Sensory Velocity Research Articles

The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial.

Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. The effect of tissue adhesives as a material for wound closure following CTS decompression has been insufficiently investigated. This study aimed to evaluate outcomes by comparing two modalities of wound closure following carpal surgery in patients randomly assigned to either tissue adhesives or sutures. Methodology This randomized, prospective study was conducted in April 2022 at the University Hospital of Split in Croatia. Patients aged 61.56 ± 12.03 years were randomized to either tissue adhesive Glubran Tiss 2®-based (n = 50) or suture-based (n = 50) wound-closure techniques. The following outcomes were assessed before surgery and six months postoperatively: hand strength, electroneurographic characteristics of the median nerve, and the Boston Carpal Tunnel Questionnaire. Results Significant differences between glue-based and suture-based wound-closure techniques were found in the six-month postoperative hand grip strength (25.06 ± 6.69 vs. 21.41 ± 5.62 kg; p = 0.002), postoperative sensory amplitude (10.08 ± 5.50 vs. 7.54 ± 5.41 mV; p = 0.012), and postoperative sensory velocity (42.22 ± 11.04 vs. 35.23 ± 16.40 m/s; p = 0.008). In the glue-based group, significantly more patients achieved a postoperative sensory velocity greater than 45 m/s (47.9% vs. 22.0%; p= 0.006), postoperative distal sensory latency less than 3.5 ms (89.6% vs. 84.0%; p = 0.304), and postoperative motor latency of less than 4.2 ms (60.42% vs. 38.00%; p = 0.022). Conclusions This trial demonstrated that cyanoacrylate-based adhesion material for wound closure after open CTS decompression compared with sutures showed a significant six-month postoperative increment in hand grip strength and median nerve sensory conduction.

Deep and superficial sensory nerve conduction to the first dorsal web space of the foot

BackgroundPolyneuropathy tends to progress in a distal to proximal fashion beginning at the tips of the toes. Sensory nerve conduction testing in the distal foot may identify early polyneuropathic changes. Deep fibular (DFN) sensory conduction techniques have been described to assess the distal dorsal foot, however, there has been no accommodation for reported anatomic communication between the DFN and superficial fibular nerve (SFN) in the dorsal foot. This study aims to stimulate both the DFN and SFN at the ankle to evaluate the function of the observed anatomic sensory nerve variations in the first dorsal web space. Normal nerve conduction values will also be presented in a sample of young adults and sex and BMI effects will be evaluated. Materials and methodsThe study participants included 201limbs tested in 101 subjects (31 males and 70 females) between the ages of 18 and 47 (mean age 24.6 ± 4.8 years). The DFN and intermediate branch of the SFN (IDCN) were stimulated at the ankle 12 cm proximal to a surface recording electrode over the first dorsal web space of the foot. The obtained sensory nerve amplitude and latency values were recorded and velocity values were calculated. ResultsThe current study identified a first dorsal web space response in 78% of limbs tested. Web space responses were variable in origin with SFN only, DFN only and both SFN and DFN recorded responses in the web space. The mean DFN peak to trough amplitude was 5.8 ± 2.3 μV, while the peak velocity was 31.2 ± 2.9 m/s. The mean SFN-IDCN peak to trough amplitude was 5.9 ± 2.3 μV and the mean peak velocity was 32.1 ± 3.8 m/s. There was a statistically significant sex effect for SFN-IDCN onset latency and velocity with women demonstrating shorter onset latencies and faster velocities than the men. There was a significant SFN-IDCN BMI effect for onset latency and velocity, such that those with low BMI had shorter latency and faster nerve conduction values. A significant DFN sex effect was also identified for amplitude with males and females demonstrating a mean amplitude of 5.4 μV and 6.0 μV, respectively. ConclusionsThere is a high degree of anatomic and functional variability in sensory supply to the first dorsal web space of the foot requiring exploration of the DFN and SFN when assessing focal nerve entrapments or generalized polyneuropathy. A general dorsal foot sensory velocity and amplitude value may serve as an index for evaluation of early polyneuropathy.

Performance Analysis of Conventional Machine Learning Algorithms for Diabetic Sensorimotor Polyneuropathy Severity Classification Using Nerve Conduction Studies.

