Area Of Nerve Research Articles

Ultrasound characteristics of the cervical vagus nerve in patients with type 2 diabetes and diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) and autonomic neuropathy are commonly coexistent in patients with type 2 diabetes mellitus (T2DM). Current assessment tools for diabetic neuropathy remain complicated and limited. We aimed to investigate the sonographic changes of the cervical vagus nerve in DPN patients with T2DM. Patients with T2DM were divided into a DPN group (DPN, n = 44) and non-DPN controls (NDPN, n = 43) based on electromyogram results. Another 43 healthy controls (CON) were included. High-frequency ultrasound (HFU) of the vagus nerve was performed in all participants. Compared with controls, the honeycomb structure of the vagus nerve in patients with T2DM decreased, p < 0.001. The DPN group had higher cross-sectional area (CSA) of the right vagus nerve than the NDPN group (1.60 ± 0.52 vs. 2.00 ± 0.57 mm2, p =0.001). Logistic regression showed that right vagus nerve CSA was a risk factor of DPN (odds ratio [OR] = 3.924, p = 0.002). Right vagus nerve CSA was positively correlated with diabetes duration (p = 0.003), and negatively correlated with the motor conduction velocity (MCV) of the ulnar, median, and common peroneal nerves (p < 0.001 for all), as well as the sensor conduction velocity (SCV) of the ulnar and median nerve (both p < 0.005). HFU shows thickening of the cervical vagus nerve in patients with DPN, which is a potential diagnostic feature of diabetic neuropathy.

Ultrasound Cross-Sectional Area in Median Nerve Axonal Loss and Demyelination in Carpal Tunnel Syndrome

IntroductionUltrasound is an effective diagnostic tool for carpal tunnel syndrome (CTS). However, it is unclear how ultrasound correlates with axonal loss and/or demyelination on electrodiagnostic studies (EDS). The objective of this study is to determine whether ultrasound cross-sectional area (CSA) of the median nerve varies between patients with axonal loss or demyelination. MethodsA retrospective review was completed of patients who presented to an orthopaedic hand clinic with numbness/paresthesias over a 6-year period. Demographics, CTS symptoms scale 6 (CTS-6) scores, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, EDS results, and ultrasound results were collected. Median neuropathies were graded as normal, demyelination, or axonal loss using EDS reports. The data were analyzed with chi-square and t-tests. ResultsIn all, 383 hands were included (92 axonal loss, 182 demyelination only, and 108 neither). The average patient age was 52.2 and the average body mass index (BMI) was 31.7. The group consisted of 70.7% females, and 23.2% had diabetes. Patients with either axonal loss or demyelination had larger CSA and higher CTS-6 and BCTQ scores than patients with negative EDS. Patients with axonal loss also had larger CSA and higher CTS-6 and BCTQ scores than patients with demyelination only. The rates of positive ultrasound results between axonal loss and demyelination groups did not differ until the ultrasound cutoff was increased from 10 to 12 mm2. ConclusionRates of positive ultrasound results (CSA ≥ 10 mm2) do not differ between wrists with axonal loss or demyelination alone. Therefore, the character of carpal tunnel neuropathy does not affect ultrasound’s diagnostic ability. Additionally, CSA increases as wrists develop axonal loss, and an increased ultrasound cutoff of 12 mm2 is correlated with this pathology.

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes.

Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

Histologic Comparison of the Fascicular Area of Processed Nerve Allograft Versus Cabled Sural Nerve Autograft.

The use of multiple cables of sural nerve autograft is common for peripheral nerve reconstruction when injured nerve caliber exceeds the nerve graft caliber. Although the optimal matching of neural to nonneural elements and its association with functional outcomes are unknown, it is reasonable to consider maximizing the neural tissue structure available for nerve regeneration. No prior studies have compared directly the cross-sectional fascicular area between cabled nerve autografts and size-selected nerve allografts. This study evaluated the cross-sectional fascicular area between native nerve stumps and two reconstructive nerve grafting methods: cabled sural nerve autograft (CSNA) and processed nerve allograft (PNA). CSNA from matched cadaveric specimens and PNA were used to reconstruct nerve defects in the median and ulnar nerves of six pairs of cadaveric specimens. Nerve reconstructions were done by fellowship-trained hand surgeons. The total nerve area, fascicular area, and nonfascicular area were measured histologically. The CSNA grafts had significantly less fascicular area than PNA and caliber-matched native nerve. The PNA grafts had a significantly higher percent fascicular area compared with the intercalary CNSA graft. Fascicular area was significantly greater in PNA versus CSNA. The PNA consistently demonstrated a match in fascicular area closer to the native nerve stumps than CSNA, where CSNA had significantly smaller fascicular area compared with native nerve stumps.

