Needle electromyography provides essential information about the functional aspects of the muscle. But little attention has been given in the literature to needle electromyography examinations in ...carpal tunnel syndrome. We examined the relationship between preoperative needle electromyography findings and functional recovery of the abductor pollicis brevis (APB) muscle in severe carpal tunnel syndrome patients.
The subjects of this study were 49 patients, 58 hands, who fit the following 5 criteria: (1) idiopathic carpal tunnel syndrome; (2) pre-op MMT grade of the APB muscle was M0 or M1; (3) APB-CMAP (compound muscle action potential) was not evoked in a median nerve conduction study; (4) needle electromyography of the APB muscle had been done; (5) underwent carpal tunnel release only. The patients were divided into two groups according to the results of pre-op needle electromyography: voluntary motor unit potential of the APB muscle was evoked MUP(+) groupor not MUP(-) group. We evaluated APB muscle strength at one year after surgery, and patient satisfaction and functional evaluations (CTSI-FS) at more than one year after.
The APB muscle recovery rate to M3 or higher was 100% in the MUP(+) group, and 57% in the MUP(-) group. Patient satisfaction was also high and functional recovery was sufficient in the MUP(+) group. No patients requested a second opponensplasty.
Our findings suggest that post-op restoration of thumb function relates to whether or not the MUP ofthe APB muscle is evoked. Single-stage opponensplasty may be unnecessary if the MUP of the APB muscle is; evoked. Needle electromyography is therefore useful in consideration for opponensplasty.
Level Ⅲ, case-control study.
Background:
Evaluations of the stability of osteochondritis dissecans (OCD) lesions of the elbow using magnetic resonance imaging (MRI) have resulted in reports with variable accuracy. Therefore, the ...International Cartilage Repair Society (ICRS) classification remains the gold standard to determine OCD lesion stability. Because OCD commonly occurs in pediatric patients, a noninvasive method comparable with the ICRS classification is desired.
Hypothesis/Purpose:
Based on the previous literature, the capitellum of unstable OCD lesions has an irregular outline on MRI because of displacement or dislocation of the lesion via synovial fluid inflow. Therefore, we defined a 4-stage classification, similar to the ICRS classification, which focused on the outline of the capitellum and articular cartilage status on MRI without subchondral bone information. The purpose of this study was to validate this MRI-based staging system against the ICRS classification and to verify its accuracy in diagnosing unstable OCD lesions of the elbow.
Study Design:
Cohort study (diagnosis); Level of evidence, 2.
Methods:
A total of 81 patients with OCD of the elbow who were surgically treated were evaluated. The MRI-based stages were as follows: stage 1, normal-shaped capitellum and articular cartilage without signal intensity change; stage 2, normal-shaped capitellum and articular cartilage with signal intensity change; stage 3, irregular-shaped capitellum and discontinuity of the articular cartilage; and stage 4, dislocated lesion with an articular cartilage defect. Agreement between the MRI and ICRS classifications was evaluated, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for lesion instability were determined. The intraclass correlation coefficient (ICC) for intrarater and interrater reliability of the MRI-based staging system was calculated.
Results:
Agreement between the MRI-based staging system and the ICRS classification was 88.9%, with a sensitivity of 98.4%, specificity of 84.2%, PPV of 95.3%, and NPV of 94.1% for diagnosing an unstable lesion. The ICC was high for both intrarater (0.925) and interrater (0.915-0.939) reliability.
Conclusion:
The MRI-based staging system corresponded well with the ICRS classification, providing an accurate preoperative assessment of OCD lesions of the elbow, even with minimal subchondral bone information.
On-field screening for 'elbow injury in baseball', a condition commonly seen in youth baseball players, was conducted over two years on 160 elementary school students in Ibaraki Prefecture, Japan. ...This on-field screening was conducted in collaboration with the Ibaraki Prefecture High School Baseball Federation. Pitchers, catchers, symptomatic players, and players who had previously experienced elbow pain were given a comprehensive evaluation that included a physical exam and ultrasound. Out of the 135 students who were successfully screened, 10 were diagnosed with osteochondritis dissecans of the humeral capitellum (OCD). Notably, seven among these were asymptomatic. This assessment identified limited range of motion and pain when extending their elbow as significant risk factors for OCD. An attempt at on-field screening for baseball elbow injuries in collaboration with the local baseball federation was introduced. The risk factors for OCD were identified. Considering these factors, more efficient screening will be possible in the next attempt.
We used real-ear insertion gain (REIG), with the international speech test signal (ISTS), to evaluate the amplifying characteristics of hearing aids, set for patients who have been wearing such aids ...for a long time in a stable manner. We further compared this to the target values of the DSLv5 and NAL-NL2 methods.
