Ruiz has received research support from National Institutes of Health. The institution of Dr. Cubillos-Ruiz has received research support from The Mark Foundation for Cancer Research. Edgar Alfonso Romero-Sandoval has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Pain Research. The institution of Edgar Alfonso Romero-Sandoval has received research support from NINDS. The institution of Edgar Alfonso Romero-Sandoval has received research support from NIDA. The institution of Edgar Alfonso Romero-Sandoval has received research support from NIGMS. Dr. Strowd has received personal compensation for serving as an employee of Kaplan. Dr. Strowd has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Monteris Medical, Inc. Dr. Strowd has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novocure. Dr. Strowd has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. The institution of Dr. Strowd has received research support from Southeastern Brain Tumor Foundation. The institution of Dr. Strowd has received research support from Jazz Pharmaceuticals. The institution of Dr. Strowd has received research support from National Institutes of Health. The institution of Dr. Strowd has received research support from Alpha Omega Alpha. The institution of Dr. Strowd has received research support from American Board of Psychiatry and Neurology. Dr. Strowd has received publishing royalties from a publication relating to health care. Dr. Strowd has received publishing royalties from a publication relating to health care.

Aqueous humor cytokine levels are associated with the severity of visual field defects in patients with primary open-angle glaucoma

BackgroundTo evaluate the aqueous humor (AH) levels of cytokines in primary open-angle glaucoma (POAG) patients and cataract patients.MethodsThirty-eight POAG patients and 26 cataract patients were recruited. Peripheral blood (PB) was collected from each subject. The POAG group was divided into 2 subgroups according to the severity of visual field defects. The cutoff point of the mean deviation (MD) of the visual field was -12 dB. AH was obtained at the time of anterior chamber puncture during cataract or glaucoma surgery by using a 27-gauge needle attached to a microsyringe. AH and PB levels of interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta2 (TGF-β2) and IL-4 were assayed by enzyme-linked immunosorbent assay. Postoperative intraocular pressures (IOPs) of POAG patients were recorded during the follow-up period.ResultsTNF-α and TGF-β2 showed significantly higher AH levels in the POAG group than in the cataract group (P < 0.001 and P = 0.001, respectively). For the POAG group, preoperative IOPs were significantly positively correlated with AH levels of TNF-α (r2 = 0.129, P = 0.027) and TGF-β2 (r2 = 0.273, P = 0.001). AH levels of TGF-β2 were significantly different among cataract patients, POAG patients with MD> -12 dB and POAG patients with MD≤ -12 dB (P = 0.001). AH levels of TNF-α were significantly positively associated with IOP reduction after trabeculectomy (P = 0.025). AH and PB levels of cytokines were not related to the long-term success of trabeculectomy.ConclusionThe levels of TNF-α and TGF-β2 showed different profiles in POAG patients and cataract patients. AH levels of TGF-β2 were correlated with the severity of glaucomatous neuropathy in POAG patients. The findings suggest possible roles for cytokines in the pathogenesis and development of POAG.

Predictors of the 6-min walk test in patients with ovarian cancer.

To identify the predictors of the 6-min walk test (6MWT) and investigate the relationship between 6MWT, performance status, functional mobility, fatigue, quality of life, neuropathy, physical activity level, and peripheral muscle strength in patients with ovarian cancer (OC). Twenty-four patients diagnosed with stage II-III ovarian cancer were included in the study. Patients were assessed using the following measurement methods: 6MWT for walking capacity, Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, an armband physical activity monitor for physical activity level, Checklist Individual Strength (CIS) for fatigue, Functional Cancer Treatment Evaluation with Quality of Life-Extreme (FACT-O) for quality of life, Functional Evaluation of Cancer Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, a hand-held dynamometer for peripheral muscle strength, and 30-s chair-stand test for functional mobility. The mean 6MWT distance was 578.48 ± 115.33 meters. 6MWT distance correlated with ECOG-PS score (r = -0.438, p = 0.032), handgrip strength (r = 0.452, p= 0030), METs (r = 0.414, p= 0.044) 30s-CST (r= 0.417, p= 0.043), and neuropathy score (r = 0.417, p = 0.043) significantly. There was no relationship between 6MWT distance and other parameters (p> 0.05). Multiple linear regression analysis demonstrated that performance status was the sole predictor of 6MWT. The walking capacity seems to be associated with performance status, peripheral muscle strength, level of physical activity, functional mobility, and severity of neuropathy in patients with ovarian cancer. Evaluating these may help clinicians to understand factors behind the decreased walking capacity.

