Early diagnosis of prediabetic peripheral neuropathy depends on the evaluation of small fibers.Traditional nerve conduction tests can only evaluate the function of large myelinated fibers,while lack of sensitivity to small fibrous lesions.These lesions were related to pain and autonomic neuropathy.In recent years,with the progress of neurophysiological diagnosis technology,the early diagnosis of diabetic peripheral neuropathy has been improved.Clinical methods,commonly used in the detection of small fibrous lesions,mainly include skin sympathetic response,quantitative sensory test,contact heat pain evoked potential,and quantitative sudomotor axonal reflex test.In this paper,the pathogenesis of diabetic peripheral neuropathy,neurological pathological changes and applications of electrophysiology technology were reviewed to provide an objective basis for early diagnosis of prediabetic peripheral neuropathy.

BACKGROUND:Danhong injection, scavenging free radicals and inhibiting lipid peroxidation, can improve microenvironment injury after cerebral infarction. OBJECTIVE:To explore the influence of bone marrow mesenchymal stem cel s combined with Danhong injection on expression of GAP-43 and Bcl-2 after cerebral infarction in rats. METHODS:Sixty Wistar rats were selected to prepare models of cerebral infarction by middle cerebral artery occlusion and then randomly divided into control group, bone marrow mesenchymal stem cel group, and combination group. Control group received tail vein injection of PBS. Bone marrow mesenchymal stem cel group received tail vein injection of 2.5×109/L bone marrow mesenchymal stem cel suspension. Combination group received injection of 2.5× 109/L bone marrow mesenchymal stem cel suspension+2 mL/kg Danhong injection, for 5 consecutive days, once a day. RESULTS AND CONCLUSION:There were no significant differences in the neurological dysfunction scores among the three groups at 24 hour and 3 days after implantation (P>0.05). The neurological dysfunction scores in the ombination group were significantly lower than those in the bone marrow mesenchymal stem cel group and control group at 1 and 2 weeks after transplantation (P<0.05). In the combination group, GAP-43 and Bcl-2 expression was significantly higher than the bone marrow mesenchymal stem cel group and control group (P<0.05). Bone marrow mesenchymal stem cel transplantation combined with Danhong injection can significantly promote the local expression of GAP-43 and Bcl-2 after cerebral infarction, and has obvious inhibitory effects on cel apoptosis in rats with cerebral infarction.

Objective To investigate the correlation between plasma homocysteine level and impaired glucose tolerance(IGT) patients in peripheral neuropathy.Methods 80 patients with IGT were selected according to the results of routine nerve conduction test,including 40 patients associated with peripheral neuropathy (IGT-PN),and 40 patients without peripheral neuropathy (IGT-NPN).Besides,40 healthy subjects were selected as control.Plasma homocysteine levels were measured in the three groups by enzyme rate method.The severity of neuropathy was scored and graded by the Toronto Clinical Scoring System (TCSS).Results Plasma homocysteine levels were significantly higher in the all IGT groups than those in the control group.The plasma homocysteine level in the IGT-PN group (14.2±2.7) μmol/L was significantly higher than that in the IGT-NPN group (12.3±2.6) μmol/L (P＜0.05).Regression analysis showed that plasma homocysteine level had independent effects on IGT with peripheral neuropathy.Plasma homocysteine level was positively correlated with TCSS score.Conclusions Plasma homocysteine may play an important role in the pathogenesis of peripheral neuropathy in patients with IGT,and their level may be associated with the severity of peripheral neuropathy.

Objective To investigate a non-invasive and objective measure for patients with diabetic small fiber neuropathy by contact heat evoked potential (CHEP). Methods CHEP was performed in diabetic patients (n=46) and normal subjects (n =40). Thermal stimuli were given at 52 ℃ to 3 body sites: right forearm, right dersum hand and right peroneal area. CHEP were recorded from Cz. The main components of CHEP were observed. Studies on sensory nerve conduction were performed in all the diabetic patients and the normal subjects. Results In 7 patients there were no recordable CHEP on stimulation of the forearm, and in some cases of dorsum hand (n =9) and the leg (n = 16). In contrast, CHEP were recordable in all control subjects. The diabetic group had reduced N-P amplitudes and prolonged N-wave latencies. In patients with normal sensory nerve conductions, amplitudes of CHEP were reduced and latencies of CHEP were prolonged. Twenty-five patients had normal sensory nerve conduction for upper limbs, the amplitudes of CHEP being (34.0±12.6) μV vs (48.4±17.5)μN, Z= -3. 151, P<0.01 for the forearm, (28.2±10. 1) μV vs (43.0±16.6) μV, Z= -3.712, P<0.01 for the dersum hand with a latency of (420.4±27.8) ms vs (407.2±24.6) ms, t =2.015,P=0.048. In 18 patients with normal sensory nerve conductions for lower limbs, the latency of CHEP for the leg was (473.5±46. 6) ms vs (448.6±35.0) ms, t =2. 219 (P =0. 031) and amplitudes (23. 8±7.4) μV vs (41.5 ±18.5) μV, Z = - 3. 855 (P <0.01). Conclusion CHEP provides an objective and non-invasive potential clinical utility in the evaluation of diabetic small fiber neuropathy.

