Diabetic peripheral neuropathy (DPN) is one of the common chronic complications of diabetes, presenting with neuropathic pain, sensory abnormalities, and sensory loss, and may lead to foot infections, ulcers, or amputation in severe cases. Its pathogenesis remains unclear, with challenge in early diagnosis and limited treatment efficacy. Emerging evidences suggest that DPN involves in not only the peripheral nervous system but also the central nervous system (CNS). With advances in imaging technologies, multimodal MRI has become a key tool to investigate CNS involvement in DPN. This review summarizes the structural, functional, metabolic, and perfusion-related CNS changes in DPN patients based on structural MRI, functional MRI, MR spectroscopy, and perfusion-weighted imaging, aiming to help early detection, clinical subtyping, and personalized treatment of DPN.

Peripheral neuropathic pain (PNP) patients exhibit complex and diverse symptoms, often accompanied by abnormal pain and hyperalgesia, which seriously affect their quality of life. Currently, pharmacological treatments for PNP have limited effectiveness and are prone to side effects, making them inadequate for long-term patient needs. Peripheral nerve stimulation (PNS) can relieve pain by precisely stimulating specific peripheral nerves, offering advantages such as minimal invasiveness, broad applicability, and personalized treatment. This article reviews the pathophysiology of PNP and application of PNS in PNP treatment, aiming to provide references for PNP treatment.

Diabetic peripheral neuropathy (DPN) is one of the common chronic complications of diabetes, presenting with neuropathic pain, sensory abnormalities, and sensory loss, and may lead to foot infections, ulcers, or amputation in severe cases. Its pathogenesis remains unclear, with challenge in early diagnosis and limited treatment efficacy. Emerging evidences suggest that DPN involves in not only the peripheral nervous system but also the central nervous system (CNS). With advances in imaging technologies, multimodal MRI has become a key tool to investigate CNS involvement in DPN. This review summarizes the structural, functional, metabolic, and perfusion-related CNS changes in DPN patients based on structural MRI, functional MRI, MR spectroscopy, and perfusion-weighted imaging, aiming to help early detection, clinical subtyping, and personalized treatment of DPN.

Peripheral neuropathic pain (PNP) patients exhibit complex and diverse symptoms, often accompanied by abnormal pain and hyperalgesia, which seriously affect their quality of life. Currently, pharmacological treatments for PNP have limited effectiveness and are prone to side effects, making them inadequate for long-term patient needs. Peripheral nerve stimulation (PNS) can relieve pain by precisely stimulating specific peripheral nerves, offering advantages such as minimal invasiveness, broad applicability, and personalized treatment. This article reviews the pathophysiology of PNP and application of PNS in PNP treatment, aiming to provide references for PNP treatment.

【Objective】 To evaluate the efficacy of sacral neuromodulation (SNM) in the treatment of neurogenic bladder (NB) with Meta-analysis, so as to provide reference for clinical treatment options for NB. 【Methods】 Relevant literatures regarding the efficacy of SNM in treating NB during Jan.2010 and Dec.2022 were collected from the PubMed and CNKI databases, and screened with inclusion and exclusion criteria.After the quality of literatures was assessed, data were extracted and then analyzed using Review Manager 5.3. 【Results】 The research included 14 studies involving 601 patients.Meta-analysis showed that SNM significantly improved urinary frequency (WMD=4.30, 95%CI: 2.84-5.77, P<0.01), daily episodes of urinary incontinence (WMD=2.92, 95%CI: 2.76-3.07, P<0.01), single void volume (WMD=-113.93, 95%CI: -159.91- -67.98, P<0.01), maximum flow rate (WMD=-3.23, 95%CI: -4.04- -2.42, P<0.01), residual urine (WMD=111.79, 95%CI: 79.93-143.64, P<0.01), maximum bladder capacity (WMD=-65.63, 95%CI: -84.38- -46.88, P<0.01), and bladder compliance (WMD=-4.65, 95%CI: -8.75- -0.55, P=0.03). 【Conclusion】 SNM is effective in the treatment of NB, but more randomized controlled trials are needed to verify the efficacy.