Development andvalidation ofa clinical model forpredicting the severity ofcarpal tunnel syndrome.

To develop a clinical instrument to assess carpal tunnel syndrome (CTS) severity before electrodiagnostic testing. Data from 1037 patients with CTS (39.1% male) were included. The mean (SD) age was 58.0 (10.8) years. The severity of CTS was based on electrodiagnostic findings. We devised a composite index incorporating a pain numeric rating scale (NRS) rated from 0 (no pain at all) to 10 (the worst pain ever possible), thenar muscle weakness or atrophy (TW), cross-sectional area (CSA) of the median nerve (mm2), and nocturnal pain (NP). The index was calculated as [scale(NRS)+scale(CSA)+NP+TW]/4, where NP and TW are binary features (0 or 1). The accuracy and area under the curve of the index were 0.85 and 0.71, respectively (Cohen's Kappa = 0.51, McNemar's test P = 0.249). The index increased pretest probabilities by 1.6, 1.8, and 3.3 times with positive likelihood ratios of 3.3, 2.5, and 13.5, and false-positive rates of 26.6, 17.6, and 4.8% for mild, moderate, and severe CTS, respectively. The index thresholds for mild, moderate, and severe CTS were <0.8, ≥0.8 to <1.1, and ≥1.1, respectively. Using a composite index, patients with CTS can be categorized for the severity of the syndrome.

Enlarged cross-sectional area of the left vagus nerve in patients with major depressive disorder.

Autonomic dysfunction and a chronic low-grade inflammation are supposed to play a role in the etiology of major depressive disorder (MDD). The vagus nerves (VN) form a major part of the parasympathetic nervous system and of the gut-brain axis. They are supposed to exert anti-inflammatory and epithelial barrier protective effects in the gut. A reduced vagal activity was described in patients with MDD. We aimed to examine the VN in patients with MDD with high-resolution ultrasound (HRUS) and hypothesized that the cross-sectional area (CSA) and the echogenicity of the VNs were altered in comparison to healthy controls. The echogenicity (gray scale mean) and the CSA of the cervical VNs at the level of the thyroid gland and both median nerves were examined with HRUS in 50 patients with MDD and 50 matched healthy controls. The left VN-CSA was significantly larger in the MDD group compared to the control group (1.7 ± 0.4 mm2 versus 1.5 ± 0.4 mm2; p = 0.045). The CSA of the right VN and both median nerves (MN) were similar between groups. In MDD subgroup analyses, recurrent depressive disorders were the main contributing factor for the left VN-CSA enlargement. Echogenicity was not altered in the VN and MN between groups. The enlargement of the left VN-CSA in patients with MDD, and especially in these patients with recurrent depressive disorders, might turn out as a promising imaging biomarker. Longitudinal studies are warranted to examine whether the VNs-CSA change in the course of MDD.

Traumatic injury of left femoral nerve causing unilateral hindlimb lameness in a cat

AbstractA 1‐year‐old, female, domestic shorthair cat was referred for orthopaedic evaluation of acute‐onset, non‐progressive left pelvic limb lameness of 2.5‐week duration. Orthopaedic examination revealed an abnormal gait with impaired ability to support weight on the left pelvic limb. There was marked atrophy of the quadriceps muscles. Neurological examination revealed an absent patellar reflex and decreased sensation in the cutaneous zone of the saphenous nerve of the left pelvic limb. Magnetic resonance imaging showed T2‐weighted/short‐tau inversion recovery hyperintensity and contrast enhancement in the area of the femoral nerve and within muscles innervated by this nerve. Findings were deemed consistent with traumatic nerve injury and denervation/traumatic myopathy or myositis/neuritis. Electromyography of the quadriceps muscles revealed fibrillation potentials and positive sharp waves. Follow‐up over the next 9 months revealed no changes in the neurological deficits. This was deemed to be consistent with either partial axonotmesis or partial neurotmesis of the left femoral nerve.

