Computer Vision-Based Bridge Inspection and Monitoring: A Review.

Bridge inspection and monitoring are usually used to evaluate the status and integrity of bridge structures to ensure their safety and reliability. Computer vision (CV)-based methods have the advantages of being low cost, simple to operate, remote, and non-contact, and have been widely used in bridge inspection and monitoring in recent years. Therefore, this paper reviews three significant aspects of CV-based methods, including surface defect detection, vibration measurement, and vehicle parameter identification. Firstly, the general procedure for CV-based surface defect detection is introduced, and its application for the detection of cracks, concrete spalling, steel corrosion, and multi-defects is reviewed, followed by the robot platforms for surface defect detection. Secondly, the basic principle of CV-based vibration measurement is introduced, followed by the application of displacement measurement, modal identification, and damage identification. Finally, the CV-based vehicle parameter identification methods are introduced and their application for the identification of temporal and spatial parameters, weight parameters, and multi-parameters are summarized. This comprehensive literature review aims to provide guidance for selecting appropriate CV-based methods for bridge inspection and monitoring.

Molecularly imprinted polymer functionalized magnetic Fe3 O4 for the highly selective extraction of triclosan.

We present a facile strategy to prepare the molecularly imprinted polymers layer on the surface of Fe3 O4 nanoparticles with core-shell structure via sol-gel condensation for recognition and enrichment of triclosan. The Fe3 O4 nanoparticles were first synthesized by a solvothermal method. Then, template triclosan was self-assembled with the functional monomer 3-aminopropyltriethoxysilane on the silica-coated Fe3 O4 nanoparticles in the presence of ethanol and water. Finally, the molecularly imprinted polymers were formed on the surface of silica-coated Fe3 O4 nanoparticles to obtain the product. The morphology, magnetic susceptibility, adsorption, and recognition property of magnetic molecularly imprinted polymers were characterized using transmission electron microscopy, Fourier transform infrared spectroscopy, X-ray diffractometry, vibrating sample magnetometry, and re-binding experiments. The magnetic molecularly imprinted polymers showed binding sites with good accessibility, fast adsorption rate, and high adsorption capacity (218.34 µg/g) to triclosan. The selectivity of magnetic molecularly imprinted polymers was evaluated by the rebinding capability of triclosan and two other structural analogues (phenol and p-chlorophenol) in a mixed solution and good selectivity with an imprinting factor of 2.46 was obtained. The application of triclosan removal in environmental samples was demonstrated.

Discovery of New Immune Checkpoints: Family Grows Up.

The first generation of immune checkpoint inhibitors (ICIs) including anti-CTLA-4 and anti-PD-1/anti-PD-L1 has achieved profound and great success. Till 2019 Q1, there are nine ICIs landing the oncology market: Ipilimumab (anti-CTLA-4, Bristol-Myers Squibb), Nivolumab (anti-PD-1, Bristol-Myers Squibb), Pembrolizumab (anti-PD-1, Merck), Atezolizumab (anti-PD-L1, Roche/Genentech), Durvalumab (anti-PD-L1, Astra Zeneca), Tremelimumab (anti-CTLA-4, Astra Zeneca), Cemiplimab (anti-PD-1, Sanofi/Regeneron), Toripalimab (anti-PD-1, Junshi), and Sintilimab (anti-PD-1, Innovent), which have covered the majority of hematologic and solid malignancies' indication. Beyond the considerable benefits for the patients, frustrated boundary still exists: limited response rate in monotherapy in late-stage population, poor effectiveness in neoplasms with immune desert and immune excluded types, and immune-related toxicities, some are life-threatened and with higher incidence in I-O combination regiment. Moreover, clinicians observed some cases switching to progression after achieving partial or complete response, indicating treatment failure or drug resistance. So people begin looking for the next generation of immune checkpoint members.

Patient satisfaction between primary care providers and hospitals: a cross-sectional survey in Jilin province, China.

