Diabetic peripheral neuropathy (DPN) is the most common complication associated with diabetes. DPN can present as a loss of sensation, may lead to neuropathic ulcers, and is a leading cause of amputation. Reported estimates of the prevalence of DPN vary due to differences in study populations and diagnostic criteria. Furthermore, the epidemiology and clinical characteristics of DPN in Korean patients with type 2 diabetes mellitus (T2DM) are not as well understood as those of other complications of diabetes such as retinal and renal disease. Recently, the Diabetic Neuropathy Study Group of the Korean Diabetes Association (KDA) conducted a study investigating the impact of DPN on disease burden and quality of life in patients with T2DM and has published some data that are representative of the nation. This review investigated the prevalence and associated clinical implications of DPN in Korean patients with diabetes based on the KDA study.
Amputation ; Diabetes Mellitus, Type 2 ; Diabetic Neuropathies* ; Epidemiology ; Humans ; Korea* ; Peripheral Nervous System Diseases* ; Prevalence ; Quality of Life ; Retinaldehyde ; Sensation ; Ulcer

PURPOSE: This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN). METHODS: PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses. RESULTS: Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=+0.71) and CIPN pain (d=+0.73) (p < .001). Massage and foot bath were also effective in reducing CIPN symptoms (d=+0.68; 95% CI=+1.05, +0.30; p < .001; I2=19%).Exercises were effective in improving muscle strength and endurance(d=+0.55) and quality of life (d=+2.96), but they were not significantly effective in improving CIPN. CONCLUSION: Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. PROSPERO registration: CRD42017076278.
Acupuncture ; Baths ; Bias (Epidemiology) ; Chemotherapy, Adjuvant ; Drug Therapy* ; Foot ; Humans ; Massage ; Muscle Strength ; Peripheral Nervous System Diseases* ; Quality of Life

The purpose of this article was to provide a literature review of occupational neurological disorders and related research in Korea, focusing on chemical hazards. We reviewed occupational neurological disorders investigated by the Occupational Safety and Health Research Institute of Korean Occupational Safety and Health Agency between 1992 and 2009, categorizing them as neurological disorders of the central nervous system (CNS), of the peripheral nervous system (PNS) or as neurodegenerative disorders. We also examined peer-reviewed journal articles related to neurotoxicology, published from 1984 to 2009. Outbreaks of occupational neurological disorder of the CNS due to inorganic mercury and carbon disulfide poisoning had helped prompt the development of the occupational safety and health system of Korea. Other major neurological disorders of the CNS included methyl bromide intoxication and chronic toxic encephalopathy. Most of the PNS disorders were n-hexane-induced peripheral neuritis, reported from the electronics industry. Reports of manganese-induced Parkinsonism resulted in the introduction of neuroimaging techniques to occupational medicine. Since the late 1990s, the direction of research has been moving toward degenerative disorder and early effect of neurotoxicity. To understand the early effects of neurotoxic chemicals in the preclinical stage, more follow-up studies of a longer duration are necessary.
Adolescent ; Adult ; Central Nervous System Diseases/chemically induced/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Nervous System Diseases/chemically induced/*epidemiology/etiology ; Neurodegenerative Diseases/chemically induced/epidemiology ; Neurotoxicity Syndromes/*epidemiology/*etiology ; Occupational Diseases/chemically induced/*epidemiology/etiology ; Parkinsonian Disorders/chemically induced/epidemiology ; Peripheral Nervous System Diseases/chemically induced/epidemiology ; Republic of Korea

Snoring is the most common symptom, along with increased daytime sleepiness, in patients with obstructive sleep apnea (OSA). However, doctors often neglect snoring in clinical practice, and snoring is not addressed in the treatment guidelines of OSA. Therefore, study about snoring and its clinical implications in sleep medicine are needed. The natural history of snoring shows that snoring can evolve into OSA, and the most important risk factors for this continuum are obesity and male sex. Snoring can be a social problem causing annoyance and family difficulties. Animal and human studies have shown that snoring involves the four injury mechanisms of upper airway inflammation, peripheral neuropathy, parasympathetic hypofunction, and endothelial injury. Previous studies have reported that systemic diseases such as atherosclerosis, metabolic syndrome, hypertension, and cardiac diseases were comorbid with snoring. However, most of these studies enrolled patients characterized by survey or questionnaire; therefore, data were biased with effects of OSA. Thus, consensus on the definition and detection of snoring is lacking. Additional studies are required to determine the exact clinical implications of snoring.
Animals ; Atherosclerosis ; Bias (Epidemiology) ; Comorbidity ; Consensus ; Heart Diseases ; Humans ; Hypertension ; Inflammation ; Male ; Natural History ; Obesity ; Peripheral Nervous System Diseases ; Risk Factors ; Sleep Apnea, Obstructive ; Snoring* ; Social Problems

