BACKGROUND: After local injection of Botulinum toxin type-A (BoTX-A), not only the function of the neuromuscular conjunction was affected, but also the changes occurred remote from the injected site. F-waves result from the back fire of the motoneuron activation, which may indirectly reflect the functional state of the motoneurons.OBJECTIVE: To evaluate the remote effect of local BoTX-A injection by F-wave test.DESIGN: Self-control study based on patients with movement disorders.SETTING: Neruologic clinic in a university hospital.PARTICIPANTS: Twenty-six patients with movement disorders not received previous local BoTX-A were selected from Neurological Clinic in Renmin Hospital of Wuhan University between September 2002 and July 2003, including 19 cases with hemificiospasm, 5 Meige syndrome and 2 torticollis spasmodicus.INTERVENTIONS: F- and M-waves of ulnar and tibial nerves were recorded before 1, 12 - 24 weeks after local injection of BoTX-A in 26 patients.MAIN OUTCOME MEASURES: The following parameters were analyzed:latency(ML) and amplitude (Mamp) of M-wave, minimal (Fmin) and average latency (Fave), amplitude of negative peak(Famp), duration (Fdur), persistence (Fpcr) and chronodispersion (Fchr) of F-wave.RESULTS: No definite F-response of ulnar nerve stimulation was obtained 1 week after injection in 3 HFS patients (5 nerves) . Fave prolonged significantly on ulnar and tibal nerve and Fdur increased significantly on ulnar nerve 1 week after injection, but there was no significant difference 12 - 24 weeks later, compared with before injection. No significant correlation of the altered F-wave parameters was found with the dosage of BoTX-A.CONCLUSION: Fdur and Fave could sensitively assess the remote effect,which correlates with distance away from the injected muscle, rather than the dosage of BoTX-A.

Objective To investigate the diagnostic significance of sensory nerve action protential (SNAP) on diabetic neuropathy (DN), through measuring amplitude and amplitude ratio. Methods There were 91 patients with type 2 diabetes involing 51 cases without neurologic symptom/sign as subgroup Ⅰ, 30 cases with mild neuropathy as subgroup Ⅱ and 10 cases with severe neuropathy as subgroup Ⅲ, according to Toronto clinical scoring system (TCSS). Thirty-nine healthy volunteers with age- and gender-matched were served as controls. SNAP were antidromically recorded using surface electrodes. The observed parameters were as follows: conduction velocity and amplitude of median, radial and sural nerve, shorten for Vine, Vra and Vsu and Ame, Ara and Asu, respectively; sural/radial nerve amplitude ratio (SRAR) and median/ radial nerve amplitude ratio (MRAR). Results (1) As compared with the controls (P<0.05),conduction velocity (m/s, Vine : 46. 2 ±7.3, Vra: 45.8±6. 9, Vsu: 30. 3±9. 5) and amplitude (μV, Am: 15.4±10.5, Ar: 16.6±9.8, As: 5.9±6. 3)decreased significantly in subgroup Ⅲ; Vsu (46.2± 4. 7) significantly slowed in subgroup Ⅱ (P = 0. 002) ; both Ame (34. 5 ± 10. 2, 33. 0 ± 14. 6) and Asu (13.8± 5.6, 10.7 ± 5.5) decreased significantly in both subgroup Ⅰ and Ⅱ respectively, with Asu decreasing more significantly in subgroup Ⅱ (Z=- 3.22, P = 0. 001) ; SRAR (0. 432±: 0. 112) was significantly smaller only in subgroup Ⅰ , both SRAR (0. 330 ±0. 102) and MRAR (1. 008 ± 0. 225) were significantly smaller in subgroup Ⅱ. SRAR decreased more significantly in subgroup Ⅱ (t = - 3. 86, P = 0. 003). (2) The abnormal rate of Ame was the highest in subgroup Ⅰ (26. 0%), and Asu in subgroup Ⅱ (41.4%) ; while that of combination of Asu and SRAR (68.9%) was significantly higher than that of Asu alone (x2 = 9. 212, P = 0. 003). (3) TCSS scores were negatively related to Van (r = - 0. 583), Ame (r=-0. 406), Asu (r=-0.620) and SRAR (r=-0.527, all P<0.05), and there was no significant correlation of TCSS scores with MRAR in subgroup Ⅱ; both SRAR (r = -0.435) and MRAR (r = - 0. 319) were negatively related to the diabetic duration (both P < 0. 05). Conclusions In mild or early DN, SNAP amplitude is more sensitive than conduction velocity, combination of SRAR and Vsu may be serve as a useful indication for early diagnosis. In the DN patient, diabetic duration has more influence on the measurement of sensory NCS, and SRAR is related to the severity of neuropathy.

