Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects

BACKGROUND Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.AIM To evaluate the cross-sectional area(CSA) of the median nerve using B-mode ultrasonography(USS) and the presence of peripheral neuropathy(PN) in a cohort of adult diabetic Nigerians.METHODS Demographic and anthropometric data of 85 adult diabetes mellitus(DM) and 85 age-and sex-matched apparently healthy control(HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument(MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile(FLP), fasting blood glucose(FBG) and glycated haemoglobin(HbA1 c) while their MN CSA was evaluated at a point 5 cm proximal to(5 cmCATL) and at the carpal tunnel(CATL) by high-resolution Bmode USS. Data was analysed using SPSS version 22.RESULTS The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5 cmCATL(P < 0.01) and at the CATL(P < 0.01) on both sides. The presence of diabetic peripheral neuropathy(DPN) further increased the MN CSA at the CATL(P < 0.05) but not at 5 cmCATL(P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.CONCLUSION Thickening of the MN CSA at 5 cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at5 cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.

Ultrasonographic measurement of median nerve cross-sectional area reference values in a healthy Han population from Guiyang,China

High-resolution ultrasonography was used to analyze the nerve cross-sectional area （CSA） of the median nerve at 7 sites： the wrist crease, pisiform bone, hamate bone, 6 cm proximal to the tip of the wrist crease, proximal forearm （where the nerve enters the pronator teres muscle）, 4 cm proximal to the tip of the medial epicondyle, and mid-humerus （mid-point between elbow crease and axilla） in 200 healthy volunteers from Guiyang, China. Results showed similar CSA values between the left and right sides, but the CSA 6 cm proximal to the tip of the wrist crease, proximal forearm, 4 cm proximal to tip of the medial epicondyle, and mid-humerus in males was greater than that of females. Moreover, CSA values at the wrist crease, pisiform bone, and hamate bone were greater in the middle-aged and old groups when compared to the young group, and correlated with body mass and height. Thus, reference values of median nerve CSA of the upper limbs can facilitate the analysis of abnormal nerve conditions.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis

BACKGROUND Acromioclavicular joint(ACJ)space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis(ACJO).However,the morphology of the ACJ space is irregular because of osteophyte formation,subchondral irregularity,capsular distention,sclerosis,and erosion.Therefore,we created the ACJ cross-sectional area(ACJCSA)as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIM To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODS ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance(S-MR)imaging that revealed no evidence of ACJO.Oblique coronal,T2-weighted,fat-suppressed SMR images were acquired at the ACJ level from the two groups.We measured the ACJCSA and the ACJ space width(ACJSW)at the ACJ on the S-MR images using our imaging analysis program.The ACJCSA was measured as the cross-sectional area of the ACJ.The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTS The average ACJCSA was 39.88±10.60 mm;in the normal group and 18.80±5.13 mm;in the ACJO group.The mean ACJSW was 3.51±0.58 mm in the normal group and 2.02±0.48 mm in the ACJO group.ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals.Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm^(2),with 91.4%sensitivity and 90.0%specificity.CONCLUSION The optimal ACJSW cutoff score was 2.37 mm,with 88.6%sensitivity and 96.7%specificity.Even though both the ACJCSA and ACJSW were significantly associated with ACJO,the ACJCSA was a more sensitive diagnostic image parameter.

Correlation between current and cross-sectional area of parallel fixed-movable dual electrodes in ESC

Electroslag casting with parallel fixed-movable dual electrodes is a new method for achieving better quality of castings in complex mold cavities.In this work,a mathematical model,y=kx^2+(k+1)x,was established to describe the ideal correlation between the current ratio(y)and the cross-sectional area ratio(x)of the dual electrodes,where k is the filling ratio.Investigation was conducted on the electroslag casting process with dual electrodes of various cross-sectional areas,but at a constant k value.The experimental results indicated that the ideal correlation was obtained at the stable casting stage,and the fitting results were consistent with the experimental results at certain k values.The experimental findings show that better castings can be obtained when the current ratio is greater than 1.536 and the cross-sectional area ratio is greater than 0.5.