The subjects were adults with moderate sensorineural hearing loss. We examined 40 ears in 25 individuals (15 people wearing hearing aids in both ears and ten people wearing aid in only one ear). Fit assessments were performed based on the speech performance-intensity functions and tolerance of environmental noise, and the ears studied were categorized as either ears with sufficient benefit or ears with insufficient benefit. Additionally, we evaluated the REIG for international speech test signals at 65-dB and 80-dB sound pressure level (SPL). We compared the REIG and target values for voice input at 65-dB and 80-dB SPL, calculated from the DSLv5 and NAL-NL2 methods.
Among the 40 ears, 34 received sufficient benefit and six received an insufficient benefit from hearing aids. The REIG for ISTS at 65-dB in the sufficient benefit ears, at frequencies of 1,000 Hz and 2,000 Hz, were similar to the target values of NAL-NL2 and DSLv5 but were significantly lower at 250 Hz, 500 Hz, and 4,000 Hz frequencies. The compression ratio of REIG for sufficient benefit ears was similar to that of DSLv5. The REIG for ISTS at 65-dB in the insufficient benefit ears was smaller than that in the sufficient benefit ears at frequencies of 2,000 Hz and 4,000 Hz.
This study suggested that the target values of NAL-NL2 and DSLv5 are appropriate, even for Japanese-speaking individuals, at mid-pitch sounds. Although it is necessary to investigate the necessity for low-pitch and high-pitch gains further in the future, this study provides meaningful data regarding the amplifying characteristics in Japanese-speaking individuals who have been wearing hearing aids in a stable manner.
For conventional electrocatalysts for the nitrate reduction reaction, Pt substrates have been used and modified with Sn adatoms to form Sn/Pt interfaces, which work as highly efficient catalytic ...active sites. In this work, Pt nanoparticles were deposited on fluorine-doped tin oxide (FTO) substrates by cathodic arc plasma deposition (APD) to produce Pt/Sn interfaces. As expected, APD–Pt/FTO showed the electrocatalytic nitrate reduction activity in acidic media and the Pt/Sn interfaces worked as the catalytic active site. Our interfacial design concept and synthetic approach will offer new catalyst development strategies at nanoscale.
Nitric oxide (NO) plays a key role in the regulation of vascular tone and is known as one of the key markers of endothelial dysfunction. We investigated the relationship between NO and risk factors ...of lifestyle-related disease in factory workers.
Our study included 877 factory workers presenting hypertension, dyslipidemia and type 2 diabetes. Oxidated forms of NO, NO2-/NO3- (NOx) plasma concentrations were measured using a colorimetric method.
NOx plasma levels in patients with lifestyle-related disease were significantly lower than those in the controls. The brachial-ankle pulse wave velocity (baPWV) measured in those patients was significantly greater than that of the controls. Multiple regression analysis revealed that LDL cholesterol was an independent risk factor for reducing NOx plasma concentrations. Interestingly, individuals with low NOx plasma concentrations were more likely to present type 2 diabetes compared to those with the highest plasma levels of NOx (odds ratio OR 95% confidence interval; CI=3.65 1.61-8.28, P=0.002, 2.67 1.15-6.20, P=0.022, and 3.27 1.43-7.48, P=0.005). Subjects with the lowest levels of plasma NOx were more likely to present dyslipidemia (OR 95% CI=1.69 1.13-2.53, P=0.01).
Endothelial function evaluated with plasma NOx may be indicative of lifestyle-related diseases independently from the vascular function assessed using baPWV.
Background and objective Signal changes in MRI for Kienböck's disease have only been qualitatively assessed so far. In light of this, we proposed a new grading system for quantitative analysis with ...an ordinal scale. Methods The study included 31 patients (17 men, 14 women) with Kienböck's disease. By referring to Nakamura's MRI grading system, we devised a grading system with five grades (Grades 1-5) using proton density-weighted (PDW) coronal images with respect to the signal intensity of the lunate. All cases were examined by using the MRI grading system by three hand surgeons, both preoperatively and postoperatively. We evaluated the inter-rater reliability of our grading system by using the interclass correlation coefficient. After surgery, we implemented annual MRI evaluation for as long as possible and quantitatively assessed changes in MRI grades. We also investigated the correlation between postoperative MRI grades, Mayo Wrist Scores (MWS), and age at the surgery by using Pearson's coefficient. Results The MRI evaluation was performed 2-15 years after surgery. The reliability of our grading system was high; inter-rater interclass correlation coefficients were 0.783 (examiners 1-2), 0.780 (examiners 1-3), and 0.825 (examiners 2-3), representing a substantial agreement. The correlation coefficient between the MRI grade and MWS was -0.31, suggesting a mild negative correlation; postoperative MRI grade also correlated with age at surgery (Pearson's coefficient: 0.447). Conclusions Our proposed MRI grading system has high reliability and could be used to assess the regeneration of a necrotic lunate for quantitative analysis on an ordinal scale. Improvements were observed one to four years postoperatively, demonstrating a mild correlation with the clinical results.