Ultrasound imaging of the phrenic nerve at the scalene muscle level.

The aim of this study is to utilize ultrasound to evaluate the normal cross-sectional area (CSA) of the phrenic nerve (PN), at the level of the anterior scalene muscle. The study included 62 PNs in 31 healthy subjects (13 men, 18 women); mean age, 36.6 years; mean height, 161.1 cm; mean weight, 69.6 kg; and mean body mass index 25.8 kg/m2. High-resolution ultrasound images of the bilateral PNs were obtained by a radiologist with 15 years of experience in neuromusculoskeletal ultrasound. Three separate CSA measurements for the bilateral PNs bilaterally were obtained. Images were also reviewed by an experienced neurologist to evaluate for inter-rater variability. The mean CSA of the right PN was 0.54 mm2 ± 0.16. The mean CSA of the left PN was 0.53 mm2 ± 0.18. We believe that the reference values for the normal CSA of the PNs obtained in our study could help in the sonographic evaluation of PN enlargement, as it relates to the diagnosis of various diseases affecting the PN. Furthermore, knowledge of its location and size, at the level of the scalene muscle, could help prevent PN-related complications during interventional procedures in that area. Additionally, for each participant, demographic information of age and gender as well as body mass index, weight, and height were documented.

Pressure Pain Hypersensitivity and Ultrasound Changes in the Radial Nerve in Patients with Unilateral Lateral Epicondylalgia: A Case-Control Study.

Some authors have proposed the potential role of the radial nerve in lateral epicondylalgia. The aims of this study were to investigate the presence of pressure pain hyperalgesia and nerve swelling (increased cross-sectional area) assessed with ultrasound imaging on the radial nerve in people with lateral epicondylalgia, and to investigate if an association exists between pressure pain sensitivity and cross-sectional area. A total of 37 patients with lateral epicondylalgia (43% women, age: 45.5 ± 9.5 years) and 37 age- and sex-matched pain-free controls were recruited for participation. Pressure pain thresholds (PPTs) were assessed bilaterally on the radial nerve at the spiral groove, the arcade of Frohse, and the anatomic snuffbox in a blinded design. Further, the cross-sectional area of the radial nerve at the spiral groove and antecubital fossa was also assessed. The results demonstrated lower PPTs on the radial nerve of the affected side in individuals with lateral epicondylalgia as compared with the unaffected side (p < 0.01) and with both sides in healthy controls (p < 0.001). Additionally, the cross-sectional area of the radial nerve on the affected side in patients was higher compared with the unaffected side (p < 0.01) and both sides in healthy controls (p < 0.001). The cross-sectional area of the radial nerve at the spiral groove was negatively associated with PPTs over the radial nerve at the spiral groove (r = -0.496, p = 0.002) and positively associated with function (r = 0.325, p = 0.045). Our findings revealed generalized pressure pain hyperalgesia and also nerve swelling of the radial nerve in people with lateral epicondylalgia, suggesting the presence of a widespread sensitization of nerve tissues in this population. The radial nerve could represent a potential peripheral drive to initial and maintain altered pain processing in lateral epicondylalgia.

Chitosan-based thermosensitive hydrogel with long-term release of murine nerve growth factor for neurotrophic keratopathy.

