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Summary Background Loss of sensations in the sole following diabetic sensorimotor polyneuropathy (DSPN) leads to diabetic foot ulcers and its sequelae. We hypothesized that sensory reinnervation of sole by transfer of saphenous nerve (SN) to sensory fascicles of posterior tibial nerve (PTN) in these patients may reverse the neuropathy. Methods This prospective interventional case series included patients with advanced DSPN and intact sensory supply of SN. PTN was neurotized by transfer of SN nerve in the tarsal tunnel and postoperatively sensations of the sole were tested. Any existing ulcers on sole were noted and their healing was monitored. Finding A total of 17 patients (22 feet), 9 male and 8 female, were included. Seven patients had ulcers in the feet. At 6 months follow-up all patients developed protective sensation in the sole. The average 2 PD improved from 60 mm to 45.5 mm, average vibration perception improved from 34.12 V to 24.33, Medical Research Council (MRC) score improved from S0 in 12 feet and S1 in 10 feet to S3+ in 13 feet, S3 in 5 feet, and S2 in 2 feet at 6 months along with healing of ulcers in all 7 feet. Interpretation Transfer of SN to PTN for sensory neurotization is an innovative and simple option to prevent complications of DSPN. This procedure has the potential to change the natural history of DSPN.

With the development of urban rail transit, taking the metro train has become one of the main modes of transportation, and passengers have an increasing demand for the comfort of taking the metro trains. This paper mainly discusses the impact of noise and vibration caused by metro train on passengers. All 13 metro lines in Guangzhou, China, were selected to conduct the questionnaire survey on the subjective perception of 601 respondents. At the same time, noise and vibration measurements were carried out in the train. The results show that the distribution of noise and vibrations along the metro lines is not uniform, and 50.6% of the interviewees are disturbed by noise. Wheel-rail squeal was found to be the most annoying and disturbing noise source. Three dose-response relationships for noise, vertical vibration, and horizontal vibration are proposed, respectively. The proposed dose-response relationship can be applied to the evaluation of noise annoyance or vibration perception in an environment similar to metro lines. Once the noise or vibration level of a metro line is obtained, the noise disturbance or vibration perception can be estimated. As for the dose-response relationship of vibration perception, people's sensitivity to vibration is much lower than that to noise. Horizontal vibrations are more acceptable to passengers, while vertical vibrations are more disturbing to passengers. The results are helpful to predict the noise annoyance and vibration perception of train passengers between metro stations, and to achieve the purpose of designing effective noise and vibration reduction measures.

To assess the impact of renal transplantation on peripheral nerve damage in patients with chronic kidney disease (CKD). Fifteen patients with CKD (eGFR

Pijun Yan,1 Qin Wan,1 Zhihong Zhang,2 Qian Tang,1 Yuru Wu,1 Yong Xu,1 Ying Miao,1 Huan Zhao,3 Ran Liu3 1Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China; 2Department of General Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China; 3Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of ChinaCorrespondence: Pijun YanDepartment of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of ChinaTel/Fax +86-830-3165361Email peter2007110361@126.comPurpose: Bile acids, amphipathic cholesterol metabolites, have been reported to have cytoprotective and neuroprotective effects in humans and animal models. The relationship of physiological serum total bile acid (TBA) levels with diabetic peripheral neuropathy (DPN), however, has not been determined. The purpose of this study was to investigate the relationship between physiological serum TBA and DPN.Patients and Methods: In total, 856 patients with type 2 diabetes mellitus (T2DM) aged 20– 89 years were enrolled in this cross-sectional study. Serum TBA was measured, and its relationship with DPN and other parameters was analyzed.Results: T2DM patients with DPN had significantly lower serum TBA compared with those without (P< 0.01). Serum TBA was negatively associated with glycated hemoglobin A1C, plateletcrit, fibrinogen, urine albumin-to-creatinine ratio, vibration perception thresholds, and prevalence of DPN, peripheral arterial disease, and diabetic foot ulceration after adjustment for age, sex, and body mass index (P< 0.01 or P< 0.05). A graded association with prevalence of DPN and increase in serum TBA quartiles was observed (P for trend < 0.01), and there was an 48.2% decreased risk of DPN in the highest quartile of serum TBA versus the lowest quartile (95% CI 0.299– 0.617; P=0.000) after multivariate adjustment. Receiver-operating characteristic analysis revealed that the optimal cutoff point of serum TBA to indicate DPN was 2.85 μmol/L (sensitivity 77.6% and specificity 45.6%).Conclusion: These findings suggest that lower physiological serum TBA level may be associated with the prevalence of DPN in T2DM patients and may be a potential biomarker for DPN.Keywords: total bile acid, diabetic peripheral neuropathy, type 2 diabetes mellitus, Chinese population

Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel’s sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.

Aims/Introduction Painful diabetic peripheral neuropathy (pDPN) is associated with small nerve fiber degeneration and regeneration. This study investigated whether the presence of pDPN might influence nerve regeneration in patients with type 2 diabetes undergoing intensive glycemic control. Materials and Methods This exploratory substudy of an open‐label randomized controlled trial undertook the Douleur Neuropathique en 4 questionnaire and assessment of electrochemical skin conductance, vibration perception threshold and corneal nerve morphology using corneal confocal microscopy in participants with and without pDPN treated with exenatide and pioglitazone or basal–bolus insulin at baseline and 1‐year follow up, and 18 controls at baseline only. Results Participants with type 2 diabetes, with (n = 13) and without (n = 28) pDPN had comparable corneal nerve fiber measures, electrochemical skin conductance and vibration perception threshold at baseline, and pDPN was not associated with the severity of DPN. There was a significant glycated hemoglobin reduction (P, There has been a resurgence of interest in identifying new drug targets or, predictive biomarkers of disease‐modifying therapies in diabetic neuropathy. We show that the presence of painful diabetic neuropathy was associated with greater corneal nerve regeneration and an improvement in painful neuropathic symptoms in patients with type 2 diabetes undergoing intensive glycemic control.

Objectives: To investigate influence of metabolic syndrome on vibration perception threshold in first-degree relatives of type 2 diabetes who were not diagnosed with diabets before. Material and Methods: First-degree relatives of type 2 diabetes at the age of 40 - 60 s who had not been diagnosed with diabetes before were enrolled. Height, weight, waist circumference, hip circumference, blood pressure (systolic and diastolic blood pressure), body fat percentage, fasting plasma lipid, fasting plasma glucose, 2-hour blood glucose after 75 g oral glucose and vibration perception threshold were measured. Results: 58 subjects were diagnosed with the level of vibration perception threshold ≥ 16 V. Vibration perception threshold in the metabolic syndrome group was significantly higher than that in the non-metabolic syndrome group (P p P < 0.05). Vibration perception threshold was positively correlated with weight, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose and 2-hour blood glucose. Stepwise multiple regression analysis showed that there was a positive correlation between waist circumference, systolic blood pressure and vibration perception threshold. Conclusion: Some first-degree relatives of type 2 diabetes who have not been diagnosed with diabetes have high risk of peripheral neuropathy, especially those with metabolic syndrome. Waist circumference and blood pressure are the main factors affecting Vibration perception threshold levels. Early detection of vibration perception threshold should be performed in first-degree relatives of type 2 diabetes with metabolic syndrome. Waist circumference and blood pressure may be important risk factors of peripheral neuropathy for them.