Background Diabetic sensorimotor polyneuropathy (DSPN) is a major form of complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is very common and well-established in the field of research, its application in DSPN diagnosis using nerve conduction studies (NCS), is very limited in the existing literature. Method In this study, the NCS data were collected from the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. The NCS variables are median motor velocity (m/sec), median motor amplitude (mV), median motor F-wave (msec), median sensory velocity (m/sec), median sensory amplitude (μV), Peroneal Motor Velocity (m/sec), peroneal motor amplitude (mv), peroneal motor F-wave (msec), sural sensory velocity (m/sec), and sural sensory amplitude (μV). Three different feature ranking techniques were used to analyze the performance of eight different conventional classifiers. Results The ensemble classifier outperformed other classifiers for the NCS data ranked when all the NCS features were used and provided an accuracy of 93.40%, sensitivity of 91.77%, and specificity of 98.44%. The random forest model exhibited the second-best performance using all the ten features with an accuracy of 93.26%, sensitivity of 91.95%, and specificity of 98.95%. Both ensemble and random forest showed the kappa value 0.82, which indicates that the models are in good agreement with the data and the variables used and are accurate to identify DSPN using these ML models. Conclusion This study suggests that the ensemble classifier using all the ten NCS variables can predict the DSPN severity which can enhance the management of DSPN patients.

Normative data for ulnar nerve conduction and the influence of gender and height on ulnar nerve conduction velocity in healthy Nigerians.

Background:Despite the usefulness of ulnar nerve conduction studies in identifying disorders of ulnar nerves, there is a lack of normative values for the ulnar nerve in Nigerian population.Objective:The objective of the study was to generate normative values for motor and sensory ulnar nerve conduction studies (NCSs) in Nigerian population and to determine the influence of gender and height on ulnar nerve conduction velocity (NCV).Materials and Methods:A total of 200 healthy volunteers were selected after clinical evaluation to exclude common causes of ulnar neuropathy. We carried out NCS of ulnar nerves on all the healthy volunteers according to a standardized protocol. The NCS parameters included in the final analysis were amplitude, latency, NCV, and f-wave latency. Ethical approval was obtained for the study.Results:The mean ulnar nerve sensory velocity was 55.22 ± 5.67 with 2.5 and 97.5 percentile of 46.9 and 70.1, respectively. The mean latency of the ulnar nerve (sensory) was 2.97 ± 0.62 with 2.5 and 97.5 percentile of 2.00 and 4.52, respectively. The mean amplitude of the ulnar nerve (sensory) was 35.56 ± 9.97 with 2.5 and 97.5 percentile of 15.9 and 57.7, respectively). The ulnar NCV was significantly (P = 0.0202) higher in male. Mild inverse correlation (r = 0.2) was found between ulnar NCV and height of the participants (P = 0.0089).Conclusion:In the Nigerian population, normative values of motor and sensory ulnar nerve conduction parameters are similar to the existing values in the literature. The ulnar NCV appeared to be influenced by height and gender.

The Burden of Peripheral Neuropathy in Nondiabetic Chronic Kidney Disease and the Role of Ghrelin Isoforms in its Development.

Peripheral neuropathy is one of the most common complications in chronic kidney disease (CKD). The neuroprotective role of ghrelin is being explored recently. Here we aim to determine the burden of neuropathy in nondiabetic CKD and to find the association of peripheral nerve function with plasma ghrelin levels in these patients. This was a cross-sectional study conducted in nondiabetic CKD patients on conservative management to determine the magnitude of neuropathy. The association of ghrelin isoforms with nerve functions was assessed between three groups, namely CKD with neuropathy, CKD without neuropathy, and healthy volunteers, with 20 participants in each group. The proportion of neuropathy in nondiabetic CKD was 78% (n = 78), of which 51% (n = 40) were asymptomatic. Des acyl ghrelin (DAG) and total ghrelin (TG) levels were 1545.5 ± 487.4 and 1567.4 ± 485.3 pg/mL, respectively, in CKD patients with neuropathy and were found to be elevated compared to those without neuropathy, who had 1000.4 ± 264.2 and 1019.7 ± 264.3 pg/mL of DAG and TG, respectively (P < 0.001). Assessment of correlation between nerve conduction parameters and DAG levels showed positive correlation between DAG levels and common peroneal latency (r = 0.69; P < 0.01), median sensory latency (r = 0.45; P < 0.05), and sural latency (r = 0.51; P < 0.05). We found negative correlation between median velocity (r =-0.56; P < 0.05), common peroneal velocity (r = -0.64; P < 0.01), median sensory velocity (r =-0.49; P < 0.05), and sural velocity (r = -0.54; P < 0.05). There was no statistically significant difference in acyl ghrelin levels among the groups. The prevalence of peripheral neuropathy in CKD is significantly higher with almost half of them being asymptomatic. Impaired renal clearance in CKD leads to the accumulation of DAG, which subsequently inhibits the neuroprotective functions of AG leading to neuropathy in CKD.

