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DIABETIC NEUROPATHY: CLINICAL MANAGEMENT - PART 7

Thứ hai, chỉnh sửa hoặc sửa chữa một phần của những bất thường trong tái sinh là một mục tiêu cụ thể với một giải thích lâm sàng rõ ràng. Hơn nữa, sự cải thiện tốc độ hồi phục trước một sự cải tiến về mật độ sợi thần kinh và có thể là một biện pháp nhạy cảm hơn. | 304 Polydefkis Fig. 7. For each subject a regression line from postcapsaicin time-points is generated and the slope of this line is used as the rate of regeneration. The mean line for each group is shown as a thick solid line. The rate of regeneration following denervation is 0.177 0.075 fibers per mm day for control subjects red 0.10 0.07 fibers per mm day p 0.03 for subjects with diabetes but no neuropathy green and 0.04 0.03 fibers per mm day p 0.03 for subjects with diabetes and neuropathy blue . facilitate the recruitment of homogeneous study subject populations. Second correction or partial correction of abnormalities in regeneration is a concrete target with a clear clinical interpretation. Furthermore an improvement in the regeneration rate will precede an improvement in nerve fiber density and is likely to be a more sensitive measure. Finally such a study designed to detect a 50 normalization of regeneration with 80 power in nonneuropathic subjects with diabetes would require about 65 subjects per treatment arm. A recent trial of Timcodar dimesylate in healthy control subjects used such measures of collateral and regenerative sprouting as outcome measures. Although the compound did not accelerate regeneration by either measure the trial did demonstrate that such an approach was feasible and the measures were reproducible and robust 42 . In conclusion skin biopsy with determination of epidermal nerve fiber density is a powerful tool that provides investigators insight into a population of nerve fibers that is prominently affected in diabetes and yet has been relatively under investigated. The superficial nature of epidermal nerve fibers allows repeated sampling of these nerves in a Punch Skin Biopsy in Diabetic Neuropathy 305 relatively non invasive fashion and in sites that cannot be assessed through conventional electrodiagnostical techniques. These features have allowed investigators to diagnose neuropathy earlier and to define an association between .