Cross-sectional Area Parameters Research Articles

Psoas muscle cross sectional area relates to bone density and microarchitecture in candidates for spine fusion surgery

Prior studies demonstrate that muscle and bone health are integrally related, and both independently impact orthopedic surgery outcomes. However, relationships between bone density, in vivo microarchitecture, and muscle area have not been previously investigated in orthopedic surgery patients. This study assessed associations between psoas cross sectional area (CSA), bone mineral density (BMD), and microstructure in a cohort undergoing spine fusion. Pre-operatively, bilateral psoas CSA was measured on axial lumbar spine CT in the L3-L4 disc space. To adjust for body size, Psoas Muscle Index (PMI) was calculated (CSA divided by the square of patient height). High resolution peripheral quantitative CT (HR-pQCT, XtremeCT2) assessed volumetric BMD (vBMD), cortical (Ct) and trabecular (Tb) microarchitecture at the distal radius and tibia. Areal BMD (aBMD) was measured by DXA at the lumbar spine (LS), total hip (TH), femoral neck (FN), and the 1/3 radius (1/3R). Pearson correlations related psoas CSA and bone imaging parameters before and after correcting for height and weight. Among 88 patients included, mean age was 63 ± 12 years, BMI was 28 ± 7 kg/m2, 47 (53 %) were female. Larger psoas CSA was associated with higher vBMD, greater Ct thickness and better Tb microarchitecture (higher Tb number and lower Tb separation) at the tibia and radius. Larger psoas CSA was also associated with greater aBMD at TH and FN bilaterally and 1/3R (r 0.33 to 0.61; p < 0.002 for all comparisons). Psoas CSA was not associated with aBMD at the LS. Similar results were observed when relating PMI, and adjusting for age, height and weight to HR-pQCT and DXA measurements. Investigation of subgroups by sex demonstrated that relationships were similar magnitude among women but not the men. Patients who underwent primary compared to revision spine surgery had similar associations. Our results demonstrate a link between psoas muscle size and peripheral bone microarchitecture among patients undergoing posterior lumbar spinal fusion. Given the importance of both muscle and skeletal integrity to the success of spine surgery, further study regarding the associations between measurements of psoas muscle, bone microarchitecture, and surgical outcomes is warranted.

Muscle fibre size and myonuclear positioning in trained and aged humans.

Changes in myonuclear architecture and positioning are associated with exercise adaptations and ageing. However, data on the positioning and number of myonuclei following exercise are inconsistent. Additionally, whether myonuclear domains (MNDs; i.e., the theoretical volume of cytoplasm within which a myonucleus is responsible for transcribing DNA) and myonuclear positioning are altered with age remains unclear. The aim of this investigation was to investigate relationships between age and activity status and myonuclear domains and positioning. Vastus lateralis muscle biopsies from younger endurance-trained (YT) and older endurance-trained (OT) individuals were compared with age-matched untrained counterparts (YU and OU; OU samples were acquired during surgical operation). Serial, optical z-slices were acquired throughout isolated muscle fibres and analysed to give three-dimensional coordinates for myonuclei and muscle fibre dimensions. The mean cross-sectional area (CSA) of muscle fibres from OU individuals was 33%-53% smaller compared with the other groups. The number of nuclei relative to fibre CSA was 90% greater in OU compared with YU muscle fibres. Additionally, scaling of MND volume with fibre size was altered in older untrained individuals. The myonuclear arrangement, in contrast, was similar across groups. Fibre CSA and most myonuclear parameters were significantly associated with age in untrained individuals, but not in trained individuals. These data indicate that regular endurance exercise throughout the lifespan might better preserve the size of muscle fibres in older age and maintain the relationship between fibre size and MND volumes. Inactivity, however, might result in reduced muscle fibre size and altered myonuclear parameters.

Shear-wave elastography evaluation of thenar muscle in carpal tunnel syndrome.

