Active Micro-Nano-Collaborative Bioelectronic Device for Advanced Electrophysiological Recording

The development of precise and sensitive electrophysiological recording platforms holds the utmost importance for research in the fields of cardiology and neuroscience.In recent years,active micro/nano-bioelectronic devices have undergone significant advancements,thereby facilitating the study of electrophysiology.The distinctive configuration and exceptional functionality of these active micro-nano-collaborative bioelectronic devices offer the potential for the recording of high-fidelity action potential signals on a large scale.In this paper,we review three-dimensional active nano-transistors and planar active micro-transistors in terms of their applications in electroexcitable cells,focusing on the evaluation of the effects of active micro/nano-bioelectronic devices on electrophysiological signals.Looking forward to the possibilities,challenges,and wide prospects of active micro-nano-devices,we expect to advance their progress to satisfy the demands of theoretical investigations and medical implementations within the domains of cardiology and neuroscience research.

Femoral Access with Ultrasound-Guided Puncture and Z-Stitch Hemostasis for Adults with Congenital Heart Diseases Undergoing Electrophysiological Procedures

Aims:Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized,there is limited data on this combined application in adult congenital heart disease(ACHD)patients undergoing electrophysiological(EP)procedures.We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients under-going EP procedures.Methods and Results:The population of ACHD patients undergoing transfemoral EP pro-cedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed.During the study period,femoral access(left/right,arterial/venous)was performed under real-time ultrasound guidance.At the end of the procedure,a single Z-stitch was performed at the puncture site.We eval-uated the incidence of in-hospital complications associated with femoral access puncture in this population.Among 101 patients who had a total of 147 previous ipsilateral vascular punctures(mean 1.5 per person),100 patients underwent successful femoral vascular access for EP procedures.The median age of the patients was 47±15 years and 34(34%)were male.Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses(mean 3 punctures per person).No patient developed vascular puncture relevant inguinal hematoma,pseudo aneurysm,arteriovenousfistula,venous or arterial thrombosis.Conclusion:In ACHD patients undergoing EP procedures,optimal femoral access management can be achieved with ultra-sound-guided puncture and postprocedural Z-stitch hemostasis.

Epileptic brain network mechanisms and neuroimaging techniques for the brain network

Epilepsy can be defined as a dysfunction of the brain network,and each type of epilepsy involves different brain-network changes that are implicated diffe rently in the control and propagation of interictal or ictal discharges.Gaining more detailed information on brain network alterations can help us to further understand the mechanisms of epilepsy and pave the way for brain network-based precise therapeutic approaches in clinical practice.An increasing number of advanced neuroimaging techniques and electrophysiological techniques such as diffusion tensor imaging-based fiber tra ctography,diffusion kurtosis imaging-based fiber tractography,fiber ball imagingbased tra ctography,electroencephalography,functional magnetic resonance imaging,magnetoencephalography,positron emission tomography,molecular imaging,and functional ultrasound imaging have been extensively used to delineate epileptic networks.In this review,we summarize the relevant neuroimaging and neuroelectrophysiological techniques for assessing structural and functional brain networks in patients with epilepsy,and extensively analyze the imaging mechanisms,advantages,limitations,and clinical application ranges of each technique.A greater focus on emerging advanced technologies,new data analysis software,a combination of multiple techniques,and the construction of personalized virtual epilepsy models can provide a theoretical basis to better understand the brain network mechanisms of epilepsy and make surgical decisions.

Risk of permanent pacemaker implantation following transcatheter aortic valve replacement:Which factors are most relevant?

Transcatheter aortic valve replacement(TAVR)has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement.The encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk patients.However,this is not without challenges.Need for permanent pacemaker(PPM)post-TAVR remains the most frequent and clinically relevant challenge.Naturally,identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is important.Various demographic factors,electrocardiographic features,anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following TAVR.Amongst these electrophysiological variables,most notably a prolonged QRS>120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression models.The index study by Nwaedozie et al highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS>120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.