The objective of this study was to clarify whether anteroposterior dimension of the radius along the screw axis of a fixed angle volar locking plate (VLP) can be predicted from the width of the ...radius on the VLP.
Sixty-nine wrists in 68 patients with distal radius fractures that underwent fixation with a fixed angle VLPs were evaluated. All patients underwent pre- and postoperative computed tomographic scans of the distal radius. The transverse width of the radius was measured at the position of the third screw hole from the proximal edge. The anteroposterior dimension of the radius (R) was measured along the axes of the distal screws. The distal row screw holes were defined as R1, R2, R3, and R4 from the radial to the ulnar side. Correlation analysis between the width and the anteroposterior dimension, and single regression analysis were performed for each screw hole. The correlations amongst the R values for the different distal row screws were also assessed.
The correlation coefficients between the transverse width and anteroposterior dimensions were 0.54, 0.58, 0.55, and 0.42 for R1, R2, R3, and R4 respectively (
< 0.05). The regression equations were R1 = 0.49W + 7.99, R2 = 0.47W + 11.8, R3 = 0.52W + 10.8, and R4 = 0.41W + 11.5 respectively. The correlation coefficients among anteroposterior dimensions were 0.85, 0.64, 0.59, 0.70, 0.61, and 0.80 for R1/R2, R1/R3, R1/R4, R2/R3, R2/R4, and R3/R4 respectively (
< 0.01).
There were significant correlations in the anteroposterior dimensions amongst the distal row screw lengths. The regression equations used in this study may be helpful to predict the length of distal row screw and prevent complications due to inappropriate screw choices.
Level III (Therapeutic).
In infant poliomyelitis or poliomyelitis-like paresis, there has been no means of treating residual paralysis and the policy has been to wait until an affected infant has grown sufficiently to enable ...tendon transfer or arthrodesis. However, recent reports have described relatively good results for early surgical intervention in the form of nerve transfer.
In a 4-year and 6-month-old child we transferred a partial ulnar nerve for elbow flexor reconstruction even 3 years and 10 months after the onset of poliomyelitis-like palsy and also transferred partial accessory and radial nerves for shoulder function restoration 6 months after the first operation.
Elbow flexor restored M4 on the British Medical Research Council scale. The shoulder subluxation resolved, however, the strengths of the deltoid and infraspinatus remained almost M1. At the most recent clinical examination, the patient was 18 years old and the active range of motion of patient’s left elbow was 0°–125°, and those of the whole shoulder girdle were abduction 35°, flexion 60°, extension 30° and external rotation 0°.
The outcomes we achieved may support partial nerve transfer techniques as viable treatment options for persistent long-standing motor deficits following poliomyelitis-like palsy in children. However, we recommend performing partial nerve transfer as early as possible after recovery from flaccid paralysis and also use of nerves that derive from narrow spinal cord segments. After denervation, children’s neuromuscular systems seem to have the ability to regenerate after a much longer period than has generally been believed. This speculation is based on only a single case report; thus, more experience is needed before this generalization can confidently be made.
We used our novel three-dimensional magnetic resonance imaging-computed tomography fusion images (3D MRI-CT fusion images; MCFIs) for detailed preoperative lesion evaluation and surgical simulation ...in osteochondritis dissecans (OCD) of the elbow. Herein, we introduce our procedure and report the findings of the assessment of its utility. We enrolled 16 men (mean age: 14.0 years) and performed preoperative MRI using 7 kg axial traction with a 3-Tesla imager and CT. Three-dimensional-MRI models of the humerus and articular cartilage and a 3D-CT model of the humerus were constructed. We created MCFIs using both models. We validated the findings obtained from the MCFIs and intraoperative findings using the following items: articular cartilage fissures and defects, articular surface deformities, vertical and horizontal lesion diameters, the International Cartilage Repair Society (ICRS) classification, and surgical procedures. The MCFIs accurately reproduced the lesions and correctly matched the ICRS classification in 93.5% of cases. Surgery was performed as simulated in all cases. Preoperatively measured lesion diameters exhibited no significant differences compared to the intraoperative measurements. MCFIs were useful in the evaluation of OCD lesions and detailed preoperative surgical simulation through accurate reproduction of 3D structural details of the lesions.
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