A COMPARISON OF FUNCTIONAL ASSESSMENT OF PRE- AND POSTSURGICAL CARPAL TUNNEL SYNDROME USING BOSTON CARPAL TUNNEL QUESTIONNAIRE AND NERVE CONDUCTION STUDY: A PROSPECTIVE STUDY FROM A TERTIARY CENTER OF SOUTH INDIA

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome of median nerve causing frequent disability especially among working populations. Boston Carpal Tunnel Questionnaire and Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after surgical release of carpal tunnel. OBJECTIVES: To assess functional outcome of patients with Carpal Tunnel Syndrome after surgery as assessed by Boston Carpel Tunnel Questionnaire and Electrophysiological study. METHODS: A prospective observational study conducted over a period of one year (January 2017 to January 2018). The study was conducted among consecutive 31 electrophysiological conrmed carpal tunnel syndrome attending the outpatient department of Physical Medicine and Rehabilitation, Government Medical College, Thiruvananthapuram. All patients underwent open carpal tunnel release. Functional outcome was assessed using Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at interval of 3 weeks, 6weeks and 3 months postoperatively. Electrophysiological study assessed using nerve conduction study both preoperatively and 3 weeks post operatively. Data was entered in Microsoft excel and analyzed using SPSS statistical software. RESULTS: The study involves 31 conrmed cases of Carpal tunnel syndrome patients. Mean Boston Carpal Tunnel Questionnaire (BCTQ) score preoperatively was 58.52 ± 12.73 which was markedly improved postoperatively at 3weeks with mean score of 29.77±6.68. At 6 weeks and 3 month follow up period it was reduced respectively to mean score of 23.94±4.23 and 22.94±4.62. Preoperative NCS shows decreased conduction velocity with mean nerve sensory velocity (NSV) score 21.51±8.19 and mean nerve motor velocity (NMV) score of 20.72±8.81 which statistically improved following surgery with mean NSV score of 32.04±9.01 and mean NML score of 33.78±8.1. Correlation between pre- and post-operative BCTQ and NCS parameters shows positive correlation with latency and negative correlation with amplitude and conduction velocity. Increased latency and decreased conduction velocity associated with higher BCTQ score with signicant 'p' value (p&lt;0.05). CONCLUSION: There is statistically signicant improvement of functional outcome following carpal tunnel release surgery assessed through Boston Carpal Tunnel Questionnaire and Electrophysiological ndings

The evaluation of the effect of vitamin D replacement on the symptoms of carpal tunnel syndrome in patients with low vitamin D levels

Aim: To evaluate the effect of vitamin D replacement on carpal tunnel syndrome (CTS) symptoms and signs in CTS patients with low vitamin D levels. Methods: This study was designed prospective observably. The patient population was admitted to the EMG (electromyography) laboratory in a tertiary hospital’s Physical Medicine and Rehabilitation Department between 1 January and 31 July 2018. Initially, 55 patients were included in the study. The patients were categorized into two groups as group 1 (<10 ng / ml) and group 2 (10-20 ng / ml) according to the vitamin D levels. A total of 39 patients and 63 wrists, 17 patients in group 1 (28 wrists) and 22 patients in group 2 (35 wrists), were included in the analysis. Results: There was a statistically significant decrease in visual analogue scale and quick arm-shoulder-hand disability score in two groups when compared before treatment. In two groups, there was a significant improvement in grip and pinch strength after treatment. At the same time, after treatment we showed that there was a statistically significant increase in median nerve sensory amplitude in two groups. The increase in median nerve sensory velocity was significant in group 2 whereas it was not statistically significant between group 1 vs group 2. Conclusions: Vitamin D replacement can improve symptoms, functional status and electrophysiological findings in CTS patients with low vitamin D levels.

Associations Between Insurance Type and the Presentation of Cubital Tunnel Syndrome

In the setting of cubital tunnel syndrome (CuTS), delays in diagnosis can have permanent effects including sensory loss, muscle weakness, and atrophy of intrinsic hand muscles. This study sought to evaluate the association of insurance type on the severity of CuTS. We hypothesized that publicly insured patients will have delayed presentation to the orthopedics office and more significant condition severity. A retrospective chart review was conducted for all patients evaluated for CuTS between December 2013 and January 2018 by a fellowship-trained orthopedic hand and upper extremity surgeon at our tertiary referral center. Insurance type, demographics, and measures of CuTS severity were compared. Patients presenting with CuTS of severity greater than or equal to McGowan stage 2A had 4.4-fold greater odds of being publicly insured than privately. Motor and sensory velocities across the elbow were diminished at 42.2 ± 13.9m/s and 33.0 ± 20.8m/s in publicly insured patients compared with 47.5 ± 11.3 m/s and 47.0 ± 16.4m/s for privately insured patients. The same trend was present for motor and sensory amplitudes at 6.6 ± 3.8 μV and 16.9 ± 17.8 μV in publicly insured patients compared with 8.5 ± 3.2 μV and 26.0 ± 18.9 μV in privately insured patients. Patients with public insurance were symptomatic for longer prior to their initial visit, on average 82.8 ± 86.5 weeks, compared with 42.4 ± 58.9 weeks for patients with private insurance. Publicly insured patients were significantly delayed in seeing an orthopedic surgeon for evaluation and treatment of CuTS and presented with more severe clinical and electrodiagnostic findings compared with privately insured patients. These findings suggest that insurance type, among other socioeconomic factors, may be a barrier to CuTS care. Prevalence IV.

