The Neurophysiological Severity of Carpal Tunnel Syndrome Cannot Be Predicted by Median Nerve Cross-Sectional Area and Wrist-to-Forearm Ratio.

PURPOSE: The median nerve cross-sectional area at the wrist (CSA) and the wrist-to-forearm ratio of the cross-sectional areas (WFR) are ultrasound parameters used in the diagnosis and grading of carpal tunnel syndrome. This study aimed to determine the diagnostic accuracy of the CSA and WFR as well as to compare their diagnostic value. METHODS: A retrospective evaluation was conducted of a cohort of 218 patients who had undergone nerve conduction studies (NCSs) and an ultrasound of the median nerve. The examined wrists were classified into an NCS negative and three NCS positive (mild, moderate, and severe) categories. The CSA and WFR were compared across the categories. RESULTS: The CSA and WFR were significantly smaller in the NCS negative category than in the NCS positive categories. The WFR was significantly smaller in the mild category than in the moderate category. The CSA could not be used to differentiate across the NCS positive categories. CONCLUSIONS: The CSA and WFR are satisfactorily reliable in detecting carpal tunnel syndrome, but they cannot be considered as surrogate indicators of electrophysiological severity.

Biochemical characterization of androgen receptor-interacting protein 4.

ARIP4 [AR (androgen receptor)-interacting protein 4] is a member of the SNF2-like family of proteins. Its sequence similarity to known proteins is restricted to the centrally located SNF2 ATPase domain. ARIP4 is an active ATPase, and dsDNA (double-stranded DNA) and ssDNA (single-stranded DNA) enhance its catalytic activity. We show in the present study that ARIP4 interacts with AR and binds to DNA and mononucleosomes. The N-terminal region of ARIP4 mediates interaction with AR. Kinetic parameters of the ARIP4 ATPase are similar to those of BRG-1 and SNF2h, two members of the SNF2-like protein family, but the specific activity of ARIP4 protein purified to >90% homogeneity is approximately ten times lower, being 120 molecules of ATP hydrolysed by an ARIP4 molecule per min in contrast with approx. 1000 ATP molecules hydrolysed per min by ATP-dependent chromatin remodellers. Unlike other members of the SNF2 family, ARIP4 does not appear to form large protein complexes in vivo or remodel mononucleosomes in vitro. ARIP4 is covalently modified by sumoylation, and mutation of six potential SUMO (small ubiquitin-related modifier) attachment sites abolished the ability of ARIP4 to bind DNA, hydrolyse ATP and activate AR function. We conclude that, similar to its closest homologues in the SNF2-like protein family, ATRX (alpha-thalassemia, mental retardation, X-linked) and Rad54, ARIP4 does not seem to be a classical chromatin remodelling protein.