Ulnar Nerve Conduction Velocity Research Articles

Effect of Forearm Supination and Pronation on Median & Ulnar Nerve Conduction Velocity Among Throwers, Archers, and Non-Athletes

ABSTRACT The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.

Evaluation of hand-arm vibration syndrome owing to nerve conduction study and cumulative exposure index -A 2.5-year cohort study.

This study aims to clarify the relationship between peripheral neuropathy in hand-arm vibration syndrome and cumulative exposure index. 68 participants without symptoms were surveyed. The participants were divided into three groups based on past and current vibration exposure (VE). Comparison among groups according to past VE showed that the median and ulnar sensory nerve conduction velocities and median sensory nerve action potential (SNAP) amplitude were significantly lower in past high and low exposure groups than in the past non-exposure group. Comparison among groups according to current VE showed that the median and ulnar SNAP amplitudes were significantly lower in the current high exposure group than in the current low or non-exposure group. Vibration tool handlers have potential peripheral nerve lesions at a certain stage without subjective symptoms of the finger.

Changes in ulnar and median nerve conduction velocity after reverse total shoulder arthroplasty: Correlation with distalization and lateralization

PurposeThe purpose of this study was to assess ulnar and median nerve injury after reverse total shoulder arthroplasty (RSA) by measuring the sensory nerve conduction velocity (SCV). The secondary objective was to evaluate the impact of lateralization and/or distalization on SCV changes. MethodsTwenty consecutive cases were prospectively included and retrospectively reviewed. SCV of the ulnar and median nerves as well as humeral lateralization/distalization quantified by plain radiography were evaluated pre-operatively and at 1 week post-operatively. Changes in SCV were tested using the paired t-test, and correlations between humeral lateralization/distalization and SCV changes were tested using Kendall's rank correlation coefficient and maximal information coefficient (MIC). ResultsThe SCV of the ulnar nerve was delayed from 55.4 ​m/s pre-operatively to 53.0 ​m/s post-operatively (p ​= ​0.021), whereas there was no significant change in the median nerve (p ​= ​0.17). There was a weak to moderate correlation between ulnar nerve SCV delay and lateralization (τ ​= ​−0.38; p ​= ​0.021; MIC ​= ​0.70) but no significant correlation with distalization (p ​= ​0.65; MIC ​= ​0.56). ConclusionsFollowing RSA, a small but significant delay in SCV of the ulnar nerve was observed. A negative correlation was found between lateralization and SCV delay of the ulnar nerve.

High serum levels of CCL11/Eotaxin-1 are associated with diabetic sensorimotor polyneuropathy and peripheral nerve function but not with cardiac autonomic neuropathy in people with type 2 diabetes

ABSTRACT Aims To investigate whether higher serum CCL11/Eotaxin-1, a biomarker for aging and neurodegenerative and neuroinflammatory disorders, is associated with diabetic sensorimotor polyneuropathy (DSPN), peripheral nerve dysfunction, and cardiac autonomic neuropathy in people with type 2 diabetes. Methods This cross-sectional study included 106 patients with type 2 diabetes and 40 healthy controls, matched for the age and sex distribution of the diabetes group as a whole. The CC chemokines CCL11/Eotaxin-1 and CCL22/MDC were measured in fasting serum samples. DSPN and peripheral nerve function were assessed by neurological examination and nerve conduction studies, and cardiac autonomic function, by heart rate variability (HRV) and corrected QT (QTc) time. The cardio-ankle vascular index (CAVI) was measured as a marker for arterial stiffness. Results Serum CCL11/Eotaxin-1 levels were significantly higher in diabetic patients than in healthy controls (183 ± 63.5 vs. 113.1 ± 38.5 pg/ml, p < 0.001), but serum CCL22/MDC levels were not significantly different between the two groups. In the diabetes group, the serum CCL11/Eotaxin-1 level was positively correlated with ulnar and sural nerve conduction velocities (p = 0.0009, p = 0.0208, respectively) and sensory nerve action potential (p = 0.0083), and CAVI (p = 0.0005), but not with HRV indices or QTc time, and serum CCL22/MDC was not significantly correlated with any indices of nerve conduction. In a model adjusted for age and duration of diabetes, serum CCL11/Eotaxin-1 was still associated with ulnar nerve conduction velocity (p = 0.02124). Serum CCL11/Eotaxin-1, but not CCL22/MDC, was significantly higher in patients with than in those without DSPN (208.2 ± 71.6 vs. 159.1 ± 45.1 pg/ml, respectively; p < 0.0001). Conclusions Serum CCL11/Eotaxin-1 is elevated in patients with DSPN and is associated with peripheral nerve dysfunction, in particular sensory nerve conduction velocity, suggesting that serum CCL11/Eotaxin-1 may be a potential biomarker for DSPN. Clinical Trial Registration University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000040631).

Effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers.

To compare the effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers with symptomatic neck pain and asymptomatic office workers. A total of 40 participants, both male and female office workers, with symptomatic neck pain (n = 20) and asymptomatic (n = 20), were recruited. Pain intensity, ulnar nerve conduction velocity, median nerve conduction velocity, and muscle activity were determined before and after 1 hour of computer use. There was a significant increase in pain intensity in the neck area in both groups (P < .001). The symptomatic neck pain group revealed a significant decrease in the sensory nerve conduction velocity of the ulnar nerve (P = .008), whereas there was no difference in the median nerve conduction velocity (P > .05). Comparing before and after computer use, the symptomatic neck pain group had less activity of the semispinalis muscles and higher activity of the anterior scalene muscle than the asymptomatic group (P < .05). The trapezius and wrist extensor muscles showed no significant differences in either group (P > .05). This study found signs of neuromuscular deficit of the ulnar nerve, semispinalis muscle, and anterior scalene muscle after 1hour of computer use among office workers with symptomatic neck pain, which may indicate the risk of neuromuscular impairment of the upper extremities. The recommendation of resting, and encouraging function and flexibility of the neuromuscular system after 1hour of computer use should be considered.

Gene Distribution in Pediatric-Onset Inherited Peripheral Neuropathy: A Single Tertiary Center in Thailand.

Inherited peripheral neuropathy presents a diagnostic and therapeutic challenge due to its association with mutations in over 100 genes. This condition leads to long-term disability and poses a substantial healthcare burden on society. This study aimed to investigate the distribution of genes and establish the genotype-phenotype correlations, focusing on pediatric-onset cases. Exome sequencing and other analytical techniques were employed to identify pathogenic variants, including duplication analysis of the PMP22 gene. Each patient underwent physical examination and electrophysiological studies. Genotypes were correlated with phenotypic features, such as age at disease onset and ulnar motor nerve conduction velocity. We identified 35 patients with pediatric-onset inherited peripheral neuropathy. Pathogenic or likely pathogenic variants were confirmed in 24 out of 35 (68.6%) patients, with 4 of these variants being novel. A confirmed molecular diagnosis was achieved in 90.9% (10/11) of patients with demyelinating Charcot-Marie-Tooth disease (CMT) and 56.3% (9/16) of patients with axonal CMT. Among patients with infantile-onset CMT (≤2 years), the most common causative genes were MFN2 and NEFL, while GDAP1 and MFN2 were frequent causes among patients with childhood- or adolescent-onset CMT (3-9 years). The MFN2 gene was the most commonly implicated gene, and the axonal type was predominant in this cohort of Thai patients with pediatric-onset inherited peripheral neuropathy.

Long-term effects of pancreatic islet transplantation on polyneuropathy in patients with brittle diabetes: A single-center experience.

