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 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 whether vitamin B complex supplements would reduce stroke-related disabili-ty in hyperhomocysteinemia (Hhcy) patients with recent ischemic stroke. Methods One thousand patients with brain infarc-tion and Hhcy were assigned to receive either a daily dose of vitamin B complex (treatment group, n=500) or not (control group, n=500) on the base of conventional secondary prevention medications for a period of 2 years. The neurological dys-function was assessed by National Institutes of Health Stroke Scale (NIHSS) and stroke disability was evaluated by Barthel Index (BI) score. High performance liquid chromatographic method with fluorescence detection was used for the determina-tion of total plasma homocysteine levels. After 2 years of follow-up, the patients in the treatment group, whose tHcy level was reduced by 3-μmol/L or more, was defined as the treatment subgroup. Results The homocysteine levels were significantly reduced after 3, 12 and 24-month treatment than those of control group (P＜0.05). A lower NIHSS scale was found at 12, 18 and 24-month in treatment group compared with that in control group (P＜0.05), no significant differences at other time points between two groups (P>0.05). For the BI score, there were no significant differences at any time points between two groups (P>0.05). After 2 years of vitamin B complex supplementation, there were lower NIHSS scale and higher BI scale in treatment subgroup than those of control group (P＜0.05). Conclusion The lower level of tHcy induced by vitamin B inter-vention may be beneficial to the improvement of neurological deficit in patients with ischemic stroke.

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 evaluate the impairment of ulnar nerve and its relationship with sensory symptoms in the ulnar territory in patients with carpal tunnel syndrome (CTS) through electrophysiological approach.Methods We retrospectively reviewed 55 cases with CTS admitted in our hospital from January 2012 to February 2013.Patients with CTS were graded as mild-moderate (35 cases) and severe (20 cases) according to Stevens standard and were divided into symptomatic and non-symptomatic group according to the presence of sensory symptom in little finger region.Twenty healthy volunteers were included as control.Median and ulnar nerves electrophysiological study were performed using the Keypoint.net (Medoc Ltd) electromyogram device.Results Finger 5-wrist sensory conduction velocities (SCVs) of ulnar nerve were reduced ((51.71 ± 2.93) m/s vs (58.62 ± 3.21) m/s,t =8.80,P ＜ 0.01) in CTS group,compared with control group.But the sensory nerve action potential (SNAP) amplitudes had no difference.Pearson correlation analysis showed that finger 5-wrist SCVs and the SNAP amplitudes of ulnar nerve were negatively correlated with the distal motor latency of the median nerve,while positively correlated with the compound muscle action potential amplitudes,finger 1-wrist,finger 3-wrist SCVs and SNAP amplitudes of median nerve,in mild-moderate group,finger 5-wrist SCVs of ulnar nerve were slowed and the SNAP amplitudes were reduced ((51.59 ±2.70) m/s vs (53.72 ±2.58) m/s; (13.51 ± 1.84) μV vs (15.21 ±2.16) μV,t =2.24,2.30,P ＜ 0.05 respectively) in the symptomatic group,compared with the non-symptomatic group.However,in severe group,only 2 cases had sensory symptom in little finger region.Conclusions CTS patients may have impairments due to ulnar nerve entrapments at wrist,which aggravate with disease progression.Sensory symptoms in ulnar territory are more frequent during the mild-moderate stage,and may relate with ulnar nerve involvement.

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.

Chronic inflammatory demyelinating polyneuropathy (CIDP) with positive anti-contactin-associated protein-1 (Caspr1) antibody is a rare autoimmune antibody mediated peripheral neuropathy. A 62-year-old male patient was reported in this article, whose clinical manifestations were subacute onset, abnormal distal limb motor sensation, and increased cerebrospinal fluid protein level. The patient had a good response to plasma exchange. Electromyography of lower limbs showed that motor involvement was dominant, motor conduction velocity slowed down, compound motor active potential (CMAP) and sensory nerve active potential amplitude decreased, and F wave was not elicited; electromyography of upper limbs without symptoms showed that CMAP amplitude of median nerve decreased, and conduction velocity was normal. There are few reports of anti-Caspr1 positive CIDP in the world. The article summarized the characteristics of the patient and reviewed the relevant literature, in order to improve clinicians′ understanding and diagnosis and treatment ability of the disease.