Modeling Blood Flow in Veins of Uniform Properties (Giraffe Jugular Vein)

This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.

Exposed Cross-section of the Archaean Lower Crustin the Shanxi-Hebei-Inner Mongolia Border Region:Problems and Prospects

The Archaean lower crust represented by granulite facies rocks, which is rare in China, is found to be exposed in the Shanxi-Hebei-Inner Mongolia border region. Studies of the regional structure and deformation and metamorphism of the region indicate that there occurred at least two phases of deformation and metamorphism in the region. Early-phase nearly E-W-directed deformational structure is well preserved in the Zhangjiakou-Xuanhua area. Observations of the features of the geological structure from north to south (in the Hengshan metamorphic terrain) have revealed a possible exposed cross-section through the Archaean lower crust. The structure was superimposed by a NE-SW-trending high-temperature ductile shear zone in the Datong area in the late phase, thus reworking the Archaean sequence.

Optimal Minimum Number of CT Slices Required to Measure Cross Sectional Areas of Small Pulmonary Vessels

The cross-sectional area (CSA) of small pulmonary vessels can be quantified by CT, which is a reliable method of evaluating vascular alterations in such vessels. However, the optimal number of slices required for accurate quantitation remains unknown. We evaluated relationships among all slices at 10-mm interval and all slices at 3-cm interval, 6-cm interval, and 3-slices and found the closest correlation (0.939) between all slices at 10-mm intervals and 3-cm intervals. Thus, all slices at 3-cm intervals are suitable for accurately measuring CSA.

Mulching broad ridges with a woven polypropylene fabric increases the growth and yield of young pear trees ‘Yuluxiang' in the North China Plain

Unlike traditional ridging, mulching broad ridges with a woven polypropylene fabric (WPF) can reduce soil evaporation during the drought season and avoid long saturation time in the root zone of pear trees during the rainy season. In this study, field experiments were conducted from 2017 to 2020 in a pear orchard in the North China Plain to investigate the effects of mulching broad ridges (0.3 m in height and 2 m in width) with WPF on soil temperature and moisture, nitrogen leaching, vegetative and reproductive growth of young pear trees(Pyrus bretschneideri Rehd.‘Yuluxiang’). The experiments involved two treatments, namely, control (traditional no-ridge planting without mulching) and mulching broad ridges with WPF (RM treatment). The results showed that the RM treatment increased soil moisture and temperature and decreased nitrogen leaching, resulting in vigorous growth of the young pear trees. Moreover, the RM treatment increased the tree trunk cross-sectional area and height of the young pear trees by 37%and 8%in 2020, respectively. The nitrate nitrogen content at the soil layer depth of 0-30 cm was significantly higher in the RM than that in control. Furthermore, the RM treatment significantly increased the fruit yield due to larger tree size. In addition, compared with control, significantly higher fruit soluble solid content of RM treatment was detected in 2020. High precipitation (423 mm) occurred during fruit enlargement stage in 2020, RM treatment decreased the rainfall infiltration in the ridge and the soil moisture in root region, resulting in the improvement of fruit quality, compared with control.Therefore, mulching broad ridges with WPF can be implemented to increase soil moisture during drought season, soil temperature, and nitrate nitrogen content, thereby improving the growth and fruit yield of young pear trees. Additionally, it can reduce soil moisture in the root zone during the rainy season and improve the fruit quality of the trees. Finally, it can reduce nitrate nitrogen leaching, thereby reducing environmental pollution.

