IntroductionAmyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by motor neuron degeneration, leading to muscle weakness, atrophy, and ultimately respiratory failure. Previous research has highlighted the roles of neurotrophic factors and inflammatory responses in ALS pathogenesis; however, their interplay remains poorly understood. This exploratory study aims to elucidate the expression characteristics and correlations of fibroblast growth factor 2 (FGF2) and peripheral blood inflammatory indicators (PBIIs) such as derived neutrophil-to-lymphocyte ratio (dNLR) and systemic inflammatory response index (SIRI) in ALS patients.MethodsThis was a prospective case–control study, involving ALS patients meeting Gold Coast diagnostic criteria and age- and sex-matched healthy controls (HCs). Serum FGF2 levels were measured using enzyme-linked immunosorbent assay (ELISA), and PBIIs were assessed through routine blood analysis. Statistical analysis was conducted mainly using intergroup comparison, correlation analysis, and multivariate linear regression.ResultsThe results showed significantly elevated levels of FGF2 and PBIIs in ALS patients compared to HCs, with strong correlations between FGF2, PBIIs, clinical staging, and disease progression rates. In multivariate linear regression analysis, PBIIs, especially SIRI, were significantly associated with disease severity and early disease progression. While serum FGF2 and FGF2 to dNLR ratio demonstrated potential as an auxiliary biomarker for later-stage disease.DiscussionThese findings provide new insights into the molecular mechanisms underlying ALS and suggest practical diagnostic and prognostic tools, reinforcing the importance of targeting neurotrophic and inflammatory pathways in ALS management. This study holds significant promise for advancing both clinical practice and future research endeavors in the field.

Background Diabetic oculomotor neuropathy (DON) is a microcirculatory ischaemic disease. At present, the ratio of albumin to fibrinogen (AFR) is considered as an indicator of microcirculation. Previous studies have reported that low serum albumin and high fibrinogen levels are related to diabetic peripheral neuropathy. There is no research on the relationship between AFR and DON. Objective The study aimed to investigate the association of AFR with DON. Methods In our research, 173 T2D patients with DON from 2011 to 2022 were included, as were 167 randomly chosen patients with T2D (controls) without DON in the same period. We constructed three models to analyze the relationship between AFR and DON through binary logistic regression analysis. After excluding other related risk factors, it is found that AFR is the protective factor of DON, and the lower AFR value is related to the increased risk of DON. When distinguishing between DON patients with DSPN and those without DSPN, receiver operating characteristic (ROC) curve analysis revealed a meaningful area under the curve (AUC). Results In our research, a low AFR was more related to DON. When the AFR is < 10.96, DSPN is more likely to occur. Conclusion Therefore, AFR may be a potential biomarker of DON, at least in T2D patients.

Diabetic oculomotor neuropathy (DON) is a microcirculatory ischaemic disease. At present, the ratio of albumin to fibrinogen (AFR) is considered as an indicator of microcirculation. Previous studies have reported that low serum albumin and high fibrinogen levels are related to diabetic peripheral neuropathy. There is no research on the relationship between AFR and DON. The study aimed to investigate the association of AFR with DON. In our research, 173 T2D patients with DON from 2011 to 2022 were included, as were 167 randomly chosen patients with T2D (controls) without DON in the same period. We constructed three models to analyze the relationship between AFR and DON through binary logistic regression analysis. After excluding other related risk factors, it is found that AFR is the protective factor of DON, and the lower AFR value is related to the increased risk of DON. When distinguishing between DON patients with DSPN and those without DSPN, receiver operating characteristic (ROC) curve analysis revealed a meaningful area under the curve (AUC). In our research, a low AFR was more related to DON. When the AFR is < 10.96, DSPN is more likely to occur. Therefore, AFR may be a potential biomarker of DON, at least in T2D patients.

