Design, Synthesis, and Biological Evaluation of Eukaryotic Initiation Factor 2B (eIF2B) Activators.

The eukaryotic initiation factor 2B (eIF2B) is a key regulator in protein-regulated signaling pathways and is closely related to the function of the central nervous system. Modulating eIF2B could retard the process of neurodegenerative diseases, including Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and vanishing white matter disease (VWM) et al. Here, we designed and synthesized a series of novel eIF2B activators containing oxadiazole fragments. The activating effects of compounds on eIF2B were investigated through testing the inhibition of ATF4 expression. Of all the targeted compounds, compounds 21 and 29 exhibited potent inhibition on ATF4 expression with IC50 values of 32.43 nM and 47.71 nM, respectively, which were stronger than that of ISRIB (IC50=67.90 nM). ATF4 mRNA assay showed that these two compounds could restore ATF4 mRNA to normal levels in thapsigargin-stimulated HeLa cells. Protein Translation assay showed that both compounds were effective in restoring protein synthesis. Compound potency assay showed that both compounds had similar potency to ISRIB with EC50 values of 5.844 and 37.70 nM. Cytotoxicity assay revealed that compounds 21 and 29 had low toxicity and were worth further investigation.

An action research on the establishment of a Community of Practice on technology-enhanced language learning and teaching at tertiary level.

This study aims to explore how an effective cross-institutional Community of Practice (CoP) can be established to promote technology-enhanced language learning and teaching (TeLL&T) at tertiary level, as there is an urgent need for establishing such CoPs due to the large-scale implementation of technology-enhanced language learning and teaching in recent years. In this study, an action research design was adopted, and a five-stage procedure has been identified for the establishment of the CoP on TeLL&T: (1) Investigation of students' and teachers' needs in TeLL&T through surveys and interviews; (2) Identifying a critical mass to form the CoP; (3) Constructing the CoP website to provide a platform with rich TeLL&T resources; (4) University students and teachers sharing their good practices of TeLL&T through various means; (5) Evaluation of the CoP activities. Different evaluation surveys were conducted among university students and teachers to evaluate the effectiveness of the CoP activities. Findings of evaluation surveys suggest that the CoP activities were well received. This study also illustrated the challenges and solutions of creating and maintaining a substantial CoP on TeLL&T. It is hoped that the findings will shed some light on how to establish an effective CoP on TeLL&T at tertiary level.

Reservoir Computing-Based Design of ZnO Memristor-Type Digital Identification Circuits.

Reservoir Computing (RC) is a network architecture inspired by biological neural systems that maps time-dimensional input features to a high-dimensional space for computation. The key to hardware implementation of the RC system is whether sufficient reservoir states can be generated. In this paper, a laboratory-prepared zinc oxide (ZnO) memristor is reported and modeled. The device is found to have nonlinear dynamic responses and characteristics of simulating neurosynaptic long-term potentiation (LTP) and long-term depression (LTD). Based on this, a novel two-level RC structure based on the ZnO memristor is proposed. Novel synaptic encoding is used to maintain stress activity based on the characteristics of after-discharge and proneness to fatigue during synaptic transmission. This greatly alleviates the limitations of the self-attenuating characteristic reservoir of the duration and interval of the input signal. This makes the reservoir, in combination with a fully connected neural network, an ideal system for time series classification. The experimental results show that the recognition rate for the complete MNIST dataset is 95.08% when 35 neurons are present as hidden layers while achieving low training consumption.

Associating Renewable Energy, Globalization, Agriculture, and Ecological Footprints: Implications for Sustainable Environment in South Asian Countries.