Neurotrophic keratopathy is a persistent defect of the corneal epithelium, with or without stromal ulceration, due to corneal nerve deficiency caused by a variety of etiologies. The treatment options for neurotrophic keratopathy are limited. In this study, an ophthalmic solution was constructed from a chitosan-based thermosensitive hydrogel with long-term release of murine nerve growth factor (CTH-mNGF). Its effectiveness was evaluated in corneal denervation (CD) mice and patients with neurotrophic keratopathy. In the preclinical setting, CTH-mNGF was assessed in a murine corneal denervation model. CTH-mNGF was transparent, thermosensitive, and ensured sustained release of mNGF for over 20 hours on the ocular surface, maintaining the local mNGF concentration around 1300 pg/mL in vivo. Corneal denervation mice treated with CTH-mNGF for 10 days showed a significant increase in corneal nerve area and total corneal nerve length compared with non-treated and CTH treated mice. A subsequent clinical trial of CTH-mNGF was conducted in patients with stage 2 or 3 neurotrophic keratopathy. Patients received topical CTH-mNGF twice daily for 8 weeks. Fluorescein sodium images, Schirmer's test, intraocular pressure, Cochet-Bonnet corneal perception test, and best corrected visual acuity were evaluated. In total, six patients (total of seven eyes) diagnosed with neurotrophic keratopathy were enrolled. After 8 weeks of CTH-mNGF treatment, all participants showed a decreased area of corneal epithelial defect, as stained by fluorescence. Overall, six out of seven eyes had fluorescence staining scores < 5. Moreover, best corrected visual acuity, intraocular pressure, Schirmer's test and Cochet-Bonnet corneal perception test results showed no significant improvement. An increase in corneal nerve density was observed by in vivo confocal microscopy after 8 weeks of CTH-mNGF treatment in three out of seven eyes. This study demonstrates that CTH-mNGF is transparent, thermosensitive, and has sustained-release properties. Its effectiveness in healing corneal epithelial defects in all eyes with neurotrophic keratopathy suggests CTH-mNGF has promising application prospects in the treatment of neurotrophic keratopathy, being convenient and cost effective.

Variations of the obturator nerve and implications in obturator nerve entrapment treatment: an anatomical study.

Obturator nerve entrapment or idiopathic obturator neuralgia is an unfamiliar pathology for many physicians which can lead to diagnostic errancy. This study aims to identify the potential compression areas of the obturator nerve to improve therapeutic management. 18 anatomical dissections of lower limbs from 9 anatomical cadavers were performed. Endopelvic and exopelvic surgical approaches were utilized to study the anatomical variations of the nerve and to identify areas of entrapment. On 7 limbs, the posterior branch of the obturator nerve passed through the external obturator muscle. A fascia between the adductor brevis and longus muscles was present in 9 of the 18 limbs. The anterior branch of the obturator nerve was highly adherent to the fascia in 6 cases. In 3 limbs, the medial femoral circumflex artery was in close connection with the posterior branch of the nerve. Idiopathic obturator neuropathy remains a difficult diagnosis. Our cadaveric study did not allow us to formally identify one or more potential anatomical entrapment zones. However, it allowed the identification of zones at risk. A clinical study with staged analgesic blocks would be necessary to identify an anatomical area of compression and would allow targeted surgical neurolysis.

Dental Pulp-Derived Mesenchymal Stem Cells Increase Axon Numbers in Mental Nerve Repair.

The mental nerve, the extended part of the inferior alveolar nerve, is often injured during dentoalveolar, orthognathic, or tumor surgery. Numerous therapeutic interventions, including surgery and pharmacotherapy, have been used to enhance the recovery of nerve injuries. Dental pulp stem cells (DPSCs) represent an easily accessible source of adult stem cells that can be isolated from the pulp of extracted teeth. This study evaluated the effect of DPSCs on the regeneration of the mental nerve injury model of rabbits. In this presented study, DPSCs were cultured and cell characterizations were performed by using flow cytometry and immunostainings. Bilateral mental nerve injury models of rabbits were created. In the control group (n = 10), saline was applied, and in the study group (n = 10), 2 × 106 DPSCs were applied to the repaired nerve areas. After 3 weeks, animals were killed and histological examination was obtained by using Masson's trichrome staining. An unpaired Student's t test was used when comparing the groups. Differences were considered to be statistically significant at P values of less than 0.05. The DPSCs demonstrated a homogeneous population of mesenchymal stromal cells which expressed cluster of differentiation CD44, CD73, CD90, and CD105 and lack of CD34, CD45, and HLA-DR. Our finding clearly demonstrated that a lower number of cross-sectioned axons were founded in the control group (60.18 ± 2.52) compared to the study group (72.96 ± 2.43) (p = 0.00). DPSCs promote mental nerve axonal regeneration. These results suggest that DPSCs provide an important accessible source of adult stem cells for mental nerve regeneration.

Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound.

Although idiopathic median neuropathy at the carpal tunnel (IMNCT) is objective and verifiable, distinction of normal and abnormal nerves is imprecise and probabilistic. The associated symptoms and signs (carpal tunnel syndrome [CTS]) vary, particularly for nonsevere (mild and moderate) median neuropathy. Discordance between diagnosis of mild or moderate median neuropathy at the carpal tunnel using symptoms and signs and diagnosis based on objective tests is a measure of the potential for overdiagnosis and overtreatment. What is the difference in the estimated prevalence of mild-to-moderate IMNCT using nonsevere signs and symptoms compared with the estimated prevalence using electrodiagnostic studies (EDS) and ultrasound (US)? We used data from an existing cross-sectional data registry. To create this registry, between January 2014 and January 2019, we considered all new adult English-speaking people who had an EDS that included the median nerve or people with a diagnosis of CTS who did not have surgery yet. A small and unrecorded number of people declined participation. The cross-sectional area of the median nerve at the distal wrist crease using US in people who already had EDS was measured. People with a diagnosis of CTS underwent both EDS and US. The six signs and symptoms of Carpal Tunnel Syndrome 6 (CTS-6, a validated tool to estimate the probability of IMNCT using ratings of symptoms and signs of CTS) were recorded. This resulted in a registry of 185 participants; we excluded 75 people for obvious, severe IMNCT (defined as nonrecordable nerve conduction velocity, thenar atrophy, or greater than 5 mm 2-point discrimination). Three of the 110 qualifying patients had missing information on ethnicity or race, but we accounted for this in our final analysis. Without a reference standard, as is the case with IMNCT, latent class analysis (LCA) can be used to establish the probability that an individual has specific pathophysiologic findings. LCA is a statistical method that identifies sets of characteristics that tend to group together. This technique has been used, for example, in diagnosing true scaphoid fractures among suspected fractures based on a combination of demographic, injury, examination, and radiologic variables. The prevalence of mild-to-moderate IMNCT was estimated in two LCAs using four signs and symptoms characteristic of mild-to-moderate IMNCT, as well as EDS and US measures of median neuropathy. The estimated prevalence of mild-to-moderate IMNCT based on signs and symptoms was 73% (95% CI 62% to 81%), while the estimated prevalence using EDS and US measurements was 51% (95% CI 37% to 65%). The notable discordance of 22% between the estimated prevalence of mild-to-moderate IMNCT using signs and symptoms and prevalence based on EDS and US criteria, and the overlapping CIs of the probability estimations, indicate considerable uncertainty and a corresponding notable potential for underdiagnosis or overdiagnosis. When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as EDS or US, to increase the probability of actual median neuropathy that can benefit from surgery. We might benefit from a more accurate and reliable diagnostic strategy or tool for mild-to-moderate IMNCT; this might be the focus of a future study. Level III, diagnostic study.

The evaluation of tibial nerve using shear-wave elastography and ultrasound in patients with systemic sclerosis: A cross-sectional study.