A proportion of individuals with type 1 diabetes mellitus for more than 50 years (medallists) may be protected from developing nephropathy, retinopathy and neuropathy. Detailed neuropathy phenotyping was undertaken in a cohort of 33 medallists aged 63.7 ± 1.4 years with diabetes for 58.5 ± 0.8 years and HbA1c of 65.9 ± 2.1 mmol/mmol. Medallists had a significantly higher HbA1c (P

To observe the clinical efficacy of heat-sensitive moxibustion plus Western medicine in treating patients with diabetic peripheral neuropathy (DPN). A total of 70 patients with DPN were divided into an observation group and a control group by sealed envelope method combined with the random number table method, with 35 cases in each group. The control group was treated with routine medicine, and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment in the control group. After 2 courses of treatment, the scores of Toronto clinical scoring system (TCSS) and vibration perception threshold (VPT) in both groups were observed, and the clinical efficacy was compared. During treatment, 3 cases dropped out in the control group and 4 cases in the observation group. After treatment, the total effective rate in the observation group was higher than that in the control group (P

Background: Alpha-lipoic acid (ALA) was used in the treatment of diabetic peripheral neuropathy (DPN) using different routes, doses and treatment durations. The aim of this work is to assess the efficacy of oral 600mg ALA twice daily over 6 months in the treatment of patients with DPN. Methods: This is a prospective, single-center, double-blinded, placebo-controlled study conducted at the outpatient clinic of Mansoura Specialized Hospital, Mansoura University. A total of 200 patients with DPN were randomly assigned to add on treatment with either oral 600mg twice daily ALA (n=100) or placebo (n=100) for 6 months. Treatment outcome was assessed using vibration perception threshold (VPT), neurological symptom score (NSS), neurological disability score (NDS), and visual analog scale (VAS) for pain at baseline and at each visit (1, 3 and 6 months) after the start of treatment. Results: Comparison between the study groups regarding the baseline data revealed no statistically significant differences. with respect to the outcome parameters, no significant differences were found between the studied groups at baseline. However, in subsequent visits, ALA-treated patients had significantly better results regarding almost all the outcome parameters (NSS, NDS, VAS, VPT). Mild nausea was reported in 6 patients. None of the studied patients discontinued treatment. Conclusions: Oral 600mg ALA twice-daily treatment for DPN over 6 months is effective, safe and tolerable.

Background and objective Chronic pain following musculoskeletal trauma is common, which may partially be attributed to the early presence of central sensitisation (CS). Multiple measures are suggested to assess clinical features of CS, yet no systematic review has evaluated the measurement properties of these measures in a musculoskeletal trauma population. Databases and data treatment This systematic review, which followed a published and PROSPERO registered protocol (CRD42018091531), aimed to establish the scope of CS measures used within a musculoskeletal trauma population and evaluate their measurement properties. Searches were conducted in two stages by two independent reviewers. The Consensus-based Standards for the selection of Health Measurement instruments (COSMIN) checklist was used to evaluate risk of bias and overall quality was assessed using the modified Grading of Recommendations Assessment, Development and Evaluation. Results From 86 studies, 30 different CS outcome measures were identified. Nine studies evaluated measurement properties of nine outcome measures; eight evaluated reliability and one evaluated construct validity. Measures included seven quantitative sensory testing methods (pressure, cold and electrical pain thresholds; warm, cold and vibration detection thresholds; vibration perception thresholds), pain drawings and a pinwheel. Risk of bias was assessed as doubtful/inadequate for all but one study, overall quality of evidence was low/very low for all measures. Reliability of measures ranged from poor to excellent. Conclusions Many measures are used to evaluate CS but with limited established measurement properties in musculoskeletal trauma. High quality research to establish measurement properties of CS outcome measures is required.

Cardiovascular disease which is associated with cardiac dysfunction, usually measured with circulating levels of B-type natriuretic peptide (BNP), has been associated with incidence and progression of diabetic peripheral neuropathy (DPN). The potential relationship of circulating physiological levels of BNP with DPN, however, has not been reported. Circulating levels of BNP were measured in 258 patients with type 2 diabetes mellitus (T2DM), and participants were divided into a DPN group ( n = 61 ) and no DPN group ( n = 197 ). The relationship between circulating physiological levels of BNP and DPN and other parameters was analyzed. Circulating levels of BNP were significantly elevated in T2DM patients with DPN compared to those without ( P = 0.001 ). Circulating levels of BNP were significantly and positively associated with systolic blood pressure ( P = 0.035 ), neutrophil-to-lymphocyte ratio ( P = 0.007 ), creatinine ( P = 0.030 ), vibration perception threshold values ( P = 0.021 ), and the prevalence of diabetic foot ulceration ( P = 0.039 ), peripheral arterial disease ( P = 0.013 ), DPN ( P = 0.032 ), and diabetic nephropathy ( P = 0.020 ) and negatively with lymphocyte count ( P = 0.003 ) and ankle-brachial index ( P = 0.038 ), irrespective of age, sex, and body mass index. Moreover, circulating levels of BNP was an independent decisive factor for the presence of DPN after multivariate adjustment (odds ratio, 1.044; 95% confidence interval, 1.006-1.084; P = 0.024 ). Additionally, the higher quartiles of circulating BNP were related significantly to an increased risk of DPN compared to the lowest quartile ( P = 0.003 ). Last but most importantly, the analysis of receiver operating characteristic curves revealed that the best cutoff value for circulating levels of BNP to predict DPN was 15.18 pg/mL (sensitivity 78.7% and specificity 48.2%). These findings suggest that high circulating physiological levels of BNP may be associated with the development of DPN and may be a potential biomarker for DPN in patients with T2DM.

Diabetes mellitus has many microvascular and macrovascular complications. Diabetic foot is a major consequence of these complications. Foot ulcers are the leading cause of non-traumatic amputations and early diagnosis can prevent amputation. In this study, thermal foot images and biothesiometer values of 50 control subjects and 50 known diabetic subjects were analyzed. The thermal images were analyzed using a graphical interface-enabled program developed indigenously to identify possible hotspots (abnormal temperature variation). Data comparison was conducted based on the concept of asymmetry. Temperature and vibration perception values obtained at the same points on the left and the right feet were compared. The use of a combination of thermal images and vibration perception resulted in lower incidence of false positive results in the pre-evaluation of possible plantar lesions. Pearson’s correlation test was performed to analyze the statistical significance of these factors. This study concluded that the classification of factors leading to pre-ulcerative lesions in the diabetic foot could be accomplished with a higher level of confidence by using multiparameter data rather than a single-variable predictive model.

AIMS: To evaluate the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus based on the current literature. METHODS: Three electronic databases were searched for eligible studies that investigated the sensitivity and specificity of the Ipswich touch test. Methodological quality was assessed using the QUADAS-2 tool. RESULTS: Five studies that reported the sensitivity and specificity of the Ipswich touch test were included. When compared to the 10 g monofilament, the sensitivity ranges from 51 to 83.3% and the specificity ranges from 96.4 to 98%. When compared to the vibration perception test ≥25 V, Ipswich touch test sensitivity ranges from 76 to 100% and specificity ranges from 90 to 96.6%. CONCLUSIONS: The Ipswich touch test has a high specificity in screening for loss of protective sensation in the feet of patients with diabetes mellitus. It is a useful test to be included in diabetic foot screenings, especially when other sensory tools are not available. However, more rigorous studies need to be conducted as there is currently only a limited pool of research evidence to substantiate it as a screening tool for loss of protective sensation in the diabetic foot.