We aim to evaluate the shear wave velocity (SWV) of the thenar muscle as an adjunct diagnostic tool for carpal tunnel syndrome (CTS). Ninety-two wrists with CTS and 30 control wrists without CTS underwent ultrasonographic evaluation of thenar muscle and median nerve including shear-wave elastography. Cross sectional area (CSA) of medial nerve and SWV of thenar muscle and median nerve were evaluated. CTS patients were assessed for Boston CTS, Padua CTS, modified Hirani grading scores, and nerve conduction study (NCS). SWVs, CSA, and NCS parameters were compared between two groups. The SWVs of thenar muscle and median nerve (p < 0.001, respectively), and CSA of median nerve (p < 0.001) were more significantly greater in patients with CTS than in controls. The SWV of median nerve was moderately correlated with CSA of median nerve (r=0.35, p < 0.001) and modified Hirani CTS score (r=0.35, p < 0.001). The SWV of thenar muscle was inversely correlated with modified Hirani CTS score (r=-0.21, p=0.04). The SWV of thenar muscle and median nerve of CTS were significantly increased compared to that of control, and significantly negatively correlated with NCS parameters (modified Hirani CTS score). SWVs may be used as an adjunct diagnostic tool for CTS.

MR neurography of lumbosacral nerve roots for differentiating chronic inflammatory demyelinating polyneuropathy from acquired axonal polyneuropathies: a cross-sectional study.

BackgroundMagnetic resonance (MR) neurography is an imaging technique focused on the peripheral nerves. Its role in the diagnosis and differential diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) has yet to be investigated. This study explored the value of MR neurography in identifying CIDP and differentiating it from acquired axonal polyneuropathies.MethodsIn this study, 20 patients with CIDP, 10 patients with acquired axonal polyneuropathies, and 20 healthy controls were prospectively enrolled. Three-dimensional T2-weighted image fat-suppressed and diffusion tensor imaging sequences of the lumbosacral plexus were completed in all participants. The cross-sectional area (CSA) and diffusion parameters, including the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the L3 to S1 nerve roots, were measured and compared across the 3 groups using Kruskal-Wallis 1-way analysis of variance. Receiver operating characteristic (ROC) curves were plotted to determine the value of CSA and diffusion parameters in the diagnosis and differential diagnosis of CIDP.ResultsCSA and ADC increased in CIDP patients but didn’t differ between patients with axonal polyneuropathies and healthy controls [CAS: 45.35±23.889, 22.25±3.878, 22.81±4.079 mm2, ADC: (1.64±0.269)×10−3, (1.37±0.204)×10−3 and (1.39±0.156)×10−3 mm2/s, in CIDP, axonal polyneuropathies and healthy controls, respectively, both P<0.001]. Compared with healthy controls, FA reduced in patients with CIDP and axonal polyneuropathies but no difference was observed in the two groups (FA: 0.24±0.053, 0.27±0.014 and 0.32±0.045, in CIDP, axonal polyneuropathies and healthy controls, respectively, P<0.001). To identify CIDP, ROC analysis showed that FA had better efficiency with cut-off value of 0.278 and sensitivity and specificity of 85% and 90% respectively. To differentiate CIDP from axonal polyneuropathies, CSA had better diagnostic accuracy with cut-off value of 29.46 mm2 and sensitivity and specificity of 75% and 100% respectively.ConclusionsCSA and ADC values of lumbosacral nerve roots can help to identify patients with CIDP and further distinguish them from patients with axonal polyneuropathies. FA decreased in both types of polyneuropathies and may thus have limited value in the discrimination of the 2 types of neuropathies.

Quantitative shear wave elastography assessment of tibial nerve in diagnosis of diabetic peripheral neuropathy

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. Diagnosis of DPN is very important in the prognosis of disease and treatment as early treatment of DPN decreases both short-term and long-term morbidities. SWE elastography is a noninvasive and reproducible method for the precise evaluation of nerve stiffness.ResultsTibial nerve stiffness is notably high at SWE in diabetic patients with DPN (mean shear wave elastography value of RT tibial SWE 75.3 ± 15.1 kPa) compared to patients without DPN (mean shear wave elastography value of RT tibial SWE 37.8 ± 11.6 kPa) and nerve stiffness in healthy control subjects (mean shear wave elastography value of RT tibial SWE 24.9 ± 6.3 kPa). There is a significant increase in the cross-sectional area (CSA) among diabetic patients with DPN (mean cross-sectional area of the right tibial nerve of 17 ± 1.9 mm2) and without DPN (mean cross-sectional area of the right tibial nerve of 14.5 ± 3.8 mm2) in comparison with control subjects (mean cross-sectional area of the right tibial nerve of 13.2 ± 3.1 mm2) in the right side. Borderline significance of the CSA parameters of the tibial nerve study on the left side in different groups. The cutoff point to determine DPN among diabetic patients in the right lower limb is more than 63.8 kPa. With 89% sensitivity and 100% specificity in the detection of DPN on the right side, the SWE has 100% PPV and 95.5% NPV in the detection of DPN on the right side.ConclusionSWE is an effective assistant method in the diagnosis of DPN and is useful when a suspected neuropathy is not detectable by electrophysiology.

