Objective To explore the influencing factors of type 2 diabetes mellitus(T2DM)merging with diabetic peripheral neuropathy(DPN),and to construct and verify a prediction model based on random forest algorithm.Methods 512 T2DM patients who were hospitalized in our hospital from January 2019 to December 2021 were divided into simple T2DM group(n=292)and T2DM combined with DPN group(DPN,n=220)based on whether or not DPN was present.The general data and biochemical indicators of the two groups were compared.Logistic regression analysis was conducted to identify the influencing factors of DPN in T2DM patients.A random forest model was constructed.Results Compared with the T2DM group,the DPN group showed an increase in weight loss rate,incidence of diabetic retinopathy(DR),WBC and HbA1c(P<0.05),with decrease in DM duration≥10 years,TG and HDL-C(P<0.05).Logistic regression analysis showed that age≥60 years,HbA1c,TG,HDL-C,rate of weight loss,DR were influencing factor for T2DM combined with DPN.The random forest model showed that when the number of trees was 387,the error rate was the lowest.The importance ranking of the influencing factors of T2DM combined with DPN were the rate of weight loss,TG,DR,HDL-C,HbA1c and age≥60 years.Conclusions Age≥60 years,HbA1c,TG,HDL-C,rate of weight loss and DR are influencing factors for T2DM combined with DPN,that can be used for early clinical diagnosis and treatment.

Pathological insulin resistance (IR) is closely related to gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in women with GDM. Increasing studies have investigated the efficacy of IR indices, such as quantitative insulin sensitivity index, homeostasis model assessment of insulin resistance, triglyceride-glucose index and sex hormone-binding globulin, in predicting GDM and related complications in recent years. This article reviews the research progress in the above topics.

Objective: To evaluate the role of hippocampal mast cells in the early postoperative cognitive impairment in rats. Methods: Eighty male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-250 g, were divided into 4 groups (n=20 each) using a random number table method: normal saline control group (group C), cromolyn injected into lateral cerebral ventricle group (group L), operation group (group O), and cromolyn injected into lateral cerebral ventricle plus operation group (group LO). Cromolyn 2 μl (100 μg/ul) was intracerebroventricularly injected in L and LO groups.The equal volume of normal saline was given instead in C and O groups.Open reduction and internal fixation was performed after tibial fracture was induced 30 min later in O and LO groups.Contextual fear conditioning and Y-maze tests were performed at 1 and 3 days after operation, and the freezing time and the number of learning trails were recorded.The animals were then sacrificed, and hippocampal tissues were obtained for determination of activated mast cell count (by toluidine blue staining) and expression of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) mRNA (by polymerase chain reaction). Results: Compared with group C, the number of learning trails was significantly increased, and the freezing time was shortened, the number of activated mast cells in hippocampi was increased, and the expression of IL-1β mRNA was up-regulated at 1 and 3 days after operation, and the expression of TNF-α mRNA was up-regulated at 1 day after operation in group O(P<0.05), and no significant change was found in the parameters mentioned above in group L (P>0.05). Compared with group O, the number of learning trails was significantly decreased, and the freezing time was prolonged, the number of activated mast cells in hippocampi was decreased, and the expression of IL-1β mRNA in hippocampi was down-regulated at 1 and 3 days after operation, and the expression of TNF-α mRNA in hippocampi was down-regulated at 1 day after operation in group LO (P<0.05). Conclusion Activation of hippocampal mast cells can induce central inflammatory responses and is involved in the mechanism of early postoperative cognitive impairment in rats.

Our previous works disclosed the contributing role of macrophage migration inhibitory factor (MIF) and dopaminergic inhibition by lysine dimethyltransferase G9a/Glp complex in peripheral nerve injury-induced hypersensitivity. We herein propose that the proinflammatory cytokine MIF participates in the regulation of neuropathic hypersensitivity by interacting with and suppressing the descending dopaminergic system. The lumbar spinal cord (L-SC) and ventral tegmental area (VTA) are two major locations with significant upregulation of MIF after chronic constriction injury (CCI) of the sciatic nerve, and they display time-dependent changes, along with a behavioral trajectory. Correspondingly, dopamine (DA) content shows the reverse characteristic change to MIF with a time-dependent curve in post-surgical behavior. The levels of both MIF and DA are reversed by the MIF tautomerase inhibitor ISO-1, and a negative relationship exists between MIF and DA. The reversed role of ISO-1 also affects tyrosine hydroxylase expression. Furthermore, CCI induces Th promoter CpG site methylation in the L-SC and VTA areas, and this effect could be abated by ISO-1 administration. G9a/SUV39H1 and H3K9me2/H3K9me3 enrichment within the Th promoter region following CCI in the L-SC and VTA was also decreased by ISO-1. In cultured dopaminergic neurons, rMIF enhanced the recruitment of G9a and SUV39H1, followed by an increase in H3K9me2/H3K9me3. These molecular changes correspondingly exhibited alterations in Th promoter CpG site methylation and pain behaviors. In summary, MIF functions as a braking factor in curbing dopaminergic descending inhibition in peripheral nerve injury-induced hypersensitivity by mediating Th gene methylation through G9a/SUV39H1-associated H3K9 methylation.