The main purpose of this work is to investigate the impacts of globalization (GL), renewable energy (RE), and value-added agriculture (AG) on ecological footprints (EF) and CO2 emissions. For quantitative analysis, this research paper includes yearly data from 1990-2018 for four South Asian nations: Bangladesh, India, Pakistan, and Sri Lanka. These countries are most vulnerable to climate hazards and rapid economic transitions. The Westerlund test provides a strong association among the panel data. The findings of ordinary least squares (DOLS) and fully modified ordinary least squares (FMOLS) show that RE is lowering CO2 emissions and EF in the long run. A 1% increase in RE results in a 10.55% and 2.08% CO2 decrease in emissions and EF, respectively. Globalization and AG are contributing to environmental degradation in selected South Asian countries. Therefore, these countries need to exploit solar energy to its full capacity. Moreover, these countries need to explore more RE resources to reduce their dependence on non-RE sources. These countries can make their agricultural sectors sustainable by following efficient farming practices. Environmental awareness should be enhanced among the farmers. Farmers can use animal fertilizers and clean inputs in AG to achieve sustainable agricultural products. Overall, this work suggests that these countries can achieve a cleaner environment by adopting RE and by promoting efficient technologies through globalization.

The Impact of Compassion from Others and Self-compassion on Psychological Distress, Flourishing, and Meaning in Life Among University Students.

Objectives: Research shows that compassion from others and from the self may enable university students to face, overcome, and bounce back from adversity and generate a greater sense of thriving and meaning in life. However, the underlying processes are largely unknown. The present study aimed to examine the associations of compassion with psychological distress, flourishing, and meaning in life among university students and explore the mechanisms underlying these associations. Methods: A total of 536 Hong Kong university students completed questionnaires measuring their experiences of compassion from others, self-compassion, resilience, psychological distress, flourishing, and meaning in life. Results: Serial mediation analyses showed that compassion from others was associated positively with self-compassion, which was, in turn, linked to greater resilience and consequently lower levels of psychological distress and higher levels of flourishing and meaning in life. Conclusions: Our findings reveal the associations of compassion from others and self-compassion with the well-being and life meaning of university students. The findings highlight the importance of being open and receptive to love and kindness from others. The findings also point to the importance of developing a caring attitude toward oneself.

Impaired delay discounting and time sensitivity in methcathinone use disorder.

Substance use disorder (SUD) is characterized by continued drug use despite adverse consequences. Methcathinone is a new type of psychoactive substance that is associated with high excitement and impulsive behaviors. However, it is unclear if individuals with methcathinone use disorders (MCUD) are with impaired decision-making ability. We analyzed the task performance in 45 male MCUD subjects and 35 male matched healthy controls (HC) with intertemporal decision-making task. Constant sensitivity discounting model was used to estimate potential changes in both discounting rate and time sensitivity. The results showed that MCUD individuals exhibited a higher delay discounting rate (p = 0.003, Cohen's d = 0.683) and reduced sensitivity to time (p < 0.001, Cohen's d = 1.662). The delay discounting rate was correlated to the first age for drug use (r = - 0.41, p = 0.004), and the time sensitivity was negatively correlated with the duration of abstinence (r = - 0.31, p = 0.036). We conclude that MCUD individuals are with impaired decision-making ability and time perception disturbances.

Design, synthesis and biological evaluation of isoxazole-containing biphenyl derivatives as small-molecule inhibitors targeting the programmed cell death-1/ programmed cell death-ligand 1 immune checkpoint.

Monoclonal antibodies targeting the programmed cell death-1/ programmed cell death-ligand 1 (PD-1/PD-L1) immune checkpoint have achieved enormous success in cancer immunotherapy. But the antibody-based immunotherapies carry a number of unavoidable deficiencies such as poor pharmacokinetic properties and immunogenicity. Small-molecule PD-1/PD-L1 inhibitors offer the superiority of complementarity with monoclonal antibodies and represent an appealing alternative. A novel series of isoxazole-containing biphenyl compounds were designed, synthesized and evaluated as PD-1/PD-L1 inhibitors in this paper. The structure-activity relationship of the novel synthesized compounds indicated that the ring-closure strategy of introducing isoxazole could be employed and the 3-cyanobenzyl group was significant for the inhibitory activity against the PD-1/PD-L1 protein-protein interactions. Molecular docking studies were performed to help understand the binding mode of the small-molecule inhibitor with the PD-L1 dimer. In particular, compound II-12 was a promising anti-PD-1/PD-L1 inhibitor with the IC50 value of 23.0 nM, providing valuable information for future drug development.

