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1.
Sensors (Basel) ; 22(18)2022 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-36146419

RESUMO

In recent decades, the increased use of sensor technologies, as well as the increase in digitalisation of aircraft sustainment and operations, have enabled capabilities to detect, diagnose, and predict the health of aircraft structures, systems, and components. Predictive maintenance and closely related concepts, such as prognostics and health management (PHM) have attracted increasing attention from a research perspective, encompassing a growing range of original research papers as well as review papers. When considering the latter, several limitations remain, including a lack of research methodology definition, and a lack of review papers on predictive maintenance which focus on military applications within a defence context. This review paper aims to address these gaps by providing a systematic two-stage review of predictive maintenance focused on a defence domain context, with particular focus on the operations and sustainment of fixed-wing defence aircraft. While defence aircraft share similarities with civil aviation platforms, defence aircraft exhibit significant variation in operations and environment and have different performance objectives and constraints. The review utilises a systematic methodology incorporating bibliometric analysis of the considered domain, as well as text processing and clustering of a set of aligned review papers to position the core topics for subsequent discussion. This discussion highlights state-of-the-art applications and associated success factors in predictive maintenance and decision support, followed by an identification of practical and research challenges. The scope is primarily confined to fixed-wing defence aircraft, including legacy and emerging aircraft platforms. It highlights that challenges in predictive maintenance and PHM for researchers and practitioners alike do not necessarily revolve solely on what can be monitored, but also covers how robust decisions can be made with the quality of data available.


Assuntos
Aeronaves , Aviação
2.
BMC Neurol ; 21(1): 162, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863304

RESUMO

BACKGROUND: Patients who have been successfully treated for an aneurysmal subarachnoid hemorrhage (aSAH) often retain multiple health complaints, including mood disorders, cognitive complaints, fatigue, and problems with social participation. These problems are not always fully addressed during hospital visits or in current outcome measures, such as the modified Rankin score and the Glasgow Outcome Scale. Here, we present the development of the "Questionnaire for the Screening of Symptoms in aneurysmal Subarachnoid Hemorrhage" (SOS-SAH), which screens for the self-reported symptoms of patients with mild disabilities. METHODS: During the development of the SOS-SAH we adhered to the PROM-cycle framework for the selection and implementation of patient-reported outcome measures (PROMs). The SOS-SAH was developed in an iterative process informed by a literature study. Patients and healthcare professionals were involved in the development process through participating in a working group, interviews, and a cognitive validation study. RESULTS AND CONCLUSIONS: Relevant patient-reported outcomes (PROs) were identified for patients with aSAH. The SOS-SAH was developed primarily using domains and items from existing PROMs and, if necessary, by developing new items. The SOS-SAH consists of 40 items and covers 14 domains: cognitive abilities, hypersensitivity to stimuli, anxiety, depression, fatigue, social roles, personality change, language, vision, taste, smell, hearing, headache, and sexual function. It also includes a proxy measurement for use by family members to assess cognitive functioning and personality change.


Assuntos
Programas de Rastreamento/instrumentação , Medidas de Resultados Relatados pelo Paciente , Psicometria/instrumentação , Hemorragia Subaracnóidea/complicações , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Resultado do Tratamento
3.
Mult Scler ; 25(13): 1728-1735, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31218911

RESUMO

BACKGROUND: Preclinical studies suggest that fluoxetine has neuroprotective properties that might reduce axonal degeneration in multiple sclerosis (MS). OBJECTIVE: To determine whether fluoxetine slows accumulation of disability in progressive MS. METHODS: In a double-blind multicenter phase 2 trial, patients with primary or secondary progressive MS were randomized to fluoxetine 40 mg/day or placebo for a period of 108 weeks. Clinical assessments were performed every 12 weeks by trained study nurses who visited the patients at their home. The primary outcome was the time to a 12-week confirmed 20% increase in the Timed 25 Foot Walk or 9-Hole Peg test. Secondary outcomes included the Hauser ambulation index, cognitive tests, fatigue, and brain magnetic resonance imaging (MRI). RESULTS: In the efficacy analysis, 69 patients received fluoxetine and 68 patients received placebo. Using the log-rank test (p = 0.258) and Cox regression analysis (p = 0.253), we found no significant difference in the primary outcome between the two groups. Due to an unexpected slow rate of progression in the placebo group, there was insufficient statistical power to detect a potential benefit of fluoxetine. We found no differences between the two groups for secondary outcomes. CONCLUSION: The trial failed to demonstrate a neuroprotective effect of fluoxetine in patients with progressive MS.