OBJECTIVES: To propose the referential data to evaluate the health impacts of Vietnam veterans' children whose father were exposed to herbicides in Vietnam War. METHODS: Vietnam veterans who visited to Pusan Veteran Hospital for medical care were recruited from April to October, 1998. They were 71 and asked about their own combat history, symptoms and illness, and health status of their 182 children. The informations were collected by direct and phone interview. Exposure estimation was also performed as exposure score depending on year and unit of participation, and personal episodes related to exposure to herbicide in the war. It classified into three groups; lower(<18.0), moderate(18-53), high(> or =53) exposure group. RESULTS: The mean age and the period into the combat of the veterans were 52.8 years and 15.0 months. The mean exposure score was 18.1+/-9.9, and mainly distributed in lower (46.5%) and moderate(52.1%) exposure group. Most(90.1%) of them were diagnosed as sequelae(21 cases) and suspected sequelae(43 cases) of the herbicides by Korean veteran's hospital diagnostic criteria. The major sequelae was peripheral neuropathy 13 cases, chloracne 5 cases, and the major suspected sequelae was hypertension 20 cases, diabetes mellitus 18 cases, liver disease 12 cases, central neuropathy 11 cases, etc. About birth, 42.2% and 16.9% experienced spontaneous abortion and stillbirth, respectively. The mean exposure score was higher in stillbirth experience group(p<0.05). About half of the children(90 cases, 49.5%) hold the abnormal health status: those were skin pigmentation 38 cases, rash 23 cases, congenital anomaly 15 cases, general weakness 12 cases, purpura 8 cases, visual disturbance 8 cases, etc. These health problems had no association with father's exposure level(p>0.05). CONCLUSIONS: These results were depend on their own answers, and expectation for compensation did not excluded, therefore, this study may have limitations: inaccuracy of informations due to recall bias and response bias. Nevertheless, through this study, we could image the fundamental aspect for health impacts of Vietnam veterans' children for preparing the national control program and policy. A large scale epidemiologic study with valid exposure assessment on the health impacts of Vietnam veterans' children is recommneded.
Abortion, Spontaneous ; Bias (Epidemiology) ; Busan* ; Child* ; Chloracne ; Compensation and Redress ; Diabetes Mellitus ; Epidemiologic Studies ; Exanthema ; Fathers ; Female ; Herbicides ; Humans ; Hypertension ; Liver Diseases ; Parturition ; Peripheral Nervous System Diseases ; Pregnancy ; Purpura ; Surveys and Questionnaires* ; Skin Pigmentation ; Stillbirth ; Veterans* ; Vietnam*

BACKGROUND: This is the studies about "If the soldiers expose in the paraquat, how much have it influenced on themselves who participated in the Vietnam War and their second generation?" and this is also researched about the factors that "How differents do the symptoms according to their health conditions and a class of diseases?". First of all, We divided them into 3 groups as exposure duration and exposure degree of the paraquat and We gave marks against each steps, too. (< point 10: low group, point 11-19: middle group, > point 20: high group). We've focused in "Does the high score really involves with their descendants who suffers from paraquat?" as direct damages men during from June 1965 to February 1971 (72 persons) and their descendants (266 persons) who are in the Pusan veterans hospital and outpatients. METHODS: It is completed by direct interview, telephone interview, army records, army history, and medical records with them. We've tried to minify sample bias as analyzing their information. We could contact only a few people among living in Pusan or Kyongnam province. Generally, someone including persons who couldn't get a damaging proofs from paraquat hardly joined us and the others strongly rejected the interview for this research. RESULTS: Among the 72 participating soldiers in the Vietnam war, average age of patient is 53 years old (the youngest: 46 years old, the oldest: 64 years old), average of exposure score is 16 point (minimum: 1.9 point, maximum: 31.9 point), average of pregnant frequency is 5.2 persons, and average degree of smoking is 14.382 single cigarette (minimum: 4 single cigarette, maximum: 60 single cigarette). The second generation is suffering from abortion, skin disorder, still birth, congenital anomalies, weakness, visual disturbance, peripheral neuropathy in frequency. CONCLUSION: There's no relation between exposure score of paraquat and diseases of the descendants.
Bias (Epidemiology) ; Busan ; Gyeongsangnam-do ; Hospitals, Veterans ; Humans ; Interviews as Topic ; Male ; Medical Records ; Middle Aged ; Military Personnel ; Outpatients ; Paraquat* ; Parturition ; Peripheral Nervous System Diseases ; Skin ; Smoke ; Smoking ; Tobacco Products ; Vietnam*