Resistance Training Enhances Muscle Function and Hemorheological Properties in Middle‐aged Obese Women

PurposeThe present study investigated the effects of resistance training for 12‐week on body composition, blood pressure, blood lipid level, cross sectional area (CSA) of muscles, isokinetic muscle function, and hemorheological properties in middle‐aged obese women.MethodsThirty obese women (50.79 ± 5.80 years), with no history of any injuries to the musculoskeletal system and no participating any regular exercise program, were included in the present study. All participants were randomly assigned to a control group (CON, n = 15) or an experimental group (EXP, n = 15); but two participants in the CON voluntarily withdrew because of personal reasons, and thirteen participants in the CON finally participated. The EXP underwent resistance training program composed of warm‐up, main resistance exercise (bench press, preacher bench biceps curl, barbell rowing, dumbbell shoulder press, dead lift, barbell squat, seated leg extension, and lying leg curl), and cool‐down. Main resistance exercise was consisted of three sets of 8–10 repetitions (reps) performed with 80% of 1‐RM. The training frequency was 80 min, 3 days per week for 12 weeks. The CON maintained their daily lifestyle without training. All participants underwent body composition (weight, body mass index, lean body mass, fat mass, and %body fat), blood pressure (systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure), blood lipid level (triglyceride, total cholesterol, high‐density lipoprotein cholesterol, and low‐density lipoprotein cholesterol), cross sectional area (CSA) of muscles (quadriceps CSA, hamstring CSA, and total thigh muscle CSA), isokinetic muscle function (peak torque, relative peak torque, mean power, and total work in quadriceps femoris and hamstrings), and hemorheological properties (erythrocyte deformability and erythrocyte aggregation) were measured before and after 12‐week of training.ResultsThe EXP showed a significant decrease in fat mass (p = .018) via 12‐week of resistance training. Also, the EXP yielded more significant improved muscle function including peak torque (p &lt; .001), relative peak torque (p &lt; .001), and total work (p = .001) in quadriceps femoris and total work (p = .018) in hamstrings. Regarding hemorheological properties, the EXP showed a significant increase in erythrocyte deformability (p = .001) via 12‐week of resistance training. However, there was no significant change in blood pressure and muscle CSA parameters via 12‐weeks of resistance training.ConclusionThe present study verified our resistance training program shows greater muscle strength and endurance, decreasing fat mass, and improving hemorheological properties such as erythrocyte deformability.

Achilles Tendon and Patellar Tendon Structure in Combat Soldiers Following Prevention Exercises.

Military training that increases physical stress on musculoskeletal morphology also increases the risk of orthopedic injuries. Somatosensory prevention programs that reduce stress and improve functionality could be beneficial for better organization of tendon structure. The aim of this study was to investigate the impact of a somatosensory prevention exercise on the tendon structure (percentage of echo-type fibers; A-P and M-L diameters and cross-sectional area) of the Achilles tendon and patellar tendon among combat soldiers. These tendons of male Infantry soldiers aged 18-21 were screened before and after a 14-week training course. The intervention group, who performed preventative exercises, included 108 soldiers (BMI = 23.85 ± 2.76), while the control group, who participated in the same military course without these exercises, included 98 soldiers (BMI = 24.26 ± 4.03). Ultrasound scanning for tendon structure included percent of echo-type I-IV fibers, A-P diameter, M-L diameter, and cross-sectional area parameters. Time by group interaction was found for echo-type I and II in both tendons. No significant differences were found between the two groups in the pretesting percentage of echo-type IV fibers of the Achilles tendon (P = .522), in echo-type III fibers of the Achilles tendon (P = .833), and echo-type IV fibers of the patellar tendon (P = .162). Greater pre-post differences in echo-type III and IV fibers were found in the control group compared with the intervention group for both the Achilles tendon (P = .021, P = .002) and the patellar tendon (P < .001, P < .001). Increased damaged fibers (echo-type III and IV) of both tendons were found among the control group, yet not among soldiers who performed prevention exercises.

