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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.
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Anti-contactin-1(CNTN1) IgG4 antibody is a reliable biomarker of a specific subset of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients with distinct clinical features, including advanced age, aggressive symptom, predominantly motor involvement, sensory ataxia, and poor response to intravenous immunoglobulin. Nerve conduction study showed decrease of nerve conduction velocity, reduction of compound motor active potential amplitude without temporal dispersion at early stage of the disease. The article reported an anti-CNTN1 IgG4 antibody positive case, reviewed the current relevant literature, and then summarized the clinical characteristics of anti-CNTN1 IgG4 antibody associated CIDP.
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Objective@#To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS) , and to analyze its relationship with body mass index (BMI) and wrist joint index.@*Methods@#From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients.@*Results@#Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01) ; the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01) . The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05) . The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36) .@*Conclusion@#A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.
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Objective To study the electrophysiological characteristics of hands muscle of upper limb onset amyotrophic lateral sclerosis (UL-ALS), and the variant-flail arm syndrome (FAS) for diagnosis and differential diagnosis. Methods We chose 55 UL-ALS and 12 FAS patients as the cases, 20 cervical spondylotic amyotrophy (CSA) patients as the case controls, and 20 healthy volunteers as the normal controls from January 2013 to March 2018 in the Third Central Hospital of Tianjin. Conventional nerve conduction studies of the median nerve and ulnar nerve were performed in all the patients. The main analysis was done in the compound muscle action potential (CMAP) recorded on the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) and the ratio of the two. Results The ratio of CMAPAPB/CMAPADM of ALS was 0.59 (0.25, 0.79), which was depressed obviously compared with FAS (1.02 (0.92, 1.18), Z=-4.440, P=0.000), CSA (1.88 (1.42, 3.19), Z=-5.902,P=0.000) and the normal controls (0.96 (0.88, 1.15), Z=-5.416, P=0.000). The low ratio of CMAPAPB/CMAPADM (<0.6) was encountered in 40％(23/55) ALS patients, 0 CSA patient and 1/12 FAS patients. An absent APB CMAP and an abnormally low APB/ADM CMAP amplitude ratio (<0.25) were observed only in 25.4％ (14/55) ALS patients. The area under receiver operating characteristic curve in patients of UL-ALS was 0.911 (P=0.000), and in FAS was 0.518 (P=0.559). Using a cut-off value of CMAPAPB/CMAPADM=0.7 for diagnosing ALS yielded 85.5％sensitivity and 95.0％specificity. Conclusion The split hand syndrome is not specific for ALS; however, the low APB/ADM CMAP amplitude ratio may help predict prognosis and can be the diagnostic marker for ALS.
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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.
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This study retrospectively reviewed 75 patients with impaired glucose tolerance(IGT)admitted in our hospital from March 2015 to October 2015.All patients underwent Toronto clinical scoring system(TCSS) evaluation.Patients with IGT were further divided into normal score group(TCSS-N, n=50)and abnormal score group(TCSS-A, n=25)according to their scoring results, and 30 healthy volunteers were served as control group.All patients and controls underwent motor and sensory nerve conduction studies, as well as sympathetic skin response(SSR)test using the Keypoint.Net(Medoc Ltd)electromyogram device.The results showed that the SSR amplitude of lower limbs was reduced [(0.61±0.44 vs 1.00±0.33)mv, P<0.05]andlatencyoflowerlimbswas extended [(1 880±282 vs 1 642±256)ms, P<0.05]in IGT group compared with control group.But median, ulnar, tibial, and peroneal nerve sensory and motor conduction revealed no difference between two groups.In TCSS-A group, the SSR amplitude of lower limbs was reduced [(0.47±0.39)mv, P<0.05], latency of lower limbs was extended [(2 062±291)ms,P<0.05]and the sensory nerve action potential(SNAP)amplitude of the tibial nerve was significantly lower compared with control group [(1.83±0.37 vs 2.07±0.30)μv, P<0.05].Compared to TCSS-N group, latency of lower limbs was extended [(2 062±291 vs 1 808±246)ms, P<0.05]in TCSS-A group.The SSR amplitude of lower limbs were reduced[(0.66±0.44)mv,P<0.05]and latency were prolonged(P<0.05)in TCSS-N group compared with control group.Pearson correlation analysis showed that the SSR amplitude and latency of the lower limbs were correlated with the postprandial blood glucose, blood glucose fluctuation, body weight, as well as body mass index.These results suggest that there exists peripheral nerve damage in the patients with IGT, mainly involving the small fiber nerve of the lower limbs.Large fibers may also be mildly affected as the disease progresses.
