ABSTRACT
Objective: To explore the value of quantitative analysis of gastrocnemius metabolites with 1H-MRS for early evaluation on diabetic peripheral neuropathy in diabetic rat models. Methods: Totally 40 male SD rats were randomly divided into experimental group and normal group (each n=20). In experimental group, diabetes models were established by feeding with high sugar and high-fat fed diet and streptozotocin injection. The right gastrocnemius 1H-MRS of 2 groups were collected before modeling as well as 7 days, 14 days and 21 days after modeling. The concentration values of choline-containing compounds (Cho), creatine compounds (Cr), intra-myocellular lipids (IMCL), Cho/Cr and IMCL/Cr were obtained. The rats in normal group were fed with general diet. Electrophysiological and pathological examinations were performed 21 days after modeling, the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of right sciatic nerve were measured. The metabolite concentration values at each time point in experimental group were compared, and MNCV and SNCV were compared between groups. The pathological results of 2 groups were observed. Results: There were differences of values of Cho, Cho/Cr, Cr, IMCI, IMCI/Cr in experimental group at different time points (F=6.69, 5.41, 3.65, 3.51, 3.10, all P<0.05). Cho and Cr values 14 days and 21 days after modeling were higher than those before modeling (both P<0.05), and IMCL values 7 days after modeling were higher than those before modeling (P<0.05). MNCV and SNCV of the right sciatic nerve in experimental group were slower than those in normal group 21 days after modeling (t=2.74, 4.62, both P<0.05). Compared with normal group, the nerve fibers in experimental group were sparse, loose and disordered, some myelin sheaths were stained lightly and unevenly and axons became thin and atrophic. Conclusion: 1H-MRS can be used for noninvasive quantitative analysis of skeletal metabolites, so as for early evaluation of DPN in rat diabetic models.
ABSTRACT
Purpose: Our study aims at evaluating the efficacy and safety of botulinum toxin A in the early treatment of sixth nerve palsy in type 2 diabetic patients. Methods: This study is a prospective and interventional clinical case series of patients presenting with acute onset of sixth cranial nerve palsy, who received injection botulinum toxin A. Results: Thirty-one cases were included in the study. 58% of the study subjects had incomplete palsy at presentation (abduction deficit -1 to -3) and 42% had complete palsy (-4 and -5). The median dosage of injection was 5 U (range 3--6 U). The median follow-up period is 2 months. The P value shows that there is statistically significant improvement in head turn, ocular deviation in primary position, and improvement in abduction between baseline and 1 week (P-value <0.001), 1 month (P-value <0.001) and 2 month (P-value <0.001) postinjection follow-up visits. 90.3% of patients had full resolution of symptoms in the last follow-up visit. 83.9% of patients were successfully treated. Conclusion: Early injection of botulinum toxin A in select patients with acquired sixth nerve palsy due to diabetes is a safe and efficient treatment option in alleviating symptoms, restoring function and quality of life and reducing need for surgical interventions in future.