Референтні показники структурного аналізу стегнової кістки в жінок української популяції

Актуальність. На сьогодні комплексна оцінка стану кісткової тканини та ризику остеопоротичних переломів передбачає спільне використання показників мінеральної щільності кісткової тканини (МЩКТ), 10-річної ймовірності основних остеопоротичних переломів (Fracture Risk Assessment Tool, FRAX), показника трабекулярної кістки (Trabecular Bone Score, TBS) і параметрів структурного аналізу стегнової кістки (Hip Structural Analysis, HSA). Останніми роками створено референтні показники для осіб української популяції щодо трьох вищезазначених методик, проте дані щодо останньої методики відсутні. Мета дослідження: вивчити вікові особливості параметрів структурного аналізу стегнової кістки в жінок української популяції та запропонувати їх референтні показники для використання в практичній охороні здоров’я. Матеріали та методи. За допомогою методики двохенергетичної рентгенівської абсорбціометрії обстежено 690 умовно здорових жінок віком 20–89 років без остеопорозу, інших клінічно значущих захворювань та станів, що впливають на метаболізм кісткової тканини, без супутньої патології кульшового суглоба тощо. Результати. Результати проведеного дослідження продемонстрували вірогідний вплив віку на показники FSI, CSMI, CSA, d1, d2, d3, y, α і HAL, проте не на показник θ. Встановлено вірогідне зменшення з віком показника FSI на тлі вірогідного зростання параметрів CSMI, CSA та HAL. Показники зросту та маси тіла були вірогідно пов’язані з параметрами CSMI, CSA і HAL. Показник міцності стегнової кістки (FSI) був вірогідно пов’язаний з масою тіла, проте не зі зростом. Крім того, він вірогідно корелював з показником МЩКТ, виміряним на рівні шийки стегнової кістки і меншою мірою на рівні всієї стегнової кістки та поперекового відділу хребта. Показник довжини осі стегнової кістки (HAL) вірогідно не корелював з жодним вимірюваним показником МЩКТ, що підтверджує його незалежну роль у прогнозуванні ризику переломів стегнової кістки. Висновки. Отримані нормативні показники структурного аналізу стегнової кістки в здорових жінок української популяції можуть бути використані для комплексної оцінки стану кісткової тканини та ризику переломів стегнової кістки.

Is the Lipid Content of the Psoas Major Correlated with Chronic Low Back Pain and Spinopelvic Alignment? A Magnetic Resonance Spectroscopic Study

Study DesignCross-sectional observational study.PurposeThis study aimed to analyze any potential associations of extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) contents with (1) the intensity of low back pain (LBP); (2) age, cross-sectional area (CSA), and fatty infiltration (FI) of the psoas major; and (3) spinopelvic parameters.Overview of LiteratureThe psoas major has clinically relevant function; however, the association of this muscle with chronic LBP is controversial. Magnetic resonance spectroscopy enables a detailed analysis of the composition of muscular fat tissues such as its EMCL and IMCL contents.MethodsThe study population comprised 40 patients (19 males, 21 females; mean age, 61.7±2.4 years). Possible correlations of LBP Visual Analog Scale (VAS) scores, age, CSA, FI, and spinopelvic parameters with EMCL and IMCL contents of the psoas major were assessed.ResultsNo association was identified between the EMCL and IMCL contents and LBP VAS scores (r=0.05, p=0.79 and r=0.06, p=0.75, respectively). The EMCL content correlated with age (r=0.47, p<0.01), body mass index (BMI) (r=0.44, p<0.01), CSA (r=−0.59, p<0.01), and FI (r=0.49, p<0.01). EMCL content showed a significant negative correlation with sacral slope (SS) (r=−0.43, p<0.05) and positive correlation with pelvic tilt (PT) (r=0.56, p<0.01).ConclusionsEMCL content correlated with age, BMI, CSA, and FI of the psoas major, while IMCL content had no correlation. This study found correlations between SS and PT and EMCL content of the psoas major, but no correlations were found between spinopelvic parameters and IMCL content of the psoas major.

Assessing the Performance of Morphologic and Echogenic Features in Median Nerve Ultrasound for Carpal Tunnel Syndrome Diagnosis.