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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.
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Objective To investigate the clinical and imaging features of pseudo subarachnoid hemorrhage(pseudo-SAH) in order to provide a theoretical basis for correct diagnosis and reducing misdiagnosis.Methods The clinical and imaging data of 5 patients with pseudo-SAH were retrospectively analyzed and summarized.Results Five pseudo-SAH patients had a history of unconsciousness,respiratory disorder,mechanical ventilation,hypoxemia and acidosis.Cranial CT showed diffuse cerebral edema and high density of cerebral fissure and cerebral ventricle,and there was no bloody cerebrospinal fluid via lumbar puncture.In the five patients,one improved,three died,and one gave up treating because of invalid treatment.Conclusions All patients have a history of hypoxic-ischemic encephalopathy before onset of pseudo-SAH.The clinical manifestation of pseudoSAH includes encephalopathy symptom such as unconsciousness,headache,seizure,etc.Cranial CT shows diffuse cerebral edema,high density of cerebral fissure and cerebral ventricle,and there is no bloody cerebrospinal fluid via lumbar puncture.Prognosis of pseudo-SAH is often bad.And most patients show critically illness and high mortality.
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Objective To use nerve conduction study (NCS) to evaluate the function of large fibers,skin sympathetic response (SSR) and contact heat evoked potential (CHEP) to evaluate the function of small fibers in patients with impaired glucose regulation (IGR),and to analyze the occurrence of peripheral neuropathy and damage characteristics.Methods According to the classification criteria of glucose metabolism proposed by WHO in 2006,we selected 120 patients with IGR from January 2015 to December 2016 in our hospital,including 37 impaired fasting glucose (IFG) patients,83 impaired glucose tolerance (IGT) patients,and 60 normal subjects served as control group.All subjects received median,ulnar,tibial,peroneal,sural NCS,SSR and CHEP using the Keypoint.net (Medoc Ltd) electromyogram device.IGR patients were evaluated using the Michigan Neuropathy Screening Instrument (MNSI).Results The abnormal rate of MNSI score in IGR patients was 18.3％ (22/120);the abnormal rate of NCS was 22.5％ (27/120),and the abnormal rate of SSR was 39.2％ (47/120).In IFG group,the abovementioned abnormal rates were 8.1％ (3/37),13.5％ (5/37),29.7％ (11/37) respectively,and 22.9％ (19/83),26.5％ (22/83),43.4％ (36/83) in IGT group.Compared with control group,the tibial,sural nerve sensory nerve action potential amplitude decreased in IGT group (1.3 (0.1,1.9) μV vs 1.4(1.1,3.2) μV,Z=-3.05,P=0.002;(10.5±2.0)μV vs (7.6 ± 1.9)μV,t=0.60,P=0.001);and there was no significant difference between IFG patients and control group.Compared with control group,IFG patients' SSR amplitude reduced in lower limbs (0.7 (0.4,0.8) mV vs 0.8 (0.6,1.0) mV,Z =-2.95,P =0.003),CHEP amplitude decreased in dorsum hand and peroneal area stimuli ((63.0 ±10.0)μV vs(52.4 ±15.3)μV,t=0.61,P=0.003;(44.7 ±12.5)μV vs (28.2 ± 10.6)μV,t=0.31,P =0.000);and in IGR group,SSR amplitude reduced in upper and lower limbs (1.1 (0.5,2.2) mV vs 1.3(0.7,2.6)mV,Z=-2.12,P=0.030;0.4(0.2,0.8)mV vs 0.8(0.6,1.0) mV,Z=-5.96,P=0.000),CHEP amplitude decreased in dorsum hand and peroneal area stimuli ((63.0 ± 10.0) μV vs (38.7± 13.5)μV,t =0.37,P=0.000;(44.7 ±12.5)μV vs(21.9 ± 13.6)μV,t =0.35,P=0.000).Conclusions There is peripheral neuropathy in IGR patients,and the incidence of neuropathy in patients with IGT is higher than those with IFG.Neurophysiological methods are earlier than clinical scores to detect neuropathy.There are only small fiber damages in IFG patients,and IGT patients present by large and small fibrous lesions,mainly in small fibers and lower sensory nerve fibers,characterized by axonal damage and length dependence.