Pancreatic islet transplantation (ITx) is increasingly used in patients with brittle type 1 diabetes (T1D). If successful, ITx results in insulin-free euglycemia, but its application is limited by a need for lifelong immunosuppression. The aim of this study was to assess the long-term effects of ITx on the occurrence and course of polyneuropathy in a cohort of patients with brittle T1D. In this prospective, single-center study, 13 patients (4 males and 9 females) with brittle T1D had a baseline neurological exam with the calculation of Utah Neuropathy Scale (UNS) and a limited nerve conduction study before ITx, and about yearly after in the patients who achieved insulin independence. Patients were followed for a period of 17 to 133 months. There was no significant difference between UNS and nerve conduction study parameters at baseline and at the end of follow-up, except for significant decreases in peroneal (50.34 ± 6.12 vs. 52.42 ± 6.47 ms, P = 0.005) and ulnar (27.5 ± 2.15 vs. 29.45 ± 2.10 ms, P = 0.009) F-wave latencies and an increase in ulnar sensory nerve conduction velocity (49.98 ± 6.27 vs. 47.19 ± 5.36 m/s, P = 0.04). If successful, ITx has a good long-term safety profile for peripheral nerve toxicity, and a favorable effect on diabetic neuropathy.

Effect of Forearm and Elbow Joint Positions on Ulnar Nerve Conduction Velocity: A Study of Throwers, Archers, and Non-Athletes

ABSTRACT Background: The intensive physical regimen followed by throwers and archers can impose stress on the elbow and hand in particular positions, which may increase the risk of developing peripheral nerve disorders and symptoms like pain and numbness. Purpose: The purpose of the study is to investigate the effect of forearm and elbow joint positions on ulnar nerve conduction velocity in throwers, archers, and non-athletes. Method: Total 34 subjects both males and females were included with body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar nerve conduction velocity (NCV) across elbow joint at different angles (0° elbow extension, 45°, 90°, and 120° elbow flexion) with different forearm positions. Result: Repeated Measure Analysis of Variance (RMANOVA) revealed that there was a statistically significant difference in mean values of ulnar NCV at different angles, forearm positions & groups (p < .05). Conclusion: The forearm and elbow positions can have a significant impact on ulnar NCV, especially in athletes who perform repetitive upper limb motions. Results showed that the archers had significantly slower NCV than throwers and non-athletes at 90° of elbow flexion and forearm pronation.

Effect of body mass index on ulnar nerve conduction velocity among medical students

Background: Obesity and overweight incidence is increasing among the medical students. The main reason for obesity among medical students is sedentary lifestyle, unhealthy food intake and stress. Increase in subcutaneous fat impairs the conduction in nerve fibers. Body mass index (BMI) is an easy tool to assess the obesity as it is noninvasive and non-expensive. Nerve conduction studies are the tools for assessing the performance of the nervous system. Aims and Objectives: The aim of the study was to evaluate the effect of obesity on the ulnar nerve conduction velocity among medical students. Materials and Methods: A total of 50 medical students were recruited for the study and the study was done in the Department of Physiology, ESIC Medical College, Hyderabad. Two groups were made Group A (n = 25 with BMI 18.5–24.9) and Group B (n = 25 with BMI &gt;25). AD instrument was used for data acquisition for right ulnar nerve conduction velocity in both the groups. Results from both the groups were compared. Results: Nerve conduction velocity among the Group B students (50.95 ± 15.91) was decreased compared to Group A students (57.56 ± 14.79) but the decrease in nerve conduction velocity was not significant (P = 0.28). Conclusions: Nerve conduction velocity gets impaired with obesity among medical students, but further studies need to be done with more sample size.

Effect of backpack load on nerve conduction velocity and risk of peripheral neuropathy in upper extremities of undergraduate medical students carrying backpack

Background: Prolonged load carriage can potentially affect hand and upper limb use through compression of the nerves, reduction in blood flow, and muscle fatigue. Backpacks of undergraduate medical student are not much different from their syllabus. They carry heavy backpacks on regular basis and many times they wear it incorrectly. Aims and Objectives: We aimed to see the effect of backpack load on motor nerve conduction velocity and hand grip strength in the upper extremities. Materials and Methods: The present study included 31 undergraduate medical students between the age of 18 and 25 years. The procedure is conducted in three phases on different days. In each phase, participants were asked to walk for 5 min with load. In Phase 1, nerve conduction velocity and grip strength weere measured in unloaded condition and after carrying load &lt;10% of body weight. To limit the effect of fatigue, participants are instructed to return to laboratory in next consecutive weeks to repeat the procedure for Phase 2 and 3 as in Phase 1 by increasing load to 10–20% and 20–30% of their body weight respectively. Results: Values of median and ulnar motor nerve conduction velocity obtained without and with increasing % of backpack load after 5 min walk were decreased non-significantly as load increased. There was significant (P&gt;0.001) difference in grip strength of medical students carrying backpack with increasing load after 5 min walk. Conclusion: In this study, we aimed at quantifying the effects of load carriage on overall upper limb performance, with a focus on conduction velocity of motor nerves. This has implications for occupations such as soldiers, firefighters, paramedics, and others who may be required to operate machinery, equipment, tools, or systems that require precise motor control.