Evaluation of AVNRT & AVRT by Different Criteria: Old & New

The two most frequent causes of paroxysmal SVT are atrioventricular tachycardia (AVRT) and atrioventricular nodal re-entrant tachycardia (AVNRT). The purpose of this study was to assess the diagnostic efficacy of traditional and newly proposed ECG criteria in the identification of Avnrt and Avrt. Aim of the Study: The aim of this study was to evaluate Atrioventricular Nodal Reentrant Tachycardia (AVNRT) and Atrioventricular Re-entrant Tachycardia (AVRT) using both traditional and novel criteria. Methods: This prospective observational study was conducted at the Electrophysiology Unit, Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD) in Dhaka, from February 2019 to January 2020. A total of 62 patients with Supraventricular Tachycardia (SVT) undergoing electrophysiology study (EPS) were included. Standard ECG criteria were applied for the differential diagnosis, and electrophysiological diagnoses were made using established criteria. Statistical analysis, including descriptive statistics and appropriate tests, was performed using SPSS 23.0. Result: In our study of 62 patients with Supraventricular Tachycardia (SVT), we found that 66.1% had AVNRT and 33.9% had AVRT. The mean age in AVNRT was higher than AVRT (41.3 ± 9.7 vs. 38.5 ± 14.3, p = 0.36) with statistically no significant difference, with similar gender distribution between AVNRT and AVRT groups. Classical AVNRT criteria were present in 30.6% of patients, and 45.2% showed a Pseudo R' wave in aVR. Additionally, 30.6% had an RP interval ≥100ms, more prevalent in AVRT patients (66.7%). Conclusion: Integrating traditional and novel criteria, including lead aVR analysis, enhances the electrocardiographic diagnosis of AVNRT and AVRT, offering a pathway to refined patient care.

Effect of iron overload on electrophysiology of slow reaction autorhythmic cells of left ventricular outflow tract in guinea pigs

Objective: To investigate the electrophysiology effects and mechanism of iron overload on the slow response autorhythmic cells in the left ventricular outflow tract of guinea pigs.Methods: Standard microelectrode cell recording techniques were adopted to observe the electrophysiological effects of different concentrations of Fe^(2+)(100 μmol/L, 200 μmol/L) on the left ventricular outflow tract autorhythmic cells.Heart tissues were perfused with FeSO_4(200 μmol/L) combing with CaCl_2(4.2 mmol/L), Verapamil,(1 μmol/L), and nickel chloride(200μmol/L) respectively to observe the influences of these contents on electrophysiology of FeSO_4(200μmol/L) on the left ventricular outflow tract autorhythmic cells.Results: Fe^(2+)at both 100 μmol/L and 200 μmol/L could change the electrophysiological parameters of the slow response autorhythmic cells of the left ventricular outflow tract in a concentrationdependent manner resulting into decrease in Vmax, APA and MDP, slower RPF and VDD, and prolonged APD_(50) and APD_(90)(P all <0.05).Besides, perfusion of increased Ca^(2+) concentration could partially offset the electrophysiological effects of Fe^(2+)(200 μmol/L).The L-type calcium channel(LTCC) blocker Verapamil(1 μmol/L) could block the electrophysiological effects of Fe^(2+)(200 μmol/L).But the T-type calcium channel(TTCC) blocker nickel chloride(NiCl_2, 200 μmol/L) could not block the electrophysiological effects of Fe^(2+)(200 μmol/L).Conclusions: Fe^(2+) can directly change the electrophysiological characteristics of the slow response autorhythmic cells of the left ventricular outflow tract probably through the L-type calcium channel.

