Quantitative evaluation of neurosensory disturbance after bilateral sagittal split osteotomy using Semmes-Weinstein monofilaments: a systematic review.

PURPOSE: To evaluate neurosensory disturbance of the inferior alveolar nerve, after bilateral sagittal split osteotomy, from before surgery to 1 year postoperatively, by quantitatively evaluating published data using Semmes-Weinstein monofilaments. MATERIALS AND METHODS: A literature search was conducted by use of PubMed, EMBASE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library in June 2012. The related citations function in PubMed, reference lists, and authors' names were used to expand the search. From each included study, study and sample characteristics were extracted, as were results. The main outcome was the lightest pressure the patient could discern at 1 month and at 1 year after the osteotomy procedure, in comparison with before surgery. RESULTS: Of the 3,107 articles initially identified, 7 were chosen according to the preset inclusion and exclusion criteria. The results from the studies could not be combined for the purpose of a meta-analysis because of the lack of standardization. Only 2 studies provided data that allowed an estimation of average detectable applied force to be carried out. Before surgery, the lowest detectable threshold corresponded to a mean of 0.07 to 0.16 g. At 1 month after surgery, the lowest detectable threshold averaged 6 g, and at 1 year after surgery, the mean value was 0.16 to 0.4 g. CONCLUSIONS: After bilateral sagittal split osteotomy, at 1 month after surgery, the sensory threshold increases approximately 35- to 85-fold compared with the presurgery threshold. Within 1 year, the threshold normally decreases almost to presurgery levels, representing 96% to 98% sensory recovery. Studies should aim to quantitatively use the Semmes-Weinstein monofilament method and standardize the presentation of results.

Development of a short olfactory test based on the Connecticut Test (CCCRC).

OBJECTIVE: To create a short olfactory test, Connecticut Smell Test (CST), based on the CCCRC (Connecticut Chemosensor and Clinical Research Center). DESIGN: A prospective patient-based study. SETTINGS: Smell and Taste Outpatient Clinic at the Fundación Hospital Alcorcón, Madrid, Spain. MATERIAL AND METHODS: We compared a short test based on the CCCRC with the Pocket Smell Test (PST) based on the University of Pennsylvania Smell Identification Test) UPSIT in 40 patients with nasal polyposis, in order to determine the specificity, sensitivity, positive predictive and negative predictive values. The validity index was 95% with an accuracy rate of 10%. We determined unit cost, the time required to perform the test in the outpatient office and the difficulty to perform the test. RESULTS: The sensibility was 93.3% and the specificity was 76% with a positive predictive value of 70% and a negative predictive value of 95%. The unitary cost of CST was euro0.65 when it is performed by a doctor. The unitary cost of PST is euro1.76. Our short test took 34 seconds to perform. More than 96% of the patients thought the test was easy to do. CONCLUSION: Our test is a valid, easy and quick test to be used in patients with nasal polyposis.

Influence of intrinsic noise generated by a thermotesting device on thermal sensory detection and thermal pain detection thresholds.

Various factors can influence thermal perception threshold measurements and contribute significantly to unwanted variability of the tests. To minimize this variability, testing should be performed under strictly controlled conditions. Identifying the factors that increase the variability and eliminating their influence should increase reliability and reproducibility. Currently available thermotesting devices use a water-cooling system that generates a continuous noise of approximately 60 dB. In order to analyze whether this noise could influence the thermal threshold measurements we compared the thresholds obtained with a silent thermotesting device to those obtained with a commercially available device. The subjects were tested with one randomly chosen device on 1 day and with the other device 7 days later. At each session, heat, heat pain, cold, and cold pain thresholds were determined with three measurements. Bland-Altman analysis was used to assess agreement in measurements obtained with different devices and it was shown that the intersubject variability of the thresholds obtained with the two devices was comparable for all four thresholds tested. In contrast, the intrasubject variability of the thresholds for heat, heat pain, and cold pain detection was significantly lower with the silent device. Our results show that thermal sensory thresholds measured with the two devices are comparable. However, our data suggest that, for studies with repeated measurements on the same subjects, a silent thermotesting device may allow detection of smaller differences in the treatment effects and/or may permit the use of a smaller number of tested subjects. Muscle Nerve 40: 257-263, 2009.

Assessing subclinical tactual deficits in the hand function of diabetic blind persons at risk for peripheral neuropathy.