To study the clinical characteristics and incidence of microvascular complications among childhood and adolescent onset type 1 (T1DM) and type 2 diabetes (T2DM) seen at a tertiary care diabetes center in India.From our electronic medical records, we retrieved clinical and biochemical details of 4555 individuals with childhood and adolescent onset diabetes (diagnosed below the age of 20 years) seen between 1992 and 2017. T1DM was diagnosed if there was history of ketoacidosis or fasting C-peptide0.3 PMol/mL and stimulated C-peptide0.6 PMol/mL or if insulin treatment was required from the time of diagnosis. T2DM was diagnosed based on absence of ketosis, or fasting C-peptide ≥0.6 PMol/mL and stimulated1.0 PMoL/mL, or response to oral hypoglycemic agents for more than 2 years. We calculated the incidence rates of retinopathy (presence of at least one definite microaneurysm by retinal photography), nephropathy (urinary albumin excretion ≥30 μg/mg of creatinine) and neuropathy (vibration perception threshold ≥20 V) per 1000 person-years of follow up.Among the 4555 individuals with childhood and adolescent-onset diabetes, 71.4% had T1DM, 19.5% T2DM and 9.1% other forms of diabetes. Age at first visit and duration of diabetes were significantly higher in T2DM when compared to T1DM. The age adjusted incidence of retinopathy was 52.9/1000 person years (Confidence Intervals [CI]: 42.9-62.8) in T1DM and 49.8/1000 person years (CI 30.8-68.8) in T2DM; nephropathy, 6.2 (CI 3.3-9.0) and 13.8 (CI 5.6-22.0); and neuropathy, 8.8(CI 3.6-14.0) and 24.0 (CI 9.8-38.2) in T1DM and T2DM, respectively.The incidence of microvascular complications is high among childhood and adolescent-onset T1DM and T2DM and these calls for more aggressive control of diabetes.

Background Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy. Loss of sensations in sole leads to diabetic foot ulcers (DFU) and its complications. Surgical decompression has been used in the treatment of diabetic peripheral neuropathy, however; its effectiveness has been questioned. Purpose of this study was to evaluate the sensory recovery in sole after tarsal tunnel decompression (TTD) in patients having DSPN. Methods Thirteen patients (Age28-70 years, average 35.57 years; 7 Males, 6 Females; 20 feet) with DSPN and positive Tinel's sign over the tarsal tunnel were included in the study. Pre and post-operative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration perception threshold (VPT) and two-point discrimination (2-PD). Results were classified as per British Medical Research Council (MRC) scoring system. Results –Sixteen feet were followed-up for 6 months. In all feet perception of touch, pain and pressure recovered. Temperature perception recovered in 75% feet. VPT came to normal range (16.81V) from 40.37 V and 2-PD came down to average of 6.0 mm from preoperative average of11.2 mm.MRC scale improved from S0 in 5 feet and S2 in 15 feet to S3+ in all 16 feet.There were no ulcers or amputation in operated limbs during follow up period of 6 months. Conclusions TTD improves plantar sensations in diabetic neuropathy and prevents ulcers and its related complications.

Summary Recent attempts have been made to direct the sensory neurotisation of free superficial circumflex iliac artery (SCIA) flaps. However, donor nerves enabling sensory recovery are limited. We report our findings in fifteen patients who underwent distal limb defect reconstruction using a sensate SCIA flap, including the lateral cutaneous branch of the subcostal nerve (LCSN), between August 2017 and September 2018. The distance from the anterosuperior iliac spine to the point where the LCSN crossed the iliac crest ranged between 6.5 and 10 cm. The diameter ranged between 1.5 and 4.0 mm. The flap size ranged between 8 × 4 and 13 × 10 cm2. All of the flaps survived uneventfully. Tests of sensory modalities, including the Semmes-Weinstein (SW) touch, vibration, pinprick, temperature and static two-point discrimination (s2PD) tests were applied in nine regions of each flap post-operatively. One or more modalities were present in at least one region at 6 months post-operatively, and the recovery of vibration perception was more consistent than that of SW touch and pinprick perception. The recovery of s2PD was noted in 4 cases over a follow-up period of more than 12 months. A reliable sensate flap with the LCSN can be considered as an attractive option for the sensory reconstruction of distal limb defects of moderate size.

Introduction Assessment of sensory impairment in diabetic patients by pain threshold test using intraepidermal electrical stimulation (IES) is a recently developed technique. However, there are no normative pain thresholds in healthy people. Methods We examined pain, vibration, and pressure thresholds in 178 healthy subjects using IES, vibration perception testing (VPT), and Semmes-Weinstein monofilament testing (SWMT). Results The mean values for each age group for pain threshold ranged from 0.07 to 0.12 mA. Pain thresholds were unaffected by age. As the age increased, VPT values decreased from 18.0 to 10.6 seconds and SWMT values increased from 21.4 to 45.3 g/mm2 . There were no significant differences in pain threshold, VPT, and SWMT between men and women. Discussion The pain threshold test appears to be useful for diabetic neuropathy screening because normative values are not affected by age.

BackgroundTesting of vibration perception threshold (VPT) at the fingertips as a quantitative measure of tactile sensitivity is a commonly used tool in diagnosing hand–arm vibration syndrome. There is limited research on dose–response relationships between hand–arm vibration (HAV) exposure and VPT on an individual level.AimsAssess possible dose–response relationships on an individual level between HAV exposure and VPT at the fingertips.MethodsWe assessed average daily vibration exposure (m/s2A8) and cumulative lifetime HAV exposure for 104 participants from different departments in a road maintenance company based on vibration measurements and questionnaires. VPT was measured based on the technical method described in ISO 13091-1:2005 using octave frequencies 8–500 Hz. We investigated associations using linear regression models with significance level p≤0.05.ResultsThe participants were either exposed to rock drills (n=33), impact wrenches (n=52) or none of these tools (n=19). Exposure to rock drills and impact wrenches was associated with elevated VPT for all seven test frequencies in the second and fifth fingers of both hands. A dose–response with the daily exposure measure m/s2(A8) was found based on 1.2 m/s2(A8) for impact wrenches, and 5.4 m/s2(A8) for rock drills. A stronger association was found with the cumulative exposure for rock drills compared with impact wrenches, and for the second finger compared with the fifth finger.ConclusionsHAV exposure was associated with elevated VPT, also at exposure levels below the common exposure action value of 2.5 m/s2(A8). Lowering the HAV exposure can contribute to prevent increasing VPTs in these workers.

Three physiological systems—the nervous system, the endocrine system, and the sensory system—serve as the basis for behavioral mechanisms. In this chapter, which may be a review for students who are well versed in basics of general biology, we provide important information about the structure and function of each of these systems. In coverage of the nervous system, we highlight the axon structure, the electrical and chemical modes of transmitting nervous signals, and the structure and evolution of the brain, which serves as the integrative center for the nervous system. The endocrine system integrates physiological information and uses hormones to regulate physiological processes. Hormones are important in the development of animals and affect, for example, sexual and social maturation. The sensory systems receive information from the environment and convert (transduce) that information into signals within the nervous system. Vision, sound and vibration perception, chemoreception (smell and taste), and touch are the most commonly considered forms of sensation, but we also present the basics of other potentially sensed information, such as magnetic fields and electrical potentials. Understanding these three systems is key to moving on to more advanced topics in animal behavior.