A Comparison Between the Efficacy of Venlafaxine and Duloxetine in Improving Chemotherapy-Induced Chronic Neurotoxicity in Cancer Patients

Background: Chemotherapy-induced peripheral neuropathy is one of the most common side effects of chemotherapy. This study aimed to determine the effectiveness of venlafaxine and duloxetine in improving chronic neurotoxicity induced by chemotherapy in cancer patients. Materials and Methods: The study was performed on cancer patients undergoing outpatient chemotherapy or hospitalization in Rasoul Akram hospital. The admitted patients were blindly divided into two groups. The first group was treated with venlafaxine, and the second group was treated with duloxetine. The treatment lasted up until the patients’ full recovery up to 10 weeks. Different intensities of the patients’ neuropathy were measured on all days of treatment based on NCI Common Terminology Criteria for Adverse Events (CTCAE) v 3.0 criteria. At the end of the treatment, the side effects of venlafaxine and duloxetine were identified. Results: A total of 30 patients in two groups (n=15 for each group) were treated with venlafaxine and duloxetine. There was no significant difference between the two groups in terms of age and gender. The severity of neuropathy was significantly reduced in the venlafaxine compared to the duloxetine group from 7 to 10 weeks. The results indicated that 75% and 85.7% fall asleep in the venlafaxine group and the duloxetine group, respectively. Further, there was no significant difference between the two groups in terms of drug side effects. Conclusion: This study showed that venlafaxine is a suitable drug for the treatment of chronic neurotoxicity in patients with relatively fewer side effects compared to other used drugs. Although these results require further prospective studies due to the small sample size, future drug regimens may preferably contain venlafaxine.

Quantitative thermal testing as a screening and follow-up tool for diabetic sensorimotor polyneuropathy in patients with type 2 diabetes and prediabetes.

The diagnosis and assessment of neuropathy severity of diabetic sensorimotor polyneuropathy (DSPN) are mainly based on clinical neuropathy scores and electrophysiologic studies. This study aimed to determine whether quantitative thermal testing (QTT) can be used as a screening and follow-up tool for DSPN of prediabetes and type 2 diabetes at baseline and at 1-year follow-up. All patients were assessed using the Toronto Clinical Neuropathy Score (TCNS) and underwent electrophysiological testing, including a nerve conduction study (NCS) and QTT, at baseline and at a 1-year follow-up. The TCNS and the composite scores of nerve conduction were used to assess the severity of DSPN. The DSPN status at the 1-year follow-up was classified as remaining no DSPN, remaining DSPN, regression to no DSPN, or progression to DSPN. Diabetic sensorimotor polyneuropathy was initially diagnosed in 89 patients with prediabetes and type 2 diabetes (22%). The regressed to no DSPN in 29 patients and progressed to DSPN in 20 patients at the 1-year follow-up. TCNS was significantly correlated with composite scores of nerve conduction, hand cold detection threshold (CDT), hand warm detection threshold (WDT), foot CDT, and foot WDT. Stepwise logistic regression demonstrated that the foot CDT (p < 0.0001) was independently associated with the presence of DSPN. The TCNS, composite scores of the nerve conduction, hand WDT, hand CDT, foot WDT, and foot CDT were all statistically significant among the four different DSPN status groups at two different time periods (baseline and the 1-year follow-up). The foot CDT can be used as an initial screening tool for DSPN alternatively. The characteristics of nerve damage after 1 year of DSPN can be progressive or reversible, and the neurological functions of large and small fibers have a parallel trend, which can be objectively measured by NCS and QTT.

Impact of vitamin B6 deficiency on the severity of diabetic peripheral neuropathy – A cross sectional study

BackgroundDiabetic Peripheral Neuropathy is one of the most important and significantly prevalent microvascular complications of Diabetes Mellitus. Pyridoxine is a key nutrient for protecting nerve health. The objective of this research is to study the prevalence rate of pyridoxine deficiency in Diabetic neuropathy patients, to understand the correlation between various biochemical and markers of diabetic neuropathy and pyridoxine deficiency. Results249 patients were selected for the study based on the selection criteria participants. 51.8% prevalence of pyridoxine deficiency in Diabetic neuropathy patients. The nerve conduction velocity significantly reduced in pyridoxine deficiency cases (p < 0.05). A strong inverse relationship is observed with fasting blood sugar levels and glycated hemoglobin pyridoxine deficiency might contribute to impaired glucose tolerance. ConclusionThere also exists a strong inverse relationship with glycemic markers. Significant direct correlation is observed with nerve conduction velocity. Pyridoxine also has properties of antioxidant which may be utilized for the management of Diabetic Neuropathy.