Development of Cueing Algorithm Based on “Closed-Loop” Control for Flight Simulator Motion System

The classical washout algorithm had fixed gains and manually constructed filters, so that it led to poor adaptability. Furthermore, it lost the sustained acceleration cues of high- and mid-frequency in cross-over (tilt-coordination) channel, and the acceleration of cross-over frequency was also limited by angular velocity limiter, so the false cues in flight simulation process were clearly perceived by pilots. The paper studied the characteristics of the classical washout algorithm and flight simulator motion platform, tried to redesign the source of cross-over acceleration channel and translation acceleration channel, and transferred the part of cross-over acceleration that was unsimulated sustained acceleration to translation acceleration channel. Comparisons were mainly made between classical washout algorithm and revised algorithm in a longitudinal/pitch direction. The evaluation was based on the implementation of human vestibular perception system. The results demonstrated that the revised algorithm could significantly reduce the phase lag, and improved the spikes tracking performance. Furthermore, sensory angular velocity and the error of sensory acceleration were strictly controlled within the threshold of human perception system, and the displacement was a little broader than the classical washout algorithm. Therefore, it was proved that the new algorithm could diminish the filters parameters and heighten the self-adaptability for the washout algorithm. In addition, the magnitude of false cues was remarkably reduced during flight simulator, and the workspace utilization of the motion platform was developed by “closed-loop” control system.

Application of endoscopic selective posterior rhizotomy in the treatment of limb spasticity following brain injury

Objective To evaluate the efficacy and safety of endoscopic selective posterior/dorsal rhizotomy (SPR) in the treatment of limb spasticity following brain injury in adults. Methods A total of 88 patients with limb spasticity following brain injury treated with SPR from January 2015 to August 2016 at Department of Neurosurgery, Xinxiang Central Hospital were retrospectively enrolled into this study. Russman-Gage standard and Ashworth standard were used to evaluate the degree of limb spasticity and muscle tension after operation. Surface electromyography (SMG) and evoked potential (EP) were used to measure the sensory and motor nerve conduction velocities of affected limbs 3 weeks after operation. Lower extremity motor function was assessed with the Fugl-Meyer scale in lower extremity (FMA-L) at 3 and 8 weeks after operation. Walking ability was assessed with the Functional ambulation category (FAC) scale, and parameters of patients' stride, stride distance, stride speed and toe deflection angle distance were measured. All patients were followed up clinically after operation. The follow-up included observing the remission of limb spasticity and reviewing the lumbar spine radiographs. Results The spasticity of extremities was alleviated in 88 patients after operation. Three weeks after operation, the integrated electromyogram (iEMG) of tibialis anterior muscle in 88 patients was higher than that before operation (1.5±0.2 mV vs. 0.5±0.2 mV, P<0.001), while the gastrocnemius muscle was lower than that before operation (0.7±0.3 mV vs. 1.2±0.2 mV, P<0.001). After detection, latency of cortical somatosensory evoked potential (SEEP) in the dorsomedian part of the head(39.7±3.1 ms) and L2 (18.5±3.5 ms) was longer than that before operation (34.9 ±3.5 ms, 13.3 ±2.3 ms, both P<0.001). The sensory nerve conduction velocities in head (4.9±1.1 cm/ms) and popliteal region to L2(4.8±1.3 cm/ms) region were lower than those before operation (6.6±1.4 cm/ms, 6.3±1.5 cm/ms, both P<0.001). At 3-8 weeks post operation, the scores of FMA-L and FAC scales, stride length, stride distance and stride speed of 88 patients were higher than those before operation (all P<0.05), while the deflection angle of toes was lower (P<0.01). The rising trend time of 88 patients ranged from 6.2 to 26.6 months, with an average of 12.2±6.4 months. There were 83 (83/88, 94.3%) patients who had relief of spasticity in lower limbs and 74 (74/79, 93.7%) whose Achilles tendon reflex disappeared. No spinal deformity was found in the reexamination. Conclusion The neuroendoscopic SPR treatment for limb spasticity after brain injury could effectively relieve the symptoms of limb spasticity and promote the recovery of motor function. It seems safe and worthy of clinical application and promotion. Key words: Natural orifice endoscopic surgery; Craniocerebral trauma; Muscle spasticity; Extremities; selective posterior/dorsal rhizotomy