Background and aims The aim of this prospective, single center study was to define factors associated with early cardiovascular mortality in diabetes. Materials and methods 1345 patients under age 75 were included who were undergoing assessment of their diabetes between January 2008 and May 2010 as part of standard practice in a specialist clinic at a regional teaching hospital in Serbia. Peripheral artery disease (PAD) was assessed by audible Doppler waveform and ABPI with cut-offs >1.4 and Results Those who died (n2=70) were more frequently male (60 vs. 45.3%, p=0.08), younger (66.4±7.4 vs. 79.9±3.4, p6, there were significant differences in TEA/CVI (4.2 [95% CI: 1.6–10.9)], p=0.003), PAD (3.9 [95% CI: 1.8–8.8)], p Conclusion Decreased VPT, the presence of PAD on clinical testing and higher maximum estimated lifetime BMI are strongly associated with premature cardiovascular death. These measures may be independent markers of greater risk of reduced life expectancy. Funding Acknowledgement Type of funding sources: None.

Physical activity (PA) is recommended for patients with diabetes to improve glycemic control. In prediabetes and T2D there is a causal relationship between PA and peripheral nerve health; however, the effect of PA on nerve structure and function in longstanding T1D is unclear. We aimed to determine the relationship between PA and small nerve fiber morphology, large nerve fiber function and cardiac autonomic function in this population. Data from 75 participants was collected as part of the Canadian Study of Longevity in T1D. Participants completed a physical exam, medical history and neuropathy assessment including nerve conduction studies (NCS), corneal confocal microscopy measurement of corneal nerve fiber length (CNFL) and assessment of heart rate variability. Participants also reported their daily PA from the preceding 12-months. There were 41(55%) female participants, mean ± SD age was 66 ± 8 years, median duration of diabetes was 54 [52,58] years, BMI was 26.6 ± 3.8, HbA1c of 7.3 ± 0.8. 65(89%) participants met the criteria for diagnosis of diabetic neuropathy. The weekly mean PA time was 156 ± 132 min and 35(47%) reported ≧150 minutes/week. PA time was associated with a greater cooling detection threshold (r=0.24; p=0.043), higher peroneal and sural amplitude (r=0.36; p=0.0017, rs=0.26; p=0.024) and conduction velocity (rs=0.28; p=0.015, r=0.23; p=0.050). Vibration perception threshold at the toe was inversely associated with PA (r=-0.31; p=0.025), whereas there was no association at the finger. There was no association between PA time and heart rate variability (r=-0.040; p=0.74) or CNFL (r=0.23; p=0.055). Linear regression for NCS, adjusting for age and A1c, showed that for each 30 min of PA there was an 0.09 mv higher peroneal amplitude (p=0.032) and 0.048 ms lower peroneal F-wave latency (p=0.022). In individuals with longstanding T1D, PA is associated with substantially better large nerve fiber function in the lower limbs and some better measures of small nerve fiber function. Disclosure E. J. H. Lewis: Board Member; Self; Nutarniq Corp, Board Member; Spouse/Partner; Nutarniq Corp, Research Support; Self; Canadian Institutes of Health Research. B. A. Perkins: Advisory Panel; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Insulet Corporation, Novo Nordisk Canada Inc., Other Relationship; Self; Abbott Diabetes, Medtronic, Novo Nordisk Canada Inc. L. Lovblom: None. S. O. Lanctot: None. D. Scarr: None. N. Cardinez: None. A. Weisman: None. M. H. Brent: Advisory Panel; Self; Novartis Pharmaceuticals Canada Inc., Roche Canada, Research Support; Self; Bayer AG, Novartis Pharmaceuticals Canada Inc. V. Bril: Advisory Panel; Self; Akcea Therapeutics, Alnylam Pharmaceuticals, Inc., CSL Behring, Sanofi Genzyme, Consultant; Self; Janssen Research & Development, LLC, Research Support; Self; Takeda Canada. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Scientific Affairs, LLC., Lilly Diabetes, Merck & Co., Inc., Mitsubishi-Tanabe, Maze Inc, Prometic, Novo Nordisk, Sanofi. Funding JDRF (17-2013-312)

Background and aim Photobiomodulation is an emerging therapy for Diabetic peripheral neuropathy (DPN) of which the management is still a dilemma for clinicians. Elevated Neuron Specific Enolase (NSE) is associated with neuropathy. We aimed this study to assess the effect of Low Level Laser Therapy (LLLT) on Serum Neuron Specific Enolase in Type II Diabetes Mellitus patients with DPN. Methodology Pre post interventional study was done on 50 patients with DPN. DPN was confirmed using 10g Monofilament test, Vibration perception threshold (VPT) and Michigan Neuropathy Screening Instrument. All patients were provided with LLLT for 9 min on dorsal and plantar of foot with a dosage of 3.1 J/cm 2 for 10 days. A blood sample was collected at baseline and 4 weeks after LLLT for NSE estimation. Result A significant reduction in serum NSE levels (0.006) after 4 weeks of laser therapy was observed in 42 patients when compared with baseline. A significant reduction in the vibration perception threshold (p = 0.003) and Numeric pain rating scale (p = 0.004) were observed. Conclusion In this pilot study, we have assessed the effect of LLLT on serum NSE levels among patients with DPN and showed improved quality of life and decrease in serum NSE levels. These findings should be investigated in larger trials.

Objective This study aims to assess whether acupuncture analgesia’s effects are local or systemic and whether there is a dose response for these effects. Methods Twenty-eight healthy volunteers aged 18–45 were randomized to two doses of acupuncture using points closely associated with peripheral nerves in the legs. The lower-dose group involved acupoints overlying the deep peroneal nerve (DP), and the higher-dose involved acupoints overlying the deep peroneal and posterior tibial nerves (DPTN). Baseline and acupuncture quantitative sensory testing (QST) assessments were obtained locally in the calf and great toe and systemically in the hand. Results were analyzed using factorial repeated-measures analysis of variance for each of the QST variables—cold detection threshold (CDT), vibration detection threshold (VDT), heat pain threshold (HP0.5), and heat pain perception of 5/10 (HP5.0). Location (leg/hand) and time (baseline/acupuncture) were within-subject factors. Intervention (DP/DPTN) was a between-subject factor. Results CDT was increased in the calf (P Conclusions Acupuncture caused comparable local and systemic analgesic effects in cold detection and heat pain perception and only local effects in vibration perception. There was no clear acupuncture dose response to these effects.

Human perception of vibration is very subjective parameter which depends among others on age, sex or even nationality. There are three main methods of assessment of human perception of vibration according to national standards which differ from each other. All three methods are clearly described in this paper and their advantages and disadvantages are shown. Evaluation methods are helpful in diagnosis and design of the building when they are used properly. One of interesting aspect of quality of measurements is localization of measurement points. The choice of localization of measurement points could have significant influence on result of evaluation of human response to vibration. International and national standards are compatible in this matter – measurement points should be localized in the place of human vibration perception. It means that should be located in the middle of the floor. Sometimes it is difficult to determine the exact center of the floor, especially when building has irregular construction. In this paper influence of localization of measurement point on human perception of vibration is investigated and center zone in which measurement results are proper is determined. In-situ measurements were made to investigate the problem of localization of human vibration perception in buildings.

Objective: Diabetes mellitus linked to severe macrovascular and the microvescular complications. Diabetic peripheral neuropathy is the challenging complication of the diabetes mellitus, which is linked to the morbidity, mortality, and big economic burden. We determined the frequency of peripheral neuropathy in newly diagnosed cases of type II diabetes mellitus.Materials & Methods: The current descriptive Cross Sectional study took place in Services Institute of Medical Sciences, Lahore, From June 2014 to January 2015. All the patients, those were newly diagnosed with diabetes mellitus, aged 30-60 years and both genders were included. Detailed history regarding diabetes was taken. Patients underwent for the evaluation of peripheral neuropathy by taking physical examination, previous history and vibration perception test. All the data was recorded in the Proforma.Results: Total 150 cases were studied, out of them, 42.67% were aged 30-45 years while 57.33% were in the age range of 46-60 years and their overall mean age was 46.35 ± 9.52 years. Males were 54.0% and females were 46.0%. Frequency of peripheral neuropathy for newly diagnosed type II diabetic subjects was noted 20.67%, with insignificant association of age and gender.Conclusion: It was concluded that the peripheral neuropathy was 20.67% among patients newly diagnosed with diabetes mellitus.