Sympathetic Skin Response in Ulnar Neuropathy at the Elbow.

The sympathetic skin response (SSR) reflects the function of sudomotor sympathetic unmyelinated fibers. This study evaluates SSR abnormalities in ulnar neuropathy at the elbow (UNE). Sympathetic skin response was obtained after electrical stimulation of the glabella recording simultaneously from the hand palm (P), third digit (M3) and fifth digit ipsilateral (U5) and contralateral (cU5) to the side of UNE. Ten consecutive SSRs were recorded from each recording side of all participants. The authors enrolled 31 patients (mean age 54.3 ± 11.4 years) and 25 subjects of a control group (mean age 52.6 ± 11.3 years). The mean of the areas and the area of the largest response of U5-SSR were significantly lower in the patients (106.9 ± 68.9 and 127.8 ± 79.7 μV/s, respectively) than in control group (161.8 ± 116.6 and 197.2 ± 143.3 μV/s, respectively) and in the affected than in the unaffected sides of the patients (155.3 ± 84.8 and 197.7 ± 103.3 μV/s, respectively); there were no differences in U5-SSR latencies and P-SSR and M3-SSR parameters. U5-SSR mean areas and U5-SSR largest area were reduced in 29% and 26% of patients, respectively. The differences between patients and control group and the number of patients with U5-SSR abnormalities increased when the ratios of M3/U5-SSR and U5/cU5-SSR areas were considered. U5-SSR area was related to UNE clinical severity and to some parameters of the ulnar nerve conduction velocity and cutaneous silent period. Sympathetic skin response is useful to demonstrate abnormalities of sympathetic fibers even if UNE patients do not complain for sympathetic symptoms. The SSR abnormalities were evident only if electrophysiological damage of myelinated fibers was moderate or severe.

An analytical study on motor nerve conduction velocity of ulnar and common peroneal nerve in athletes of anaerobic sports

An analytical study on motor nerve conduction velocity of ulnar and common peroneal nerve in athletes of anaerobic sports

Mean Motor Nerve Conduction Velocity of Right Ulnar Nerve among Physically Trained Adult Males in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Neural adaptation to physical training allows a person to better coordinate the activation of all relevant muscles producing maximum force. Nerve conduction velocity measures the speed of impulse along the motor neuron and is strongly associated with muscle contraction time. This study aimed to find out the mean motor nerve conduction velocity of the right ulnar nerve among physically trained adult males in a tertiary care centre. This descriptive cross-sectional study was conducted in the Neurophysiology Laboratory of a tertiary care centre from 3rd November, 2019 to 2nd November, 2020. Thirty young adult males who were engaged in the physical training at a training centre for more than 3 months were studied after receiving ethical approval from the Institutional Review Committee (Reference number: 1578/019). Motor nerve conduction parameters of the right ulnar nerve were measured and data were entered in Microsoft Excel. Statistical analysis was done using the Statistical Packages for the Social Sciences version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data, and mean and standard deviation for continuous data. Among 30 males studied, the mean motor nerve conduction velocity of the ulnar nerve was found to be 61.02±5.86 m/sec (58.92-63.11 at 95% Confidence Interval). The mean distal latency and amplitude of the muscle action potential were 2.33±0.53 ms and 8.08±1.17 mv respectively. Our study found that the mean nerve conduction velocity of the ulnar nerve was similar when compared to studies conducted in similar settings. Nepal; nerve conduction; ulnar nerve.

