{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:00:26Z","timestamp":1780542026847,"version":"3.54.1"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"First Hospital of Tsinghua University Pilot Funds","award":["LH-02"],"award-info":[{"award-number":["LH-02"]}]},{"name":"China-Japan Friendship Hospital Young talents funds","award":["2015-QNYC-A-05"],"award-info":[{"award-number":["2015-QNYC-A-05"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The objective was to analyze the clinical characteristics and pathological characteristics of sural biopsy in nitrous oxide (N<jats:sub>2<\/jats:sub>O) -induced peripheral neuropathy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We recruited 18 patients with N<jats:sub>2<\/jats:sub>O abuse-induced neurological disorders and reported their demographic data, clinical manifestations, laboratory examinations, and nerve conduction studies. Seven patients underwent sural nerve biopsy pathologic examination.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>All 18 patients had polyneuropathy, the nerve conduction results showed significant reductions in motor and sensory amplitudes, slowing of conduction velocities, and prolongation of latencies in most tested nerves compared to the controls. Toluidine blue staining of semi-thin sections of sural nerve biopsy showed decreased myelinated nerve fiber density, increased thin myelinated nerve fiber density, and axonal regeneration. Electron microscopy showed axonal degeneration and nerve regeneration.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The main manifestations of peripheral nerve damage caused by the abuse of N<jats:sub>2<\/jats:sub>O are lower limb weakness and distal sensory disorder. The nerve conduction study results demonstrated that mixed axonal and demyelinating neuropathy was the most common type of neuropathy. Sural biopsy showed the main pathological change was chronic axonal degeneration.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0274765","type":"journal-article","created":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T17:48:38Z","timestamp":1663350518000},"page":"e0274765","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy"],"prefix":"10.1371","volume":"17","author":[{"given":"Qian","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingrui","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaojie","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5869-3397","authenticated-orcid":true,"given":"Li","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renbin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,16]]},"reference":[{"key":"pone.0274765.ref001","first-page":"696","article-title":"Supplementation with demerol during nitrous oxide anesthesia; 1949.","author":"M Brotman","journal-title":"The American Society of Anesthesiologists"},{"key":"pone.0274765.ref002","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1177\/0269881116632375","article-title":"Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use","volume":"30","author":"SJ Kaar","year":"2016","journal-title":"Journal of psychopharmacology"},{"key":"pone.0274765.ref003","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.yrtph.2015.10.017","article-title":"Recreational nitrous oxide use: prevalence and risks","volume":"73","author":"J van Amsterdam","year":"2015","journal-title":"Regulatory toxicology and pharmacology"},{"key":"pone.0274765.ref004","article-title":"Nitrous oxide use among young people\u2013new trends, policy challenges, and knowledge gaps","author":"VA Frank","year":"2020","journal-title":"Drugs and Alcohol Today"},{"key":"pone.0274765.ref005","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/s00415-019-09600-w","article-title":"The sharp rise of neurological disorders associated with recreational nitrous oxide use in China: a single-center experience and a brief review of Chinese literature","volume":"267","author":"D Zheng","year":"2020","journal-title":"Journal of neurology"},{"key":"pone.0274765.ref006","doi-asserted-by":"crossref","first-page":"977","DOI":"10.2147\/NDT.S236939","article-title":"Clinical, electrophysiological and radiological features of nitrous oxide-induced neurological disorders","volume":"16","author":"L Bao","year":"2020","journal-title":"Neuropsychiatric Disease and Treatment"},{"key":"pone.0274765.ref007","doi-asserted-by":"crossref","first-page":"2817","DOI":"10.2147\/NDT.S270179","article-title":"Reversible Neuropsychiatric Disturbances Caused by Nitrous Oxide Toxicity: Clinical, Imaging and Electrophysiological Profiles of 21 Patients with 6\u201312 Months Follow-up.","volume":"16","author":"R Zheng","year":"2020","journal-title":"Neuropsychiatric Disease and Treatment"},{"key":"pone.0274765.ref008","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/ajad.12372","article-title":"Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature","volume":"25","author":"A Garakani","year":"2016","journal-title":"The American journal on addictions"},{"key":"pone.0274765.ref009","article-title":"(2022) Neurological and Psychological Characteristics of Young Nitrous Oxide Abusers and Its Underlying Causes During the COVID-19 Lockdown.","author":"G Wu","journal-title":"Frontiers in Public