PURPOSE: CIPN is a common, debilitating, and dose-limiting side effect of chemotherapy. Here, we describe characteristics of patients with CIPN using both patient-reported outcomes (PRO) and quantitative sensory testing (QST). METHODS: Breast cancer survivors with persistent moderate to severe CIPN defined by a rating of 4 or greater on a 0–10 Numeric Rating Scale (NRS) from two ongoing clinical trials were included. PROs included the Neuropathic Pain Scale (NPS) and Functional Assessment of Cancer Therapy-Gynecologic Oncology Group/Neurotoxicity (FACT/GOG-Ntx). QST included tactile and vibration detection threshold measurements. Data were analyzed using descriptive statistics and Spearman correlation coefficients. RESULTS: 49 female patients with a mean age of 61 years were assessed; 63% were Caucasian. Mean NRS scores were 4.2, 5.7, and 4.3 on 0–10 scale for pain, numbness, and tingling, respectively. Mean NPS score was 41.0 on a 0–100 scale, and the mean FACT/GOG-Ntx score was 25.8 on a 0–44 scale. QST showed mild to moderate impairments in tactile and vibration perception. The FACT/GOG-Ntx subscale for numbness was negatively correlated with tactile and vibration thresholds in both hands and feet (both p < 0.05). NPS was positively correlated with tactile thresholds in the hands and feet (p < 0.05). CONCLUSION: Patients with moderate to severe CIPN report moderate pain, numbness, and tingling, and exhibit reduced tactile and vibration perception on QST. Weak to moderate correlations were observed between PRO and QST. These data suggest that QST outcomes are associated with CIPN symptoms and may be useful in helping monitor and manage CIPN treatment.

Vibrotactile actuators have been studied in a variety of wearables that require actuation feedback because of their accurate and rapid feedback. To provide robust and reliable feedback to users, wearable vibration actuators must be seamlessly integrated into smart clothing to deliver vibrotactile stimulation of the appropriate intensity. In order to solve the vibration attenuation problem due to clothing fabric, and seamlessly integrate the actuator, wearable male-type radio button-shaped vibrotactile actuators (WMVAs) were designed and fabricated. The WMVAs were designed with a structure in which a linear resonant actuator was housed in a stud, and vibration was passed through the fabric and transferred to the skin through the cap. Three WMVAs were fabricated, one with a cap of standard size and thickness, the second with a thicker cap than the standard, and the third with a wider cap than the standard. In order to investigate the vibration transmission performance of the WMVA, vibration perception experiments were performed on various body parts of the subjects. As a result, the vibration perception of the WMVA was statistically significant in all tested body parts. Using the WMVA, the mean value of vibration perception was 2.743, while that without a cap and stud was 2.062. The mean value of the vibration perception of the actuator with a cap 2.78 times thicker is 2.736, compared with the standard actuator value of 2.512. The average value of vibration perception of an actuator with a 2.78 times larger cap than the standard size is 2.743.

Distal symmetrical axonal polyneuropathy (DSP) is due to injury to peripheral sensory, motor, and autonomic nerve fibers, resulting in distal predominant sensory loss, pain, and gait instability. DSP occurs as a complication of multiple medical conditions including diabetes or HIV, or following exposure to various toxins such as chemotherapy. It affects at least 10% of the United States population. Few treatments for DSP are approved by regulatory agencies. Reliable and responsive outcome measures are integral to developing new DSP treatments. Multiple clinician-rated measures that incorporate neuropathy signs exist, however, it is not clear which of these measures performs best for various DSP phenotypes. This systematic review summarizes the content of 18 published measures of DSP identified using PubMed and from personal archives of the authors. The relative percentage of scoring dedicated to motor, reflex, large and small fiber sensory, and autonomic domains varied considerably among measures. The most common neurologic examination items included in the scales were (1) vibration perception (n = 18, 100%), (2) reflexes (n = 16, 89%), (3) pinprick perception (n = 14, 78%), (4) muscle strength (n = 11, 61%), (5) touch–pressure perception (n = 9, 50%), and (6) joint position perception (n = 8, 44%). This review can be used to inform decisions regarding which of the available clinician-rated sign outcome measures would be most appropriate for use in a particular DSP population, based on the domains most affected by that neuropathy or on the domains most likely to be affected by a particular experimental therapy.

Aims To determine the prevalence and potential risk factors for diabetic peripheral neuropathy with a loss of protective sensation in Barbados. Methods A representative population sample aged > 25 years with previously diagnosed diabetes or a fasting blood glucose ≥ 7 mmol/l or HbA1c ≥ 48 mmol/mol (6.5%) was tested by 10 g monofilament at four plantar sites per foot and a 28 Hz tuning fork and neurothesiometer at the hallux. Data were adjusted to the age structure of people with diabetes in Barbados. Multivariable logistic regression assessed associations with peripheral neuropathy with a loss of protective sensation. Results Of 236 participants [74% response rate, 33% men, 91% black, median age 58.6 years, mean BMI 30.1 kg/m2, mean HbA1c 54 mmol/mol (7.1%)], 51% had previously diagnosed diabetes. Foot examination demonstrated that 25.8% (95% CI 20.2 to 31.5) had at least one insensate site with monofilament testing, 14.8% (95% CI 10.2 to 19.4) had an abnormal tuning fork test and 10.9% (95% CI 6.9 to 14.9) had a vibration perception threshold > 25 V. Peripheral neuropathy with a loss of protective sensation prevalence was 28.5% (95% CI 22.7 to 34.4) as indicated by monofilament with ≥ 1 insensate site and/or vibration perception threshold > 25 V. With previously diagnosed diabetes the prevalence was 36.4% (95% CI 27.7 to 45.2) with 98.4% of cases identified by monofilament testing. Increasing age, previously diagnosed diabetes, male sex and abdominal obesity were independently associated with peripheral neuropathy with a loss of protective sensation. Conclusions Over a third of people with previously diagnosed diabetes had evidence of peripheral neuropathy with a loss of protective sensation. Monofilament testing alone may be adequate to rule out peripheral neuropathy with a loss of protective sensation. Monofilament and neurothesiometer stimuli are reproducible but dependent on participant response., What's new? In Barbados, foot problems account for 89% of diabetes‐related hospital admissions, but in primary care only 41% had a foot examination over a 2‐year period. Peripheral neuropathy prevalence in a predominantly African descent Caribbean population with diabetes is unknown.In people with known and newly diagnosed diabetes, the prevalence of peripheral neuropathy with a loss of protective sensation was 28.5% (95% CI 22.7 to 34.4) as indicated by monofilament testing with ≥ 1 insensate site and/or vibration perception threshold > 25 V. Monofilament testing alone identified 98% of such cases in people with previously diagnosed diabetes.Monofilament testing alone may be adequate for screening for peripheral neuropathy with a loss of protective sensation.