Assuntos
Fluoxetina/uso terapêutico , Esclerose Múltipla Crônica Progressiva/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Ensaios Clínicos Fase II como Assunto , Humanos
4.
Neurol Sci ; 40(5): 1041-1047, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30796623

RESUMO

INTRODUCTION: No consensus exists about the upper limit of normal (ULN) of the cross-sectional area (CSA) of the median nerve in diagnosing carpal tunnel syndrome (CTS). Previously, we demonstrated a strong positive correlation between wrist circumference and CSA. ULN depending on wrist circumference turned out to have a low sensitivity, which was hypothesized to be caused by an age mismatch. The aim of this study was to re-evaluate the found invariance by augmentation of the healthy control group, adding older subjects, and to determine the diagnostic accuracy of the updated normal values. METHODS: CSA and wrist circumference were measured in an additional 42 healthy controls in the ages of 40-60. Univariable and multivariable linear regression analyses were applied to determine predicting factors for CSA. Diagnostic accuracy was assessed in a prospective cohort of 253 patients. RESULTS: A strong correlation was found between wrist circumference and CSA (r = 0.61). Wrist circumference is the most important independent predictor for ULN (r2 = 0.37). We managed to simplify our newly derived regression equations, which turned out to be unrelated to age. Sensitivity of our new equations is low, but higher than a general fixed cut-off value (53.4% and 47.4%, respectively). DISCUSSION: Wrist circumference is the most important independent predicting factor of CSA. By using our updated equations and taking wrist circumference into account, one can determine a more precise ULN for each individual, which will lead to the improvement of the diagnostic accuracy of ultrasonography (US). Sensitivity for US in diagnosing CTS remains low and it can therefore not replace EDX.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/patologia , Nervo Mediano/diagnóstico por imagem , Ultrassonografia , Punho/patologia , Adulto , Envelhecimento/patologia , Feminino , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Punho/anatomia & histologia
5.
Neurol Sci ; 40(9): 1813-1819, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31041610

RESUMO

INTRODUCTION: In carpal tunnel release, it is yet unclear whether a learning curve exists among surgeons. The aim of our study was to investigate if outcome after carpal tunnel release is dependent on surgeon's experience and to get an impression of the learning curve for this procedure. METHODS: A total of 188 CTS patients underwent carpal tunnel release. Patients completed the Boston Carpal Tunnel Questionnaire at baseline and 6-8 months postoperatively together with a six-point scale for perceived improvement. RESULTS: Patients operated by an experienced resident or certified surgeon reported a favorable outcome more often than patients operated by an inexperienced resident (adjusted OR 3.23 and adjusted OR 3.16, respectively). In addition, a negative association was found between surgeon's years of experience and postoperative Symptom Severity Scale and Functional Status Scale scores. DISCUSSION: Outcome after carpal tunnel release seems to be dependent on surgical experience, and there is a learning curve in residents.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Competência Clínica , Descompressão Cirúrgica , Internato e Residência , Curva de Aprendizado , Procedimentos Neurocirúrgicos , Avaliação de Resultados da Assistência ao Paciente , Cirurgiões , Adulto , Idoso , Competência Clínica/normas , Descompressão Cirúrgica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/normas , Cirurgiões Ortopédicos/normas , Cirurgiões/normas
6.
Neurol Sci ; 40(12): 2555-2564, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321625