The study aimed to evaluate stiffness and the cross-sectional area (CSA) of the tibial nerve (TN) using shear wave elastography (SWE) and ultrasound (US) and investigate the relationship of these with disease activity, quality of life, and severity of neuropathic pain in patients with systemic sclerosis (SSc). This cross-sectional study included 28 SSc patients (1 male, 27 females; mean age: 50±11 years; range, 28 to 67 years) and 22 age- and sex-matched healthy controls (4 males, 18 females; mean age: 48±6 years; range, 37 to 66 years) between March and April 2022. US and SWE were performed on the TN, and CSA and nerve stiffness were measured. The TN was examined by a radiologist, 4 cm proximal to the medial malleolus. A few days later, an evaluation was performed in the second session by a second observer to investigate inter-and intraobserver agreement. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). The Scleroderma Health Assessment Questionnaire, European League Against Rheumatism European Scleroderma Trial and Research (EUSTAR) group activity index, and Douleur-Neuropathique 4 scores of the patients were evaluated. Correlations between the questionnaires and measurements of nerve stiffness and CSA were assessed. Patients with SSc had significantly higher stiffness and CSA values of the right TN compared to healthy controls (p<0.001 and p=0.015, respectively). The nerve stiffness values of the right TN were positively correlated with the EUSTAR activity index (p=0.004, r=0.552). The CSA of the left TN was larger in patients with SSc (21.3±4.9 mm2 ) than in controls (12.8±3.4 mm2 ), and the nerve elasticity was positively correlated with the EUSTAR activity index (p=0.001, r=0.618). The interobserver agreement was moderate to good for measuring stiffness and CSA of the TN (ICC were 0.660 and 0.818, respectively). There was a good to excellent intraobserver agreement for measuring stiffness and CSA of TN (ICC were 0.843 and 0.940, respectively). The increased disease activity in patients with SSc is associated with TN involvement, which can be demonstrated by US and SWE.

Poster 207: Chronic Adaptations of the Ulnar Nerve in Professional Baseball Pitchers

Objectives: The presence of ulnar neuropathy in baseball pitchers is a poor prognostic factor of successful return to play and may adversely impact outcomes after ulnar collateral ligament reconstruction (UCLR). Screening programs to identify negative ulnar nerve adaptations in throwing athletes can help minimize injury risk, individualize treatment programs, and optimize rehabilitation. Ultrasound provides the advantage of viewing structural adaptations prior to the onset of symptoms, an important factor in identifying potential injuries in advance. However, it is currently unclear how the ulnar nerve adapts chronically in professional baseball pitchers. Therefore, the primary purpose of this study was to compare ulnar nerve ultrasound characteristics between the throwing (dominant) and non- throwing control (non-dominant) elbows in professional pitchers, with a secondary purpose of comparing ultrasound characteristics between subluxing and non-subluxing ulnar nerves. The authors hypothesized that ulnar nerve area and echogenicity (i.e. brightness) would be increased in the throwing elbow. Methods: All healthy professional baseball pitchers from a single organization underwent bilateral ultrasound examination at the beginning of the 2022 Minor League Baseball spring training. Ultrasound examination was done by a musculoskeletal radiologist (**) for imaging and subsequent quantification of the ulnar nerve properties, as well as to identify ulnar nerve subluxation. ImageJ software was utilized to measure ulnar nerve area, echogenicity (i.e. brightness), and circularity by one investigator (**) who was blinded to subluxation findings and arm dominance. Comparison of ulnar nerve ultrasound characteristics were performed between: dominant vs. non-dominant elbows, subluxing vs. non- subluxing dominant elbows, and between all (dominant and non-dominant) subluxing vs. non-subluxing elbows. Results: Overall, 74 male professional baseball pitchers (age: 22.5 ± 2.4 years; professional experience: 1.7 ± 1.5 years) were enrolled. There was a trend toward statistical significance for echogenicity bilaterally (dominant: 137 optical density vs. non-dominant: 128 optical density, p=0.053), while area (0.2 mm2 vs. 0.2 mm2, p=0.767) and circularity (0.67 vs. 0.69, p=0.165) did not differ bilaterally (Table 1). There were no demographic differences between pitchers with subluxing vs. non-subluxing dominant ulnar nerves, including similar years of professional experience and similar Beighton hypermobility scores between groups (Table 2). Echogenicity was significantly lower in subluxing dominant ulnar nerves compared to non-subluxing dominant ulnar nerves (128 optical density vs. 142 optical density, p=0.020). Echogenicity remained significantly lower in subluxing ulnar nerves after evaluating all subluxing vs. non-subluxing elbows (121 optical density vs. 138 optical density, p=0.001) (Table 3). Ulnar nerve area and circularity did not differ based on ulnar nerve subluxation. Conclusions: There was a trend towards the ulnar nerve of the throwing elbow having increased echogenicity relative to the non-throwing elbow, suggesting that echogenicity may play a role in the chronic adaptations of the ulnar nerve. Nerve echogenicity also differed based on ulnar nerve subluxation, however further research is necessary to determine why this difference exists and the potential direction of causality. [Table: see text][Table: see text][Table: see text]