Eff ects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation

BACKGROUND:To investigate the eff ects of early standardized enteral nutrition(EN)on the crosssectional area of erector spine muscle(ESMcsa),plasma growth diff erentiation factor-15(GDF-15),and 28-day mortality of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with invasive mechanical ventilation(MV).METHODS:A total of 97 AECOPD patients with invasive MV were screened in the ICUs of the First People's Hospital of Lianyungang.The conventional EN group(stage Ⅰ)and early standardized EN group(stage Ⅱ)included 46 and 51 patients,respectively.ESMcsa loss and GDF-15 levels on days 1 and 7 of ICU admission and 28-day survival rates were analyzed.RESULTS:On day 7,the ESMcsa of the early standardized EN group was significantly higher than that of the conventional EN group,while the plasma GDF-15 levels were significantly lower than those in the conventional EN group(ESMcsa:28.426±6.130 cm^(2) vs.25.205±6.127 cm^(2);GDF-15:1661.608±558.820 pg/mL vs.2541.000±634.845 pg/mL;all P<0.001).The 28-day survival rates of the patients in the early standardized EN group and conventional EN group were 80.40%and 73.90%,respectively(P=0.406).CONCLUSION:ESMcsa loss in AECOPD patients with MV was correlated with GDF-15 levels,both of which indicated acute muscular atrophy and skeletal muscle dysfunction.Early standardized EN may prevent acute muscle loss and intensive care unit-acquired weakness(ICU-AW)in AECOPD patients.

腭帆张肌横截面积对鼻咽癌患者放射性中耳炎的影响

目的 :探究腭帆张肌横截面积对鼻咽癌患者放射性中耳炎的影响。方法 :选取我院在2015年6月到2016年2月期间接受放射性治疗的鼻咽癌患者37例,采用三维适形调強放射治疗,对所有患者的鼻咽部进行扫描,并测量腭帆张肌与翼内肌通过咽鼓管中下部层面的横断面面积。结果 :放疗后共有25例并发分泌性中耳炎,放疗后患者的左、右腭帆张肌横截面面积均明显小于放疗前,对比具有显著性差异(P<0.05),腭帆张肌发生萎缩耳放射性中耳炎的发生率较未出现萎缩耳明显升高(P<0.05)。结论 :鼻咽癌患者在接受放疗后,腭帆张肌会出现明显的萎缩现象。

Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome

Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.

Effects of resistance training performed to repetition failure or non-failure on muscular strength and hypertrophy:A systematic review and meta-analysis

Purpose:We aimed to perform a systematic review and meta-analysis of the effects of training to muscle failure or non-failure on muscular strength and hypertrophy.Methods:Meta-analyses of effect sizes(ESs)explored the effects of training to failure vs.non-failure on strength and hypertrophy.Subgroup meta-analyses explored potential moderating effects of variables such as training status(trained vs.untrained),training volume(volume equated vs.volume non-equated),body region(upper vs.lower),exercise selection(multi-vs.single-joint exercises(only for strength)),and study design(independent vs.dependent groups).Results:Fifteen studies were included in the review.All studies included young adults as participants.Meta-analysis indicated no significant difference between the training conditions for muscular strength(ES=-0.09,95%confidence interval(95%CI):-0.22 to 0.05)and for hypertrophy(ES=0.22,95%CI:-0.11 to 0.55).Subgroup analyses that stratified the studies according to body region,exercise selection,or study design showed no significant differences between training conditions.In studies that did not equate training volume between the groups,the analysis showed significant favoring of non-failure training on strength gains(ES=-0.32,95%CI:-0.57 to-0.07).In the subgroup analysis for resistance-trained individuals,the analysis showed a significant effect of training to failure for muscle hypertrophy(ES=0.15,95%CI:0.03-0.26).Conclusion:Training to muscle failure does not seem to be required for gains in strength and muscle size.However,training in this manner does not seem to have detrimental effects on these adaptations,either.More studies should be conducted among older adults and highly trained individuals to improve the generalizability of these findings.