RESUMO

BACKGROUND: Cognitive functioning has been linked to employment outcomes in multiple sclerosis (MS) in cross-sectional studies. Longitudinal studies are however lacking and previous studies did not extensively examine executive functioning. OBJECTIVES: We examined whether baseline cognitive functioning predicts a change in employment status after 2 years, while taking into account mood, fatigue and disability level. METHODS: A total of 124 patients with relapsing-remitting MS (pwMS) and 60 healthy controls were included. They underwent neurological and neuropsychological examinations and completed online questionnaires. PwMS were divided into a stable and deteriorated employment status group (SES and DES), based on employment status 2 years after baseline. We first examined baseline differences between the SES and DES groups in cognitive functioning, mood, fatigue and disability level. A logistic regression analysis was performed, with change in employment status (SES/DES) as dependent variable. RESULTS: The DES group included 22% pwMS. Group differences were found in complex attention, executive functioning, self-reported cognitive functioning, fatigue and physical disability. More physical disability (OR = 1.90, p = 0.01) and lower executive functioning (OR = 0.30, p = 0.03) were retained as independent predictors of DES (R2 = 0.22, p ≤ 0.001). CONCLUSIONS: Baseline physical disability and executive functioning, but none of the other variables, moderately predicted a deterioration in employment status 2 years later. TRIAL REGISTRATION: This observational study is registered under NL43098.008.12: 'Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose'. This study is registered at the Dutch CCMO register (https://www.toetsingonline.nl).


Assuntos
Atenção/fisiologia , Disfunção Cognitiva/fisiopatologia , Emprego , Função Executiva/fisiologia , Fadiga/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Índice de Gravidade de Doença , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Acta Neurochir (Wien) ; 161(4): 663-671, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30783807

RESUMO

BACKGROUND: The effectiveness of the surgical treatment of carpal tunnel syndrome (CTS) is well known on short term. However, limited data is available about long-term outcome after carpal tunnel release (CTR). The aims of this study were to explore the long-term outcome after CTR and to identify prognostic factors for long-term outcome. METHODS: Patients with clinically defined CTS underwent CTR and completed the Boston Carpal Tunnel Questionnaire at baseline (T0), at about 8 months (T1), and after a median follow-up of 9 years (T2), as well as a 6-point scale for perceived improvement (at T1 and T2). Potentially prognostic factors were identified by logistic regression analysis and correlation. RESULTS: At long-term follow-up, 87 patients (40.3%) completed the questionnaires. Mean score on Symptom Severity Scale (2.87 to 1.54; p < 0.001) and Functional Status Scale (2.14 to 1.51; p < 0.001) improved at 8 months and did not change significantly after 8 months. A favorable outcome was reported in 81.6%. A good treatment outcome after 8 months and to a lesser extent a lower FSS score at T0 were associated with a better long-term outcome. CONCLUSIONS: CTR is a robust treatment for CTS and its effect persists after a period of 9 years. The most important factor associated with long-term outcome is treatment outcome after about 8 months and to a lesser extent functional complaints preoperatively. Outcome is independent of patient characteristics, electrodiagnostic test results, or findings at the initial neurological examination.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Síndrome do Túnel Carpal/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Inquéritos e Questionários , Resultado do Tratamento
8.
J Neurophysiol ; 119(3): 1209-1221, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29357473

RESUMO

DFNA9 is a rare progressive autosomal dominantly inherited vestibulo-cochlear disorder, resulting in a homogeneous group of patients with hearing impairment and bilateral vestibular function loss. These patients suffer from a deteriorated sense of spatial orientation, leading to balance problems in darkness, especially on irregular surfaces. Both behavioral and functional imaging studies suggest that the remaining sensory cues could compensate for the loss of vestibular information. A thorough model-based quantification of this reweighting in individual patients is, however, missing. Here we psychometrically examined the individual patient's sensory reweighting of these cues after complete vestibular loss. We asked a group of DFNA9 patients and healthy control subjects to judge the orientation (clockwise or counterclockwise relative to gravity) of a rod presented within an oriented square frame (rod-in-frame task) in three different head-on-body tilt conditions. Our results show a cyclical frame-induced bias in perceived gravity direction across a 90° range of frame orientations. The magnitude of this bias was significantly increased in the patients compared with the healthy control subjects. Response variability, which increased with head-on-body tilt, was also larger for the patients. Reverse engineering of the underlying signal properties, using Bayesian inference principles, suggests a reweighting of sensory signals, with an increase in visual weight of 20-40% in the patients. Our approach of combining psychophysics and Bayesian reverse engineering is the first to quantify the weights associated with the different sensory modalities at an individual patient level, which could make it possible to develop personal rehabilitation programs based on the patient's sensory weight distribution. NEW & NOTEWORTHY It has been suggested that patients with vestibular deficits can compensate for this loss by increasing reliance on other sensory cues, although an actual quantification of this reweighting is lacking. We combine experimental psychophysics with a reverse engineering approach based on Bayesian inference principles to quantify sensory reweighting in individual vestibular patients. We discuss the suitability of this approach for developing personal rehabilitation programs based on the patient's sensory weight distribution.