Electrophysiology and genetic testing in the precision medicine of congenital deafness:A review

Background:Congenital hearing loss is remarkably heterogeneous,with over 130 deafness genes and thousands of variants,making for innumerable genotype/phenotype combinations.Understanding both the pathophysiology of hearing loss and molecular site of lesion along the auditory pathway permits for significantly individualized counseling.Electrophysiologic techniques such as electrocochleography(ECochG)and electrically-evoked compound action potentials(eCAP)are being studied to localize pathology and estimate residual cochlear vs.neural health.This review describes the expanding roles of genetic and electrophysiologic evaluation in the precision medicine of congenital hearing loss.The basics of genetic mutations in hearing loss and electrophysiologic testing(ECochG and eCAP)are reviewed,and how they complement each other in the diagnostics and prognostication of hearing outcomes.Used together,these measures improve the understanding of insults to the auditory system,allowing for individualized counseling for CI candidacy/outcomes or other habilitation strategies.Conclusion:Despite tremendous discovery in deafness genes,the effects of individual genes on neural function remain poorly understood.Bridging the understanding between molecular genotype and neural and functional phenotype is paramount to interpreting genetic results in clinical practice.The future hearing healthcare provider must consolidate an ever-increasing amount of genetic and phenotypic information in the precision medicine of hearing loss.

In-Cell Nanoelectronics:Opening the Door to Intracellular Electrophysiology

Establishing a reliable electrophysiological recording platform is crucial for cardiology and neuroscience research.Noninvasive and label-free planar multitransistors and multielectrode arrays are conducive to perform the large-scale cellular electrical activity recordings,but the signal attenua-tion limits these extracellular devices to record subthreshold activities.In recent decade,in-cell nanoelectronics have been rapidly developed to open the door to intracellular electrophysi-ology.With the unique three-dimensional nanotopography and advanced penetration strategies,high-throughput and high-fidelity action potential like signal recordings is expected to be realized.This review summarizes in-cell nanoelectronics from versatile nano-biointerfaces,penetration strategies,active/pas-sive nanodevices,systematically analyses the applications in electrogenic cells and especially evaluates the influence of nanodevices on the high-quality intracellular electrophysiological signals.Further,the opportunities,challenges and broad prospects of in-cell nanoelectronics are prospected,expecting to promote the development of in-cell electrophysiological platforms to meet the demand of theoretical investigation and clinical application.

Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome

Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria;WPW on ECG;age <18 years;and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.

Arrhythmic risk stratification in ischemic,non-ischemic and hypertrophic cardiomyopathy:A two-step multifactorial,electrophysiology study inclusive approach

Annual arrhythmic sudden cardiac death ranges from 0.6%to 4%in ischemic cardiomyopathy(ICM),1%to 2%in non-ischemic cardiomyopathy(NICM),and 1%in hypertrophic cardiomyopathy(HCM).Towards a more effective arrhythmic risk stratification(ARS)we hereby present a two-step ARS with the usage of seven non-invasive risk factors:Late potentials presence(≥2/3 positive criteria),premature ventricular contractions(≥30/h),non-sustained ventricular tachycardia(≥1episode/24 h),abnormal heart rate turbulence(onset≥0%and slope≤2.5 ms)and reduced deceleration capacity(≤4.5 ms),abnormal T wave alternans(≥65μV),decreased heart rate variability(SDNN<70ms),and prolonged QT_(c)interval(>440 ms in males and>450 ms in females)which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step.In the second step,these intermediate-risk patients undergo a programmed ventricular stimulation(PVS)for the detection of inducible,truly high-risk ICM and NICM patients,who will benefit from an implantable cardioverter defibrillator.For HCM patients,we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.

Effects of Diazoxide Treatments on Electrophysiologyic Properties in Guinea Pig Papillary Muscles Undergoing Ischemia/Reperfusion

The effects of diazoxide treatments on electrophysiologyic properties in guinea pig papillary muscles undergoing ischemia/reperfusion was studied using intracellular microelectrode technique. Twenty-four guinea pigs were randomly divided into three groups (n=8 in each group). In control group, St.Thomas solution was given. In experimental group, St.Thomas solution with diazoxide (100 mol/L) was given. In pretreatment group, the muscle was treated with diazoxide 20 min before arrested with St.Thomas cardioplegia. The results showed that the APD_50 and APD_90 in experimental and pretreatment groups were significantly shorter after 5 and 10 min reperfusion (P<0.01, P<0.05), but longer after 30 min reperfusion (P<0.01, P<0.05) than in control group. In experimental and pretreatment groups, APA, OS, Vmax recovered more quickly than those in control group. The time to re-systole after reperfusion in control group was longer than that in experimental and pretreatment groups. There was no significant difference in RP among three groups. The time of arrest in pretreatment group was longer than that in experimental and pretreatment group (P<0.05). This study indicates that protective effects of St.Thomas solution with diazoxide is better than that of pretreatment with diazoxide or St.Thomas solution alone.