Objective:To evaluate the efficacy of ulnar nerve decompression (cubital and ulnar tunnels) in double crush syndrome (DCS) of the ulnar nerves.Methods:A retrospective analysis was performed on the clinical data of 23 patients with DCS of the ulnar nerves in Peripheral Specialty of Neurosurgery Department, Japan-China Friendship Hospital from June 2018 to December 2022. All patients underwent both cubital tunnel decompression and ulnar tunnel decompression. Efficacy was evaluated by observing improvement of subjective symptoms and objective indicators and ulnar nerve motor function.Results:Follow-up was performed for (25.82±9.3) months, ranged 9-42 months, in these 23 patients. At the final follow-up, 20 patients (86.95%) had numbness relief, all 23 patients (100%) reported pain alleviation, 12 patients (52.17%) had improved muscle atrophy, and 18 patients (78.26%) had improved motor dysfunction;the sensory nerve conduction velocity ([42.13±2.8] m/s) after decompression was significantly increased than that before decompression ([31.74±3.9] m/s), and the motor nerve conduction velocity ([41.57±2.9] m/s) after decompression was significantly increased than that before decompression ([28.39±6.1] m/s, P<0.05); two-point discrimination threshold of the ring finger ([7.43±1.3] mm) after decompression was significantly decreased than that before decompression ([8.48±1.9] mm, P<0.05); and excellent functional recovery rate of the ulnar nerves was 82.6% (19/23). During the follow-up, no recurrence appeared. Conclusion:Clear efficacy of ulnar nerve decompression (cubital and ulnar tunnels) in DCS of the ulnar nerves is noted.

Objective:To evaluate the efficacy of ulnar nerve decompression (cubital and ulnar tunnels) in double crush syndrome (DCS) of the ulnar nerves.Methods:A retrospective analysis was performed on the clinical data of 23 patients with DCS of the ulnar nerves in Peripheral Specialty of Neurosurgery Department, Japan-China Friendship Hospital from June 2018 to December 2022. All patients underwent both cubital tunnel decompression and ulnar tunnel decompression. Efficacy was evaluated by observing improvement of subjective symptoms and objective indicators and ulnar nerve motor function.Results:Follow-up was performed for (25.82±9.3) months, ranged 9-42 months, in these 23 patients. At the final follow-up, 20 patients (86.95%) had numbness relief, all 23 patients (100%) reported pain alleviation, 12 patients (52.17%) had improved muscle atrophy, and 18 patients (78.26%) had improved motor dysfunction;the sensory nerve conduction velocity ([42.13±2.8] m/s) after decompression was significantly increased than that before decompression ([31.74±3.9] m/s), and the motor nerve conduction velocity ([41.57±2.9] m/s) after decompression was significantly increased than that before decompression ([28.39±6.1] m/s, P<0.05); two-point discrimination threshold of the ring finger ([7.43±1.3] mm) after decompression was significantly decreased than that before decompression ([8.48±1.9] mm, P<0.05); and excellent functional recovery rate of the ulnar nerves was 82.6% (19/23). During the follow-up, no recurrence appeared. Conclusion:Clear efficacy of ulnar nerve decompression (cubital and ulnar tunnels) in DCS of the ulnar nerves is noted.

OBJECTIVE: To investigate the association between the glucose-to-lymphocyte ratio (GLR) and prognosis of patients with sepsis-associated acute kidney injury (SA-AKI). METHODS: Based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV), SA-AKI patients aged ≥ 18 years were selected. According to the tertiles of GLR, the patients were divided into GLR1 group (GLR ≤ 4.97×10^-9 mmol), GLR2 group (4.97×10^-9 mmol < GLR < 9.75×10^-9 mmol) and GLR3 group (GLR ≥ 9.75×10^-9 mmol). Patients with SA-AKI were divided into survival group and death group according to whether they survived 28 days after admission. The patient's gender, age, vital signs, laboratory test results, comorbidities, sequential organ failure assessment (SOFA), acute physiology score III (APS III) score and treatment measures were extracted from the database. Kaplan-Meier survival analysis was used to make the survival curves of patients with SA-AKI at 28 days, 90 days, 180 days and 1 year. Multivariate Logistic regression analysis model was used to explore the independent risk factors of 28-day mortality in patients with SA-AKI. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive efficacy of GLR for the prognosis of patients with SA-AKI. RESULTS: A total of 1 524 patients with SA-AKI were included, with a median age of 68.28 (58.96, 77.24) years old, including 612 females (40.16%) and 912 males (59.84%). There were 507 patients in the GLR1 group, 509 patients in the GLR2 group and 508 patients in the GLR3 group. There were 1 181 patients in the 28-day survival group and 343 patients in the death group. Grouping according to GLR tertiles showed that with the increase of GLR, the 28-day, 90-day, 180-day and 1-year mortality of SA-AKI patients gradually increased (28-day mortality were 11.64%, 22.00%, 33.86%, respectively; 90-day mortality were 15.98%, 26.72%, 40.55%, respectively; 180-day mortality were 17.16%, 28.29% and 41.73%, and the 1-year mortality were 17.95%, 29.27% and 42.72%, respectively, all P < 0.01). According to 28-day survival status, the GLR of the death group was significantly higher than that of the survival group [×10^-9 mmol: 9.81 (5.75, 20.01) vs. 6.44 (3.64, 10.78), P < 0.01]. Multivariate Logistic regression analysis showed that GLR was an independent risk factor for 28-day mortality in patients with SA-AKI [when GLR was used as a continuous variable: odds ratio (OR) = 1.065, 95% confidence interval (95%CI) was 1.045-1.085, P < 0.001; when GLR was used as a categorical variable, compared with GLR1 group: GLR2 group OR = 1.782, 95%CI was 1.200-2.647, P = 0.004; GLR3 group OR = 2.727, 95%CI was 1.857-4.005, P < 0.001]. ROC curve analysis showed that the area under the ROC curve (AUC) of GLR for predicting 28-day mortality in patients with SA-AKI was 0.674, when the optimal cut-off value was 8.769×10^-9 mmol, the sensitivity was 57.1% and the specificity was 67.1%. The predictive performance was improved when GLR was combined with APS III score and SOFA score, and the AUC was 0.806, the sensitivity was 74.6% and the specificity was 71.4%. CONCLUSIONS GLR is an independent risk factor of 28-day mortality in patients with SA-AKI, and high GLR is associated with poor prognosis in patients with SA-AKI.
Male ; Female ; Humans ; Blood Glucose ; Glucose ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Acute Kidney Injury ; Retrospective Studies ; Intensive Care Units