Assuntos
Sinais (Psicologia) , Reconhecimento Visual de Modelos , Doenças Vestibulares/psicologia , Adaptação Fisiológica , Idoso , Teorema de Bayes , Proteínas da Matriz Extracelular/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Orientação Espacial , Psicofísica , Doenças Vestibulares/genética
9.
Eur Spine J ; 27(6): 1262-1265, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28803345

RESUMO

PURPOSE: It is difficult for clinicians to inform patients about the success rate of a treatment as a cervical anterior discectomy procedure. Ideally, a proportion of good outcome as rated by patients is known. Patient-reported outcome measurements are helpful. The purpose is to relate the difference in Neck Disability Index (NDI) after a cervical anterior discectomy procedure for single level cervical degenerative disc disease with the patients' rating of their actual clinical situation after long-term follow-up to define the substantial clinical benefit (SCB). METHODS: After completion of the NDI, patients who were surgically treated for cervical single level degenerative disease were asked to complete a five-item Likert scale to rate their clinical situation. After dichotomisation of the outcome in good versus less than good, a cut-off value was defined by determining the value of the difference of NDI with the highest specificity and sensitivity. Funding was not obtained. RESULTS: SCB for NDI after surgery for cervical single level degenerative disease should be set at ten with area under the curve (AUC) of 0.71 for sensitivity as well specificity. CONCLUSIONS: The goal for each treatment is a good outcome. While comparing treatments for cervical degenerative disc disease only those with an SCB of ten will be relevant for the patient, as patients who achieved this difference in NDI rated their actual situation at long-term follow-up as good.


Assuntos
Vértebras Cervicais/cirurgia , Avaliação da Deficiência , Discotomia/métodos , Degeneração do Disco Intervertebral/cirurgia , Fusão Vertebral/métodos , Adulto , Área Sob a Curva , Método Duplo-Cego , Feminino , Objetivos , Humanos , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
10.
Acta Neurochir (Wien) ; 159(12): 2359-2365, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28887690

RESUMO

BACKGROUND: The effect of anterior cervical discectomy without fusion (ACD), ACD with fusion by stand-alone cage (ACDF) or with arthroplasty (ACDA) on cervical sagittal alignment is not known and is the subject of this study. METHODS: A total of 142 adult patients with single-level cervical disease were at random allocated to different procedures: ACD (45), ACDF (47) and ACDA (50). Upright cervical spine radiographs were obtained. Angles of the involved angle and the angle between C2 and C7 were determined. RESULTS: After a mean follow-up of 25.4 ± 18.4 months, the angles of the involved level comparing ACD with ACDA and ACD with ACDF were different, reaching statistical significance. However, the angle between C2 and C7 did not differ between groups or between preoperative values and at follow-up. CONCLUSIONS: Irrespective of the technique used for anterior cervical discectomy for single-level degenerative disc disease, the alignment of the cervical spine is unaltered.


Assuntos
Artroplastia/efeitos adversos , Discotomia/efeitos adversos , Degeneração do Disco Intervertebral/cirurgia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Adulto , Artroplastia/métodos , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/métodos
11.
Cephalalgia ; 36(13): 1296-1301, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26682576

RESUMO

Introduction The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) is a diagnosis made by exclusion. In the literature, different etiological explanations are proposed for HaNDL, including an immune-mediated reaction after a viral infection. Case description We present a case of a 23-year-old woman with several episodes of transient headache, neurological deficits and cerebrospinal fluid lymphocytosis. All diagnostic criteria for the HaNDL syndrome were fulfilled; however, additional cerebrospinal fluid analysis showed a positive polymerase chain reaction (PCR) for human herpes virus type 7 (HHV-7). Discussion The possible role of a (prodromal) viral infection in the etiology of HaNDL is discussed. Also the role of electroencephalography (EEG) recordings is discussed. Serial EEG recordings showed generalized slowing, frontal intermittent rhythmic delta activity (FIRDA) and symmetric triphasic frontal waves with a dilation lag.