Objective To evaluate the function status of motor nerve in patients with carpal tunnel syndrome ( CTS) sensory neuropathy by single-fiber conduction studies ( SF-CS).Methods Forty patients with CTS were divided into two groups according to the nerve conduction abnormality of median nerve .The sensory conduction abnormalities ( SCA) group included 20 patients with abnormal sensory conduction , while the sensory motor conduction abnormalities ( SMCA) group included 20 patients with abnormal motor sensory conduction.The Keypoint.net electromyogram device was used to detect the wrist to the abductor pollicis brevis latency , using the saddle shaped stimulating electrodes for stimulating and the single fiber electromyography electrode for recording.The control group included 20 healthy people.Results The latency of single-fiber conduction of median nerve in SCA group , SMCA group and control group was (3.92 ±0.28) ms, (4.71 ±0.49) ms and (3.41 ±0.31) ms (F=63.829, P=0.000), respectively.The area under the receiver operating characteristic curve was 0.920 for the latency of single-fiber conduction of median nerve , and its specificity was 85%in cut off point.Conclusions There is clinical motor nerve damage in patients with CTS sensory neuropathy.The SF-CS may become an effective means for early evaluation of motor nerve function state.

Objective To analyze the electrophysiologie characteristics of critical illness of polyneuromyopathy ( CIPM ) and its effect on the duration of usage of mechanical ventilation. Methods Denmark Keypoint 4-electromyogram was utilized to record electraneurophysiology on 17 subjects with lung infection and respiratory failure who were treated with mechanical ventilation over 1 week and had difficulty in weaning from the ventilator in intensive care unit. Electrophysiology character of CIPM was described and the duration of mechanical ventilation of CIPM patients was compared with non-CIPM subjects. ResultsOf the 17 cases, 9 subjects were diagnosed with CIPM including 6 patients with critical illness polyneuropathy (CIP), and 3 patients with critical illness myopathy (CIM), the 2 subtype of CIPM. Compound muscle action potential (CMAP) and sympathetic skin response (SSR) in all of CIPM patients were abnormaL Though the amplitude of sensory nerve action potential (SNAP) in patients with CIP was reduced, nerve conduction velocity (NCV) was normal in all of them. Repetitive nerve stimulation, somatosensory evoked potential and blink reflex were normal in all of the patients with CIPM, however, the rate of occurrence of F wave was reduced in 2 patients with CIP and in 2 patients with CIM. The median and quartile range of duration of mechanical ventilation in CIPM patients was 30. 0 days (20. 0--45.0 days), significantly longer than13.5 days (9.5--17.5 days) in non-CIPM patients (U=7.500,P=0.006). ConclusionsThe ehctrophysiology change in patients with CIPM is characterized by reduced amplitude of CMAP and (or) SNAP, normal NCV and abnormal SSR. The duration of mechanical ventilation is significantly prolonged in CIPM patients.

Objective To study the roles of the contact heat evoked potential (CHEP) in evaluating the small nerve fibers of cranial and spinal in elderly diabetic patients,and to analyze the feature of the small fibers in order to provide scientific foundations for early diagnosis of diabetic neuropathy (DN).Methods Totally 50 diabetic patients and 40 healthy subjects were included in this study.The diabetic patients were divided into the normal nerve conduction group (n=17) and the abnormal nerve conduction group (n=33).CHEP was determined and thermal stimuli was given to the area of eyelid,forearm and peroneal.Sensory and motor nerve conduction velocity in the upper and lower limbs were tested in all diabetic patients.Results Compared with the healthy group,the N wave latencies were prolonged and the N-P amplitudes were reduced in the area of eyelid,forearm and peroneal in diabetic patients (all P＜0.01).Compared with the healthy group,the logarithm of N-P amplitudes were reduced in areas of forearm and peroneal [(1.70±0.10) vs.(1.60±0.14),(1.65±0.078) vs.(1.54±0.15),both P＜0.05] and N wave latencies were prolonged in eyelid area [(343.1±18.2) ms vs.(385.4±26.5) ms,P＜0.05] in normal nerve conduction group.Compared to group with normal nerve conduction velocity,the logarithm of N-P amplitudes was reduced in peroneal area [(1.54±0.15) vs.(1.44±0.15),P＜0.05] in abnormal nerve conduction group.Conclusions CHEP can detect the early impairment of the small fibers in elderly diabetic patients.The early smallfiber impairments in diabetic neuropathy may be axon-oriented in spinal nerves and myelin-oriented in cranial nerves.