Electrophysiology as a tool to unravel the origin of pancreatic pain

Intense abdominal pain is the most common symptom in chronic pancreatitis, but the underlying mechanisms are not completely understood and pain management remains a significant clinical challenge.The focus of pain origin in chronic pancreatitis traditionally has been on the pancreatic gland, assuming pain to originate in the pancreas or its surrounding organs. However, research in the last decade points to abnormal central nervous system pain processing.For this reason, electroencephalography has been receiving increasing attention. In contrast to imaging methods such as functional magnetic resonance and positron emission tomography, electroencephalogram has excellent temporal resolution making it possible to investigate central processing of pain on a millisecond time scale. Moreover, continuously advancing methodology made it possible to explore brain sources responsible for generation of evoked potentialsand hence to study brain reorganization due to pain in chronic pancreatitis. The aim of this review is to give an overview of the current methods and findings in electroencephalography as a tool to unravel the origin of pancreatic pain.

Tail nerve electrical stimulation-induced walking training promotes restoration of locomotion and electrophysiology in rats with chronic spinal cord injury

Functional recovery is the final goal in the treatment of spinal cord injury. However, to date, few treatment strategies have demonstrated significant locomotor improvement in animal experiments. By using tail nerve electrical stimulation (TANES) as an open-field locomotor training method combined with glial scar ablation and cell transplantation, we have successfully promoted locomotor recovery in rats with chronic spinal cord contusion injury. The purpose of the present study is to further investigate the mechanism of TANES and its effect on electrophysiology. Spinal cord segment T10 of female, adult Long-Evans rats was contused using the NYU impactor device with 25 mm height setting. After injury, rats were randomly divided into three groups. Group I was used as a control without any treatment, group II and group III were subjected to basic treatment including glial scar ablation and transplantation of olfactory lamina propria 6 weeks after injury, and group III received TANES-induced open-field locomotor training weekly after basic treatment. All animals were allowed to survive 22 weeks, except some rats which were transected. Basso, Beattie, and Bresnahan (BBB) open-field locomotor rating scale, horizontal ladder rung walking test, and electrophysiological tests were used to assess the restoration of functional behavior and conduction. Results showed that TANES significantly improves locomotor recovery and spinal cord conduction, reflex, as well as significantly reduces the occurrence of autophagia. Additionally, after transection, trained rats still maintained higher BBB score than that of control rats. This may be related to the activity-dependent plasticity promoted by TANES-induced locomotor training.

Effects of hydrogen sulfide on guinea pig aortic vestibule autorhythmic cells electrophysiology and its mechanism

Objective:To investigate the electrophysiological effects of hydrogen sulfide (H2S) on left ventricular outflow tract autonomic cells in guinea pigs and its mechanism.Methods:Intracellular microelectrode recording technique was used to observe the electrophysiological effects of different concentrations of hydrogen sulfide on the autonomic cells of left ventricular outflow tract.Results: CSE irreversible inhibitor PPG (200 μmol/L) makes the left ventricular outflow tract of autorhythmic cells Vmax, RPF and VDD accelerate, APA increase (P<0.05);CBS synthase inhibitor AOAA (100μmol/L) acts on the autorhythmic cells of the left ventricular outflow tract without effect. The concentration-dependency of the 50, 100 and 200μmol/L NaHS made RPF and VDD of autorhythmic cell of the left ventricular outflow tract decrease with increasing concentration of NaHS, Vmax and APA decrease (P<0.01). The ATP sensitive potassium channel (KATP) blocker glybenclamide (Gli, 20 μmol/L) partially blocked the electrophysiological effects of NaHS (P<0.05). The L-Ca2+ channel agonist Bay K8644 could partially block the electrophysiological effects of NaHS.Conclusion:The autorhythmic cells of the left ventricular outflow tract had endogenous H2S produced by CSE. H2S had a negative chronotropic effect on autorhythmic cells in the left ventricular outflow tract, and its mechanism was related to the inhibition of L-Ca2+ channels by the open KATP pathway.