Assuntos
Eletroencefalografia/métodos , Cefaleia/diagnóstico por imagem , Herpesvirus Humano 7 , Linfocitose/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Infecções por Roseolovirus/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Cefaleia/virologia , Humanos , Linfocitose/etiologia , Linfocitose/virologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/virologia , Infecções por Roseolovirus/complicações , Infecções por Roseolovirus/virologia , Síndrome
12.
Acta Neuropathol ; 128(3): 439-48, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24740647

RESUMO

In schwannomatosis, germline SMARCB1 mutations predispose to the development of multiple schwannomas, but not vestibular schwannomas. Many of these are missense or splice-site mutations or in-frame deletions, which are presumed to result in the synthesis of altered SMARCB1 proteins. However, also nonsense and frameshift mutations, which are characteristic for rhabdoid tumors and are predicted to result in the absence of SMARCB1 protein via nonsense-mediated mRNA decay, have been reported in schwannomatosis patients. We investigated the consequences of four of the latter mutations, i.e. c.30delC, c.34C>T, c.38delA, and c.46A>T, all in SMARCB1-exon 1. We could demonstrate for the c.30delC and c.34C>T mutations that the respective mRNAs were still present in the schwannomas of the patients. We hypothesized that these were prevented from degradation by translation reinitiation at the AUG codon encoding methionine at position 27 of the SMARCB1 protein. To test this, we expressed the mutations in MON cells, rhabdoid cells without endogenous SMARCB1 protein, and found that all four resulted in synthesis of the N-terminally truncated protein. Mutation of the reinitiation methionine codon into a valine codon prevented synthesis of the truncated protein, thereby confirming its identity. Immunohistochemistry with a SMARCB1 antibody revealed a mosaic staining pattern in schwannomas of the patients with the c.30delC and c.34C>T mutations. Our findings support the concept that, in contrast to the complete absence of SMARCB1 expression in rhabdoid tumors, altered SMARCB1 proteins with modified activity and reduced (mosaic) expression are formed in the schwannomas of schwannomatosis patients with a germline SMARCB1 mutation.


Assuntos
Proteínas Cromossômicas não Histona/genética , Proteínas Cromossômicas não Histona/metabolismo , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Mutação/genética , Neurilemoma/genética , Tumor Rabdoide/genética , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Linhagem Celular Tumoral , Análise Mutacional de DNA , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutagênese Sítio-Dirigida , RNA Mensageiro/metabolismo , Tumor Rabdoide/patologia , Proteína SMARCB1 , Transfecção
13.
Muscle Nerve ; 50(5): 835-43, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24599605

RESUMO

INTRODUCTION: We tested the hypothesis that a bifid median nerve predisposes to development of carpal tunnel syndrome (CTS) and investigated differences in electrophysiological findings and outcome. METHODS: A total of 259 consecutive patients with clinically defined CTS were included and investigated clinically, electrophysiologically, and ultrasonographically. Fifty-four healthy asymptomatic volunteers were investigated ultrasonographically. RESULTS: The prevalence of bifid median nerves is equal in patients with CTS and controls. Electrophysiological and ultrasonographic abnormalities are more pronounced in patients with non-bifid median nerves. Some outcome data are better in patients with non-bifid median nerves, but others do not show significant differences. CONCLUSIONS: A bifid median nerve is not an independent risk factor for development of CTS. Some of our data suggest outcome after surgical decompression to be different, but others do not. The surgical technique in these patients may therefore have to be reevaluated.


Assuntos
Síndrome do Túnel Carpal/patologia , Lateralidade Funcional/fisiologia , Nervo Mediano/fisiopatologia , Potenciais de Ação/fisiologia , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico por imagem , Estimulação Elétrica , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Análise de Regressão , Ultrassonografia
14.
Clin Neurol Neurosurg ; 236: 108078, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38103390