BACKGROUND:We evaluated the value of electrophysiological indicators by external anal sphincter electromyography (EAS-EMG), sympathetic skin response (SSR), R-R interval variation (RRIV), and Bulbocavernosus Reflex (BCR) in differential diagnosis of multiple system atrophy (MSA) and Parkinson's disease (PD). METHODS:A total of 41 patients with MSA and 32 patients with PD were enrolled. The electrophysiological changes of autonomic dysfunction were assessed with BCR, EAS-EMG, SSR, and RRIV, and the abnormal rate of each indicator was calculated. The diagnostic value of each indicator was analyzed with ROC curve. RESULTS:The incidence rate of autonomic dysfunction in MSA group was significantly higher than that in PD group (p < 0.05). The abnormal rates of BCR and EAS-EMG indicators in MSA group were higher than those in PD group (p < 0.05). The abnormal rates of SSR and RRIV indicators in MSA group and PD group were high; however, there was no significant difference between MSA and PD groups (p > 0.05). The sensitivity of BCR combined with EAS-EMG indicators in differential diagnosis of MSA and PD were 92.3% in males and 86.7% in females, respectively, and the specificity was 72.7% in males and 90% in females, respectively. CONCLUSIONS:Combined analysis of BCR and EAS-EMG has high sensitivity and specificity for differential diagnosis of MSA and PD.

Introduction/Aims Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes mellitus. Diabetic patients often have thyroid dysfunction. The aim of this study was to investigate the association between low triiodothyronine (T3) syndrome and DPN in patients with type 2 diabetes mellitus (T2DM). Methods A retrospective review was performed of 928 patients with T2DM for whom data was available for clinical manifestations and nerve conduction studies (NCS), and of 134 non-diabetic controls. The composite Z scores of conduction velocity and amplitude were calculated. Low T3 syndrome was defined as T3 levels below the lower limit of the reference interval. Results Among the patients with T2DM, 632 (68.1%) had DPN, and a larger proportion of these patients presented with low T3 syndrome than patients without DPN. After adjusting for potential confounders, low T3 syndrome was independently associated with the occurrence of DPN (odds ratio [OR] = 2.049, 95% confidence interval [CI] 1.319-3.181, p = .001) and the severity of DPN (OR = 1.597, 95% CI 1.030-2.476, p = .036). Adding the criterion of low T3 syndrome improved the prognostic performance of the traditional model (age + gender + diabetic duration + glycated hemoglobin [HbA1c]) for predicting DPN. Discussion Low T3 syndrome is associated with a higher risk and increased severity of DPN in patients with T2DM. These findings suggest that low T3 syndrome could be a predictor for risk stratification in patients with T2DM.

OBJECTIVES:To observe the characteristics of sacral reflex and sympathetic skin reflex in patients with Parkinson's disease (PD) and multiple system atrophy P-type (MSA-P) and to analyze their value as a differential diagnostic method.METHODS:The data of 30 healthy people, 58 PD patients, and 52 MSA-P patients from the First Affiliated Hospital of Wenzhou Medical University were collected. Electrophysiological bulbocavernosus reflex (BCR) and sympathetic skin response (SSR) were evaluated using the Keypoint EMG/EP system. The latency period, amplitude, and extraction rate of BCR and SSR were compared between the control, PD, and MSA-P groups.RESULTS:The incidence of the related autonomic damage in the PD group was lower than that of the MSA-P group. For BCR, the latency period was shorter and the amplitude and elicitation rates were lower in the PD group than in the MSA-P group. For SSR, the latency period was longer in the MSA-P and PD groups than in the control group, but the difference was not statistically significant.CONCLUSION:SSR cannot be used to assess autonomic nerve function. PD patients can have clinical symptoms similar to those of MSA-P patients, but the incidence is lower. Both MSA-P and PD patients have a damage to the BCR arc, but the MSA-P patients have a more severe damage.

Objectives To observe and analyze the parameters of the sacral reflex and pudendal nerve somatosensory evoked potential (SSEP) in patients with multiple system atrophy (MSA) with respect to factors such as age, disease course, and subtype and provide evidence for the clinical diagnosis of MSA. Materials and Methods A total of 51 MSA patients and 30 healthy controls were selected from the First Affiliated Hospital of Wenzhou Medical University from May 2013 to November 2015. Electrophysiological sacral reflex detection and SSEP detection were performed using the Keypoint EMG/EP system. The extraction rate, latency, and amplitude of the sacral reflex and SSEP in the MSA group and control group were compared. Results The sacral reflex latency and amplitude in patients with MSA were statistically different from those of the healthy controls. The latency of sacral reflex increases with the prolongation of the disease course, and the amplitude and initiation rate decrease with the prolongation of the disease course. There was no significant difference in sacral reflex latency and amplitude between MSA patients of different ages and subtypes. There was no significant difference in the latency or amplitude of SSEP between the MSA group and healthy control group. Conclusions The latency of sacral reflex increases with the prolongation of the disease course, and the amplitude and extraction rate decrease with the prolongation of the disease course. There was no significant difference in the parameters of sacral reflex between young MSA patients and elderly patients. And there was no statistically significant difference between MSA-P subtypes and MSA-C subtypes. This trial is registered with ISRCTNCR2009041.