Whether habit stimulation is effective in DOC patient arousal has not been reported. In this paper, we analyzed the responses of DOC patients to habit stimulation. Nineteen DOC patients with alcohol consumption or smoking habits were recruited and 64-channel EEG signals were acquired both at the resting state and at three stimulation states. Wavelet transformation and nonlinear dynamics were used to extract the features of EEG signals and four brain lobes were selected to investigate the degree of EEG response to habit stimulation. Results showed that the highest degree of EEG response was from the call-name stimulation, followed by habit and music stimulations. Significant differences in EEG wavelet energy and response coefficient were found both between habit and music stimulation, and between habit and call-name stimulation. These findings prove that habit stimulation induces relatively more intense EEG responses in DOC patients than music stimulation, suggesting that it may be a relevant additional method for eliciting patient arousal.
Adult ; Alcohol Drinking ; physiopathology ; Brain ; physiopathology ; Consciousness Disorders ; physiopathology ; therapy ; Electroencephalography ; Female ; Habits ; Humans ; Male ; Middle Aged ; Music ; Names ; Nonlinear Dynamics ; Physical Stimulation ; Rest ; Smoking ; physiopathology ; Speech ; Treatment Outcome ; Wavelet Analysis

Objective To observe the analgesic efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy.Methods After institutional reviewing board approval and patient consent,a total of 145 parturients requesting epidural labor analgesia and under-going episiotomy were randomized into three groups:M1,M2,and C,where in morphine 1 mg dis-solved in saline 10 ml,morphine 2 mg dissolved in saline 10 ml,or sole saline 10 ml was epidurally given immediately after umbilical cord clamp,respectively.Perineal pain at rest and movement within 24 hours after vaginal delivery were evaluated with present pain intensity (PPI).Further,the time in-terval between a moderate or severe PPI and epidural drug treatment were recorded.Besides,epidural morphine related side effects including nausea,vomiting,pruritus,and urinary retention were ob-served as well.Results The proportion of patients with moderate or severe pain at rest was signifi-cantly lower in group M2 (2.1%)compared to group M1 (15.7)and group C (19.1%)(P <0.05). Further,the time interval between a moderate or severe PPI and epidural drug treatment was signifi-cantly longer in group M2 (15.7±1.4 h)compared to group M1 (11.0±0.9 h)and group C (11.0 ±1.0 h)(P <0.05).No significant difference was found between groups M1 and group C with regard to morphine efficacy.However,the accumulated side effects including nausea,vomiting,pruritus, and urinary retention prominently increased in group M2 (102.1%)compared to group M1 (43.1%) and group C (12.8%)(P <0.05).Conclusion Although epidural morphine 2 mg may significantly decrease and postpone the occurrence of moderate or severe postpartum perineal pain,however,it de-serves consideration before clinical use owing to the increased side effects.

Objective To investigate the effects of programmed intermittent epidural bolus (PIEB) with continuous epidural infusion (CEI) at different time intervals for epidural labor analgesia.Methods One hundred and eighty-six nulliparous parturients were randomized to the groups P1, P2 and C.Epidural infusion was given initial loading dose: 10 ml (0.125% ropivacaine with 0.4 μg/ml sufentanil), followed by maintaining dose: 0.08% ropivacaine with 0.4 μg/ml sufentanil.Group P1 was given basal infusion 5 ml per 30 min, 30 min after the initial dose;group P2 was given basal infusion of 10 ml per 60 min, 60 min after the initial dose;CEI basal infusion of 10 ml/h immediately after the initial dose;PCEA (patient-controlled epidural analgesia dose) 5 ml (lockout interval: 30 min).The baseline maternal heart rate, noninvasive arterial blood pressure, SpO2, respiratory rate, and fetal heart rate tracing were recorded.The visual analog scale (VAS) was recorded during the first stage of labor and at full cervical dilation.The degree of motor block was assessed in both lower extremities using the modified Bromage score (MBS).The maximum blocked segment, the consumption of anesthetic, delivery mode, amount of oxytocin, The number of cases of motor block and intrapartum fever, the fetal Apgar scores,adverse reactions,maternal satisfaction score were recorded.Results The VAS obviously decreased in the three groups since receiving labor analgesia (P<0.05).The ratio of VAS score more than 3 scales in group PIEBⅡ was significantly lower than that in groups P1 and C (P<0.05).The maximum blocked segment increased in group P1, while The incidence of unilateral block was significantly decreased in group P2 (P<0.05).The total drug consumption.And the toatal number of PCA were decreased obviously in group PIEB (P<0.05).The initial PCA time was significantly prolonged in group P2 (P<0.05).The number of instrumental midwifery and intrapartum fever in group P2 were significantly lower than that in group C (P<0.05).Conclusion Programmed intermittent epidural bolus at the beginning 60 min intervals after the initial dose for epidural labor analgesia is scientific and effective.