Abstract P5-07-03: The Association Between Symptom Severity and Physical Function among Participants in I-SPY2

Abstract Background. Patient-reported outcomes (PROs) are increasingly recognized as a valuable component to understand treatment tolerability and toxicity among patients on clinical trials. We have implemented a system for monitoring patient reported outcomes (PROs), symptoms, and quality of life (QOL) using electronic PRO (ePRO) instruments for patients enrolled in the I-SPY2 trial. I-SPY2 is a phase II multi-site clinical trial evaluating the effect of novel neoadjuvant therapies for locally advanced breast cancer. We correlated patient demographic factors with symptoms, investigated the trajectory of symptoms throughout treatment, and sought to characterize symptoms associated with decline in physical function (PF). Methods. Our study population included 259 I-SPY2 patients that completed surveys on one of 9 study arms (including novel oral taxane/immunotherapy combinations, IV paclitaxel, checkpoint inhibitor+/- LAG3 inhibitor, and control IV paclitaxel +/- trastuzumab/pertuzumab). After the 12 week period of investigational agents, most patients received standard adriamycin and cyclophosphamide (AC). Symptom severity, frequency, and interference was assessed weekly using 33 items from the PRO-CTCAE item bank. PF was assessed using the NIH PROMIS instrument and was evaluated at baseline, inter-regimen (after 12 weeks of treatment), pre-surgery, and 1 and 6 months at follow-up. An odds ratio was used to assess univariate associations between age and race, and symptoms. Regularized multi-variate regression was used to evaluate early symptoms (prior to week 6) predictive of a clinically significant (&amp;gt;5 point T-score) decline in PF from baseline to post-treatment follow-up among all races and age groups. Results. Of 259 patients (mean age (SD) = 46.8 (13.6)), 160 (58%) were White, 13 (5%) were Asian, 26 (10%) were African American (AA), 25 (9.3%) were Hispanic, and 35 (13.5%) self-reported “Other”. At baseline, AA patients had a higher severity of joint pain than White patients (OR = 14.9, P &amp;lt; 0.05). During study treatment with paclitaxel and/or novel agent within the first 12 weeks of treatment, AA patients and non-white (NW) patients were more likely to report severe vomiting than White patients (OR =13.22 and 12.72, P&amp;lt; 0.05 and P&amp;lt; 0.03 respectively). During treatment with AC, NW patients were more likely to report higher severity of neuropathy than White patients (OR = 5.43, P&amp;lt; 0.03). Among all patients, in analysis of early symptoms predictive of a clinically significant decline in PF between baseline and 1 month post treatment, predictors included high frequency of diarrhea, severity of itching, and severity of joint pain. Further analysis of symptom trajectories revealed that frequency of diarrhea reported rose sharply between baseline and Cycle 2 with 9 patients (7%) reporting occasional or frequent diarrhea to 39 patients (28%) reporting occasional to almost constant diarrhea and remained stable at that proportion for the remainder of treatment. Frequency of diarrhea declined slightly during AC (17%) and dropped to baseline levels by follow-up. In contrast, severity of joint pain persisted post-treatment, rising consistently from baseline through follow- up with 3 patients (2%) reporting moderate to severe joint pain at baseline to 18 patients (35%) reporting moderate to severe joint pain at follow-up. Conclusion. Among I-SPY2 participants, when higher grade of diarrhea is persistent (or uncontrolled), it impacts physical function even after end of therapy. In some cases, race was also a determinant in symptom trajectory, although a higher enrollment of AA and NW patients will enable more robust estimates to be computed. While some of these early symptom predictors are transient and resolve by the time of follow-up, others persist long-term and contribute more directly towards impaired physical function at follow-up. Citation Format: Amrita Basu, Saumya Umashankar, Kaylee Blevins, Anna Northrop, Anika Christofferson, Ebunoluwa Olunuga, Jaeyoon Cha, Ananya Mittal, Julissa Molina-Vega, Laura Sit, Thelma Brown, Bev Parker, Diane Heditsian, Susie Brain, Carol Simmons, Alessandra Taboada, Tina J. Hieken, Kathryn Ruddy, Carolina Salvador, Candace Mainor, Anosheh Afghahi, Sarah Tevis, Anne Blaes, Irene M. Kang, Jane Perlmutter, Hope Rugo, Sai Kanaparthi, Garry Peterson, Lisa T. Weiss, Adam Asare, Laura J. Esserman, Michelle Melisko, Dawn Hershman. The Association Between Symptom Severity and Physical Function among Participants in I-SPY2 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-03.