Objective To evaluate the remote effect of local injection of botulinum toxin by use of the F-wave measures. Methods The F-wave responses as well as M-waves were recorded before injection, and at 1 week,12 to 24 weeks after local injection of botulinum toxin type-A (BTX-A) in 26 patients, including 19 with hemi-facial spasm (HFS),5 Meige syndrome and 2 torticollis spasmodicus (TS).The following parameters were analyzed: M-wave latency (ML) and amplitude (Mamp), F-wave minimal latency(Fmin) and average latency(Fave),amplitude (Famp), duration (Fdur), persistence (Fper) and chronodispersion (Fchr). The above parameters were obtained through the electric stimulation of ulnar and tibial nerves, and recorded from the abductor digiti minimi and extensor digitorum brevis, respectively. Results No definite F-wave was obtained by electric stimulation of ulnar nerve at 1 week after injection in 3 HFS patients (5 nerves). The Fave recorded from electric stimulation of ulnar and tibial nerves prolonged significantlyand Fdur from ulnar nerve increased significantly at 1 week after injection, but were not significantly different from those of pre-injection when recorded at 12 to 24 weeks after injection. No significant correlation of the altered F-wave parameters was found with the dosage of BTX-A. Conclusion Fdur and Fave could sensitively assess the remote effect of the local injection of BTX-A, the remote effect might be correlated with the distance between injected muscle and tested muscle, rather than the dosage of BTX-A.

Objective To investigate the involvement of posterior auricular muscle (PAM) and the effect of botulinum toxin type A (BTX-A) injection into PAM in patients with hemifacial spasm (HFS)complicated by auricular symptoms.Methods Sixty-three consecutive HFS patients with auricular symptoms such as tinnitus or murmur,"ticking" or a "clicking" sound and discomfort on the same side,referred to our department between July,2009 and January,2010,were enrolled,and the diagnosis of idiopathic HFS was clinically made.The patients were largely randomized into two groups according to the order of referral.One was regular group including 33 cases whose injection sites were routinely at the frontal,orbicularis oculi,zygomaticus and buccinator muscles while another was PAM group including 30 cases,in which 4 units of BTX-A was additionally injected to the PAM.Before and after injection,the test of blink reflex was performed and lateral spread of blink reflex to orbicularis oris(OO)and PAM,I.e.Abnormal muscle response(AMR),were recorded,and the peak-peak amplitude of AMR was measured.The patients were followed up clinically and electrophysiologically at least 4 weeks((29.5±2.5)days) later.Results(1)The patients reported that their auricular symptoms subsided after injection in both groups.The remission rate was 45.5%(15/33)in the regular group and 76.7%(23/30)in the PAM group,respectively,with a higher rate in the PAM group(x2=6.40,P=0.011).(2)In both groups the AMR amplitude decreased significantly after injection.In the regular group,the OO amplitudes (μV) before and after injection were 304.0±30.3 and 129.3±9.6(t =5.820,P =0.000),and PAM amplitudes,298.0±33.3 and 184.7±20.2(t=2.818,P=0.014),respectively.In the PAM group,OO amplitudes were 405.3±66.7 and 116.0±10.0(t=4.214,P=0.001),PAM amplitudes,390.0±53.6 and 72.0±9.7(t=6.011,P=0.000),respectively.(3)The decrease of PAM amplitudes in the PAM group was more significant compared with those in the regular group (t=4.237,P=0.001).Conclusions In HFS patients with auricular symptoms,the electrophysiological studies are helpful for the guidance of treatment;and the auricular symptoms could be better improved after BTX-A injection into PAM in addition to those regular injection sites.