Objective To evaluate the efficacy of programmed intermittent epidural bolus ( PIEB) for labor analgesia in parturients and the effect on neonates. Methods Two hundred primiparae with a sin?gleton fetus in vertex presentation, who requested labor analgesia, aged 21-36 yr, at 37 to 40 week gesta?tion, with cervical dilatation 1-3 cm, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were divided into 2 groups ( n=100 each) using a random number table: PIEB group and continuous epi?dural infusion ( CEI) group. PIEB regimens were programmed as 10 ml∕h starting from 1 h after the initial bolus. The programmed bolus dose was fixed at 5 ml with the lock?out interval set at 30 min. The drugs used in the analgesic pump were 0?08% ropivacaine and 0?4μg∕ml sufentanil in both groups. From the on?set of labor analgesia until 1 h after delivery, visual analog scale score was used to evaluate the uterine con?traction pain every hour. The modified Bromage score was used to assess the degree of motor block. The up?per spread of sensory block, total consumption of drugs, the number of attempts, duration of every stage, delivery mode, postpartum hemorrhage volume, and occurrence of adverse reactions ( dyspnea, hypoten?sion, pruritus, nausea, vomiting and urinary retention) were recorded. Apgar scores of the neonates were recorded, and the degree of primiparae′satisfaction with the analgesic efficacy was scored. Results Com?pared with group CEI, visual analog scale scores at T2?5 , the total consumption of drugs and the number of
attempts were significantly decreased, and the satisfaction score was significantly increased in group PIEB ( P<0?05) . The height of sensory block in the thoracic vertebra was significantly higher, and the height of sensory block in the lumbosacral spine was significantly lower in group PIEB than in group CEI ( P<0?05) . There were no significant differences between the two groups in the duration of every stage, delivery mode, postpartum hemorrhage volume, incidence of adverse reactions and Apgar scores of neonates (P>0?05). Conclusion PIEB provides reliable efficacy for labor analgesia in parturients, the degree of primiparae′satisfaction is high without increasing the occurrence of adverse reactions, and it exerts no effect on the neonates.

Objective To investigate the effect of wire?reinforced epidural catheters on the success rate of epidural catheterization for labor analgesia. Methods A total of 200 nulliparous parturients who re?ceived labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-45 yr, with body mass index<35 kg∕m2, were divided into 2 groups (n=100 each) using a random number table: common catheter group ( group Ⅰ) and reinforced catheter group ( group Ⅱ) . After suc?cessful epidural puncture, the corresponding catheter was inserted inⅠandⅡgroups. The development of difficult insertion, intravascular catheter insertion or paresthesia during insertion was defined as a failure of epidural catheterization. The occurrence of the failure of epidural catheterization was recorded. Results Compared with group Ⅰ, the failure rate of epidural catheterization was significantly decreased in groupⅡ( P<0.05) . Conclusion Wire?reinforced epidural catheters can raise the success rate of epidural catheter?ization for labor analgesia.

Objective To compare the analgesic efficacy and safety of the sole local anesthetic ropivacaine with the combination of both local anesthetic ropivacaine and opioidergic analgesic sufen-tanil given epidurally on the labor pain control.Methods After institutional review board approval and patient consent,a total of 481 nulliparas requesting epidural labor analgesia were randomized into two groups:a sole local anesthetic group (0.125% ropivacaine,group R)and a combination of local anesthetic and opioidergic analgesic group (0.125% ropivacaine+0.3 μg/ml sufentanil,group RS). Analgesic efficacy was measured using numerical rating scale (NRS)of pain and maternal visual ana-logue scale (VAS)analgesia satisfaction with regard to the first and the second stage of labor.Anal-gesic safety was measured with the Bromage scale of maternal safety and epidural labor analgesia re-lated side effects,as well as fetal safety including Apgar scoring and umbilical cord artery blood gas a-nalysis.Results A total of 346 participants completed the study,with 1 64 and 182 women in each group R and RS,respectively.The median NRS pain score during the first stage of labor was signifi-cantly lower in the combination group (2.2,IQR:1.8-2.7 )comparing to the sole local analgesic group (2.4,IQR:2-2.8)(P <0.001).No significant difference was observed in NRS pain score dur-ing the second stage of labor.Patients in both groups were rated the same VAS satisfaction of analge-sia.Patients in the sole local analgesic group experienced fewer side effects than those in the combina-tion group (37.7% versus 47.2%,P =0.082).The incidence of 1-min Apgar≤7 was lower in the sole local analgesic group 2 (1.2%) than the combination group 10 (5.5%) (P < 0.05 ). Conclusion The sole local anesthetic ropivacaine produces a comparable labor analgesic effect as the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil but the former has less maternal side effects,and less incidence of lower 1-min Apgar scoring.