Clinical efficacy of decompression and anterior transposition of the ulnar nerve in osteoarthritis-induced cubital tunnel syndrome and influencing factors

We aimed to explore the clinical efficacy of decompression and anterior transposition of the ulnar nerve in osteoarthritis-induced cubital tunnel syndrome (CTS). 109 patients with moderate-to-severe CTS treated from July 2015 to March 2019 were selected. Upper-limb function was scored. After ultrasound examination, decompression and anterior transposition of the ulnar nerve were performed; then ulnar nerve motor nerve conduction velocity (MNCV) was assessed. Patients were followed up every 3 months for 18 months and their prognosis was assessed. Upper-limb function examination results were compared according to disease severity. Univariate and multivariate regression analyses were conducted, and a nomogram prediction model was established. After treatment, the number of patients with intrinsic contracture of the hand, Tinel sign (+), clipping paper test (+) and Froment’s sign (+) significantly declined; hand grip strength, ulnar nerve MNCV, latency, amplitude, 2-point discrimination (2-PD) and Disabilities of the Arm, Shoulder and Hand (DASH) score were improved (p < 0.05). Age, gender, course of disease, long-term elbow bend work (LTEBW), ulnar nerve MNCV, 2-PD and DASH score were independent risk factors for poor prognosis (p < 0.05). The calibration curve confirmed that prognosis results after treatment were highly consistent with actual outcomes. Decompression and anterior transposition of the ulnar nerve exerted significant therapeutic effects on moderate-to-severe osteoarthritis-induced CTS. The nomogram prediction model established by age, gender, course of disease, LTEBW, ulnar nerve MNCV, 2-PD and DASH score can be used to effectively evaluate prognosis.

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 Effect of Local Cooling at the Elbow on Nerve Conduction Velocity and Motor Unit Behaviour: An Exploration of a Novel Neurological Assessment.

Background: This study aimed to determine the effects of a standard therapeutic cooling protocol using crushed ice on the elbow to explore if changes in the motor unit (MU) firing rates in the first dorsal interosseous (FDI) muscle are comparable to known changes in sensory and motor nerve conduction velocity (NCV) due to a regional temperature drop around a peripheral nerve. Methods: Twelve healthy individuals were assessed before cooling, immediately after cooling, and 15 min of rewarming. Assessments included two standard non-invasive nerve conduction velocity tests and a non-invasive investigation of the MU firing rates using surface electromyography decomposition (dEMG). Results: Repeated ANOVAs showed significant differences in the MU firing rates and NCV between time points (p = 0.01 and p < 0.001). All measures showed significant differences between pre and post cooling and between pre-cooling and 15 min of passive re-warming, however, no changes were seen between post cooling and rewarming except in the sensory NCV, which increased but did not return to the pre-cooled state. Conclusions: This current study showed a significant, temporary, and reversible reduction in ulnar NCV across the elbow in healthy subjects, which was associated with a significant decrease in mean MU firing rates in the FDI muscle.

Nerve conduction studies (NCS) and electromyography (EMG) O-NE001. Correlation of nerve conduction velocity with body fat mass and oxidative stress markers in type 2 diabetic neuropathy patients

Introduction . Diabetic peripheral neuropathy (DPN) is the most common but least recognised and understood long term complication of type 2 diabetic patients (T2DM). There is a close association between obesity and type 2 diabetes as well as its complications. Nerve conduction study is an important non-invasive diagnostic modality used in the detection of diabetic peripheral neuropathy. Obesity is associated with increased oxidative stress and lipid peroxidation is thought to play a crucial role in the development of diabetic neuropathy. The aim of this study is to see the correlation of nerve conduction velocity parameters viz nerve conduction velocity and nerve conduction amplitude with the total body fat mass and oxidative stress markers. Methods . The study included 90 type 2 diabetes patients with clinically suggestible symptoms of diabetic peripheral neuropathy (DPN). 50 type 2 diabetic subjects without peripheral neuropathy served as control. Total body fat mass was measured using bioelectric impedance analysis. Oxidative stress markers viz total antioxidant capacity and malondialdehyde were measured using elisa kit. Nerve conduction study both motor and sensory was carried out in relevant nerves. Results . Serum levels of total antioxidant capacity and super oxide dismutase were significantly decreased in type 2 diabetic with neuropathy as compared to the ones without neuropathy. Serum levels of malondialdehyde, on the other hand, was significantly elevated. Motor nerve conduction velocity (MNCV) of ulnar and common peroneal nerve and sensory nerve conduction velocity of ulnar and sural showed a significantly decreased conduction velocity as compared to control. The total body fat mass showed a significant negative correlation with the motor conduction velocity of median, posterior tibial and sensory conduction velocity of median and sural nerve. Conclusion . The nerve conduction velocity test and total body fat mass evaluation is a cost- effective tool for earlier detection of neuropathy in type 2 diabetes patient.