OBJECTIVE: To assess patient satisfaction with outpatient and inpatient care between primary care providers and secondary/tertiary hospitals, and to examine its association with socio-demographic characteristics and type of institution, based on self-reported survey data. DESIGN: Cross-sectional survey. SETTING: Healthcare facilities within Jilin province, China. PARTICIPANTS: In total, 993 outpatients and 925 inpatients aged ≥15 years old were recruited. MAIN OUTCOME MEASURES: Patient satisfaction with the care experience. RESULTS: Patient satisfaction with outpatient and inpatient care was significantly associated with type of healthcare delivery setting in Jilin, China. Seeking outpatient care from community health centers (CHCs) was significantly associated with a higher ratio of patient satisfaction. Patients of county and tertiary hospitals complained about long-waiting times, bad attitudes of health workers, high expense of treatment, and their overall satisfaction towards outpatient care was lower. In the terms of inpatient care, patients were more satisfied with treatment expense in CHCs compared with county hospitals. CONCLUSIONS: CHCs and hospitals face different challenges regarding patient satisfaction. Further healthcare reform in China need to adopt more measures (e.g. increasing quality of primary care, setting up a referral medical system etc.) to improve patient satisfaction.

OCT1 is a determinant of synbindin-related ERK signalling with independent prognostic significance in gastric cancer.

OBJECTIVE: Octamer transcription factor 1 (OCT1) was found to be expressed in intestinal metaplasia and gastric cancer (GC), but the exact roles of OCT1 in GC remain unclear. The objective of this study was to determine the functional and prognostic implications of OCT1 in GC. DESIGN: Expression of OCT1 was examined in paired normal and cancerous gastric tissues and the prognostic significance of OCT1 was analysed by univariate and multivariate survival analyses. The functions of OCT1 on synbindin expression and extracellular signal-regulated kinase (ERK) phosphorylation were studied in vitro and in xenograft mouse models. RESULTS: The OCT1 gene is recurrently amplified and upregulated in GC. OCT1 overexpression and amplification are associated with poor survival in patients with GC and the prognostic significance was confirmed by independent patient cohorts. Combining OCT1 overexpression with American Joint Committee on Cancer staging improved the prediction of survival in patients with GC. High expression of OCT1 associates with activation of the ERK mitogen-activated protein kinase signalling pathway in GC tissues. OCT1 functions by transactivating synbindin, which binds to ERK DEF domain and facilitates ERK phosphorylation by MEK. OCT1-synbindin signalling results in the activation of ERK substrates ELK1 and RSK, leading to increased cell proliferation and invasion. Immunofluorescent study of human GC tissue samples revealed strong association between OCT1 protein level and synbindin expression/ERK phosphorylation. Upregulation of OCT1 in mouse xenograft models induced synbindin expression and ERK activation, leading to accelerated tumour growth in vivo. CONCLUSIONS: OCT1 is a driver of synbindin-mediated ERK signalling and a promising marker for the prognosis and molecular subtyping of GC.

CD24 mediates gastric carcinogenesis and promotes gastric cancer progression via STAT3 activation.

The development of gastric cancer (GC) is a complex multistep process, including numerous genetic and epigenetic changes. CD24 is associated with enhanced invasiveness of GC and a poor prognosis. However, the mechanism by which CD24 induces GC progression remains poorly characterized. Here, we found that the expression of CD24 gradually increased in samples of normal gastric mucosa, non-atrophic chronic gastritis, chronic atrophic gastritis (CAG), CAG with intestinal metaplasia, dysplasia and GC. Moreover, the knockdown of CD24 induced significant levels of apoptosis in GC cells via the mitochondrial apoptotic pathway. CD24 may also promote cellular invasion and regulate the expression of E-cadherin, fibronectin and vitamin D receptor in GC cells. The activation of signal transducer and activator of transcription 3 (STAT3) may mediate CD24-induced GC survival and invasion in vitro. Furthermore, CD24-induced GC progression and STAT3 activation could also be detected in vivo and in clinical GC tissues samples. Taken together, our results indicate that CD24 mediates gastric carcinogenesis and may promote GC progression by suppressing apoptosis and promoting invasion, with the activation of STAT3 playing a critical role.

The role of ERK2 in colorectal carcinogenesis is partly regulated by TRAPPC4.