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Objective To evaluate the impairment of large and small fibers of peripheral nerves in patients with diabetes mellitus according to the current perception threshold ( CPT ) comparing with nerve conduction studies ( NCS) and sympathetic skin response ( SSR).Methods Fourty-nine diabetic patients were enrolled from August to December 2014 in Tianjin Third Central Hospital.The CPT was examined by the Neurometer?CPT/C in diabetic patients and 23 healthy subjects.Electrical stimulations of 2 000, 250 and 5 Hz were delivered respectively to the first toe distal section , the bottom of the knee-patella middle line and the index finger distal section.NCS and SSR were performed in diabetic patients.The patients were divided into normal NCS ( NCSN) group and abnormal NCS ( NCSA) group according to the results of the nerve conduction.According to the results of SSR , the patients were divided into normal SSR ( SSRN) group and abnormal SSR ( SSRA ) group.Results In three testing areas , the CPT in NCSN group had no significant difference compared with control group , which was tested by different frequency;NCSA group had increased CPT (393.5 ±68.4, 213.1 ±39.7, 172.5 ±52.8, 221.6 ±48.0, 91.7 ±33.1, 76.2 ±27.8, 274.0 ±48.4, 120.1 ±26.6, 75.3 ±21.9) compared with control group (278.1 ±53.6, 128.9 ±46.7, 78.7 ±28.7, 149.3 ±54.6, 52.3 ±23.2, 41.9 ±18.7, 214.2 ±46.0, 96.0 ±29.3, 48.6 ±17.0; F=36.277, 40.827, 50.301, 10.240, 12.837, 13.832, 11.749, 5.559, 17.412,all P<0.01).At the first toe section, CPT decreased in SSRN group ( 91.0 ±29.0, 55.2 ±21.3 ) compared with control group (128.9 ±46.7, 78.7 ±28.7;F=23.071, 22.646, both P<0.05), which was tested by the currents of 250 Hz and 5 Hz frequency.In three testing areas , the SSRA group had increased CPT compared with control group , which was tested by different frequency.Conclusion Hyperesthesia as an early manifestation of small fiber damage can be detected by CPT in diabetic patients; CPT has no advantage in the evaluation of large fiber damage.
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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.
