Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial

BACKGROUND

Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN.

METHODS

This study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment.

DISCUSSION

This study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT05521737 Registered on 30 August 2022. International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].

[Acute traumatic pectoralis major tendon ruptures. Case series with a new approach]

INTRODUCTION

Described for the first time in 1822, being the treatment in acute the method of choice since the chronic injuries results in more complex procedures by the presence of fibrosis and muscular retraction.

MATERIAL AND METHODS

Report of 19 cases with injury after physical activity, averaging age 30 years and range 20-48 years. Average follow-up of 41 months, carrying out functional evaluations pre and post-operatively of CONSTANT, UCLA, SST and ASES, immobilization in internal rotation for five weeks.

RESULTS

They showed improvement in the scales SST, CONSTANT, UCLA and ASES, being made with the U of Mann-Whitney for related samples, stablishing the value of p in 0.05 in all tests. CONSTANT preoperative values range from 32 to 93, UCLA ranges from 10 to 34, aces from 11.6 to 80 and SST from 0 to 9; CONSTANT postoperative values ranging from 73 to 96, UCLA with a range of 15 to 35, ASES with a range of 55 to 100 and SST ranging from 6 to 12.

DISCUSSION

The use of this technique presented functional results, we consider has low level of difficulty, low risk of neurovascular injury, cosmetic and present functional recovery.