Diagnosis and rational treatment of painful diabetic peripheral neuropathy: an interdisciplinary expert consensus

Diabetic peripheral neuropathy is a common chronic complication of diabetes mellitus, significantly impairing well-being, quality of life and functioning of patients. The prevalence of diabetic peripheral neuropathy in the Russian Federation ranges from 0.1% to 67.2% in type 1 and from 0.1 to 42.4% in type 2 diabetes mellitus. However, based on the large-scale epidemiological studies, the true prevalence of diabetic peripheral neuropathy is much higher (50 to 70%), with its painful variant occurring in 16% to 30% of patients. Despite the fact that diabetic peripheral neuropathy remains the most common chronic complication of diabetes mellitus, its diagnosis and therapy leave much to be desired. To optimize diagnostic and treatment approaches to painful diabetic peripheral neuropathy, a group of experts representing the leading Russian professional medical associations has developed clinical guidelines for the diagnosis and rational therapy of patients with painful diabetic peripheral neuropathy. This document presents practical aspects of the clinical diagnosis of painful diabetic peripheral neuropathy and an algorithm for differential diagnosis of pain in the lower extremities in patients with diabetes mellitus. The use of symptomatic analgesics with central action, such as anticonvulsants, antidepressants and opioids, is based on the main aspects of neuropathic pain pathophysiology. The characteristics of each drug class are given, with consideration of evidence on their efficacy, tolerability, and the possibility of combination therapy. The data on the first, second, and third lines of agents is presented in accordance with several international clinical guidelines. The need for a tailored drug choice, taking into account the evidence-based data on their efficacy and safety, concomitant drug therapy, tolerability, cost and preferences of the patient, age of the patient and concomitant disorders, is emphasized

Quantum-Dot-Based Immunochromatographic Assay for Total IgE in Human Serum

<div><p>To rapidly quantify total immunoglobulin E levels in human serum, we developed a novel quantum-dot-based immunochromatographic assay that employs digital recording of fluorescence. It can detect IgE levels of 5–1000 kU/L, with a coefficient of variation ranging from 2.0 to 9.5%. The assay can be processed in 10 min. The developed assay was tested on 95 serum samples. The correlation coefficient between the IgE values obtained by the proposed assay and those obtained by a commercial ELISA kit was 0.9884. Our assay thus shows promise as a new diagnostic tool for IgE detection.</p></div

Correlation between ELISA and immunochromatographic assay results for samples from 95 human subjects.

<p>The immunochromatographic assay is able to estimate total IgE in the serum of human subjects, with good correlation kit (R² = 0.9884) to the results of a commercial ELISA.</p

Estimation of total IgE by immunochromatographic assay and ELISA: mean (n = 8) and standard deviation.

<p>Estimation of total IgE by immunochromatographic assay and ELISA: mean (n = 8) and standard deviation.</p

Correlation between the results of ELISA and immunochromatographic assay.

<p>Estimation of human IgE in the standard solutions by the QD-based immunochromatographic assay is strongly correlated with the results obtained using a commercial ELISA kit (R² = 0.9989).</p

Change in fluorescence intensity with analysis time.

<p>The figure shows the relationship between the analysis time and the fluorescence intensity in the test zone of the immunochromatographic test system. A standard solution of IgE with a concentration of 200/L was used as a sample.</p

Estimation of total IgE by immunochromatographic assay: mean (n = 10) and standard deviation.

<p>Estimation of total IgE by immunochromatographic assay: mean (n = 10) and standard deviation.</p

Fluorescence intensity in the test zone of an immunochromatographic test strip at different combinations of antibodies against human IgE.

<p>Fluorescence intensity in the test zone of an immunochromatographic test strip at different combinations of antibodies against human IgE.</p

Selecting the optimal concentration of anti-IgE-QD.

<p>The figure shows the relationship between fluorescence intensity in the test zone of the immunochromatographic assay and the concentration of anti-IgE-QD conjugate. A standard solution of IgE with a concentration of 200 kU/L was used as a sample.</p

Comparison of the sigmoidal and exponential equations for determining the concentration of total IgE from the calibration curve.

<p>Comparison of the sigmoidal and exponential equations for determining the concentration of total IgE from the calibration curve.</p