The Electrophysiology in Idiopathic Senile Macular Hole

Of 12 patients with idiopathic senile full- thickness macular hole, 3 had bilateral involvement, 9 had monocular macular hole. Flash ERG and pattern VEP were performed in the bilateral eyes of all patients. The abnormal rate of the pattern VEP was 93.3% when we used 15' checkboard stimulus, the changes of the VEP appeared as delayed latencies, reduced amplitudes or malformation of P100. The abnormal rate of the flash ERG was 53.3%, showing primary characteristics of reduced amplitudes of cone response b...

Comparison of the Frequency-dependent Effects of Amiodarone on Ventricular Electrophysiology in Congestive Heart Failure Canine Models and Normal Dogs

Objectives To compare the frequency-dependent effects of amiodarone （Ami） on ventricular electrophysiology in fight ventricular rapid pacing-induced congestive heart failure （CHF） canine models. Methods Thirty-two dogs were randomized into four groups： the control group, the Ami group in which the normal dogs were given Ami orally 300 mg a day for 4 -5 weeks, the CHF group induced by right ventricular rapid pacing （240 pulses, min^- 1 for 4 -5 weeks ）, and the group of CHF dogs fed with Ami orally 300 mg a day for 4 - 5 weeks. The techniques of electrical stimulation and monophasic action potential （MAP） recording were used in the electrophysiology studies. Results The effects of Ami on ventricular MAP duration （MAPD90） and effective refractory period （VERP） were not frequency-dependent in CHF dogs. There was also no frequency-dependent effect on the increase in the ratio of VERP to MAPD90 （ VERP/MAPD90 ）. The prolongation of ventricular conduction time was frequencydependent. Conclusions The frequency-dependent effects of Ami on ventricular electrophysiology in CHF dogs were similar to that in normal dogs.

Superelastic Radiative Cooling Metafabric for Comfortable Epidermal Electrophysiological Monitoring

Epidermal electronics with superb passive-cooling capabilities are of great value for both daytime outdoor dressing comfort and low-carbon economy. Herein, a multifunctional and skinattachable electronic is rationally developed on a porous all-elastomer metafabric for efficient passive daytime radiative cooling(PDRC) and human electrophysiological monitoring. The cooling characteristics are realized through the homogeneous impregnation of polytetrafluoroethylene microparticles in the styrene–ethylene–butylene–styrene fibers, and the rational regulation of microporosity in SEBS/PTFE metafabrics, thus synergistically backscatter ultraviolet–visible–near-infrared light(maximum reflectance over 98.0%) to minimize heat absorption while efficiently emit human-body midinfrared radiation to the sky. As a result, the developed PDRC metafabric achieves approximately 17℃ cooling effects in an outdoor daytime environment and completely retains its passive cooling performance even under 50% stretching. Further, high-fidelity electrophysiological monitoring capability is also implemented in the breathable and skin-conformal metafabric through liquid metal printing, enabling the accurate acquisition of human electrocardiograph, surface electromyogram, and electroencephalograph signals for comfortable and lengthy health regulation. Hence, the fabricated superelastic PDRC metafabric opens a new avenue for the development of body-comfortable electronics and low-carbon wearing technologies.

External anal sphincter electromyography in multiple system atrophy:implications for diagnosis,clinical correlations,and novel insights into prognosis