Vagus Nerve Stimulation Through Electro-acupuncture for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is defined as a chronic inflammatory-mediated disease that causes ulceration and inflammation in the gastrointestinal tract. Among most patients, the course of chronic inflammation repeatedly shows intermittent exacerbations and alternating remissions. However, despite the various therapeutic options to relieve symptoms, such as corticosteroids, TNF-α inhibitors, and antibiotic drugs, there is no known cure for IBD. Nonetheless, previous research has revealed that the autonomic nervous system is involved in the pathophysiology of IBD. In this study, we reviewed clinical trials confirming the therapeutic effect of vagus nerve stimulation (VNS) on IBD in vivo. We searched in vivo and human studies on Pubmed using keywords combined with “vagus nerve stimulation”, “VNS”, and “inflammatory bowel disease”. All studies included in this review reported that direct VNS is effective in relieving symptoms of IBD and has no severe adverse effects. The most frequently stimulated site was the unilateral cervical vagus nerve area, and parameters for stimulation were set as 5-20 Hz. Based on the results, we aim to summarize the evidence for the efficacy of VNS on IBD and suggest the possibility of auricular electroacupuncture treatment as a therapeutic option for IBD.

Ultrasonic visualization technique for anatomical and functional analyses of the sciatic nerve in rats.

Ultrasound has been widely used in the diagnosis and minimally invasive treatment of peripheral nerve diseases in the clinic, but there is still a lack of feasibility analysis in rodent models of neurological disease. The purpose of this study was to investigate the changes in the cross-sectional area of the sciatic nerve of different genders and body weights and to explore the effectiveness and reliability of an ultrasound-guided block around the sciatic nerve in living rats. Using ultrasound imaging anatomy of the sciatic nerve of rats, the cross-sectional area of the sciatic nerve in rats of different genders from 6 to 10 weeks old was calculated, and then analyzed its correlation with body weight. Further analyses were conducted through behavioral and cadaveric studies to evaluate the feasibility of ultrasound-guided perineural injection of the sciatic nerve in rats. We first reported that the sciatic nerve cross-sectional area of rats was increased with age (F = 89.169, P < 0.001), males had a higher sciatic nerve cross-sectional area than females (F = 60.770, P < 0.001), and there was a positive correlation with body weight (rMale = 0.8976, P < 0.001; rFemale = 0.7733, P < 0.001). Behavioral observation of rats showed that the lower extremity complete block rate was 80% following the administration of drugs around the sciatic nerve under ultrasound guidance and staining with methylene blue occurred in all sciatic nerves and surrounding muscles and fascia using 20 ultrasound-guided injections. Ultrasound visualization technology can be used as a new auxiliary evaluation and intervention therapy for animal models of peripheral nerve injury, and will provide overwhelming new references for the basic research of neurological diseases.

Ultrasound as the main method for diagnosing peripheral nerve injuries in mine blast trauma