BACKGROUND Diabetic peripheral neuropathy (DPN) can lead to foot ulceration and amputation. There are currently no disease-modifying therapies for DPN. The aim of this study was to determine if hypertension contributes to DPN in patients with type 1 diabetes mellitus (T1DM). METHODS Subjects with T1DM (n = 70) and controls (n = 78) underwent a comprehensive assessment of DPN. RESULTS Hypertension was present in 40 of 70 T1DM subjects and 20 of 78 controls. Hypertension was associated with abnormal nerve conduction parameters (P = 0.03 to CONCLUSIONS This study shows that hypertension is associated with impaired nerve conduction in T1DM. It supports previous small trials showing that angiotensin-converting enzyme inhibitors improve nerve conduction and advocates the need for larger clinical trials with blood pressure lowering agents in DPN.

Background: High levels of uric acid (UA) are associated with various peripheral neuropathies. Furthermore, uric acid levels have been found to correlate with both the clinical and electrophysiological severity of diabetic sensorimotor polyneuropathy, mainly with sensory functions. Objectives: To determine whether higher UA levels are associated negatively with nerve function in healthy subjects. Methods: A total of 126 healthy subjects recruited prospectively for another study were included. We extracted demographic data, body mass index (BMI), blood pressure, Toronto Clinical Neuropathy Score (TCNS), electrophysiological findings, vibration perception thresholds (VPT), and laboratory test results including UA, hemoglobin A1c (HbA1c), estimated glomerular filtration rate (eGFR), and lipid levels. Results: The mean age of the cohort was 56 ± 17 years with 56% females. Males had higher UA values compared with females. Univariate beta regression coefficient analysis between UA levels and demographic, clinical, electrophysiological, and laboratory findings showed significant positive correlations with male gender, components of the metabolic syndrome, and with VPT, while an inverse correlation was found with electrophysiological sensory parameters. A multivariate regression model showed positive correlations only with BMI, finger VPT, and triglycerides. Conclusion: Higher UA levels correlate with lower sensory nerve function in healthy subjects, expanding the evidence of possible negative influence of UA on peripheral nerves, although a causative role has not yet established.

Objective The aim of the current study was to assess the diagnostic accuracy of the Neuropad for detecting distal sensory peripheral neuropathy (DSPN) related to human immunodeficiency virus (HIV)-infection. Design Single-gate observational case-control study. Methods A convenience sample of 30 HIV-infected subjects with a mean age of 48.9 years (95% CI 45.6–52.3) and no other potential causes of neuropathy were recruited from the Ian Charleson Day Centre (London, UK). Sudomotor function was assessed with the Neuropad, an adhesive patch designed to measure sweat production, using a 10-min cut-off. Vibration perception threshold (VPT) testing with a neurothesiometer and the painDETECT questionnaire (PD-Q) were used as reference standard measures of DSPN. Results 16 participants with sudomotor dysfunction and 14 with healthy sudomotor function were included in analysis. Compared to VPT (>25 V) the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Neuropad yielded 66.7%, 48.1%, 12.5% and 92.9% respectively. For the PD-Q (>12) sensitivity of the Neuropad was 100% and specificity was 58.3%, with PPV and NPV of 37.5% and 100% respectively. Conclusions The Neuropad may be a suitable screening tool for HIV-related DSPN, and can reliably exclude healthy individuals in the clinical setting. Abnormal Neuropad results require referral to confirm diagnosis. Limitations exist in the sampling method and study size. The use of reference standard measures of small nerve fibre function and continuous Neuropad quantification would strengthen future research.

Background While surgical reconstruction restores mechanical stability following anterior cruciate ligament (ACL) rupture, many experience early-onset osteoarthritis despite surgery. Neurophysiological changes are hypothesized to contribute to knee osteoarthritis progression. Proprioceptive deficits have been reported following ACL injury/reconstruction; however, vibration perception threshold (VPT) has been less studied. This study explored relationships between pain, VPT, proprioception, function, and strength following ACL-reconstruction. Methods Twenty individuals (27 ± 6 years; 10 males) (standard deviation) status-post ACL-reconstruction were compared with a control group. Measurements included VPT, proprioception (threshold to detect passive movement), pain, function (Knee Outcome Survey (KOS)) and isometric quadriceps strength. Group differences were assessed using Mann-Whitney U tests, side-to-side differences with Wilcoxon Signed Rank tests, and associations evaluated using Spearman correlations. Results The ACL-reconstruction group had minor functional deficits (15 ± 11%) and resting pain (1.8 ± 1.7). Impaired VPT and proprioception (hypoesthesia) were demonstrated on surgical compared to contralateral and control limbs (p ≤ 0.008). Proprioception was significantly different between contralateral and control knees, but not VPT. Surgical knee proprioceptive deficits and VPT deficits were positively correlated (ρ = 0.462, p = 0.047) but not in controls (ρ = −0.042, p = 0.862). Strength was negatively correlated to pain (ρ = −0.589; p = 0.006), but not to KOS scores, proprioception or VPT (p ≥ 0.099). Conclusion Proprioceptive deficits following ACL injury have been ascribed to loss of afferent input from the torn ligament. Alternatively, multi-modality as well as contralateral sensory deficits suggest a spinal/supraspinal source of neurophysiological findings which may predispose to early osteoarthritis. Level of evidence III.

Background: HIV/AIDS is a worldwide pandemic. Peripheral neuropathy is the most common neurologic complication with distal sensory polyneuropathy (HIV-DSP) as the most frequent form of manifestation. HIV-DSP is one of the major causes of global pain morbidity and often undiagnosed earlier, resulting in treatment given when HIV-DSP grade is already severe. Early detection is imperative to prevent the progression of HIV-DSP and improve patient’s quality of life. Polyneuropathy score, 10-g Semmes-Weinstein Monofilament (SWM) and vibration perception threshold (VPT)-quantitative sensory testing (QST) are considered to be potential candidates for HIVDSP screening tool. Objective: To measure the reability of Polyneuropathy Score, SWM and VPT- QST in diagnosing HIV-DSP. Methods: This research is a descriptive study with cross-sectional design. Research was conducted on 77 patients of HIV/AIDS outpatient clinic in RS Saiful Anwar (RSSA) during November 2016 - April 2017 (n = 77). Patients were screened for HIV-DSP by using polyneuropathy score, such as: Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Scoring Sysytem (TCSS), Brief Peripheral Neuropathy Score (BPNS), SWM, and VPT-QST. Sensitivity, specificity, positive predictive value and negative predictive value of BPNS, TCSS, MNSI, SWM and VPT-QST are analyzed using cross tabulation. Area under receiver operating characteristic (ROC) curve analysis was used to measure diagnostic accuracy of each tools. SPSS 19.0 was used for statistical analysis. Results: TCSS had a sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio, negative likelihood ratio, and accuracy as much as: 70%, 97%, 97%, 74%, 23,33, 0,28 and 83%. The result of TCSS analysis using ROC showed that TCSS had excellent diagnostic value with AUC (Area Under Curve) of 0.89 (95%CI 82%-96,5%). The AUC of BPNS score, monofilamen and VPT-QST respectively: 0,469, 0,194, and 0,189. Conclusion: The result of the HIV-DSP diagnostic test using TCSS score has the best value compared to other tools.