Objective To summarize the experience of rapid liver and kidney graft harvesting. Methods From Jan 2001 to Sep 2003,a quick procedure for combined liver and kidney procurement were used in 138 cases. The procedure includes in situ perfusion through aorta and superior mesenteric vein(SMV) plus drainage through inferior vena cava. Liver,pancreas,spleen and kidney were harvested en bloc. Results The warm ischemia time averaged at 2 to 6 minutes for kidneys and 3 to 8 minutes for livers. The total procurement time averaged at 20 to 30 minutes. All aberrant arteries were preserved. After transplantation there was no primary non-function in all 131 liver grafts,and the peak sALT level during the first 3 post-operative days was (581?392) U/L. Acute tubular necrosis rate was 3.3%(9/274) in renal grafts. Conclusion[WT5”BZ] This rapid procurement protects the quality of liver and kidney simultaneously. It is a simple,effective,safe and reasonably standardized procedure.

Objective To summarize the clinical technique and experience of one stage combination of renopancreatic transplantation(SKPT) with portal venous drinage of pancreatic endocrine and enteric drainage of exocrine(PE).Methods Five patients with insulin-dependent diabetes mellitus and end-stage renal disease underwent SKPT with PE drainage.The clinical data,operative techbuque,and the prevention of non-technical complications were summarized.Results This procedure was successfully applied in the 5 patients.Three patients recovered excellently;but 2 died perioperatively,one died of sepsis due to pancreatic leakage,and one of FK506 toxicity.On postoperative day 3,in the 3 survivors,blood creatinine and urea nitrogen levels returned to normal;insulin administration was discontinued on 7d postoperatively,and the endogenous and exogenous secretory functions of the graft were normal.Conclusions SKPT with PE is a resonable procedure,because of its potential physiologic,metabolic,and immunologic advantages.PE drainage may become the prefer technique of pancreas transplantation.Intensive perioperative managements are effective methods to prevent complications and to improve the therapeutic effects.

Objective To investigate the relationship between total homocysteine (tHcy) and carotid intima-media thickness (CIMT) in brain infarction patients. Methods Sixty patients with fasting plasma tHcy levels ≤10μmol/L (non-Hhcy group), 60 patients with fasting plasma tHcy levels>10μmol/L and≤15μmol/L (H1 group), and 60 patients with fast-ing plasma tHcy levels>15μmol/L (H2 group) were chosen in hospitalized patients with acute cerebral infarction. Values of CIMT were detected in three groups of patients. The clinical biochemical indicators including triglyceride (TG), total choles-terol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood sugar (FBS), folic acid (FA), Vitamin B12 (VitB12) and glycated hemoglobin (HbA1c) were also detected. Results There was signifi-cant difference in CIMT between three groups (P<0.01). The value of CIMT increased in H2 group [0.98(0.90, 1.05)mm] com-pared with that of non-Hhcy group [0.85(0.80, 0.95)mm]. The value of CIMT increased in H2 group compared with H1 group [0.98(0.90, 1.05)mm vs 0.85(0.85, 0.95)mm], P<0.05). There were significant differences in tHcy, FA and VitB12 between three groups. Based on the log-transformed values of CIMT as the dependent variable, multiple stepwise linear regression showed significant associations of the following variables with increased CIMT: increasing age, the history of smoking, the history of diabetes, higher LDL-C and tHcy levels. Conclusion Brain infarction in patients with higher tHcy level often have lower levels of FA and VitB12, and increased CIMT. When the level of tHcy >15 μmol/L, there is more significantly higher level of CIMT. The increased CIMT level was associated with some cerebrovascular risk factors in patients with brain infarction.