To assess the feasibility of using ultrasound (US) image features related to the median nerve echogenicity and shape for carpal tunnel syndrome (CTS) diagnosis. In 31 participants (21 healthy participants and 10 patients with CTS), US images were collected with a 30-MHz transducer from median nerves at the wrist crease in 2 configurations: a neutral position and with wrist extension. Various morphologic features, including the cross-sectional area (CSA), were calculated to assess the nerve shape. Carpal tunnel syndrome commonly results in loss of visualization of the nerve fascicular pattern on US images. To assess this phenomenon, we developed a nerve-tissue contrast index (NTI) method. The NTI is a ratio of average brightness levels of surrounding tissue and the median nerve, both calculated on the basis of a US image. The area under the curve (AUC) from a receiver operating characteristic curve analysis and t test were used to assess the usefulness of the features for differentiation of patients with CTS from control participants. We obtained significant differences in the CSA and NTI parameters between the patients with CTS and control participants (P < .01), with the corresponding highest AUC values equal to 0.885 and 0.938, respectively. For the remaining investigated morphologic features, the AUC values were less than 0.685, and the differences in means between the patients and control participants were not statistically significant (P > .10). The wrist configuration had no impact on differences in average parameter values (P > .09). Patients with CTS can be differentiated from healthy individuals on the basis of the median nerve CSA and echogenicity. Carpal tunnel syndrome is not manifested in a change of the median nerve shape that could be related to circularity or contour variability.

Evolutionary Optimum Design for a Task Specified 6-Link Planar Robot

Optimal structure design for robots is fundamentally important, as it stands first in the order of robotic system design. The structure of industrial robots should be robust, versatile and strong enough – to withstand a variety of forces/loads, guarantee stability and security in operation. To achieve best solution, it is desirable to perform structure design optimization. Here, it is proposed to determine optimal geometric dimensions for a task specified 6-link planar robot considering pick and place operation. The aim is to minimize torque required for defined motion and to maximize manipulability measure of the robot subject to dynamic, kinematic, deflection and structural constraints. Links physical characteristics (length and cross sectional area parameters) are design variables. Five different cross-sections (hollow circle, hollow square, hollow rectangle, C-channel and I-channel) have been experimented for the link. Evolutionary algorithms viz. Elitist Nondominated Sorting Genetic Algorithm (NSGA-II) and Multi Objective Differential Evolution (MODE), Multiobjective Genetic Algorithm (MOGA) are used. Normalized weighting objective functions and average fuzzy membership functions are used to select the best optimal solution. Multiobjective performance measures, namely, Solution Spread Measure (SSM) and Ratio of Non-dominated Individuals (RNI) are used to evaluate Pareto optimal fronts. Two other multiobjective performance measures, namely, Optimizer Overhead (OO) and Algorithm effort are used to find computational effort of optimization algorithms. Results obtained from various techniques are compared and analyzed.

Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography.

Background and PurposeTo determine the correlation between the cross-sectional area (CSA) of the median nerve measured at the wrist using three-dimensional (3D) ultrasonography (US) and the electrophysiological severity of carpal tunnel syndrome (CTS).MethodsWe prospectively examined 102 wrists of 51 patients with clinical CTS, which were classified into 3 groups according to the electrodiagnostic (EDX) findings. Median nerve CSAs were measured using 3D US at the carpal tunnel inlet and at the level of maximal swelling.ResultsTen wrists were negative for CTS. Of the 92 CTS-positive wrists, 23, 30, and 39 were classified as having mild, moderate, and severe CTS, respectively. The median nerve CSA differed significantly between the severe- and moderate-CTS groups (p=0.0007 at the carpal tunnel inlet and p<0.0001 at the maximal swelling site). There was a correlation between median nerve CSA and EDX parameters among those wrists with severe and mild CTS (p<0.0001 at both sites).ConclusionsThe median nerve CSA as measured by 3D US could provide additional information about the severity of CTS, as indicated by the strong correlation with standard EDX findings.

Percutaneous angioplasty of internal jugular and azygous veins in patients with chronic cerebrospinal venous insufficiency and multiple sclerosis: early and mid-term results