The extracellular signal-regulated kinase (ERK), mitogen-activated protein kinase (MAPK) pathway is an important cell proliferation pathway. We previously reported that the transport protein particle complex 4 (TRAPPC4), ERK2 interaction may activate ERK1/2, modulate pERK2 nuclear localization and regulate proliferation and apoptosis in colorectal cancer (CRC) cells. The present study further investigated the function of the TRAPPC4-ERK2 interaction in CRC in vitro and in vivo. Silencing of TRAPPC4 induced G0/G1 phase cell cycle arrest, upregulated p21 and downregulated cyclin B1 in CRC cells. Overexpression of TRAPPC4 after ERK2 silencing decreased the percentage of G0/G1 phase cells, increased the percentage of G2/M and S phase cells, downregulated p21, upregulated cyclin B1, and enhanced CRC cell viability. Immunohistochemical staining revealed that knockdown of TRAPPC4 downregulated pERK2, whereas overexpression of TRAPPC4 upregulated pERK2. Epidermal growth factor (EGF) stimulated upregulation of TRAPPC4 and pERK2 in SW1116 cells; EGF stimulation or overexpression of TRAPPC4 induced pERK2 nuclear translocation. Silencing of TRAPPC4 reduced SW1116 xenograft tumor growth in vivo, whereas overexpression of TRAPPC4 increased tumor growth, compared to control tumors. Moreover, modulation of TRAPPC4 expression in vivo affected the levels of pERK2 in the cytoplasm and nucleus and expression of p21. These results conclusively demonstrate that TRAPPC4 regulates ERK2 activation and also affects the distribution of activated pERK2 in CRC cells. The ability of ERK2 to play a role in colorectal carcinogenesis depends, at least in part, on TRAPPC4.

Identification of potential target genes of butyrate in dimethylhydrazine-induced colorectal cancer in mice.

The mechanism by which butyrate prevents colorectal cancer (CRC) is unclear. The objective of this study was to identify potential target genes of butyrate in 1,2-dimethylhydrazine (DMH)-induced CRC in mice. Nontumor colorectal tissues of mice from DMH + butyrate, DMH, and control groups were hybridized on Agilent Mouse Whole Genome 44K Oligo Microarrays. Selected genes were validated by qRT-PCR. Data was further analyzed by KEGG, gene ontology (GO), and pathway studio software. The tumor incidence in the DMH + butyrate and DMH groups was 30% and 90%, respectively (P < 0.05). There were 355 genes downregulated due to DMH treatment while upregulated by butyrate, and 475 genes upregulated by DMH while downregulated by butyrate. The results revealed that most of the tumor-related signaling pathways (e.g., MAPK pathway, Wnt pathway, insulin pathway, and VEGF pathway) were downregulated by butyrate. The GO terms related to cell differentiation, cell cycle, cell proliferation, cell death, cell adhesion, and cell migration were significantly affected. The chemopreventive effects of butyrate were confirmed in the DMH-induced CRC mice model. And mechanisms encompassing multiple pathways and GO terms are involved in the regulation of gene expression.

Maintenance treatment of mild gastroesophageal reflux disease with proton pump inhibitors taken on-demand: a meta-analysis.

BACKGROUND/AIMS: To evaluate the efficacy of on-demand strategy with proton pump inhibitors (PPIs) in mild gastroesophageal reflux disease (GERD). METHODOLOGY: A literature search was conducted to identify randomized controlled clinical trials which investigating on-demand treatment with PPIs in mild GERD. The control group should be placebo or once-daily treatment. Comparison of treatment effect was performed. RESULTS: Eight studies met the inclusion criteria, of which six were compared with placebo, two others with once-daily treatment. The percentage of patients unwilling to continue the study was 12.1% in the on-demand group while 39.6% in the placebo group. The meta-analysis revealed a statistically significant difference between the two groups (RR: 0.32; 95% CI: 0.23, 0.43). We obtained a similar result when compared with once-daily treatment (RR: 0.52; 95% CI: 0.34, 0.79). CONCLUSIONS: This meta-analysis indicates that on-demand therapy with PPIs is superior to placebo or once-daily treatment in terms of mild GERD.

Comparison of the clinicopathological characteristics of young and elderly patients with gastric carcinoma: a meta analysis.