Role of Ultrasound to Monitor Patients With Carpal Tunnel Syndrome Treated With a Local Corticosteroid.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy resulting from compression of the median nerve at the carpal tunnel (CT). We assessed the role of high-resolution ultrasound (US) in monitoring patients with CTS treated with corticosteroid injection. We performed high-resolution US evaluations of the wrists of patients with CTS before and after treatment with local corticosteroid. Thirty-nine and 17 wrists were included for analysis at the end of 1 and 3 months, respectively. The cross-sectional area (CSA) and anteroposterior diameter (APD) of the median nerve at the CT and clinical and electrophysiologic data were recorded. We assessed whether changes in US measurements before and after the treatment correlated with clinical and electrophysiologic parameters. The Boston symptom severity scale (p < .01), Boston functional status scale (p < .01), median nerve motor latency (p = .017), median nerve sensory velocity (p = .003), and difference in motor latencies (p = 0.03) and difference in sensory latencies (p = .03) between median and ulnar nerves showed significant changes over 1 or/and 3 months compared to baseline values. Changes in the CSA and APD correlated with changes in some clinical and electrophysiologic parameters. However, measurements of the CSA and APD at 1 or 3 months were not significantly different from baseline values. High-resolution US parameters such as the APD and CSA of the median nerve at the CT inlet were not useful to monitor patients with CTS treated with corticosteroid injections.

Type of Diabetes Mellitus Has Influence on Electrophysiological Parameters.

Introduction:Compulsory electromyoneurography (EMNG) analysis of all neurophysiological parameters, including the most sensitive parameter for early detection of diabetic polyneuropathy (cutaneous silent periods), in patients without subjective symptoms, and EMNG analysis demonstrates the existence of incipient signs for polynomial neuropathy due to which timely therapeutic approach is needed to prevent complications of diabetic disease and prevent irreversible changes in peripheral nerves.Aim:Examine the influence of type diabetes mellitus, therapeutic modality, and gender of patients on neurophysiological parameters obtained by EMNG analysis.Methods:The study included 90 patients with diabetes who were divided into three groups of 30, depending on the duration of the disease. Group 1 consisted of 30 respondents with type 2 diabetes mellitus and up to 5 years of disease duration. Group 2 consisted of 30 respondents with type 2 diabetes mellitus type and 5 to 10 years of disease duration. Group 3 consisted of 30 respondents with Type 1 diabetes mellitus. An electron-neurography analysis of peripheral nerve in the extremities was performed.Results:Group 1 (50%) and group 2 (56.17%) respondents had statistically higher incidence of tingling than those in Group 3 (13.3%), p=0.004. Tingling was not statistically significantly different in relation to the examined groups (p=0.314). Reflexes were statistically the most preserved in Group 3 (86.7%), p = 0.001. Measurement of motor conductivity values at median nerve had a significant difference in all parameters (distal latency, amplitude, mean conduction velocity (MCV) and latency in the group with DM type 1, compared to respondents with DM type 2. The same significant difference between all parameters was found when testing peroneus nerve. When measuring motor velocity conductivity in ulnar nerve, there was no significant difference in amplitude, while DM1 type 1 patients had significant differences in values: distal latency and MCV p<0.0001, latency p<0.002. Measurement of sensory velocity was not statistically significant between patients with DM types 1 and 2. In relation to therapy, oral insulin therapy was not shown to be of statistical significance, except for tibialis amplitude measurements, where insulin-treated DM patients had a value amplitude of 12.96±1.48, and in oral therapy group less than 0.04 (p<0.05) 9.14±0.93. In the DM type 2 group no, neurophysiological parameters showed significant gender differences, while in respondents with DM type 2, where the disease lasted shorter, a significant gender difference was present in terms of motor velocity and sensory conductivity in all the nerves examines, except MCV in ulnar nerve. In the DM type 1 respondents, a significant gender difference was present in measuring MCV at tibial nerve and peroneus nerve (p <0.01 and p <0.02), as well as latency of MCV in H reflexes (p<0.01), in males was 56.25±1.03 and in females 32.89±0.47.Conclusion:Diabetic polyneuropathy is significantly more present in patients older than 60 years who have type 2 diabetes mellitus (2/3 of those with a duration of 5 years or less and in ½ respondents with DM duration of less than 5 years), without any hesitation on the type of therapy. Measurement values of motor conductivity at median nerve had a significant difference in all parameters (distal latency, amplitude, MCV, and latency F) in the group with DM type 1. The same significant difference between all parameters was also found in n. peroneus. Distal latency values at sural nerve and tibial nerve, latency values and MCV in H reflexes, do not depend on DM type.