To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases. The surgical outcomes and follow-up results were analyzed retrospectively.
 Results: One patient received carotid endarterectomy suffered hemiplegia, whose symptoms were improved after positive clinical treatment. One patient suffered transient ischemic attack, and 5 patients displayed the cerebrovascular syndromes a week later after surgery. Twelve patients suffered nerve function damage 48 hours later after surgery. Nine patients received intra-aortic ballon pump, 1 patient received thoracotomy hemostasis, 3 patients suffered sternal dehiscence; 27 patients showed atrial fibrillation. Two patients died after surgery. The follow-up duration ranged from 1-7 years and the follow-up rate was 90%. The ischemic symptoms were improved in 44 patients. Six patients complained the recurrence of angina, but no abnormalities were found in coronary angiography or computed tomography angiography. One patient died of malignant tumor during the follow-up duration.
 Conclusion: For patients with concomitant carotid and coronary artery severe stenosis, it is more likely to suffer ischemic cerebral stroke. However, carotid stenosis is not the only factor, other key factors relevant to ischemic cerebral stroke shouldn't be ignored either.
Atrial Fibrillation ; epidemiology ; Blood Loss, Surgical ; statistics & numerical data ; Carotid Stenosis ; complications ; surgery ; Cerebrovascular Disorders ; epidemiology ; Comorbidity ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; adverse effects ; mortality ; Coronary Artery Disease ; complications ; surgery ; Coronary Stenosis ; complications ; surgery ; Endarterectomy, Carotid ; adverse effects ; Female ; Hemiplegia ; epidemiology ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; Intraoperative Complications ; epidemiology ; Ischemic Attack, Transient ; epidemiology ; Male ; Nervous System Diseases ; Peripheral Nerve Injuries ; epidemiology ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke ; epidemiology ; Surgical Wound Dehiscence ; epidemiology ; Thoracotomy ; adverse effects

This study was done to characterize the natural course of C-peptide levels in patients with type 1 diabetes and identify distinguishing characters among patients with lower rates of C-peptide decline. A sample of 95 children with type 1 diabetes was analyzed to retrospectively track serum levels of C-peptide, HbA1c, weight, BMI, and diabetic complications for the 15 yr after diagnosis. The clinical characteristics were compared between the patients with low and high C-peptide levels, respectively. The average C-peptide level among all patients was significantly reduced five years after diagnosis (P < 0.001). The incidence of diabetic ketoacidosis was significantly lower among the patients with high levels of C-peptide (P = 0.038). The body weight and BMI standard deviation scores (SDS) 15 yr after diagnosis were significantly higher among the patients with low C-peptide levels (weight SDS, P = 0.012; BMI SDS, P = 0.044). In conclusion, C-peptide level was significantly decreased after 5 yr from diagnosis. Type 1 diabetes patients whose beta-cell functions were preserved might have low incidence of diabetic ketoacidosis. The declines of C-peptide level after diagnosis in type 1 diabetes may be associated with changes of body weight and BMI.
Adolescent ; Body Mass Index ; Body Weight ; C-Peptide/*blood ; Child ; Child, Preschool ; Diabetes Complications ; Diabetes Mellitus, Type 1/blood/*diagnosis ; Diabetic Ketoacidosis/epidemiology ; Diabetic Retinopathy/epidemiology ; Female ; Follow-Up Studies ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Infant ; Male ; Peripheral Nervous System Diseases/epidemiology ; Retrospective Studies

BACKGROUND: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). PARTICIPANTS AND METHODS: A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. RESULTS: Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a "feeling of weakness" and "chronic numbness or pain" significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW. CONCLUSION Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.
Adolescent ; Adult ; Arsenic ; analysis ; toxicity ; Cross-Sectional Studies ; Dietary Exposure ; adverse effects ; Dose-Response Relationship, Drug ; Drinking Water ; adverse effects ; chemistry ; Female ; Groundwater ; chemistry ; Humans ; Male ; Middle Aged ; Myanmar ; epidemiology ; Peripheral Nervous System Diseases ; chemically induced ; epidemiology ; physiopathology ; Sensation Disorders ; chemically induced ; epidemiology ; physiopathology ; Water Pollutants, Chemical ; analysis ; toxicity ; Young Adult

OBJECTIVETo explore the risk factors of diabetic peripheral neuropathy (DPN) and the relationship between DPN and diabetic retinopathy (DR).

METHODSThe data of the in-patients with type 2 diabetes mellitus (T2 DM) were retrospectively studied. A total of 200 T2 DM patients were divided into DPN group (n = 136) and non-DPN group (n = 64) according to peripheral neuropathy. The basic clinical data and the incidence rate of DR were compared between two groups. Logistic regression analysis was used to study the risk factors of DPN.

RESULTSThe course of disease, the level of BMI, glycosylated hemoglobin (HbA1c), 2 hour postprandial blood glucose (2 hPG), 2 hour glucose C peptide (2 hC-P) and the incidence rate of the DR were significantly different between two groups (P < 0.01). Logistic regression analysis showed that significant differences were observed in T2 DM complicated by DR (P = 0.023), the course of disease (P = 0.008), the level of HbA1c (P = 0.006), BMI (P = 0.000) and 2 hC-P (P = 0.065).

CONCLUSIONDiabetic retinopathy, the course of disease, the level of BMI,HbA1c and 2 hC-P are the risk factors for type 2 diabetic peripheral neuropathy. Diabetic peripheral neuropathy is positive correlated with diabetic retinopathy.

Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; metabolism ; Body Mass Index ; C-Peptide ; blood ; China ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Neuropathies ; blood ; epidemiology ; etiology ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Male ; Middle Aged ; Peripheral Nervous System Diseases ; blood ; epidemiology ; etiology ; Risk Factors