Effect of aerobic exercise on the contractile function of gastrocnemius myosin heavy chain

Objective To study the effect of 4-6 weeks’ treadmill training of male SD rats on the contractile function of their gastrocnemius myosin heavy chain (MHC). Methods Forty male SD rats were randomly divided into control group and training group. The treadmill training of the training group rats was incessantly performed for 4-6 weeks at an intensity of about 75% VO2max (18.5-24 m/min,gradient of 0°,each training session lasting 50 minutes,twice a day). The content of gastrocnemius MHC mRNA was tested by reverse transcription polymerase chain reaction (RT-PCR),and the changes of muscle fibre and its cross-section area (CSA) were measured using immunohistochemistry. Electric stimulation tests were used to determine the maximal tension of isometric contraction of the post-training gastrocnemius. Results ① After continuous treadmill training for 4-6 weeks,we found that the content of the total MHC,MHC Ⅰ,MHC Ⅱx,MHC Ⅱa mRNAs was 105%,105%,109% and 108% of that in the resting control group,respectively,and the MHC Ⅱb mRNA content did not change significantly. The percentage of MHC Ⅰ mRNA in the total MHC mRNA increased while that of MHC Ⅱ mRNA decreased after aerobic training. ② The slow type of fibre type Ⅰ was the main part of the MHC after training and the CSA of the muscle fibres increased simultaneously. ③ The maximal tension of isometric contraction by pulse stimulation of square wave in the training group increased significantly compared with that in the control group (P<0.01). Conclusion The findings indicate that aerobic exercise may promote an increase in the contractile function of MHC.

Ultrasonographic reference values for assessing normal radial nerve ultrasonography in the normal population

High-resolution ultrasound has been used recently to characterize median and ulnar nerves, but is seldom used to characterize radial nerves. The radial nerve is more frequently involved in en- trapment syndromes than the ulnar and median nerves. However, the reference standard for normal radial nerves has not been established. Thus, this study measured the cross-sectional areas of radial nerves of 200 healthy male or female volunteers, aged 18 to 75, using high-resolution ultrasound. The results showed that mean cross-sectional areas of radial nerves at 4 cm upon the lateral epicondyle of the humerus and mid-humerus （midpoint between the elbow crease and axilla） were 5.14± 1.24 and 5.08 ± 1.23 mm2, respectively. The age and the dominant side did not affect the results, but the above-mentioned cross-sectional areas were larger in males （5.31± 1.25 and 5.19 ±1.23 mm2） than in females （4.93 ± 1.21 and 4.93 ± 1.23 mm2, respectively）. In addition, the cross-sectional areas of radial nerves were positively correlated with height and weight （r = 0.38, 0.36, respectively, both P 〈 0.05）. These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evalua- tion of peripheral neuropathies.

Experiments on self-excited oscillation in a thin-walled collapsible tube

Self-excited oscillation in a collapsible tube is an important phenomenon in physiology. An experimental approach on self-excited oscillation in a thin-walled collapsi- ble tube is developed by using a high transmittance and low Young＇s modulus silicone rubber tube. The elastic tube is manufactured by the method of centrifugal casting in our laboratory. An optical method for recording the evolution of the cross-sectional areas at a certain position along the longitudinal direction of the tube is developed based on the technology of refractive index matching. With the transparent tube, the tube law is measured under the static no-flow condition. The cross section at the middle position of the tube transfers from a quasi-circular configuration to an ellipse, and then to a dumbell-shape as the chamber pressure is increased. During the self-excited oscillation, two periodic self-excited oscillating states and one transitional oscillating state are identified. They all belong to the LU mode. These different oscillating states are related to the initial cross-sectional shape of the tube caused by the difference of the downstream transmural pressure.

A Methodology for Identifying Defects in Wire Rope Based on Permanent Magnet Excitation

A wire rope defects detection method based on permanent magnet excitation is proposed.A detection system,mainly composed of permanent magnet excitation,distance detection,multi-sensor magnetic flux leakage signal acquisition and data analysis device,is set up.According to the different characteristics of the multi-sensor magnetic flux leakage signal,the localized fault(LF)and loss of metallic cross-sectional area(LMA)signal is separated,and then the two defects can be detected.The experiments show that the method can effectively detect the two defects when they appear simultaneously on the wire rope.