Objective : To investigate the effect of paederosidic acid methyl ester (PAME) on postoperative learning and memory impairment in mice and its mechanism. Methods : C57BL/6J male mice were randomly divided into Sham group , operation group , operation + PAME group ( PAME group) , operation + NADPH oxidase 4(Nox4) adeno⁃associated virus overexpression group (Nox4 overexpression group) , operation + Nox4 adeno⁃associated virus no⁃laden group ( AAV no⁃load group) , and operation + PAME + Nox4 overexpression group ( PN group) . Exploratory laparotomy was performed. PAME(20 mg/kg) was administered by continuous gavage for 7 days after operation , and adeno⁃associated virus was injected into the hippocampus 28 days before operation. Morris water maze test and conditioned fear test were used to detect the learning and memory ability of mice. The expression of Nox4 protein was observed by immunofluorescence. The protein expressions of Nox4 , long chain acyl CoA synthetase 4 (ACSL4) and glutathione peroxidase 4 (GPX4) were detected by Western blot. Reactive oxygen species (ROS) and iron content were determined by spectrophotometry. Results : Compared with the Sham group , the learning and memory ability of the operation group , the Nox4 overexpression group and the AAV no⁃load group decreased , the protein expression of Nox4 and ACSL4 increased , the protein expression of GPX4 decreased , and the ROS and iron content increased. After PAME treatment , the postoperative learning and memory ability of mice was improved , and Nox4 and ferroptosis in hippocampal neurons were alleviated. Conclusion Conclusion PAME treatment can improve the learning and memory ability of postoperative mice , which may be related to the inhibition of hippocampal Nox4⁃mediated ferroptosis.

Objective:To investigate the efficacy of microsurgical decompression in carpal tunnel syndrome (CTS) caused by different etiologies.Methods:A retrospective analysis was performed. The clinical data of 54 patients with CTS, admitted to our hospital from January 2018 to December 2018, were chosen; 20 patients were with idiopathic CTS (20 laterals), 16 patients were with diabetic-related CTS (26 laterals), and 18 patients were with dialysis-related CTS (22 laterals). All patients were treated with median nerve microsurgical decompression. Before surgery and 2 weeks after surgery, Boston carpal tunnel questionnaire (BCTQ) was used to evaluate the symptom and function scores, and median nerve conduction velocity was detected.Results:Intraoperatively, there was definite nerve entrapment in all three groups, but the neuropathy scopes in the diabetic-related CTS group were more extensive than those in the idiopathic group and dialysis-related CTS group. The postoperative BCTQ symptom and functional scores in the three groups were significantly decreased as compared with the preoperative ones ( P<0.05); however, there were no significant differences among the three groups in the postoperative BCTQ symptom and functional scores ( P>0.05). The postoperative sensory nerve conduction velocity and motor nerve conduction velocity in the three groups were significantly improved as compared with the preoperative ones ( P<0.05). There were significant differences among the three groups in postoperative sensory nerve conduction velocity and motor nerve conduction velocity ( P<0.05); the sensory nerve conduction velocity and motor nerve conduction velocity in the diabetic-related CTS group were significantly decreased as compared with those in idiopathic CTS group, and the sensory nerve conduction velocity and motor nerve conduction velocity in dialysis-related CTS group were significantly increased as compared with those in the diabetic-related CTS group ( P<0.05). The main surgical complications in three groups included poor incision healing: the incidence was 5% (1/20) in the idiopathic group, 15.3% (4/26) in the diabetic-related CTS group, and 18.1% (4/22) in dialysis-related CTS group, without significant differences ( χ2=1.755, P=0.416). Conclusion:Microsurgical decompression can achieve satisfactory results in the treatment of dialysis-related CTS, diabetes-related CTS and idiopathic CTS.