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Objective To investigate the relationship between blood pressure variability (BPV) and neurological deteri?oration (ND) during the acute phase in patients with hypertensive minor ischemic stroke. Methods A total of 200 hyperten?sive patients with acute minor ischemic stroke were recruited in this study. Patients were divided into two groups: stable group (n=182) and deterioration group (n=18) according to the neurological prognosis. Values of BPV in 24 h ambulatory blood pressure, 24 h systolic blood pressure variation coefficient (24 h CVSBP), 24 h diastolic blood pressure variation coeffi?cient (24 h CVDBP), day time systolic blood pressure variation coefficient (dCVSBP), day time diastolic blood pressure variation coefficient (dCVDBP), night time systolic blood pressure variability (nCVSBP) and night time diastolic blood pressure variability (nCVDBP) were compared between two groups. The related factors of BPV were analyzed by binary logistic method in the acute phase of patients with hypertensive minor ischemic stroke. Results There were significantly higher levels of 24 h CVSBP [17.75%(17.54%,19.26%) vs 12.78% (10.67%,14.39%)], 24 h CVDBP [25.48%(20.77%,27.87%) vs 17.95% (14.88%, 21.46%)], dCVSBP [18.61%(17.65%,20.65%) vs 12.30%(10.10%,14.75%)], dCVDBP [25.65%(21.25%,29.78%) vs 17.76%(14.89%,22.19%)] in deterioration group than those of stable group (P<0.01). Results of binary logistic regression analysis showed that values of 24 h CVSBP and dCVSBP were risk factors for neurological deterioration in the acute phase of patients with hypertensive minor ischemic stroke. Conclusion The increased 24 h BPV and day time BPV are correlated with neurologi?cal deterioration during the acute phase in hypertensive minor ischemic stroke patients. BPV should be concerned in the acute phase and secondary prevention in patients with ischemic stroke.
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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.
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Objective To study the value of methionine loading test (MLT) in the mild vascular cognitive impairment (VCI) after acute cerebral infarction.Methods The fasting plasma homocystine (Hcy) level and homocystine level after MLT were measured by high-performance liquid chromatography methods.We chose 240 patients with normal level of fasting plasma Hcy (normal group),159 patients with normal level of Hcy after MLT,81 patients with hyperhomocysteinemia after MLT (hyperhomocysteinemia group),and 112 patients with fasting hyperhomocysteinemia (fasting hyperhomocysteinemia group) in this study.The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were conducted in normal,hyperhomocysteinemia and fasting hyperhomocysteinemia groups on admission,at 7d,14 d,30 d after treatment.Results Logistic regression analysis showed that the increased level of Hcy might be an independent risk factor for VCI [OR:1.285,95％CI:1.038-1.265,P＜0.05].The scores of MMSE and MoCA were lower in patients with fasting hyperhomocysteinemia and patients with hyperhomocysteinemia after MLT than in patients with normal fasting plasma Hcy at 7 d,14 d and 30 d after treatment (P＜0.01 or 0.05),while the scores had no significant differences among the three group on admission (P＞0.05).There were no significant differences in MMSE and MoCA scores between patients with fasting hyperhomocysteinemia and patients with hyperhomocysteinemia after MLT on admission,7 d,14 d and 30 d after treatment (P＞0.05).Conclusions Hcy may be an independent risk factor for VCI.The MLT can discover the dormant vascular risk factors for VCI,which offers a valuable detection method for early intervention and prevention in the clinical medicine.
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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 (P15 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.
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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.
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Objective To evaluate the effect of the plasma homocystine (Hcy) after methionine loading test (MLT) on the recurrence of ischemic vascular event,including cerebral infarction,transient ischemic attack (TIA),acute coronary syndrome,other vascularembolism,in cerebral infarction patients.Methods The fasting plasma homocystine (FHcy) and homocystine after MLT (PHcy) levels were measured by high-performance liquid chromatography.383 cerebral infarction patients with normal Hcy level were selected and divided into hyperhomocysteinemia after MLT (PHcy) group (n=135) and non-hyperhomocysteinemia after MLT (NPHcy) (n=248).Recurrence rates of ischemic vascular events within a 5-years follow-up period was observed.Results The levels of FHcy,PHcy and △Hcy (PHcy level subtracted FHcy level) were higher in males than in females in the two groups (all P＜0.05).The recurrence rates of cerebral infarction/TIA,acute coronary syndrome and other vascular embolism events were higher in PHcy group than in NPHcy group within the follow-up period (all P＜0.05).By forward stepwise logistic analysis,we found that the increased PHcy and △Hcy levels were the independent risk factors for recurrent ischemic vascular events [odds ratio (OR):0.509,2.107,95％ confidence interval (CI):0.286-0.904,1.185-3.745,both P＜0.05].Conclusions PHHcy may be an independent risk factor for recurrence ischemic vascular events in cerebral infarction.
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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.
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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.
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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.