Multiple system atrophy with predominant parkinsonism (MSA-P) is a degenerative disorder that presents with autonomic dysfunction, atypical parkinsonism, and ataxia. Parkinson's disease (PD) is an age-related neurological disorder of the central nervous system. Differentiation between MSA-P and PD is important because treatments, complications, and prognoses differ. The bulbocavernosus reflex (BCR) tests the afferent and efferent signals of the pudendal nerve as well as the sacral cord. In this study, we investigated differences in BCR parameters between MSA-P and PD patients. Thirty-eight MSA-P patients and 32 PD patients were selected to participate in our electrophysiological investigations. The Keypoint EMG/EP system was used to induce the BCR, and latencies and amplitudes were recorded for systematic statistical analyses. Area under the curve of the receiver operating characteristic was used to assess the specificity and sensitivity of the BCR parameters. A BCR was elicited in 76.32% of MSA-P patients and 93.75% of PD patients. The BCR latencies of the MSA-P group were longer than those of the PD group (p < 0.001). In addition, the MSA-P group had a lower BCR amplitude compared to the PD and control groups (p < 0.001). We discovered the difference between MSA-P and PD through BCR latencies and amplitudes. Compared to PD patients, MSA-P patients have longer latencies and lower amplitudes. Therefore, the BCR may be used to discriminate between MSA-P and PD in some cases.

The aim of this study was to compare clinical characteristics, electroneurography (ENoG) results, and functional outcomes of patients with Bell's palsy (BP) and Ramsay Hunt syndrome (RHS).Around 57 patients with BP and 23 patients with RHS were enrolled in this study from January 2010 and September 2015. Both clinical characteristics and ENoG results were recorded at hospital admission. The evaluations of functional outcomes were conducted with House-Brackmann (H-B) grading system at 6-month follow-up.There were no significant differences in age, gender proportion, initial H-B grades, time before commencement of treatment and the presence of comorbid disease in 2 groups. However, the final H-B grades at 6-month follow-up were significantly better in BP patients than RHS patients. The results of ENoG showed that degeneration index (DI) was significantly higher in the RHS group than the BP group. But no significant difference was found in the value of prolonged latency time (PLT) between the 2 groups. In multivariate analysis, age and ENoG DI were independently associated with functional outcome of recovery in the BP group (OR 0.167, 95% CI 0.038-0.622, P = 0.009 and OR 0.289 95% CI 0.107-0.998, P = 0.050, respectively). However, in the RHS group, only ENoG DI was related to the final H-B grades (OR 0.067, 95% CI 0.005-0.882, P = 0.040). Spearman's rank correlation analysis showed that higher age and ENoG DI were related to poorer prognosis in 2 groups (P < 0.05). PLT was related to functional outcomes only in the BP group (rs = 0.460, P < 0.001). The receiver operating characteristic (ROC) of ENoG DI analysis revealed that the cutoff value was 67.0% for BP prognosis and 64.5% for RHS prognosis. What's more, patients with hypertension or diabetes mellitus had both higher final H-B grade and ENoG DI than those without the same comorbidity.Patients with RHS had poorer prognosis than those with BP. Some factors including age, ENoG DI, and the presence of disease influenced recovery from BP and RHS. The present study demonstrated that BP patients with ENoG DI < 67.0% and RHS patients with ENoG DI < 65.5% had a greater opportunity for recovery within half a year.