A Randomized, Double-Blind Study of the Effects of a Sustained Release Formulation of Sodium Nitrite (SR-nitrite) on Patients with Diabetic Neuropathy

Sodium nitrite has been reported to be effective in reducing chronic peripheral pain. To evaluate the safety and efficacy of 40 and 80 mg, BID, of an oral sustained release formulation of sodium nitrite (SR-nitrite) in patients suffering from diabetic neuropathy, and to determine whether SR-nitrite would reduce the frequency of headaches reported previously by subjects receiving the same doses of an immediate release formulation. Phase II, single-center, randomized, double-blind, placebo controlled clinical trial. The Ohio Pain Clinic and Kettering Medical Center. Twenty-four patients were randomized to 40 mg or 80 mg SR-nitrite or placebo twice daily for 12 weeks. The primary objective was to determine whether headaches would be reduced using SR-nitrite. The primary efficacy endpoint was the mean difference in the change of the Neuropathic Pain Symptom Inventory (NPSI) pain score from baseline to that reported after 12 weeks of treatment. Secondary endpoints included changes from baseline for the Brief Pain Inventory (BPI) Scale, the RAND 36 questionnaire, Short Form McGill Questionnaire, daily patient reported score for neuropathic pain, changes in HbA1c, PulseOx and quantitative sensory testing. The number of subjects reporting adverse events and the number of adverse events did not change with dose. There were no reports of treatment-related headaches. Although no significant differences were identified in patient responses to the questionnaires, a trend was observed. In the NPSI assessment, patients in the 40 mg and 80 mg dose group reported a 12.7% and 22.0% reduction in pain, respectively, compared to an 8.4% reduction by patients in the placebo group. A trend was also observed with the BPI total severity score. However, the 40 mg dosing group reported the greatest reduction in pain using the McGill Pain index and via patient logs of daily pain scores, where the mean of pain scores reported by subjects in the 40 mg group dropped by day 41 and generally stayed lower than the mean of scores reported by subjects in either of the other two groups. Patients in the 80 mg SR-nitrite group had an improvement in both Nerve Sensory Conductance and Nerve Sensory Velocity. No changes were observed in HbA1c levels or PulseOx. Small sample size. Sustained release sodium nitrite prevents the prevalent reports of headaches by patients treated with an immediate release formulation of sodium nitrite. In a previous study of patients with peripheral arterial disease (PAD), 40 mg BID treatment led to a statistically significant reduction in reported pain, similar trends were observed at the end of the trial period for most of the pain questionnaires used in the study. The 80 mg BID treatment had the more pronounced affect on bioactivity (quantitative sensory testing), which was similar to the PAD study, where this dose group had the greatest improvement in FMD {AU: spell out FMD}. The ability to alleviate pain with BID treatment of SR-nitrite offers promise for a new non-addictive, non-sedating treatment of chronic pain and warrants further study. Diabetes, diabetic neuropathy, neuropathic pain, peripheral neuropathy, sodium nitrite.

Electrophysiological and functional outcome after carpal tunnel release in patients with carpal tunnel syndrome: A prospective evaluation

Background: The Carpal tunnel syndrome (CTS) is median nerve entrapment neuropathy at wrist and is one of the commonly diagnosed disabling condition of the upper extremity. The only scientifically established disease modifying treatment is carpal tunnel release (CTR). Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after release. Material and Methods: Two year Prospective Study conducted in Tata Main Hospital, Jamshedpur on 33 cases of carpal tunnel syndrome. All patients underwent open carpel tunnel release. Electrophysiological and functional outcome was assessed using Nerve Conduction Study (NCS) and Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at 1 month, 3 months and 6 months postoperatively. Results: The CTS was most common in age group 40-50 years. Females were more affected with the ratio of 7:1. Mean BCTQ score preoperatively was 2.9. Post-operative at 1 month it showed marked improvement in mean score to 1.83. At 3 and 6 month follow up it reduced to 1.58 and 1.51 respectively. NCS were assessed using mean values of Nerve sensory latency (NSL), Nerve Motor Latency (NML), Nerve Sensory Velocity (NSV), and Nerve Motor Velocity (NMV). Preoperative evaluation shows higher latency (NSL 5.23±0.88, NML 5.23±0.63) and lower velocity (NSV 30.12±3.09, NMV 30.28±4.30). Both of which improved following CTR with mean NSL 4.46±0.59, NML 4.72±0.47, NSV 39.55±1.93, and NMV 36.55±5.32 at 1 month. Further follow up at 3 and 6 month also showed significant improvement. Conclusions: Boston Carpal Tunnel Questionnaire is good tool to evaluate functional outcome after carpal tunnel release. Nerve Conduction Studies serve as a valuable tool to assess follow up as it can provide reassurance to the patient that their operation is successful and that there is further potential for clinical improvement.