Health"},{"key":"pone.0274765.ref010","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1177\/0269881119882532","article-title":"Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users","volume":"34","author":"AR Winstock","year":"2020","journal-title":"Journal of Psychopharmacology"},{"key":"pone.0274765.ref011","doi-asserted-by":"crossref","first-page":"3288","DOI":"10.1016\/j.clinph.2016.08.005","article-title":"Clinical and electrodiagnostic characteristics of nitrous oxide-induced neuropathy in Taiwan.","volume":"127","author":"H-T Li","year":"2016","journal-title":"Clinical Neurophysiology"},{"key":"pone.0274765.ref012","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1007\/s00415-021-10748-7","article-title":"Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic","volume":"269","author":"R Vollhardt","year":"2022","journal-title":"Journal of neurology"},{"key":"pone.0274765.ref013","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1179\/1476830513Y.0000000073","article-title":"Clinical, nerve conduction and nerve biopsy study in vitamin B12 deficiency neurological syndrome with a short-term follow-up","volume":"17","author":"J Kalita","year":"2014","journal-title":"Nutritional neuroscience"},{"key":"pone.0274765.ref014","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1046\/j.1365-2044.2000.01463.x","article-title":"Recent advances in understanding the actions and toxicity of nitrous oxide","volume":"55","author":"M Maze","year":"2000","journal-title":"Anaesthesia"},{"key":"pone.0274765.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jns.2010.10.033","article-title":"Nitrous oxide-induced B12 deficiency myelopathy: perspectives on the clinical biochemistry of vitamin B12","volume":"301","author":"L Hathout","year":"2011","journal-title":"Journal of the neurological sciences"},{"key":"pone.0274765.ref016","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1097\/CND.0000000000000108","article-title":"Clinical manifestations of isolated elevated homocysteine-induced peripheral neuropathy in adults","volume":"17","author":"V Shandal","year":"2016","journal-title":"Journal of clinical neuromuscular disease"},{"key":"pone.0274765.ref017","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3390\/brainsci4010073","article-title":"The neurotoxicity of nitrous oxide: the facts and \u201cputative\u201d mechanisms","volume":"4","author":"S Savage","year":"2014","journal-title":"Brain sciences"},{"key":"pone.0274765.ref018","doi-asserted-by":"crossref","first-page":"2720","DOI":"10.1007\/s00415-021-10858-2","article-title":"Nitrous oxide-induced predominantly motor neuropathies: a follow-up study","volume":"269","author":"E Berling","year":"2022","journal-title":"Journal of Neurology"},{"key":"pone.0274765.ref019","doi-asserted-by":"crossref","first-page":"704","DOI":"10.3389\/fneur.2019.00704","article-title":"Elucidating unique axonal dysfunction between nitrous oxide abuse and vitamin B12 deficiency","volume":"10","author":"J Tani","year":"2019","journal-title":"Frontiers in neurology"},{"key":"pone.0274765.ref020","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1002\/mus.24482","article-title":"Severe motor neuropathy or neuronopathy due to nitrous oxide toxicity after correction of vitamin B12 deficiency","volume":"51","author":"N Morris","year":"2015","journal-title":"Muscle & Nerve"},{"key":"pone.0274765.ref021","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/j.1600-0404.2005.00473.x","article-title":"Nitrous oxide inhalation as a cause of cervical myelopathy","volume":"112","author":"M Waters","year":"2005","journal-title":"Acta neurologica scandinavica"},{"key":"pone.0274765.ref022","article-title":"Nitrous oxide induced posterior cord myelopathy: beware of the methyl folate trap","volume":"12","author":"DA Marotta","year":"2020","journal-title":"Cureus"},{"key":"pone.0274765.ref023","first-page":"36","article-title":"Influence of methylenetetrahydrofolate reductase gene polymorphisms on homocysteine concentrations after nitrous oxide anesthesia","volume":"109","author":"P Nagele","year":"2008","journal-title":"The Journal of the American Society of Anesthesiologists"},{"key":"pone.0274765.ref024","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/1759720X14566617","article-title":"Diagnosis and therapeutic options for peripheral vasculitic neuropathy","volume":"7","author":"F Blaes","year":"2015","journal-title":"Therapeutic advances in musculoskeletal disease"},{"key":"pone.0274765.ref025","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/mus.22319","article-title":"Reversible isolated sensory axonal neuropathy due to cobalamin deficiency","volume":"45","author":"CD Torre","year":"2012","journal-title":"Muscle and Nerve"},{"key":"pone.0274765.ref026","first-page":"909","article-title":"Vitamin B12 deficiency neuropathy: sural nerve biopsy study","volume":"22","year":"1986","journal-title":"Israel journal of medical sciences"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0274765","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T17:49:09Z","timestamp":1663350549000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0274765"}},"subtitle":[],"editor":[{"given":"Mehmet Cudi","family":"Tuncer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,16]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0274765","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,16]]}}}