Autonomic Nervous System ; physiopathology ; Blood Pressure ; physiology ; Cardiovascular Diseases ; therapy ; Cardiovascular System ; physiopathology ; Diabetic Neuropathies ; therapy ; Humans

OBJECTIVETo observe clinical therapeutic effect of mild-warm moxibustion on diabetic peripheral neuropathy (DPN) and to probe the mechanism.

METHODSSixty cases of DPN were randomly divided into a mild-warm moxibustion group, an acupuncture group and a medication group, 20 cases in each group. In the mild-warm moxibustion group and the acupuncture group, the same points, Shenshu (BL 23), Pishu (BL 20), Zusanli (ST 36), Yongquan (KI 1), etc. were selected; and the medication group were treated with Mecobalamin tablets. Their therapeutic effects and changes of fasting blood-glucose (FBG), glycosylated hematoglobin (GHB), hemorheological indexes, plasma endothelin (ET), nitric oxide (NO) and malondialdehyde (MDA) before and after treatment were investigated.

RESULTSThe total effective rate was 90.0%, FBG, GHB, hemorheological indexes, plasma ET, NO and MDA significantly improved in the mild-warm moxibustion group (P < 0.01), with no significant difference as compared with those in the acupuncture group (P > 0.05), but with a significant difference as compared with the medication group (P < 0.05).

CONCLUSIONMild-warm moxibustion has definite therapeutic effect on diabetic peripheral neuropathy, which is better than that of Mecobalamin.

Adult ; Aged ; Diabetic Neuropathies ; physiopathology ; therapy ; Endothelin-1 ; blood ; Female ; Hemodynamics ; Humans ; Male ; Malondialdehyde ; blood ; Middle Aged ; Moxibustion ; methods ; Nitric Oxide ; blood ; Peripheral Nervous System Diseases ; physiopathology ; therapy

Diseases of the peripheral nervous system are the most prevalent in patients with end-stage renal disease (ESRD). Although increased blood levels of lead in ESRD have been reported, the role of lead remains to be elucidated. The purpose of this study was to determine the connection of blood lead concentration with peripheral nerve conduction velocity. One hundred ninety-eight healthy subjects (control group) and 68 patients with ESRD undergoing hemodialysis (ESRD group) were enrolled. Nerve conduction was measured within two hours after hemodialysis. Orthodromic sensory nerve action potentials and compound muscle action potentials were recorded on the median, ulnar, and radial nerves. Hemoglobin-corrected blood lead was significantly higher in ESRD patients than in controls (9.1+/-2.8 microgram/dL vs. 5.9+/-2.3 microgram/dL, p<0.001). 32.4% of 68 ESRD patients with diabetes mellitus were significantly related to poorer motor and sensory nerve conduction velocity (p<0.001). However, blood lead was not a significant predictor of the nerve conduction velocity (p>0.05). Our result suggested that even though the blood lead levels were high in ESRD, they were not associated with the decline of peripheral nerve function. Diabetes mellitus is a primary independent risk of neuropathy in ESRD patients.
Peripheral Nervous System Diseases/blood/etiology/physiopathology ; Peripheral Nerves/physiopathology ; Neural Conduction/*physiology ; Middle Aged ; Male ; Lead/*blood/metabolism ; Kidney Failure, Chronic/*blood/complications/*physiopathology ; Humans ; Female ; Diabetic Neuropathies/blood/physiopathology ; Case-Control Studies ; Bone and Bones/metabolism ; Body Burden ; Adult

The pathophysiology of diabetes is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction (ED) in diabetic patients includes elevated advanced glycation end-products (AGEs) and increased levels of oxygen free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate (cGMP)-dependent kinase-1 (PKG-1). The treatment of diabetic ED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of the disease. The peripherally acting oral phosphodiesterase type 5 (PDE5) inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional treatment as a non-invasive treatment option. Local administration of vasoactive medication via urethral suppository or intracorporal injection can be effective with minimal side-effects. Patients with irreversible damage of the erectile mechanism are candidates for penile implantation. Future strategies in the evolution of the treatment of ED are aimed at correcting or treating the underlying mechanisms of ED. With an appropriate vector, researchers have been able to transfect diabetic animals with agents such as neurotrophic factors and nitric oxide synthase (NOS). Further studies in gene therapy are needed to fully ascertain its safety and utility in humans.
Alprostadil ; administration & dosage ; therapeutic use ; Cyclic GMP-Dependent Protein Kinases ; physiology ; Diabetes Complications ; physiopathology ; Diabetic Neuropathies ; physiopathology ; Erectile Dysfunction ; etiology ; physiopathology ; therapy ; Glycation End Products, Advanced ; physiology ; Humans ; Male ; Nitric Oxide ; physiology ; Penile Erection ; Penile Prosthesis ; Penis ; blood supply ; Phosphodiesterase Inhibitors ; therapeutic use ; Receptor, Endothelin B ; physiology ; Suppositories ; Vacuum