Effectiveness of wax therapy for diabetic peripheral neuropathy: a systematic review based on GRADE system

Objective To evaluate the efficacy of wax therapy for diabetic peripheral neuropathy, in order to provide suggestions for treatment and prevention. Methods Cochrane Library, JBI, PubMed, EMbase, CBM, CNKI, WANFANG DATA, VIP were searched by computer from inception to October, 2016 for randomized control trails in wax therapy for diabetic peripheral neuropathy. Two researchers searched and selected articles independently and the quality was assessed in accordance with Cochrane Manual. The articles were analyzed with Review Manager 5.3, and the evidence quality was assessed with GRADE profiler 3.6.1 software. Results A total of 8 randomized controlled trials were included. The number of literature quality grade A of original research is 3, while the number of literature quality grade B of original research is 4, and the number of literature quality grade C of original research is 1. Meta-analysis showed that the sensory nervus peronaeus conduction velocities improved by wax therapy for diabetic peripheral neuropathy patients, [MD=2.51, 95%CI (1.35, 3.66) , P<0.01]. By the GRADE system grading, the evidence quality is moderate. Conclusions The effect of wax therapy for diabetic peripheral neuropathy can improve the sensory nurve conduction velocities and speed of blood circle, so as to prevent ulcer of diabetic feet. Therefore, the clinical curative effects of the therapy require large-sample and high quality studies to confirm. Key words: Diabetic peripheral neuropathy; Wax therapy; Systematic review; GRADE system

Reversible and unilateral corticospinal tract disease secondary to autoimmune free-T3-thyrotoxicosis

68-year-old female patient with no significant medical history presents with a 3-month history of progressive neurological symptoms, which began with left eye ptosis, blurred vision and non-painful jaw discomfort, followed...

Investigation of Nerve Conduction Studies of Carpal Tunnel Syndrome Cases With Different Risk Factors: An Electrodiagnostic Study.

The aim of this study was to determine whether there are electrodiagnostic differences between carpal tunnel syndrome (CTS) patients with diabetes mellitus, CTS + hypothyroidism (HT), CTS + fibromyalgia syndrome, CTS + rheumatoid arthritis (RA), and idiopathic CTS cases, by comparing nerve conduction studies. This research examined electrophysiologic studies of 47 untreated HT + CTS, 47 diabetes mellitus + CTS, 49 RA + CTS, 52 fibromyalgia syndrome + CTS, 50 idiopathic CTS cases, and a healthy control group of 50 individuals (a total of 293 patients and 433 hands with CTS). There were no significant differences between the groups in terms of sex and age. There was no significant difference between the CTS groups-in terms of numbers-with mild, moderate, and severe CTS. When the CTS groups were compared with the control group, in all CTS groups on both left and right hands, there was a significant prolongation in median motor latency and median sensory latency (in the 3rd finger); also a significant decrease in median sensory velocity in the 3rd finger. In diabetes mellitus, HT, and RA groups, the median motor amplitudes in both hands were significantly decreased compared with the idiopathic group. There was a moderate significant negative correlation between disease duration and median motor amplitudes (of both right and left sides) in RA (right; P = 0.028, r = 0.761, left; P = 0.041, r = 0.694) and HT groups (right; P = 0.035, r = 0.637, left; P = 0.049, r = 0.697). Electrodiagnostic results showed both demyelinating injury and axonal damage in diabetes mellitus, HT, and RA patients with CTS, in these patients during treatment for CTS. Early treatment planning should include the risk factor diseases.

Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study.

Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel. Patients underwent limb hypothermia of one limb for a duration of 3 h with every paclitaxel infusion, with the contralateral limb used as control. PN was primarily assessed using nerve conduction studies (NCSs) before the start of chemotherapy, and after 1, 3, and 6 months. Skin temperature and tolerability to hypothermia were monitored using validated scores. Twenty patients underwent a total of 218 cycles of continuous-flow limb hypothermia at a coolant temperature of 22°C. Continuous-flow limb hypothermia achieved mean skin temperature reduction of 1.5 ± 0.7°C and was well tolerated, with no premature termination of cooling due to intolerance. Grade 3 PN occurred in 2 patients (10%), grade 2 in 2 (10%), and grade 1 in 12 (60%). Significant correlation was observed between amount of skin cooling and motor nerve amplitude preservation at 6 months (p < 0.0005). Sensory velocity and amplitude in the cooled limbs were less preserved than in the control limbs, but the difference did not attain statistical significance. One patient with a history of diabetes mellitus had significant preservation of compound muscle action potential in the cooled limb on NCS analysis. This study suggests that continuous limb hypothermia accompanying paclitaxel infusion may reduce paclitaxel-induced PN and have therapeutic potential in select patients and warrants further investigation. The method is safe and well tolerated.