To evaluate the relationship between age and clinicopathological characteristics in gastric carcinoma patients, we performed the meta-analysis based on nine retrospective clinical trials. Comparing elderly patients with young patients it showed lower male/female ratio, more diffuse GC, more Borrmann type IV, more poorly differentiated carcinoma, more peritoneal metastasis, less vascular invasion, fewer partial resections, and better 5-year survival rate. These particular age-related characteristics need to be further investigated.

Instrumentation design for bridge scour monitoring using fiber Bragg grating sensors.

Scour is one of the main causes of bridge failures. In order to measure and monitor scour depth variations including deposition (refilling) process, three designs for a scour monitoring system using fiber Bragg grating (FBG) sensors are discussed in the present study. By a comparative study, one of them is recommended in the present study and its instrumentation manufacture process is also introduced in detail. Using this recommended design, the advantages of FBG sensors for monitoring, such as immunity from electromagnetic interference and multiplexing capability, can be fully utilized. Both scour depth variations and entire scour development process including deposition process can be correctly monitored in real-time by continuously identifying the locations of emerging FBG sensors from the riverbed. A reliable sensor protection measure is also designed for FBG sensors in harsh environments, especially in floods. Finally, a verification test using a flume is carried out in the laboratory and three experimental cases are conducted to demonstrate the capability of FBG sensors and applicability of the recommended scour monitoring system. It can be concluded that the recommended scour monitoring system using FBG sensors is capable of measuring the water level, (maximum) scour depth, entire process of scour development, and deposition height due to refilling process. The advantages over other conventional scour monitoring systems are clearly demonstrated.

Current-distance relationships for peripheral nerve stimulation localization.

BACKGROUND: Successful peripheral nerve blocks require accurate placement of the injection needle tip before local anesthetic application. In this investigation, we experimentally reconstructed polarity-dependent (anode and cathode) stimulation maps using ex vivo and in vivo animal models. METHODS: A novel ex vivo configuration (muscle-nerve composite) was first used to probe both cathodic and anodic stimulation characteristics. The electrophysiology (compound nerve action potential, CAP) of rat sciatic nerve was recorded at varying stimulation (monopolar electrode) distances and intensities. We repeated this methodology with an open dissection rat model that was more analogous to the clinical setting. Resultant data from the current sweeps were plotted as a 3-dimensional distance-stimulus-CAP map. These plots depict the minimum stimulation currents required for nerve activation and describe the expected electrophysiological outcomes as a function of distance and input stimulus intensity. The stimulation maps provide positional information relevant to clinical procedures such as nerve localization during regional anesthesia. RESULTS: Cathodic stimulation produced a complex biphasic electrophysiological response. The CAP amplitude (with fixed current) increased as the electrode moved closer towards the nerve, but decreased upon close proximity or nerve contact. This phenomenon was dependent upon stimulation intensity and was observed in both ex vivo and in vivo models. Anodic stimulation produced a monotonic relationship, with the CAP increasing with closer electrode-to-nerve distances. Minimum extraneural activation thresholds were found to be 0.34 ± 0.11 mA (mean ± sd) and 0.63 ± 0.12 mA for cathode and anode stimulation, respectively. Intraneural thresholds were substantially lower, 0.12 ± 0.03 mA and 0.32 ± 0.09 mA, for cathode and anode, respectively. CONCLUSION: Cathodic stimulation may produce conduction block at close tip-to-nerve distances. In contrast, anodic stimulation elicited output characteristics that were predictable and more suitable for nerve localization. We believe anodic stimulation is a viable option at near-nerve distances, despite the increased current requirements. This hypothesis is a paradigm shift in stimulation nerve localization, which conventionally has been cathode based. The hypothesis should be clinically validated.

Residual Strength Evaluation of Corroded Textile-Reinforced Concrete by the Deep Learning-Based Method.

Residual strength of corroded textile-reinforced concrete (TRC) is evaluated using the deep learning-based method, whose feasibility is demonstrated by experiment. Compared to the traditional method, the proposed method does not need to know the climatic conditions in which the TRC exists. Firstly, the information about the faster region-based convolutional neural networks (Faster R-CNN) is described briefly, and then procedures to prepare datasets are introduced. Twenty TRC specimens were fabricated and divided into five groups that were treated to five different corrosion degrees corresponding to five different residual strengths. Five groups of images of microstructure features of these TRC specimens with five different residual strengths were obtained with portable digital microscopes in various circumstances. With the obtained images, datasets required to train, validate, and test the Faster R-CNN were prepared. To enhance the precision of residual strength evaluation, parameter analysis was conducted for the adopted model. Under the best combination of considered parameters, the mean average precision for the residual strength evaluation of the five groups of the TRC is 98.98%. The feasibility of the trained model was finally verified with new images and the procedures to apply the presented method were summarized. The paper provides new insight into evaluating the residual strength of structural materials, which would be helpful for safety evaluation of engineering structures.