Objective To investigate prospectively the diagnostic significance of ulnar/median nerve amplitude ratio in motor neuron disorders.Methods Patients referral to our department between May 2009 and February 2012,due to muscle weakness,inflexible,cramps and atrophy,were consecutively enrolled.Conventional nerve conduction studies of 4 extremities (using surface electrodes) and needle electromyography were performed in all patients with fixed examiner.The compound muscle action potentials (CMAP) were recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) with stimulation of ulnar and median nerve at wrist,respectively.Moreover,the ratio of CMAP amplitude between ADM and APB (ADM/APB) was calculated in the patients who met the diagnostic criteria for definite amyotrophic lateral sclerosis (ALS) and Hirayama disease (HD).The patients with Guillain-Barré syndrome (GBS) and other popyneuropathies (PN) were served as case-controls,and 34 healthy volunteers (aged (45.7 ± 16.3) years) as normal-controls.Results (1) There were 78 cases with ALS,25 HD,51 GBS and 140 other PN,with the mean age(years) of 54.7 ± 11.6,17.6 ± 2.2,41.3 ± 18.4 and 57.1 ± 14.3,respectively.(2) ADM/APB in the ALS subgroup was 2.28 ±2.87 (0.12-22.38),HD0.66±0.36 (0.05-1.34),GBS 1.42 ± 1.33 (0.25-9.85),other PN 1.36 ± 1.48 (0.08-14.44) and normal-controls 1.07 ± 0.28 (0.61-1.64,F =6.872,P =0.000),respectively.(3) The areas under receiver operator characteristic curve in patients with ALS was 0.830 (s-x =0.039) and HD 0.691 (sx =0.039,P =0.000) ; the diagnostic sensitivity and specificity for ALS patients were 36.7％ and 93.3％,respectively,with cutoff value of ADM/APB =2; and the diagnostic sensitivity and specificity for HD patients were 53.6％ and 89.0％,respectively,with cutoff value of ADM/APB =0.7.Conclusions The ulnar/median CMAP amplitude ratio increases in ALS,but decreases in HD,which may be served as a relatively specific electrophysiological index.ADM/APB amplitude ratio ＞ 2.0 is suggested to be a diagnostic parameter for ALS and ＜ 0.7 for HD.

Objective To explore the clinical value of spiral CT airway measurements on awake patients under OSAHS discussed. Methods The upper airway of 104 patients with OSAHS diagnosed with polysomnography (PSG) and 25 nor-mal controls were examined and compared. The cross-sectional areas, diameters, and the thickness of the pharyngeal wall of retropalate, lingua regions planes were scanned by MSCT scan in the waking state. Results The cross-section areas of upper airway of OSAHS were significantly smaller than those of the control group, the difference was significant (P<0.05). The cross-section areas decreased and the thickness of pharyngeal walls increased with the increase of severity of OSAHS. Conclusion Patients with OSAHS has upper airway anatomic strictures. MSCT scan can effectively localize the obstructed site and degree of upper airway accurately.