OBJECTIVE: To assess subclinical impairments in tactual hand function produced by diabetes mellitus in late-blind adults with diabetic retinopathy. DESIGN: The survey compares diabetic blind with nondiabetic blind and blindfolded sighted controls in terms of their performance on a battery of tests that assess tactual hand function. SETTING: Subjects were evaluated at their rehabilitation program center in Madrid. PARTICIPANTS: Nine (referred) diabetic blind subjects affected by diabetic retinopathy versus 10 (referred) nondiabetic blind subjects versus 10 blindfolded sighted volunteers, all right-handed and matched for age. Subjects were referred by the training professionals of the rehabilitation program center and asked to volunteer. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cutaneous force and spatial resolution thresholds, haptic psychophysical functions for perceived roughness, weight, and size, and both accuracy and response times for haptic classification of 3-dimensional common objects. Measures of joint mobility, muscular strength, and motor dexterity were also included. RESULTS: The diabetic blind performed significantly poorer than the controls in terms of force sensitivity (distal and proximal finger pads, and palm), spatial resolution (distal finger pad only), motor dexterity, perceived roughness, and finally, haptic object classification response times for texture-diagnostic objects. CONCLUSIONS: Subclinical disturbances in the tactual hand function of the diabetic blind subjects were only documented in perceptual and motor tasks for which cutaneous, as opposed to kinesthetic, information was particularly relevant.

The validity of CCCRC test in patients with nasal polyposis.

Both the Connecticut Chemosensory Clinical Research Center (CCCRC) test and Cross Cultural Smell Identification Test (CC-SIT) are used to assess the sense of smell in patients all over the world. Our aim is to know whether the CCCRC test is a valid olfactory test in comparison with CC-SIT. Therefore, we have done a prospective study in 60 adult patients with nasal polyposis to compare the validity of CCCRC with UPSIT. We used the CCCRC olfactory test made up of a threshold and suprathreshold test while CC-SIT relies solely upon suprathreshold measurement. We determined the specificity, sensitivity, positive predictive value and negative predictive value for patients suffering nasal polyposis with the CCCRC test. The validity index was 95% and accuracy rate was 8%. We determined unit cost and the reliability of the CCCRC test. For patients with nasal polyposis: the sensitivity was 86%; the specificity was 94%; the positive predictive value was 93% and the negative predictive value was 88%. The reliability was 92%. The unit cost of the CCCRC was 5.60 euro. The CCCRC test is a valid test in comparison with CC-SIT. CCCRC is cheap and can be used in routine clinical settings.

Agrupamento de sensações somatossensoriais com estimulação de corrente senoidal / Clustering of somatosensory sensations during sinusoidal current stimulation

Fibras finas (FF) aferentes primárias mediam a percepção de sensações relacionadas à dor e à temperatura, e as fibras grossas (FG) ao tato. O objetivo deste trabalho é avaliar percepções relacionadas às FF (picada, pontada, agulhada, queimação) e às FG (aperto, pressão, vibração e movimento)evocadas por estimulação elétrica senoidal com 5 Hz e 2 kHz, respectivamente. O dedo indicador da mão esquerda de 150 voluntários, sem doença neurológica conhecida e medicação, foram estimulados nessas frequências com intensidades decorrente igual ao limiar de sensibilidade (LS) e 1,5 vezes LS.O voluntário escolheu das 8 palavras, 3 que mais se aproximavam à sua percepção do estímulo. Outro grupo de 60 voluntários foi utilizado como controle, sendo que as 3 palavras foram escolhidas sem nenhuma estimulação. O valor de “1” foi atribuído à palavra escolhida, e “0” à não selecionada. As sensações foram agrupadas utilizando-se o vizinho mais próximo (single linkage) e a correlação entre variáveis binárias(tetrachloric correlation). Os resultados indicam uma tendência a sensações de fibras grossas sem estimulação, sendo que 5 Hz evoca principalmente as sensações de fibras finas e 2 kHz as de fibras grossas. A exceção foi a sensação de FF queimação, a qual se mostrou inconsistente em ambos os grupos.

Thin fibers mediate the perception related to temperature and painful sensations, and thick fibers the perception related to touch. This work tries to evaluate the perceptions related to thin (prick, pang, twinge and burning) and thick fibers (squeeze, pressure, movement and vibration) evoked by sinusoidal stimulation with 5 Hz and2 kHz, respectively. The left index fingers of 150 volunteers, without known neurological problems or under medication, were stimulatedat these frequencies and at current intensities equal to the sensory threshold and 1.5 times the sensory threshold. The volunteers chose three words out of eight that better represented the sensation felt during the stimulus. Another group of 60 volunteers was used as control, for which the three words were chosen with no stimulation. The value “1” was attributed to each sensation chosen and “0” forthe others. The sensations were clustered using the single linkage nearest neighbor method and the tetrachloric correlation between binary variables. The results showed a tendency to thick fiber sensations with 2 kHz or no stimulation, while 5 Hz evoked thin fiber sensations. The exception was the FF sensation of burning, which did not fit into any group.

Obesity and peripheral neuropathy risk: a dangerous liaison.