Objective To investigate motor nerve function status in rats with diabetes mellitus by motor unit number estimation (MUNE), and discuss it′s early diagnostic value in diabetic peripheral neuropathy (DPN). Methods Diabetic rat model (DM group) was induced by streptozotocin. The MUNE of gastrocnemius muscle and motor nerve conduction (MCV, CMAP) of the sciatic nerve were measured at the 4th, 8th and 12th week after onset of hyperglycemia in the DM group and the control group (normal SD rats). The ultrastructure of sciatic nerve was observed by electron microscope. Results At the 4th week, MUNE of gastrocnemius muscle was significantly decreased in DM group compared to that of the control group (275.88 ± 87.87 vs 369.71 ± 75.64,P<0.05). There were no significant differences in MCV and CMAP of sciatic nerve be?tween two groups. The electron microscopy observation showed that most nerve fibers were normal;a small amount of axonal atrophy, and myelin lamellar structure was separated in DM group. At the 8th week, compared with the control group, MUNE were reduced in gastrocnemius muscle in DM group (357.49±72.68 vs 221.26±92.41, P<0.01). There were no significant dif?ferences in MCV and CMAP of the sciatic nerve between DM group and control group. The electron microscope observation showed that part of nerve fibers were normal, the myelin focal plate layer was loose and separated, axonal atrophy, the axonal membrane and myelin sheath inner layer was separated with big gap. At the 12th week, MUNE of gastrocnemius muscle (127.87±19.80 vs 366.85±51.25), sciatic nerve MCV [(35.06±4.43) m/s vs (50.47±6.07) m/s] and CMAP [(2.91±1.37) mV vs (5.98±2.14) mV] were significantly decreased in DM group than those of control group (P<0.01). The electron microscopy observation showed severely damaged myelin flex and axonal squeeze. Conclusion MUNE is much earlier in detecting ear?ly motor nerve dysfunction in DM than conventional motor nerve conduction test.

Objective To assess the function of motor nerve fiber in patients with diabetic peripheral neuropathy (DPN) by single-fiber conduction studies.Methods According to the diagnostic standard of DPN issued in Toronto meeting in 2009,on the basis of the result of peroneal nerve conventional conduction study,a total of 65 patients with DPN in the Department of Endocrinology and the Department of Neurology of Tianjin Third Central Hospital from October 2012 to October 2013 were enrolled into the study,from whom 33 had abnormal sensory conduction (sensory-diabetic peripheral neuropathy group,S-DPN group),32 had abnormal sensory motor conduction (sensory motor-diabetic peripheral neuropathy group,SM-DPN group).Single-fiber conduction velocity (SF-CV) and single-fiber distal motor latency (SF-DML)were detected in all subjects.The obtained results were compared with the data from 34 healthy volunteers (control group).The relationship of SF-CV,SF-DML and the duration of diabetes mellitus,fasting glucose,HbA1 c was also studied in DPN patients.Results The SF-CV ((43.1 ± 3.6) m/s) was decreased in S-DPN group compared with control group ((47.5 ± 3.3) m/s,t =5.077,P ＜ 0.01).There were no significant differences in SF-DML ((3.6 ± 0.7) ms),motor nerve conduction velocity (MCV (49.5 ± 2.6)m/s) and DML ((3.4 ± 0.6) ms) in S-DPN group compared with that of control group ((3.4 ± 0.5) ms,(50.9 ± 3.5) m/s,(3.2 ± 0.5) ms,respectively).SM-DPN group had lower SF-CV ((35.2 ± 3.6)m/s,t =9.119,14.219),MCV ((40.9 ± 3.2) m/s,t =11.131,13.025) and increased SF-DML ((4.5±0.7) ms,t=5.692,7.231),DML ((4.2 ±0.7) ms,t=5.561,6.975) compared with the other two groups (P ＜0.01).SF-CV in DPN patients was negatively related to the diabetic duration (r =-0.340,P =0.006),while SF-DML had no correlation with duration of DM,fasting blood glucose and HbAlc.Conclusions Detection of SF-CV is easy to find early motor nerve dysfunction in DPN patients.SF-CV is decreased with the increasing duration of diabetes.

OBJECTIVES: To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). METHODS: A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. RESULTS: There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. CONCLUSIONS Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.
Amniotic Fluid ; Humans ; Infant ; Infant, Newborn ; Intubation, Intratracheal ; Meconium ; Meconium Aspiration Syndrome/therapy* ; Retrospective Studies ; Suction