Ultrasonographic and Electrophysiological Evaluation of the Ulnar Nerve in Patients Diagnosed With Carpal Tunnel Syndrome

In this study, we evaluated the ulnar nerve of patients diagnosed with carpal tunnel syndrome (CTS) using electrophysiology and ultrasonography. The study included 86 patients (136 hands) and 39 controls (78 hands) with normal electrophysiological assessment. According to Bland's classification, patients were divided into group 1 (grades 1-3 CTS) or group 2 (grades 4-6 CTS). The ulnar nerve was evaluated at the wrist using nerve conduction studies and ultrasonography. The sensory velocity was slower in group 2 than in group 1 (P < 0.001), slower in group 2 than in controls (P < 0.001), and slower in group 1 than in controls (P < 0.005). Although the ultrasonography results showed a reduction in the ulnar nerve cross-sectional area in group 1 compared with controls, the difference was not statistically significant. However, the reduction was significant in group 2 compared with group 1 and controls (P < 0.001). Based on our study results, the ulnar nerve is affected electrophysiologically and morphologically in patients with CTS, especially those with advanced-stage CTS.

Ultrasound-guided Hydrodissection for Severe Carpal Tunnel Treatment

Aims: The main aim of the present study was to assess the clinical outcome after ultrasound-guided hydrodissection and triamcinolone injection into the carpal tunnel in patients with severe carpal tunnel syndrome. Materials and Method: Participants—The prospective study design of the present observational investigation measured the therapeutic effect of ultrasound-guided hydrodissection and corticosteroid injection of the carpal tunnel in 36 consecutive participants with carpal tunnel syndrome, following American Academy of Neurology (AAN) clinical criteria, and classified as severe in the baseline neurophysiological study. Each participant completed the Boston and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires and underwent median motor and sensory nerve conduction studies (NCS) at baseline and 6 months after injection. Median nerve ultrasonography was assessed at baseline (prior to steroid injection) and at 3 and 6 months after injection. The ultrasound examination included measurement of the median nerve cross-sectional area at the distal wrist crease (DWC) and 12 cm proximal to calculate the wrist-to-forearm median nerve area ratio. Injection—At the initial visit, an ultrasound-guided hydrodissection and steroid injection was performed. In all cases, a baseline electrical and ultrasonography measurements were recorded prior to the injection. Ultrasound imaging of the median nerve was done using an ultrasound device, with a 8.0 a 13 MHz linear-array transducer. We used a linear array transducer with a 8-13 Mhz frecuency range which is the standard for musculoskeletal ultrasound examination. A 21-gauge needle was used for 2 punctures. After proper disinfection of the volar aspect of the wrist, the entry point of the first puncture was located at the ulnar side of the wrist, as described by Smith et al. for the transverse ulnar (short-axis or axial) approach. For the sagittal (long-axis or sagittal) approach, the puncture was performed following the indications by Grassi et al. A combination of lidocaine (1 ml), 40 mg of triamcinolone acetonide (1 ml), and saline serum (9 ml) was injected into the area surrounding the median nerve. Statistical Analysis—Changes in the following variables were assessed at 3 and 6 months after the index procedure: Boston symptom and function scores, DASH score, median nerve motor and sensory latencies (converted to velocity for sensory studies), as well as the median nerve cross-sectional area. Results: The following mean baseline values were recorded: Boston score: 2.99, DASH score: 47.03, motor latency 5.74 ms, sensory velocity 25.52 m/s, DWC area of 13.93 mm2, wrist-to-forearm ratio (WFR) of 6.56 mm2. The following variables showed significant changes within treatment responder patients at 6 months follow-up: 26.8% improvement upon Boston score ( P &lt; .001), 39.9% upon DASH score ( P = .006), 19.6% decrease at DWC area ( P &lt; .001), 19.6% decrease of the WFR ( P = .001). Conclusions: Ultrasound-guided hydrodissection and corticosteroid injection of the carpal tunnel seems an effective treatment for severe carpal tunnel syndrome in the short-term, with a success rate estimated at 56% of the patients.