Background: Diabetic peripheral neuropathy (DPN) is a most common micro vascular complication of diabetes posing significant morbidity and mortality with early and insidious onset. Studies has variably pointed that older age, gender, duration of diabetes, dyslipidemia, are linked with development of DPN. Aims and Objectives: To determine the prevalence of neuropathy in diabetic patients and see its link with age, gender, duration of diabetes, therapy and ethnicity. Materials and Methods: This is a cross-sectional study involving 110 clinically diagnosed diabetic patients, meeting the inclusion criteria. Basic demographic data were taken during clinical examination. Presence of degree of neuropathy was screened by measuring vibration perception threshold using Biothesiometer. Data was entered on SPSS and were categorized, necessary non parametric statistical tests were applied to these categorical variables as needed. The level of significance was set at p value less than 0.05. Results: Presence of neuropathy was measured in 110 diabetic patients. The overall prevalence of DPN was 45.45%. Frequency of neuropathy was higher with increase in age with 72.7% in more than 60 years of age and 23.5% in less than or equal to 40 years of age group (p=0.007). Similarly, the increasing trend of DPN with increase in duration of DM was evident in this study with DPN present in more than 55% of patients with more than 5 years of diabetes(p=0.004). Conclusion: The prevalence rate of DPN in diabetes was observed to be higher (45.45%). Our result suggested that DPN is associated with old age and the duration of diabetes mellitus. Asian Journal of Medical Sciences Vol.10(1) 2019 72-76

Background : Despite being a very common complication, the aetiology and potential risk factors of diabetic neuropathy (DN) have not been clearly determined in a prospective study. Aims: The aim of Sheffield Prospective Diabetes Study was to identify the abnormalities of physiological, biochemical, haemorrhelogical and cellular function for complications of diabetes in type 1 diabetes. Materials and Methods: 66 newly diagnosed type 1 diabetic subjects (mean age 31 ± 9 (SD) duration (3 years ± 2) were identified and followed for 9 years. They had detailed neurological assessment (symptoms and signs score, nerve conduction, vibration perception threshold, warm thermal discrimination threshold and autonomic function tests) and blood samples taken for detail biochemical and haemorrheological analysis at base line and at follow up. Results: At the 9 years follow up, 51 subjects were studied of whom 18 were found to have DN using Dyck’s criteria. As expected subjects with DN had significantly higher (p

Aims : Diabetic Distal Symmetric Polyneuropathy (DSPN), despite being the most common and a disabling diabetic complication, remains difficult to treat. It has led to rekindle our interest in Epalrestat which has the potential to alter the natural history of the disease. The present study was designed to evaluate the efficacy of Epalrestat in DSPN and to corelate its therapeutic efficacy with baseline erythrocyte sorbitol levels. Methods : 100 patients with duration of diabetes more than five years and Diabetic Neuropathy Symptom Score (DNSS) ≥ 1 were included. They were divided into two groups of 50 patients each : Group 1 (received Tablet Epalrestat 150 mg once a day), Group 2 (received placebo). Baseline Diabetic Neuropathy Symptom Score (score out of 4), Numeric Pain Intensity Scale (score out of 10), Monofilament score (score out of 10), Vibration Perception Threshold (VPT) by Sensitometer and erthyrocyte sorbitol levels (by ELISA) were recorded. Same parameters were repeated at three months follow up visit. Results : Epalrestat was overall more effective than placebo in improving the symptoms as well as in improving the quantitative sensory nerve function measured by sensitometer The improvement in all the parameters positively correlated with baseline erythrocyte sorbitol levels. Conclusions : Epalrestat offers a ray of hope in the treatment of DSPN patients who have high baseline erythrocyte sorbitol levels and thus can be a useful tool in predicting the response to drug.

This study examined the performance of VibraTip for the diagnosis of loss of protective sensation (LOPS) and the interrater agreement of different neurological modalities performed by 3 health care professionals, a consultant diabetologist, a diabetes specialist nurse, and a podiatrist. Diagnosis of LOPS was based on 10-g Semmes Weinstein monofilament testing performed by a consultant diabetologist (reference method), while examination with a 128-Hz tuning form was also performed. The performance of VibraTip for the diagnosis of LOPS was examined using the receiver operating characteristic curves analysis. Interrater agreement was determined by weighted kappa (κ) statistics. Diagnosis of LOPS (%) was 37.5%. Receiver operating characteristic curve analysis showed that VibraTip examination versus 10-g monofilament, both performed by a consultant, could diagnose LOPS ( P < .001). Sensitivity, specificity, positive predictive value, and negative predictive value of VibraTip versus 10-g monofilament, both performed by a consultant (value, 95% confidence interval), was 0.705 (0.591-0.803), 0.836 (0.758-0.897), 0.733 (0.642-0.808), and 0.816 (0.757-0.863), respectively. The interrater agreement among the health care professionals for 10-g monofilament, VibraTip, and 128-Hz tuning fork in neurological assessment was good with κ > 0.61. VibraTip can be used as a screening tool for the detection of LOPS. There was good overall agreement in the results of neurological examination using 10-g monofilament, 128-Hz tuning fork, and VibraTip among health care professionals.

Background and aim: Damage to small nociceptive fibres may contribute to painful diabetic neuropathy. We aimed to compare large and small nerve fibre measurements together with skin biopsy and corneal confocal microscopy in patients with type 1 diabetes and painful or painless diabetic neuropathy. Methods: We have assessed the McGill pain questionnaire, neuropathy disability score, vibration perception threshold, warm and cold sensation thresholds, electrophysiology, corneal confocal microscopy and skin biopsy in participants with type 1 diabetes and painful (n = 41) or painless (n = 50) diabetic neuropathy and control subjects (n = 50). Results: The duration of diabetes, body mass index, glycated haemoglobin (HbA1c), blood pressure and lipid profile did not differ between subjects with painful and painless neuropathy. Neuropathy disability score and vibration perception threshold were higher and sural nerve conduction velocity was lower, but sural nerve amplitude, peroneal nerve amplitude and conduction velocity and cold and warm sensation thresholds did not differ between patients with painful compared to painless diabetic neuropathy. However, intraepidermal nerve fibre density, corneal nerve fibre density, corneal nerve branch density and corneal nerve fibre length were significantly lower in subjects with painful compared to painless diabetic neuropathy. Conclusions: There is evidence of more severe neuropathy, particularly small fibre damage in the skin and cornea, of patients with painful compared to painless diabetic neuropathy.

Aims/Introduction To examine the performance and identify the optimal threshold of vibration perception threshold (VPT) for diagnosing diabetic polyneuropathy (DPN) in a Chinese population according to multiple definitions of DPN as gold standards. Materials and Methods VPT was determined in 421 Chinese individuals with type 2 diabetes, who simultaneously completed a questionnaire of neuropathic symptoms, and underwent the assessment of signs of peripheral neuropathy and electromyography tests. Three definitions of DPN (i.e., clinician‐diagnosed DPN, abnormal nerve conduction and confirmed DPN) were taken as reference gold standards. Results Vibration perception threshold was a specific measure for all three groups of DPN outcomes, with the highest specificity noted for clinician‐diagnosed DPN (85.1%). The specificity for abnormal nerve conduction and confirmed DPN was 77.0 and 76.6%, respectively. The sensitivity of VPT was 67.0% for clinician‐diagnosed DPN, 66.5% for abnormal nerve conduction and 67.2% for confirmed DPN. The optimal cut‐off threshold for abnormal nerve conduction, as well as confirmed DPN, was VPT >14.9 V. The specificity and sensitivity of VPT >14.9 V as the cut‐off value for clinician‐diagnosed DPN were 85.6 and 66.2%, respectively. When taking clinician‐diagnosed DPN as the gold standard, the performance of VPT for diagnosing DPN was best with an area under the curve value of 0.804. Conclusions VPT measured using the neurothesiometer had relatively high specificity and best performance for diagnosing DPN when clinician‐diagnosed DPN rather than abnormal nerve conduction was taken as the gold standard in a Chinese population. A VPT value of ≥15 V might be equally applicable for diagnosing DPN in a Chinese population., Vibration perception threshold measured using the neurothesiometer had relatively high specificity and best performance for diagnosing diabetic polyneuropathy when clinician‐diagnosed diabetic polyneuropathy rather than abnormal nerve conduction was taken as the gold standard in a Chinese population. A vibration perception threshold value of ≥15 V might be equally applicable for diagnosing diabetic polyneuropathy in a Chinese population.