This study investigates motor (MNCS) and sensory (SNCS) nerve conduction in a sample of non-diabetic obese people without symptoms suggestive of neuropathy and looks for a possible metabolic alteration. Twenty-one patients and 20 age-matched controls underwent (a) MNCS (median, ulnar, peroneal, and tibial) and SNCS (median, ulnar, and sural); (b) quantitative sensory testing to measure sensory threshold for vibration, warm and cold sensation (WS-CS), heat and cold-induced pain; and (c) blood sample analysis to evaluate glucose and insulin levels and calculate the quantitative insulin-sensitivity check index (QUICKI). The obese group showed significantly decreased compound muscle action potential amplitude of tibial and peroneal nerves and decreased sensory action potential amplitude of all nerves. Most of the sensory thresholds were altered in obese patients. Insulin serum levels were significantly increased while QUICKI decreased in obese patients. WS and CS from the index and little fingers and WS from the big toe significantly correlated with QUICKI. Thermal and pain thresholds from the index and thermal thresholds from the little finger correlated with QUICKI values. The non-diabetic obese patients showed a subclinical involvement of different diameter sensory fibers. Such impairment was related to hyperinsulinemia and insulin sensitivity. The increase in sensory threshold of obese patients might be due to a metabolic alteration, potentially leading to a future clinical neuropathy.

Pattern identification and perceived stimulus quality as a function of stimulation waveform on a fingertip-scanned electrotactile display.

The effect of stimulation waveform on pattern perception was investigated on a 49-point fingertip-scanned electrotactile (electrocutaneous) display. Waveform variables burst frequency (F), number of pulses per burst (NPB), and pulse repetition rate (PRR) were varied in a factorial design. Contrast reduction was used to limit performance of perceiving a 1-tactor gap defined within a 3 x 3 tactor outline square. All three variables accounted for significant variations in performance with higher levels of F and NPB and lower levels of PRR, leading to better performance. In addition, we collected qualitative data on each waveform, and the qualitative differences were related to performance (e.g., waveforms perceived as having a more localized sensation were correlated with better pattern identification performance than those waveforms perceived as more broad). We also investigated the effect of stimulation contrast on pattern perception.

The sensory profile: a discriminant analysis of children with and without disabilities.

OBJECTIVES: The purpose of this study was to determine which factors on the Sensory Profile, a measure of children's responses to commonly occurring sensory experiences, best discriminate among children with autism or pervasive developmental disorder (PDD), children with attention deficit hyperactivity disorder (ADHD), and children without disabilities. METHOD: Data for three groups of children 3 to 15 years of age were used: 38 children with autism or PDD, 61 with ADHD, and 1,075 without disabilities. The researchers conducted a discriminate analysis on the three groups, using group membership as the dependent variable and the nine factors of the Sensory Profile as independent variables. RESULTS: The analysis yielded two discriminant functions: one that differentiated children with disabilities from children without disabilities and another that differentiated the two groups of children with disabilities from each other. Nearly 90% of the cases were correctly classified with these two functions. CONCLUSION: The Sensory Profile is useful for discriminating certain groups of children with disabilities. Children with disabilities are accurately classified into disability categories with the factors described by previous authors. This suggests that patterns of behavior associated with certain developmental disorders are reflected in populations of children without disabilities. It may be the frequency or intensity of certain behaviors that differentiate the groups.

Application of automatic thresholding in image analysis scoring of cells in human solid tumors labeled for proliferation markers.

We previously reported an image analysis program that uses four investigator-defined parameters including two thresholds, i.e., gray-level threshold (GLT) and hue threshold (HT), to determine the number of cells (TC) and the proliferating cell nuclear antigen (PCNA) or bromodeoxyuridine (BrdUrd) labeling indices (LI) in human solid tumors. The present study investigated if the accuracy and reproducibility of image analysis results can be improved by using computer-defined GLT and HT. Three investigators evaluated 142 images on 3 days, using visual analysis and four image analysis routines, which used different combinations of computer- and investigator-selected GLT and HT. The data show that image analysis using computer-selected GLT and HT yielded (i) LI of PCNA and BrdUrd that were indistinguishable from visual analysis, (ii) equal (BrdUrd LI) or better (TC and PCNA LI) inter-day reproducibility relative to visual analysis results, and (iii) results that were equally (TC) or more accurate (LI of PCNA and BrdUrd) with higher inter-day reproducibility (TC and LI of PCNA and BrdUrd) than image analysis obtained using investigator-defined thresholds. We conclude that the use of computer-defined GLT and HT improved the accuracy and reproducibility of image analysis results.

Variation in odor thresholds for l-carvone and cineole and correlations with suprathreshold intensity ratings.

Specific anosmias have been reported for l-carvone and cineole, two compounds of importance in food flavor perception. Detection thresholds were assessed in groups of 50+ individuals by ascending forced-choice tests conducted in quadruplicate. Wide individual differences in thresholds were observed. Within the same session, threshold correlations were in the range of +0.8 to +0.9, showing good short-term reliability. Correlations with suprathreshold ratings were moderate (in the range of r = -0.5) after subtraction of false positive ratings for blank samples. However, a cineole mixture experiment failed to show any differences between subgroups that were previously classified as high or low sensitivity on the basis of threshold measurements. Re-testing selected groups after a period of months showed considerable within-individual variation in the thresholds, especially for l-carvone. These results call into question the stability and utility of threshold classification for these two compounds.