RESUMO

BACKGROUND: Ulnar nerve entrapment at the elbow (UNE) is the second most prevalent entrapment neuropathy after carpal tunnel syndrome. The objective of this study was to evaluate the expert opinion of different surgical disciplines regarding the need for electrodiagnostic or ultrasound confirmation of UNE and, if so, which test was preferred for confirmation. METHODS: A questionnaire was sent to all neurosurgeons and plastic or hand surgeons in the Netherlands to evaluate the current practice in planning surgical treatment of UNE. RESULTS: The response rate was 36.4 % (134 out of 368). 94 % of surgeons reported that > 95 % of their patients had EDX or ultrasound studies before surgery. 80.6 % of all surgeons who responded reported that they seldom operated on UNE without electrodiagnostic confirmation. Hand surgeons (25.9 %) were more willing to operate on clinically diagnosed UNE without EDX than neurosurgeons (9.4 %) CONCLUSIONS: Dutch surgeons prefer diagnostic confirmation of UNE either by ultrasound or EDX, with a preference for EDX and the vast majority of operated patients do have either EDX or ultrasound or both before surgery. Compared to neurosurgeons, hand surgeons are more willing to operate on patients with clinically defined UNE but normal electrodiagnostic studies.


Assuntos
Cirurgiões , Síndromes de Compressão do Nervo Ulnar , Neuropatias Ulnares , Humanos , Eletrodiagnóstico , Países Baixos , Cotovelo/inervação , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/cirurgia , Condução Nervosa/fisiologia
15.
Muscle Nerve ; 45(3): 334-7, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22334166

RESUMO

INTRODUCTION: In up to 30% of patients with carpal tunnel syndrome (CTS), the cross-sectional area (CSA) of the median nerve may not be enlarged. We hypothesize that this could be the result of secondary atrophy of the nerve in severe CTS. The aim of this study was to measure the ultrasonographic CSA of the median nerve at the wrist in patients with severe CTS. METHODS: In 14 consecutive patients with clinically and electrophysiologically defined severe CTS, the CSA of the median nerve was measured and compared with that of control subjects. RESULTS: CSA of the median nerve exceeded the upper limit of normal in the majority of patients with severe CTS. CONCLUSIONS: Atrophy of the median nerve in severe CTS does not explain negative ultrasonographic test results. Instead, the CSA of the median nerve is enlarged in most patients with severe CTS.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Ultrassonografia/métodos , Potenciais de Ação/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estimulação Elétrica , Eletromiografia , Feminino , Humanos , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia
16.
Hand (N Y) ; 17(5): NP10-NP14, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35187956

RESUMO

In this case report, we describe an adult patient with bilateral congenital absence of the m. flexor pollicis longus (FPL) without any other anomalies or thenar atrophy. The FPL muscle acts to flex the thumb and is innervated by the anterior interosseous nerve. Impaired function of the FPL muscle may have several causes. A bilateral anomaly of the FPL tendon is a rare phenomenon, with only a few cases having been reported. This case report does not only demonstrate the diagnosis of bilateral FPL tendon anomaly by physical examination and magnetic resonance imaging, it also includes the embryological development of the FPL muscle and tendon.


Assuntos
Tendões , Polegar , Adulto , Atrofia , Humanos , Músculo Esquelético/diagnóstico por imagem , Tendões/anormalidades , Tendões/diagnóstico por imagem , Polegar/anormalidades , Polegar/diagnóstico por imagem , Punho
17.
BMJ Open ; 12(4): e057641, 2022 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-35387826

RESUMO

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. The optimal treatment strategy is still unknown. The objective of the Dutch Injection versus Surgery TRIal in patients with CTS (DISTRICTS) is to investigate if initial surgery of CTS results in a better clinical outcome and is more cost-effective when compared with initial treatment with corticosteroid injection. METHODS AND ANALYSIS: The DISTRICTS is an ongoing multicenter, open-label randomised controlled trial. Participants with CTS are randomised to treatment with surgery or with a corticosteroid injection. If needed, any additional treatments after this first treatment are allowed and these are not dictated by the study protocol. The primary outcome is the difference between the groups in the proportion of participants recovered at 18 months. Recovery is defined as having no or mild symptoms as measured with the 6-item carpal tunnel symptoms scale. Secondary outcome measurements are among others: time to recovery, hand function, patient satisfaction, quality of life, additional treatments, adverse events, and use of care and health-related costs. ETHICS AND DISSEMINATION: The study was approved by the Medical Ethical Committee of the Amsterdam University Medical Centers (study number 2017-171). Study results will be disseminated in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: ISRCTN Registry: 13164336.