Fingertip mechanoreceptors comprise sensory neuron endings together with specialized skin cells that form the end-organ. Exquisitely sensitive, vibration-sensing neurons are associated with Meissner’s corpuscles in the skin. In the present study, we found that USH2A, a transmembrane protein with a very large extracellular domain, was found in terminal Schwann cells within Meissner’s corpuscles. Pathogenic USH2A mutations cause Usher’s syndrome, associated with hearing loss and visual impairment. We show that patients with biallelic pathogenic USH2A mutations also have clear and specific impairments in vibrotactile touch perception, as do mutant mice lacking USH2A. Forepaw rapidly adapting mechanoreceptors innervating Meissner’s corpuscles, recorded from Ush2a−/− mice, showed large reductions in vibration sensitivity. However, the USH2A protein was not found in sensory neurons. Thus, loss of USH2A in corpuscular end-organs reduced mechanoreceptor sensitivity as well as vibration perception. Thus, a tether-like protein is required to facilitate detection of small-amplitude vibrations essential for the perception of fine-grained tactile surfaces., The present study was funded by grants from the Deutsche Forschungsgemeinshaft (grant nos. SFB665-B6 to G.R.L., SFB1315 to J.F.A.P. and SFB1158-A01 to S.G.L.) and grants from the European Research Council (grant nos. 789128 to G.R.L. and ERC-2015-CoG-682422 to J.F.A.P.). Additional funding was from the Institute of Health Carlos III (Spanish Ministry of Science and Innovation, grant no. FIS PI16/00539 to J.M.).

In order to design products that are optimised for the user, it is important to take the user's perception of the product into account as early as possible, whereby this is strongly influenced by the vibrations that occur. For the use of power tools, there is currently a lack of knowledge about possible influencing factors and the resulting perception of the user. Within this manuscript, a study design is presented with which potential influences on vibration perception can be investigated. The implementation of study design is based on the most important influencing factors within the perception and judgement process of vibration comfort, which originate from an expert workshop and a literature research in the field of psychology.

Purpose: Tactile displays convey various aspects of touch through mechanical or electrical stimuli. Recent research focuses on combining these two types of stimulation (hybrid stimuli) to achieve naturalness, comfort, and reduction in the threshold, only by experiment. However, there are no computational models to study the Pacinian corpuscle’s behavior under hybrid-stimuli.

Despite the availability of various clinical trials that used different diagnostic methods to identify diabetic sensorimotor polyneuropathy (DSPN), no reliable studies that prove the associations among diagnostic parameters from two different methods are available. Statistically significant diagnostic parameters from various methods can help determine if two different methods can be incorporated together for diagnosing DSPN. In this study, a systematic review, meta-analysis, and trial sequential analysis (TSA) were performed to determine the associations among the different parameters from the most commonly used electrophysiological screening methods in clinical research for DSPN, namely, nerve conduction study (NCS), corneal confocal microscopy (CCM), and electromyography (EMG), for different experimental groups. Electronic databases (e.g., Web of Science, PubMed, and Google Scholar) were searched systematically for articles reporting different screening tools for diabetic peripheral neuropathy. A total of 22 studies involving 2394 participants (801 patients with DSPN, 702 controls, and 891 non-DSPN patients) were reviewed systematically. Meta-analysis was performed to determine statistical significance of difference among four NCS parameters, i.e., peroneal motor nerve conduction velocity, peroneal motor nerve amplitude, sural sensory nerve conduction velocity, and sural sensory nerve amplitude (all p < 0.001); among three CCM parameters, including nerve fiber density, nerve branch density, and nerve fiber length (all p < 0.001); and among four EMG parameters, namely, time to peak occurrence (from 0 to 100% of the stance phase) of four lower limb muscles, including the vastus lateralis (p < 0.001), tibialis anterior (p = 0.63), lateral gastrocnemius (p = 0.01), and gastrocnemius medialis (p = 0.004), and the vibration perception threshold (p < 0.001). Moreover, TSA was conducted to estimate the robustness of the meta-analysis. Most of the parameters showed statistical significance between each other, whereas some were statistically nonsignificant. This meta-analysis and TSA concluded that studies including NCS and CCM parameters were conclusive and robust. However, the included studies on EMG were inconclusive, and additional clinical trials are required. 2020, The Author(s). Study Funded by Universiti Kebangsaan Malaysia (UKM) under the Grant Number DIP-2020-004, and DIP-2018-017 and the Qatar National Research Fund, Grant Number: NPRP12s-0227-190164). Scopus

Aim Self-rated health, a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including persons with diabetes. This study examines correlates of self-rated health in adults with diabetic peripheral neuropathy (DPN). Methods Participants recruited from the UK and USA (n = 295; mean (± sd) age: 61.5 ± 10.7 years; 69% male; 71% type 2 diabetes) rated their health at baseline and 18 months. DPN severity was assessed using the neuropathy disability score and the vibration perception threshold. Validated self-report measures assessed neuroticism, DPN-symptoms of pain, unsteadiness and reduced sensation in feet, DPN-related limitations in daily activities, DPN-specific emotional distress and symptoms of depression. Results In the fully adjusted baseline model, younger age, presence of cardiovascular disease and higher depression symptom scores showed likely clinically meaningful independent associations with worse health ratings. Being at the UK study site and presence of nephropathy indicated potentially meaningful independent associations with lower baseline health ratings. These predictors were largely consistent in their association with health ratings at 18 months. Conclusion Results identify independent correlates of health ratings among adults with DPN. Future research should investigate the clinical implications of associations and examine changes in these variables over time and potential effects on changes in health perceptions. If these associations reflect causal pathways, our results may guide interventions to target issues that are likely to have an impact on subjectively experienced health as an important patient-reported outcome in DPN care.

Aim: To compare vibrotactile sense, 5 years after carpal tunnel release in people with and without diabetes. Methods: Out of 35 people with diabetes and carpal tunnel syndrome, age- and gender-matched with 31 people without diabetes but with idiopathic carpal tunnel syndrome, 27 and 30 people, respectively, participated in this prolonged follow-up. Vibration perception threshold of the index and little finger (median and ulnar nerve, respectively), 5 years after surgery, was measured at seven different frequencies (8, 16, 32, 64, 125, 250 and 500 Hz). Results: Significant improvement of vibration perception threshold from 1 to 5 years after carpal tunnel release was found at 64 Hz for people with diabetes, while improvement for people without diabetes was demonstrated at several frequencies (64–250 Hz). However, both groups demonstrated a significant decrease in vibration perception threshold for the low frequencies (8–16 Hz). At 5 years, people with diabetes had significantly impaired vibration perception threshold at the index finger for high frequencies (125–500 Hz), and for nearly all frequencies (16 Hz, 64–500 Hz) at the little finger, compared to people without diabetes. Conclusion: After carpal tunnel release, significant mid-term improvement of vibrotactile sense appears limited for people with diabetes, compared to a continuous improvement for people without diabetes. In addition, a decline in low-frequency vibrotactile sense occurs for the median as well as the ulnar nerve innervated fingers. Clinical Trial Registration NCT01201109. (Less)