Multiple system atrophy is a sporadic,progressive,adult-onset,neurodegenerative disorder characte rized by autonomic dysfunction symptoms,parkinsonian features,and cerebellar signs in va rious combinations.An early diagnosis of multiple system atrophy is of utmost impo rtance for the proper prevention and management of its potentially fatal complications leading to the poor prognosis of these patients.The current diagnostic criteria incorporate several clinical red flags and magnetic resonance imaging marke rs supporting diagnosis of multiple system atrophy.Nonetheless,especially in the early disease stage,it can be challenging to differentiate multiple system atrophy from mimic disorders,in particular Parkinson’s disease.Electromyography of the external anal sphincter represents a useful neurophysiological tool for diffe rential diagnosis since it can provide indirect evidence of Onuf’s nucleus degeneration,which is a pathological hallmark of multiple system atrophy.However,the diagnostic value of external anal sphincter electromyography has been a matter of debate for three decades due to controve rsial reports in the literature.In this review,after a brief ove rview of the electrophysiological methodology,we first aimed to critically analyze the available knowledge on the diagnostic role of external anal sphincter electromyography.We discussed the conflicting evidence on the clinical correlations of neurogenic abnormalities found at external anal sphincter electro myography.Finally,we repo rted recent prognostic findings of a novel classification of electromyography patterns of the external anal sphincter that could pave the way toward the implementation of this neurophysiological technique for survival prediction in patients with multiple system atrophy.

Subclinical hearing loss associated with aging

Objective:Contribute to clarifying the existence of subclinical hearing deficits associated with aging.Design:In this work,we study and compare the auditory perceptual and electrophysiological performance of normal-hearing young and adult subjects(tonal audiometry,high-frequency tone threshold,a triplet of digits in noise,and click-evoked auditory brainstem response).Study sample:45 normal hearing volunteers were evaluated and divided into two groups according to age.27 subjects were included in the“young group”(mean 22.1 years),and 18 subjects(mean 42.22 years)were included in the“adult group.”Results:In the perceptual tests,the adult group presented significantly worse tonal thresholds in the high frequencies(12 and 16 kHz)and worse performance in the digit triplet tests in noise.In the electrophysiological test using the auditory brainstem response technique,the adult group presented significantly lower I and V wave amplitudes and higher V wave latencies at the supra-threshold level.At the threshold level,we observed a significantly higher latency in wave V in the adult group.In addition,in the partial correlation analysis,controlling for the hearing level,we observed a relationship(negative)between age and speech in noise performance and high-frequency thresholds.No significant association was observed between age and the auditory brainstem response.Conclusion:The results are compatible with subclinical hearing loss associated with aging.

Promising application of a new ulnar nerve compound muscle action potential measurement montage in amyotrophic lateral sclerosis:a prospective cross-sectional study

Previous studies have shown that ulnar nerve compound muscle action potential recorded by the conventional“belly-tendon”montage does not accurately and completely reflect the action potential of the ulnar nerve dominating the abductor digiti minimi muscle due to the effects of far-field potentials of intrinsic hand muscles.A new method of ulnar nerve compound muscle action potential measurement was developed in 2020,which adjusts the E2 electrode from the distal tendon of the abductor digitorum to the middle of the back of the proximal wrist.This new method may reduce the influence of the reference electrode and better reflect the actual ulnar nerve compound muscle action potential.In this prospective cross-sectional study,we included 64 patients with amyotrophic lateral sclerosis and 64 age-and sex-matched controls who underwent conventional and novel ulnar nerve compound muscle action potential measurement between April 2020 and May 2021 in Peking University Third Hospital.The compound muscle action potential waveforms recorded by the new montage were unimodal and more uniform than those recorded by traditional montage.In the controls,no significant difference in the compound muscle action potential waveforms was found between the traditional montage and new montage recordings.In amyotrophic lateral sclerosis patients presenting with abductor digiti minimi spontaneous activity and muscular atrophy,the amplitude of compound muscle action potential-pE2 was significantly lower than that of compound muscle action potential-dE2(P<0.01).Using the new method,damaged axons were more likely to exhibit more severe amplitude decreases than those measured with the traditional method,in particular for patients in early stage amyotrophic lateral sclerosis.In addition,the decline in compound muscle action potential amplitude measured by the new method was correlated with a decrease in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores.These findings suggest that the new ulnar nerve compound muscle action potential measurement montage reduces the effects of the reference electrode through altering the E2 electrode position,and that this method is more suitable for monitoring disease progression than the traditional montage.This method may be useful as a biomarker for longitudinal follow-up and clinical trials in amyotrophic lateral sclerosis.