Quantification Threshold Pixel Technique of Magnetic Resonance Imaging in Paraspinal Muscles Atrophy among Discopathy Patients

Purpose: To evaluate the relationship between lumbosacral discopathy status and paraspinal atrophic changes (Cross-sectional area (CSA) and fatty infiltration (FI)) among different age groups. Materials and Methods: We retrospectively evaluated 200 patients with confirmed discopathy who were examined by lumbosacral Magnetic Resonance Imaging (MRI) at the two main governmental hospitals in Gaza Strip. Using ImageJ software and quantification threshold technique, we measured the CSA and FI of paraspinal muscles {multifidus (MF) & erector spinae (ES)}. The interpretation of MRI images was performed by two radiologists with a good inter-observer agreement between the radiological discopathy findings. Results: The highest percentage and severity of discopathy were noticed at the level of L4/5 (89.5%), followed by L5/S1 (14.5%). The FI is increased towards lower levels of L3/4 to L5/S1. No correlation was found between discopathy level, the severity of discopathy, and CSA of MF & ES muscles. In contrast, a correlation was observed between FI of MF & ES muscles, discopathy level, and severity. Also, the results illustrated no significant relation was observed between CSA of MF & ES muscles and age groups (P > 0.05), while a significant correlation was reported between FI and age groups (P Conclusion: The MRI quantification threshold pixel technique for paraspinal muscles reflected the atrophic changes like CSA and FI in discopathy patients.

Size of the Electron Microparticle Calculated from the Oersted Law

An attempt to obtain a new theoretical derivation of the size of the electron microparticle has been done. To this purpose first the Maxwell equation for the electron current has been examined for the case of the one-electron current present in the Bohr model of the hydrogen atom. It has been shown that the equation is satisfied on condition that the microstructure properties of the electron particle are taken into account. In the next step, the quanta of the magnetic field characteristic for the Bohr atom and the electron time periods specific for the electron current along the orbits were substituted in place of parameters entering the classical Oersted equation. This gives an expression for the cross-section radius of the orbits not much different than results for the radius of the electron microparticle obtained in a former electron theory

Associations between cancer family history and esophageal cancer and precancerous lesions in high-risk areas of China

Background:Family clustering of esophageal cancer(EC)has been found in high-risk areas of China.However,the relationships between cancer family history and esophageal cancer and precancerous lesions(ECPL)have not been comprehensively reported in recent years.This study aimed to provide evidence for identification of high-risk populations.Methods:This study was conducted in five high-risk areas in China from 2017 to 2019,based on the National Cohort of Esophageal Cancer.The permanent residents aged 40 to 69 years were examined by endoscopy,and pathological examination was performed for suspicious lesions.Information on demographic characteristics,environmental factors,and cancer family history was collected.Unconditional logistic regression was applied to evaluate odds ratios between family history related factors and ECPL.Results:Among 33,008 participants,6143(18.61%)reported positive family history of EC.The proportion of positive family history varied significantly among high-risk areas.After adjusting for risk factors,participants with a family history of positive cancer,gastric and esophageal cancer or EC had 1.49-fold(95%confidence interval[CI]:1.36-1.62),1.52-fold(95%CI:1.38-1.67),or 1.66-fold(95%CI:1.50-1.84)higher risks of ECPL,respectively.Participants with single or multiple first-degree relatives(FDR)of positive EC history had 1.65-fold(95%CI:1.47-1.84)or 1.93-fold(95%CI:1.46-2.54)higher risks of ECPL.Participants with FDRs who developed EC before 35,45,and 50 years of age had 4.05-fold(95%CI:1.30-12.65),2.11-fold(95%CI:1.37-3.25),and 1.91-fold(95%CI:1.44-2.54)higher risks of ECPL,respectively.Conclusions:Participants with positive family history of EC had significantly higher risk of ECPL.This risk increased with the number of EC positive FDRs and EC family history of early onset.Distinctive genetic risk factors of the population in high-risk areas of China require further investigation.Trial registration:ChiCTR-EOC-17010553.