Determining the utility of minimum F-wave latency alterations in the electrodiagnosis of ulnar neuropathy at the elbow.

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

A cross-sectional study on nerve conduction velocity in stable chronic obstructive pulmonary disease

Objectives: This study was undertaken with the aim to find out possible presence of subclinical peripheral neuropathy in patients of chronic obstructive pulmonary disease (COPD) and its association with advancing severity of disease. Changes in nerve conduction parameter values in these patients have been presented. Materials and Methods: Median, ulnar, peroneal motor, and sural sensory nerve conduction latency, amplitude, and velocity were recorded in 100 known cases of COPD in the age group of 25–65 years as per the standard protocol. Results: On analysis, statistically significant lowering of sural nerve conduction velocity (P = 0.002) and amplitude (P = 0.003) was found with decreasing FEV1% in the three stages of COPD. Decrease in ulnar sensory conduction amplitude and velocity was also noted but it was not significant. Fall in sural nerve conduction velocity was found to be strongly and positively correlated (P = 0.029, r = 0.444) with decrease in FEV1%. Conclusion: These findings suggest that with increasing severity of disease, airflow limitation enhances polyneuropathy in COPD patients. It is predominantly axonal and mainly involving sensory nerve.

Programmed cell death-1 blockade in kidney carcinoma may induce eosinophilic granulomatosis with polyangiitis: a case report

BackgroundImmune checkpoint inhibitors have potential applications in treating various cancers but are associated with immune-related adverse events, such as inflammation, in a wide range of organs; however, allergic inflammation caused by these agents has not been extensively studied.Case presentationA 65-year-old man was diagnosed with a kidney neuroendocrine carcinoma. Three months after kidney resection surgery, the tumor cells had metastasized to his liver and lymph nodes. Subsequently, the patient started chemotherapy; however, regardless of treatment, the tumor grew, and the patient experienced a series of adverse effects, such as taste disorder, anorexia, and general fatigue. Finally, he was administered a programmed cell death (PD)-1 inhibitor, nivolumab (biweekly, toal 200 mg/body), which was effective against kidney carcinoma. However, the patient had a bronchial asthma attack at 22 cycles of nivolumab treatment and chest computed tomography (CT) revealed an abnormal bilateral shadow after 37 cycles of nivolumab treatment. Bronchoscopy findings revealed eosinophil infiltration in the lungs along with severe alveolar hemorrhage. Paranasal sinus CT scanning indicated sinusitis and nerve conduction analysis indicated a decrease in his right ulnar nerve conduction velocity. Based on these findings, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis; he was treated with prednisolone, which alleviated his bronchial asthma. To restart nivolumab treatment, the dose of prednisolone was gradually tapered, and the patient was administered a monthly dose of mepolizumab and biweekly dose of nivolumab. To date, there have been no bronchial attacks or CT scan abnormalities upon follow up.ConclusionsWe present a rare case in which a patient with cancer was diagnosed with eosinophilic granulomatosis with polyangiitis following treatment with a PD-1 inhibitor. Blockade of PD-1 and the programmed cell death ligand (PD-L) 1/PD-1 and PD-L2/PD-1 signaling cascade may cause allergic inflammation. Further studies are needed to identify the specific mechanisms underlying allergic inflammation after PD-1 blockade.