To assess the safety of endovascular treatment of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis (MS). A total of 72 patients with CCSVI and MS (44 with relapsing remitting--RR, 4 with primary progressive, 20 with secondary progressive and 4 with benign MS) underwent percutaneous angioplasty. Outcome measures were colour Doppler ultrasonography parameters, gradient pressure at the vein abnormality level, postoperative complications, re-stenosis, disease severity scored by means of Expanded Disability Status Scale (EDSS) and patients' assumption of disease status. Controls were done after one month on 72 patients, six months on 69 patients and one year on 61 patients, respectively (the average follow-up was 11 months). There were no postoperative complications. Colour Doppler ultrasonography showed significant improvement in cross-sectional area parameters (P < 0.05) and significant decrease in confluence velocity values (P < 0.05). Postoperative gradient pressure decreased, in internal jugular vein (IJV) significantly (P < 0.05). Re-stenosis appeared in 5.3% of patients. EDSS score was significantly improved (P < 0.01) and about half of patients reported significant or mild improvement in disease status and none of them worsening of symptoms. Endovascular treatment of the IJV and azygous veins in patients with CCSVI and MS is a safe procedure with no post-procedural complications followed by significant improvement of IJV flow haemodynamic parameters and decrease in the EDSS score. Whether CCSVI percutaneous treatment might affect clinical improvement in patients suffering from MS is yet to be seen after completion of major multicentric clinical trials, still it seems like that this procedure is not negligible.

Evolutionary bi-criteria optimum design of robots based on task specifications

The optimum robot structure design problem based on task specifications is an important one, since it has greater influence on manipulator workspace design, vibrations of the manipulator during operation, manipulator efficiency in the work environment and power consumption. In this paper, an optimization robot structure problem is formulated with the objective of determining the optimal geometric dimensions of the robot manipulators considering the task specifications (pick and place operation). The aim is to minimize torque required for motion and maximize manipulability measure of the robot subject to dynamic, kinematic, deflection and structural constraints with link physical characteristics (length and cross-sectional area parameters) as design variables. In this work, five different cross-sections (hollow circle, hollow square, hollow rectangle, C-channel and I-channel) have been experimented for the link. Three evolutionary optimization algorithms namely multi-objective genetic algorithm (MOGA), elitist nondominated sorting genetic algorithm (NSGA-II) and multi-objective differential evolution (MODE) are used for the optimum structural design of 2-link and 3-link planar robots. Two methods (normalized weighting objective functions and average fitness factor) are used to select the best optimal solution. Two multiobjective performance measures namely solution spread measure and ratio of non-dominated individuals are used to evaluate the Pareto optimal fronts. Two more multiobjective performance measures namely optimiser overhead and algorithm effort, are used to find computational effort of optimization algorithm. The results obtained from various techniques are compared and analyzed.

Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor?

Objective: To measure the cross‐sectional area (CSA) of the median nerve by ultrasonography (US) before and after surgery in subjects with carpal tunnel syndrome (CTS), and to verify whether the normalization of presurgical parameters can be predicted by presurgical CSA values.Patients and methods: Sixty‐seven consecutive cases, mean age 60.5 years, underwent surgical decompression. Before surgery, clinical and electrophysiological severity and self‐assessment of symptoms (using the Boston questionnaire, BQ) were recorded. CSAs were measured proximal to the carpal tunnel inlet (CSA‐I), at mid‐tunnel (CSA‐M), and at the tunnel outlet (CSA‐O). Follow‐ups were performed 1 and 6 months after surgery. Logistic regressions were performed with normalization of CSA, clinical and electrophysiological parameters as independent variables, and presurgical findings as dependent variables.Results: Before and after surgery there were correlations between CSA‐I and clinical and electrophysiological severity scales. After 1 and 6 months, the clinical, electrophysiological, and BQ findings improved. CSA‐I reduced at the 1‐month follow‐up and CSA‐O increased between the first and second follow‐up. Presurgical values of CSA‐I could predict the normalization of its postsurgical value, normalization of the clinical severity scale, BQ, and full patient satisfaction postsurgery.Conclusions: CSA‐I is the most sensitive US measurement before surgery. The presurgical value of CSA‐I is a predictor of postsurgical normalization of clinical parameters and of its own value.

Optimum Robot Design Based on Task Specifications Using Evolutionary Techniques and Kinematic, Dynamic, and Structural Constraints

In this article, we discuss optimum robot design based on task specifications using evolutionary optimization approaches. The three evolutionary optimization approaches employed are Simple Genetic Algorithms, Genetic Algorithms with elitism, and Differential Evolution (DE). These approaches were used for the optimum design of SCARA and articulated type manipulators based on kinematic, dynamic and structural analyses. The objective function minimizes the torque required for the motion subject to deflection and physical constraints with the design variables being the link physical characteristics (length and cross-sectional area parameters). In this work, we experimented with various cross-sections for the links. The main findings of this research are that the DE converges quickly, requires significantly less number of iterations and achieves better results by reaching smaller objective functions.