BACKGROUND: The amount of published data related to peripheral nerve blast injuries is limited.&#x0D; AIM: The study was aimed at determining the accuracy and sensitivity and assessing the specificity of ultrasound in the diagnosis of peripheral nerve injuries in mine blast trauma.&#x0D; METHODS: A total of 159 patients (274 peripheral nerves) were examined. Ultrasound was performed according to the standard technique using a HI VISION Avius HITACHI scanner with an EUP-L74M linear transducer (a frequency range of 513 MHz) and a preset musculoskeletal system ultrasound program. The duration of nerve injuries ranged from 2 to 273 days. All patients were men aged 20 to 48 years. Peripheral nerves were damaged as a result of mine blast trauma. Statistical analysis was used to assess sensitivity, specificity, and diagnostic accuracy. These characteristics were calculated according to the qualitative assessment of surgical intervention, the results of conservative treatment, and the method under study (ultrasound).&#x0D; RESULTS: A total of 274 damaged peripheral nerves were examined. The Group 1 included 93 (34%) nerves that required surgical intervention. In Group 2, consisting of 181 (66%) nerves, conservative treatment was used. Most of the nerves (47 [51%]) in Group 1 were damaged due to the compression effects of scarring in the surrounding tissues. Seventeen (18%) partial violations of the anatomical integrity of nerves with the formation of intramural and marginal neuromas were detected. Multiple and single nerve injuries were observed in 95 (59.7%) and 64 people (40.3%), respectively. Peripheral nerves of the upper extremities were damaged more frequently (185 [67.5%]), whereas nerves of the lower extremities were damaged in 89 (32.5%) cases. Ultrasound showed an increase in the cross-sectional area of nerves, blurred contours, decreased echogenicity, and changes in the bundle structure up to the complete absence of differentiation of individual fascioculi. The formation of neuromas was observed in complete and partial nerve ruptures. All 93 nerves in Group 1 underwent surgical intervention, particularly, external neurolysis (32 [34%]), internal neurolysis (15 [16%]), nerve suture (15 [16%]), excision of neuroma followed by microsurgical epineural suture (18 [19%]), and autoneural plasty (11 [12%]). In 2 (3%) cases, a decision was made to abstain from plasty and perform a tendon transposition due to a pronounced diastasis. All patients of Group 2 were shown to have a wait-and-see approach, and conservative therapy was prescribed. In 179 (99%) cases, complete recovery of sensory and motor activity was observed within 21 days. In 2 (1%) patients, a repeated ultrasound was performed due to no effect of treatment. Compression by scar tissues was revealed, and surgical intervention was made.&#x0D; CONCLUSIONS: In mine-explosive impact, ultrasound is the leading method for diagnosing peripheral nerve injuries. Ultrasound with sensitivity of 97.8% and specificity of 98.8% reveals lesions for which surgical treatment is indicated. The diagnostic accuracy is 98.5%.

The cross-sectional area of peripheral nerve in amyotrophic lateral sclerosis: A case-control study

ObjectiveA growing body of literature recognises the importance of peripheral nerve ultrasound in neuromuscular disorders. Several attempts have been made to differentiate amyotrophic lateral sclerosis (ALS) from multifocal motor neuropathy (MMN) using peripheral nerve ultrasound. A much-debated question is whether the cross-sectional area (CSA) of peripheral nerve in ALS patients is significantly smaller compared to healthy controls. This study aims to determine the CSA of peripheral nerves in patients with ALS. MethodsOne hundred and thirty-nine patients with ALS and 75 healthy controls were recruited. Ultrasound of the median, ulnar, and trunks of the brachial plexus and cervical nerve roots was undertaken in ALS patients and controls. ResultsCompared to controls, ALS patients had mild reductions of the median nerve, most sites of the ulnar nerve, trunks of the brachial plexus and cervical nerve roots. Another important finding of this study is that the median nerve tends to have a more significant reduction than the ulnar nerve in ALS patients, especially at the proximal. ConclusionsUltrasound could be sensitive to nerve motor fibre loss in patients with ALS. CSA at the proximal Median nerve may be a promising biomarker in patients with ALS.

Ultrasound of the normal vagus nerve cross-sectional area in the carotid sheath.

The aim of this article is to utilize ultrasound to evaluate the normal cross-sectional area (CSA)of the vagus nerve (VN) in the carotid sheath. This study included 86 VNs in 43 healthy subjects (15 men, 28 women); mean age 42.1 years and mean body mass index 26.2 kg/m2. For each subject, the bilateral VNs were identified by US at the anterolateral neck within the common carotid sheaths. One radiologist obtained 3 separate CSA measurements for each of the bilateral VNs with complete transducer removal between each measurement. Additionally, for each participant, demographic information of age and gender as well as body mass index, weight, and height were documented. The mean CSA of the right VN in the carotid sheath was 2.1 and 1.9 mm2 for the left VN. The right VN CSA was significantly larger than the left VN (P < .012). No statistically significant correlation was noted in relation to height, weight, and age. We believe that the reference values for the normal CSA of the VN obtained in our study, could help in the sonographic evaluation of VN enlargement, as it relates to the diagnosis of various diseases affecting the VN.