Assuntos
Síndrome do Túnel Carpal , Corticosteroides/uso terapêutico , Síndrome do Túnel Carpal/tratamento farmacológico , Síndrome do Túnel Carpal/cirurgia , Humanos , Injeções , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Punho
18.
Mult Scler J Exp Transl Clin ; 8(4): 20552173221145576, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36570872

RESUMO

Previous research discovered a protective effect of higher conscientiousness against a 3-year deterioration in employment status in persons with multiple sclerosis (pwMS). To replicate these findings, we used data from a multicentre prospective cohort study where 145 employed pwMS completed questionnaires, neurological and neuropsychological examinations at baseline and after 3 years. A 3-year deterioration in employment status was reported in 31.0%. We observed no differences in personality, demographics or clinical characteristics between pwMS with deteriorated or stable employment status. These null findings may be partly explained by the classification of deteriorated employment status, which does not reflect Dutch labour conditions.

19.
Mult Scler J Exp Transl Clin ; 8(3): 20552173221116282, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36081414

RESUMO

Background: Symptoms of anxiety and depression affect the daily life of people with multiple sclerosis (MS). This study examined work difficulties and their relationship with anxiety, depression and coping style in people with MS. Methods: 219 employed people with MS (median age = 43 years, 79% female) completed questionnaires on anxiety, depression, coping style, demographics and work difficulties, and underwent a neurological examination. Two regression analyses were performed with work difficulties as the dependent variable and either anxiety or depression as continuous independent variables. Coping style, age, gender, educational level, MS-related disability and disease duration were added as additional predictors, as well as interaction terms between coping style and either symptoms of depression or anxiety. Results: A significant model was found (F (10,205) = 13.14, p < 0.001, R 2 = 0.39) in which anxiety, emotion- and avoidance-oriented coping and MS-related disability were positively related to work difficulties. The analysis of depression resulted in a significant model (F (10,205) = 14.98, p < 0.001, R 2 = 0.42) in which depression, emotion- and avoidance-oriented coping and MS-related disability were positively related to work difficulties. None of the interaction effects were significant. Conclusions: Work difficulties were positively related to anxiety, depression, emotion- and avoidance-oriented coping and MS-related disability in workers with MS.

20.
Disabil Rehabil ; 44(23): 7096-7105, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-34607481

RESUMO

PURPOSE: This study aimed to identify mental health, physical health, demographic and disease characteristics relating to work productivity in people with multiple sclerosis (MS). METHODS: In this cross-sectional study, 236 employed people with MS (median age = 42 years, 78.8% female) underwent neurological and neuropsychological assessments. Additionally, they completed questionnaires inquiring about work productivity (presenteeism: reduced productivity while working, and absenteeism: loss of productivity due to absence from work), mental and physical health, demographic and disease characteristics. Multiple linear and logistic regression analyses were performed with presenteeism and absenteeism as dependent variables, respectively. RESULTS: A model with mental and physical health factors significantly predicted presenteeism F(11,202) = 11.33, p < 0.001, R2 = 0.38; a higher cognitive (p < 0.001) and physical impact (p = 0.042) of fatigue were associated with more presenteeism. A model with only mental health factors significantly predicted absenteeism; χ2(11)=37.72, p < 0.001, with R2 = 0.27 (Nagelkerke) and R2 = 0.16 (Cox and Snell). Specifically, we observed that more symptoms of depression (p = 0.041) and a higher cognitive impact of fatigue (p = 0.011) were significantly associated with more absenteeism. CONCLUSIONS: In people with MS, both cognitive and physical impact of fatigue are positively related to presenteeism, while symptoms of depression and cognitive impact of fatigue are positively related to absenteeism.Implications for rehabilitationMultiple sclerosis (MS) affects people of working age, significantly interfering with work productivity.Higher cognitive and physical impact of fatigue were associated with more presenteeism in workers with MS.A higher cognitive impact of fatigue and more depressive symptoms were associated with absenteeism in workers with MS.Occupational and healthcare professionals should be aware of the impact of both physical and mental health on work productivity in workers with MS.


Assuntos
Esclerose Múltipla , Feminino , Humanos , Adulto , Masculino , Autorrelato , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Estudos Transversais , Eficiência , Fadiga/complicações
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