Problem-solving deficits in methcathinone use disorder.

RATIONALE: The use of methcathinone (MCAT), a psychostimulant drug that can lead to long-term health risks and executive dysfunction, increased to an alarming rate in recent years. Impairments in low-level executive function have been reported in substance use disorder. However, little empirical evidence is available regarding high-level executive function (e.g., problem solving), which may act as a risk factor for relapse. OBJECTIVES: The present study aimed to investigate whether the problem-solving ability was altered in abstinent individuals with methcathinone use disorder (MCUD). Here, we tested fifty male MCUD individuals (short-term MCUD group: twenty-nine patients with MCAT use less than 3 years, long-term MCUD group: twenty-one patients with MCAT use longer than 3 years, which were split by medium years of drug use) and twenty-four well-matched healthy controls (HC) in the Tower of Hanoi task (TOH) to assess the impact of task difficulty on drug-related changes in problem-solving performance. We used several measures to characterize problem-solving performance: the number of mistakes made, the completion time of the task, and the thinking time before the first move. RESULTS: In the low task difficulty condition, the MCUD group and HC group showed similar levels of mistakes and completion time, while in the high task difficulty condition, the MCUD group reported more mistakes (the mean number of mistakes in each trial: 1.41 ± 1.15 vs 0.79 ± 0.76, P = 0.019, Cohen's d = 0.635) and longer completion time in the task (the mean completion time in each trial: 45.83 ± 20.51 s vs 33.40 ± 15.10 s, P = 0.010, Cohen's d = 0.690) than the HC group. The thinking time before the first move did not differ significantly between groups (P = 0.257). We further found that the long-term (more than 3 years) MCUD group made more mistakes than the short-term MCUD group and HC group, mainly in the highly difficult subtasks. The longer time than HCs was reported in the long-term MCUD group among high task difficulty of subtasks. In addition, there was a positive correlation between years of MCAT use and the number of mistakes made in high task difficulty TOH task (r = 0.326, P = 0.021). CONCLUSIONS: Chronic methcathinone use was associated with deficits in problem-solving performance, which depended on the degree of task difficulty. The impairment was more evident in the long-term (> 3 years) MCAT group.

Development of small-molecule BRD4 degraders based on pyrrolopyridone derivative.

Bromodomain-containing protein 4 (BRD4) plays a crucial role in the epigenetic regulation of gene transcription and some BRD4 inhibitors have been advanced to clinical trials. Nevertheless, the clinical application of BRD4 inhibitors could be limited by drug resistance. As an alternative strategy, the emerging Proteolysis Targeting Chimeras (PROTACs) technology has the potential to overcome the drug resistance of traditional small-molecule drugs. Based on PROTACs approaches, several BRD4 degraders were developed and have been proved to degrade BRD4 protein and inhibit tumor growth. Herein, we present the design, synthesis, and biological evaluation of pyrrolopyridone derivative-based BRD4 degraders. Four synthesized compounds displayed comparative potence against BRD4 BD1 with IC50 at low nanomolar concentrations. Anti-proliferative activity of 32a against BxPC3 cell line (IC50 = 0.165 µM) was improved by about 7-fold as compared to the BRD4 inhibitor ABBV-075. Furthermore, degrader 32a potently induced the degradation of BRD4 and inhibited the expression of c-Myc in BxPC3 cell line in a time-dependent manner. The exploration of intracellular antitumor mechanism showed 32a induced cell cycle arrest and apoptosis effectively. All the results demonstrated that compound 32a could be considered as a potential BRD4 degrader for further investigation.