Repeatability of nerve conduction measurements derived entirely by computer methods.

BACKGROUND: Nerve conduction studies are an objective, quantitative, and reproducible measure of peripheral nerve function and are widely used in the diagnosis of neuropathies. The purpose of this study is to determine the reliability of nerve conduction parameters derived entirely from computer based data acquisition and waveform cursor assignments and to quantify the relative contributions of test variability sources. METHODS: Thirty volunteers, some with symptoms suggestive of neuropathies; of these, 29 completed the study. The median, ulnar, deep peroneal, posterior tibial, and sural nerves were evaluated bilaterally at two test sessions 3-7 days apart. Within each session, nerves were tested twice within 10 minutes. The analyzed nerve conduction parameters include motor latencies, motor conduction velocity (CV), compound muscle action potential (CMAP) amplitude, F-wave latencies (minimum, mean and maximum), sensory peak latency (DSL), sensory CV, and sensory nerve action potential (SNAP) amplitude. The primary outcome measure is variance component analysis and the corresponding coefficient of variation (CoV). The between-session-test variance is the sum of within-session variance and between-session variance, quantifying the total variation between test sessions. Additional statistical measures include the intraclass correlation coefficient (ICC) and relative interval variation (RIV). RESULTS: Motor and sensory latencies, CV and F-wave latency parameters have low between-session-test CoVs, ranging from 4.2% to 9.8%. Amplitude parameters have a higher between-session-test CoVs in the range of 15.6--19.8%. Between-test CoVs are about 30--80% lower than between-session CoVs with the exception of F-wave latency parameters. Between-test ICC values are 0.96 or above for all parameters. Between-session ICC ranges from 0.98 for F-wave latency to 0.77 for sural sensory CV. All latency-related between-session ICCs have a value 0.83 or above. The RIVs are the tightest for F-wave latency parameters and widest for CMAP amplitude parameters. Repeatability in a sub-group of subjects with more severe symptom grades follows the same trend as the overall study population without substantial quantitative differences. CONCLUSION: The study demonstrates the high repeatability of nerve conduction parameters acquired by modern electrodiagnostic instruments using computer based waveform cursor assignment. The reliability is comparable to benchmark studies in which the nerve conduction measurements were performed manually in controlled multi-center clinical trials. Furthermore, the ranking of reliability, whereby F-wave latencies have the best reproducibility and amplitudes the worst, is also consistent with the benchmark studies.

Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study.

OBJECTIVE: The purpose of this study was to determine if transcutaneous electrical nerve stimulation (TENS) improves sleep in chronic low back pain (CLBP). BACKGROUND: There is uncertainty over the effectiveness of TENS in CLBP. In most studies, pain intensity has been the primary outcome measure. Although sleep abnormalities are common in CLBP, sleep outcomes have not been evaluated in most studies of TENS effectiveness. Subjective and objective sleep measures are often inconsistent in CLBP, suggesting that perception of sleep and actual sleep may differ. METHODS: This retrospective cohort study evaluated TENS for CLBP over 10 weeks. The source database included demographics, pain characteristics, pain intensity and interference on an 11-point numerical rating scale, adherence and actigraphic sleep data from real-world TENS users. Key inclusion criteria were CLBP with self-reported history of back injury and baseline pain interference with sleep ≥4. Study participants were stratified into improved and unimproved groups based on changes in pain interference with sleep (improved ≥1-point decrease). Actigraphic sleep metrics were compared between the two groups for weeks 1-2 and weeks 9-10. RESULTS: The inclusion criteria were met by 554 TENS users. There were 282 (50.9%) participants in the improved group and 272 (49.1%) in the unimproved group. The two groups had similar baseline characteristics and high TENS adherence. At the weeks 1-2 assessment, there were no differences among actigraphic sleep. At the weeks 9-10 assessment, there was a difference in total sleep time, with the improved group sleeping 29 minutes longer. In addition, the periodic leg movement (PLM) index was lower in the improved group. CONCLUSION: Regular TENS improved self-reported and objective sleep measures in individuals with CLBP. When compared to the unimproved group, the improved group had longer total sleep time and fewer PLMs. Sleep may be an important outcome for TENS effectiveness in CLBP.

Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: a large-scale, observational study.

OBJECTIVE: The objective of this study was to assess the effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) in a real-world chronic pain sample. BACKGROUND: There is a need for nonpharmacological treatment options for chronic pain. FS-TENS improved multisite chronic pain in a previous interventional study. Large observational studies are needed to further characterize its effectiveness. METHODS: This retrospective observational cohort study examined changes in chronic pain measures following 60 days of FS-TENS use. The study data were obtained from FS-TENS users who uploaded their device utilization and clinical data to an online database. The primary outcome measures were changes in pain intensity and pain interference with sleep, activity, and mood on an 11-point numerical rating scale. Dose-response associations were evaluated by stratifying subjects into low (≤30 days), intermediate (31-56 days), and high (≥57 days) utilization subgroups. FS-TENS effectiveness was quantified by baseline to follow-up group differences and a responder analysis (≥30% improvement in pain intensity or ≥2-point improvement in pain interference domains). RESULTS: Utilization and clinical data were collected from 11,900 people using FS-TENS for chronic pain, with 713 device users meeting the inclusion and exclusion criteria. Study subjects were generally older, overweight adults. Subjects reported multisite pain with a mean of 4.8 (standard deviation [SD] 2.5) pain sites. A total of 97.2% of subjects identified low back and/or lower extremity pain, and 72.9% of subjects reported upper body pain. All pain measures exhibited statistically significant group differences from baseline to 60-day follow-up. The largest changes were pain interference with activity (-0.99±2.69 points) and mood (-1.02±2.78 points). A total of 48.7% of subjects exhibited a clinically meaningful reduction in pain interference with activity or mood. This proportion increased to 57.1% for the high utilization subgroup. CONCLUSION: FS-TENS is a practical option for treating multisite chronic pain. The greatest impact is on pain interference with activity and mood. FS-TENS utilization and effectiveness exhibit a dose-response association, suggesting that daily use maximizes pain relief.

The distinct role of strand-specific miR-514b-3p and miR-514b-5p in colorectal cancer metastasis.

The abnormal expression of microRNAs (miRNAs) in colorectal cancer (CRC) progression has been widely investigated. It was reported that the same hairpin RNA structure could generate mature products from each strand, termed 5p and 3p, which binds different target mRNAs. Here, we explored the expression, functions, and mechanisms of miR-514b-3p and miR-514b-5p in CRC cells and tissues. We found that miR-514b-3p was significantly down-regulated in CRC samples, and the ratio of miR-514b-3p/miR-514b-5p increased from advanced CRC, early CRC to matched normal colorectal tissues. Follow-up functional experiments illustrated that miR-514b-3p and miR-514b-5p had distinct effects through interacting with different target genes: MiR-514b-3p reduced CRC cell migration, invasion and drug resistance through increasing epithelial marker and decreasing mesenchymal marker expressions, conversely, miR-514b-5p exerted its pro-metastatic properties in CRC by promoting EMT progression. MiR-514b-3p overexpressing CRC cells developed tumors more slowly in mice compared with control cells, however, miR-514b-5p accelerated tumor metastasis. Overall, our data indicated that though miR-514b-3p and miR-514b-5p were transcribed from the same RNA hairpin, each microRNA has distinct effect on CRC metastasis.

Factors influencing F-wave latency detection of lumbosacral root lesions using a detection theory based model.