Objective To evaluate the clinical value of Apneagraph(AG200)and CT scan in diagnosing obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Twenty-two moderate and 18 severe obstructive sleep apnea hypopnea syndrome(OSAHS) patients diagnosed by polysomnography(PSG) performed one-night pressure monitoring by Apnea-graph, the apnea hypopnea index (AHI),the site of upper airway callapse and the obstructive proportion of different level. The cross-sectional areas of the pharyngeal wall of retropalate, lingua regions planes were scanned by MSCT scan in the waking state were analyzed. The obstruction levels determined by pressure monitored and found in CT screening were compared. Results Apneagraph and CT scan had good performance in the diagnosis of OSAHS. There was no difference between two methods(P>0.05).Conclusion Apneagraph and CT scan can serve as a useful device to diagnose OSAHS.The diagnostic rate of OSAHS (especially severe OSAHS)can be elevated by combining Apneagraph and CT scan.

Objective:To investigate the pain status in diabetic foot ulcer (DFU) patients and analyze its influencing factors.Methods:A single-center cross-sectional survey research method was used. From May 2021 to February 2022, DFU patients who were admitted to the Fourth Medical Center of PLA General Hospital and met the inclusion criteria were selected and investigated. The scores of the heaviest pain, the least pain, the average pain, and the current pain in pain degree and the total score and the scores of influence on patients' daily life, mood, walking ability, daily work, relationship with others, sleep, and life interest in pain-related effects and the total score of patients were evaluated by the brief pain inventory. A self-designed general data questionnaire was used to collect the data including patients' gender, age, education level, body mass index, self-care ability, diabetes course, wound Wagner grade, bacterial culture result of wound specimen, and the levels of glycated hemoglobin, albumin, prealbumin, hemoglobin, and leukocyte count. Patients were classified according to general data, and the total scores of pain degree and pain-related effects were counted. Data were statistically analyzed with Kruskal-Wallis test and Mann-Whitney U test. The indicators with statistically significant differences in univariate analysis were selected for generalized linear model analysis to screen the independent risk factors of pain severity and pain-related effects in DFU patients. Results:A total of 44 questionnaires were sent out, and 42 valid questionnaires were collected, with effective recovery of 95.45%. The scores of the heaviest pain, the least pain, the average pain, and the current pain in DFU patients were 5 (0, 10), 2 (0, 6), 3 (0, 8), and 2 (0, 8), respectively, and the total score of the pain severity was 11 (0, 24); the scores of pain-related effects on patients' daily life, mood, walking ability, daily work, relationship with others, sleep, and life interest were 4 (0, 10), 4 (0, 10), 5 (0, 10), 5 (0, 10), 3 (0, 10), 4 (0, 10), and 4 (0, 10), respectively, and the total score of pain-related effects was 30 (0, 63). In 42 DFU patients, most patients were male, aged 39-87 (67±10) years, most patients had education level of junior high school, most patients had diabetes for more than 20 years, half of patients' wounds were Wagner grade 4, most patients had body mass index and leukocyte count within normal limits, most patients had partial dependence on self-care ability, the bacterial culture results of wound specimen in the vast majority of patients were positive, about half of the patients had abnormal level of albumin, and most patients had abnormal levels of glycosylated hemoglobin, prealbumin, and hemoglobin. Univariate analysis of the above general data showed that total scores of pain severity among patients with different hemoglobin levels and leukocyte counts were statistically significant different (with Z values of -2.05 and -2.55, respectively, P<0.05), and the total scores of pain-related effects on patients with different hemoglobin levels, leukocyte counts, and bacterial culture results of wound specimen were statistically significant different (with Z values of -2.66, -2.02, and -2.12, respectively, P<0.05). Generalized linear model analysis showed that leukocyte count was an independent risk factor for pain severity and pain-related effects in 42 DFU patients (with 95% confidence intervals of 0.28-11.87 and 5.67-36.99, respectively, standardized regression coefficient values of 6.17 and 21.33, respectively, both P values <0.05). The bacterial culture result of wound specimen was an independent risk factor for pain-related effects in 42 DFU patients (with 95% confidence interval of 2.92-39.09, standardized regression coefficient value of 21.00, P<0.05). Conclusions:DFU patients often suffer pain, and the bacterial culture results of wound specimen and leukocyte count are the main factors affecting the pain of DFU patients.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.