{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:24:31Z","timestamp":1792016671743,"version":"4.4.0"},"reference-count":51,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 104-2314-B-002-046-MY3"],"award-info":[{"award-number":["MOST 104-2314-B-002-046-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 103-2321-B-002-030"],"award-info":[{"award-number":["MOST 103-2321-B-002-030"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["107-2320-B-002-043-MY3"],"award-info":[{"award-number":["107-2320-B-002-043-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["107-3017-F-002-002"],"award-info":[{"award-number":["107-3017-F-002-002"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 105-2221-E-010-004-MY3"],"award-info":[{"award-number":["MOST 105-2221-E-010-004-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["108-2221-E-010-003-MY3"],"award-info":[{"award-number":["108-2221-E-010-003-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["110-2320-B-A49A-538"],"award-info":[{"award-number":["110-2320-B-A49A-538"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004737","name":"National Health Research Institutes","doi-asserted-by":"publisher","award":["NHRI-EX104-10219EC"],"award-info":[{"award-number":["NHRI-EX104-10219EC"]}],"id":[{"id":"10.13039\/501100004737","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010002","name":"Ministry of Education","doi-asserted-by":"publisher","award":["107L9014-2"],"award-info":[{"award-number":["107L9014-2"]}],"id":[{"id":"10.13039\/100010002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015811","name":"Brain Research Center, National Yang-Ming University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015811","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministry of Education, Aim for the Top University Plan","award":["100AC-B12"],"award-info":[{"award-number":["100AC-B12"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>About one-third of diabetic patients suffer from neuropathic pain, which is poorly responsive to analgesic therapy and associated with greater autonomic dysfunction. Previous research on diabetic neuropathy mainly links pain and autonomic dysfunction to peripheral nerve degeneration resulting from systemic metabolic disturbances, but maladaptive plasticity in the central pain and autonomic systems following peripheral nerve injury has been relatively ignored.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study aimed to investigate how the brain is affected in painful diabetic neuropathy (PDN), in terms of altered structural connectivity (SC) of the thalamus and hypothalamus that are key regions modulating nociceptive and autonomic responses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We recruited 25 PDN and 13 painless (PLDN) diabetic neuropathy patients, and 27 healthy adults as controls. The SC of the thalamus and hypothalamus with limbic regions mediating nociceptive and autonomic responses was assessed using diffusion tractography.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The PDN patients had significantly lower thalamic and hypothalamic SC of the right amygdala compared with the PLDN and control groups. In addition, lower thalamic SC of the insula was associated with more severe peripheral nerve degeneration, and lower hypothalamic SC of the anterior cingulate cortex was associated with greater autonomic dysfunction manifested by decreased heart rate variability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings indicate that alterations in brain structural connectivity could be a form of maladaptive plasticity after peripheral nerve injury, and also demonstrate a pathophysiological association between disconnection of the limbic circuitry and pain and autonomic dysfunction in diabetes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab754","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T22:28:22Z","timestamp":1634768902000},"page":"e1167-e1180","source":"Crossref","is-referenced-by-count":30,"title":["Brain Mechanisms of Pain and Dysautonomia in Diabetic Neuropathy: Connectivity Changes in Thalamus and Hypothalamus"],"prefix":"10.1210","volume":"107","author":[{"given":"Chi-Chao","family":"Chao","sequence":"first","affiliation":[{"name":"Department of Neurology, National Taiwan University Hospital, Taipei 10002, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3763-9548","authenticated-orcid":false,"given":"Ming-Tsung","family":"Tseng","sequence":"additional","affiliation":[{"name":"Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei 10617, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul-Chen","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Dermatology, National Taiwan University Hospital, Taipei 10002, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Ho (Janice)","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Yeong-An Orthopedic and Physical Therapy Clinic, Taipei 11155, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Leh","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Neurology, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3188-8482","authenticated-orcid":false,"given":"Sung-Tsang","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Taiwan University Hospital, Taipei 10002, Taiwan"},{"name":"Department of Anatomy and Cell Biology, National Taiwan University 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