OBJECTIVE: To evaluate the F-wave dilution hypothesis; which implies that absolute F-wave latencies obscure the much smaller delay associated with slow intra-lesion conduction, such is caused by nerve root compression in lumbosacral radiculopathy. A corollary objective is to determine how F-wave measurement and pathological factors influence diagnostic accuracy. METHODS: An analytical model is developed based on signal detection theory and a number of simplifying assumptions. Diagnostic accuracy, quantified by the area under the receiver operating characteristic (ROC) curve, is determined for various model realizations derived from the clinical and experimental neurophysiology literature. A preliminary experimental validation of model predictions is also performed. RESULTS: Absolute F-wave latency does not influence the accuracy of focal lesion detection. F-wave latency variance and lesion pathology are the determinant factors. F-wave latencies and distal latencies are estimated to have qualitatively similar detection characteristics, although distal latencies have quantitatively better diagnostic efficacy for comparable focal pathology. Preliminary experimental results support the modeled dependence of diagnostic accuracy on latency variance and lesion severity. CONCLUSIONS: Absolute F-wave latency does not dilute slow conduction within focal lesions, such as in lumbosacral radiculopathy. The dominant measurement factor is F-wave latency variance. SIGNIFICANCE: To maximize the diagnostic utility of F-wave latencies, focus must be placed on reducing latency variance, such as through correction for demographic covariates. This model calls into question the F-wave dilution hypothesis.

NC-stat sensory nerve conduction studies in the median and ulnar nerves of symptomatic patients.

OBJECTIVE: This study evaluated validity and reliability of automated median and ulnar sensory nerve conduction study (NCS) measurements by the NC-stat. METHODS: Median and ulnar distal sensory latencies (DSL) and amplitudes (SNAP) were measured in sixty subjects with the NC-stat and by a neurologist (reference) using traditional instrumentation. The median-ulnar DSL differences (MUD) was calculated. Validity was quantified by the Pearson correlation. Reliability was evaluated by the intraclass correlation coefficient (ICC), Bland-Altman analysis, and inter-rater agreement of MUD abnormalities. RESULTS: As a result of differences in electrode placement, NC-stat and reference mean values had systematic differences. The correlation ranged from 0.70 (ulnar DSL) to 0.91 (median DSL). The ICC ranged from 0.69 (ulnar DSL) to 0.91 (median DSL). In Bland-Altman analysis of DSLs, NC-stat measurements had a bias of 0.56 ms (median) and 0.31 ms (ulnar) and precision of 0.31 and 0.30 ms. Inter-rater agreement for MUD abnormalities was 93.8% (raw) and 0.80 (Kappa). CONCLUSIONS: NC-stat validity and reliability metrics were similar to traditional NCS. Use of the NC-stat would require applicable reference ranges. SIGNIFICANCE: NC-stat median and ulnar NCS are valid and reliable. This device may be useful for increasing availability of NCS when clinically appropriate.

Diabetic nerve conduction abnormalities in the primary care setting.

BACKGROUND: Nerve conduction studies (NCS) are the most objective measure of nerve function, and their use is recommended in the clinical and epidemiological evaluation of diabetic polyneuropathy (DPN). The purpose of this study was to utilize automated NCS technology to characterize nerve conduction of patients with diabetes in primary care settings. METHODS: The Diabetes cohort was drawn from 28 community clinics. The Control cohort consisted of subjects without diabetes and without evidence of neuropathy. Bilateral peroneal NCS were performed with an automated NCS instrument (NC-stat, NeuroMetrix, Inc., Waltham, MA). Neuropathic symptoms were quantified using an abbreviated form of the NTSS-6 questionnaire. Risk factors for abnormal NCS were determined using multivariate regression modeling. RESULTS: Data were collected for 172 control subjects and 1,358 subjects with diabetes. Statistically significant differences in peroneal NCS were found. Of the Diabetes cohort, 75.1% had at least one NCS abnormality, and 53.2% had bilateral abnormalities. Of the asymptomatic patients, 45% had bilateral NCS abnormalities. By contrast, 40% of those with clinically significant symptoms lacked bilateral NCS abnormalities. Independent predictors for bilateral NCS abnormalities were age, height, weight, hemoglobin A1c (HbA1c), and duration of diabetes. Up to 16% of the variance in NCS measurements was explained by HbA1c, duration of diabetes, and several demographic variables. CONCLUSIONS: This study suggests that automated NCS can provide nerve conduction confirmation of DPN in primary care settings and has clinical utility. These findings have important implications for the clinical and epidemiological evaluation of DPN.