Objectives: Multiple system atrophy (MSA) is characterized by a combination of symptoms including autonomic dysfunction, parkinsonism, cerebellar ataxia, and cortico-spinal disorders. The disease can have either predominant parkinsonism or cerebellar features (MSA-P and MSA-C, respectively). The measurement of the bulbocavernosus reflex (BCR) and pudendal nerve somatosensory-evoked potentials (PSEPs) was originally developed to diagnose diabetic cystopathy and other neuropathologic diseases that share similar symptoms with MSA. We investigated the relationship between abnormalities of neurophysiological parameters and MSA, and estimated the potential value of BCR. Methods: Fifty-one MSA patients (28 and 23 MSA-P and 23 MSA-C patients, respectively) and 30 healthy controls who were seen at the Department of Neurology were included in the study. A Keypoint EMG/EP system was used to test BCR and PSEPs, and the latencies and amplitudes were recorded for statistical analyses. Results: The BCR was elicited in 78.4% patients with MSA (22/28 MSA-P, 18/23 MSA-C). Prolonged BCR latencies were found in patients with MSA compared with healthy controls (p < 0.001). BCR amplitudes were significantly lower in the MSA group than the control group (p < 0.001). PSEP P41 amplitudes were not significantly different between the MSA and control groups in males (p = 0.608) or females (p = 0.897). There were no significant differences in PSEP latencies among the MSA-P, MSA-C, and control groups (p = 1.0, p = 0.263, and p = 0.060, respectively). Discussion: MSA patients exhibit prolonged BCR latencies and lower amplitudes, which provides a rough anatomical localization of nervous system lesions in MSA patients.

The study was designed to investigate the clinical application and significance of the bulbocavernosus reflex (BCR) test for diagnosing diabetic neurogenic bladder (DNB) in female subjects.In this study, 68 female patients with DNB and 40 female normal controls were subjected to a nerve conduction study (NCS) of all four limbs and the BCR test.The data were analyzed and compared, and the corresponding diagnostic sensitivities were discussed.Mean BCR latency for female DNB patients was significantly prolonged, compared to that of the control group, suggesting pudendal nerve injuries in female DNB patients.Moreover, DNB patients were categorized according to the diabetes course.Compared to that of Group A (diabetes course < 5 y), the mean BCR latency was significantly prolonged in Group B (diabetes course between 5 and 10 y) and then further prolonged in Group C (diabetes course > 10 y), which were all longer than the control group.Furthermore, compared with that of the controls, the mean BCR latency was prolonged in DNB patients with or without NCS abnormalities in limbs.Nevertheless, no significant difference was observed in BCR latency between DNB patients with and without NCS abnormalities.Significantly increasing trends were also observed in the NCS and BCR abnormality rates along with increased diabetes course.Most importantly, compared with the NCS of limbs, the BCR test was more sensitive in diagnosing DNB in the female subjects.Overall, our findings suggest that the BCR test would help to assess the pudendal nerve injury in female DNB patients, which might be a potential diagnostic tool in the clinic.

AIMS This study is to assess the value of bulbocavernosus reflex (BCR) and pudendal nerve somatosensory evoked potential (SSEP) in the topical diagnosis of cauda equina syndrome (CES) with or without sphincter dysfunction in male patients. METHODS In this study, 40 healthy male adults (control group) and 53 male adult patients (experimental group) were included. The experimental group was subdivided into sphincter subgroup (24 patients with sphincter dysfunction) and non-sphincter subgroup (29 patients without sphincter dysfunction). All subjects underwent BCR and SSEP examinations. The mean latencies of BCR and SSEP P41 were calculated and compared between the control group and the experimental group. Latencies above the average value of +2.58S were considered abnormal. The abnormality rates of BCRs and SSEPs in sphincter and non-sphincter subgroups were calculated, respectively. RESULTS BCR and SSEP latencies in the experimental group were remarkably prolonged than those in the control group. BCR and SSEP latencies in sphincter subgroup were remarkably prolonged than those in non-sphincter subgroup. Among the 106 nerves in the experimental group, 87 nerves had prolonged BCR latencies and 3 nerves had no wave elicited, with an abnormality rate of 84.9%. The abnormality rates of BCR were 95.8% and 74.1% in sphincter subgroup and non-sphincter subgroup, respectively. Among the 53 nerves in the experimental group, 39 nerves had prolonged SSEP P41 latencies and 2 nerves had no wave elicited, with an abnormality rate of 77.4%. The abnormality rates of SSEP P41 were 91.7% and 65.5% in sphincter subgroup and non-sphincter subgroup, respectively. CONCLUSIONS Both BCR and SSEP were changed in CES patients with or without sphincter dysfunction, and they were especially changed in patients with sphincter dysfunction. BCR and SSEP are valuable in the diagnosis of cauda equina lesions and their severity in males.