Synthesis of 2,3-Diarylisoindolin-1-one by Copper-Catalyzed Cascade Annulation of 2-Formylbenzonitriles, Arenes, and Diaryliodonium Salts.

A three-component cascade cyclization was developed to synthesize 2,3-diarylisoindolin-1-one by using 2-formylbenzonitrile, arenes, and diaryliodonium salts. The process underwent copper-catalyzed tandem C-N/C-C bond formation, producing isoindolin-1-one derivatives in good to excellent yields.

Comparison of domestic infantile type video intubationscope and stethoscope in positioning of double-lumen endobronchial tube / 中国内镜杂志

Objective To compare the effect of the domestic infantile type video intubationscope (VIS) and stethoscope in positioning of double-lumen endobronchial tube (DLT). Methods 100 cases of patients underwent elective thoracic surgery requiring single lung ventilation were randomly divided into two groups: domestic infantile type video intubationscope group (group V) and stethoscope group (group S), with 50 cases in each. After intubating with a DLT, the positions of DLT were judged and adjusted by VIS (group V) and stethoscope (group S) respectively, and then reviewed by fiberoptic bronchoscopy (FOB), the positioning time and accuracy were recorded. Results Comparing with the group S, the positioning time of DLT was significantly shorter and the total positioning accuracy of DLT was significantly higher in group V (P < 0.05). Conclusion It is easy and quickly, high accuracy with domestic infantile type video intubationscope in positioning of DLT, which is worthy of clinical popularization and application.

Comparison of domestic infantile type video intubationscope and stethoscope in positioning of double-lumen endobronchial tube / 中国内镜杂志

Objective To compare the effect of the domestic infantile type video intubationscope (VIS) and stethoscope in positioning of double-lumen endobronchial tube (DLT). Methods 100 cases of patients underwent elective thoracic surgery requiring single lung ventilation were randomly divided into two groups: domestic infantile type video intubationscope group (group V) and stethoscope group (group S), with 50 cases in each. After intubating with a DLT, the positions of DLT were judged and adjusted by VIS (group V) and stethoscope (group S) respectively, and then reviewed by fiberoptic bronchoscopy (FOB), the positioning time and accuracy were recorded. Results Comparing with the group S, the positioning time of DLT was significantly shorter and the total positioning accuracy of DLT was significantly higher in group V (P < 0.05). Conclusion It is easy and quickly, high accuracy with domestic infantile type video intubationscope in positioning of DLT, which is worthy of clinical popularization and application.

Factors Affecting Postoperative Neurological Deficits After Nerve Root Resection for the Treatment of Spinal Intradural Schwannomas.

STUDY DESIGN: A retrospective clinical data analysis. OBJECTIVE: To investigate the factors related to postoperative neurological deficits after nerve root resection in the treatment of spinal intradural schwannoma. SUMMARY OF BACKGROUND DATA: Neurological deficits could be observed after resection of tumor-involved nerve roots in spinal intradural schwannoma. Thus, it is important to find the factors related to postoperative neurological deficits. METHODS: Clinical and pathological data were selected from patients underwent total resection of the solitary spinal intradural schwannoma from T11 to S. Patients were divided into the postoperative neurological deficits positive group (PND group, n = 12) and negative group (non-PND group, n = 52). Clinical features including age, sex, duration of disorders, diabetes, preoperative visual analogue scale (VAS) and SF-36 score, preoperative symptoms, tumor size, tumor location, and immunostaining results were analyzed. RESULTS: Age, sex, duration of disorders, diabetes, preoperative VAS and SF-36 score, tumor length, and tumor-occupied ratio were not significantly different between the two groups (P > 0.05). Lower extremity pain, sensory disturbance, and motor disturbance were found in 25.0%, 50.0%, and 75.0% of patients in the PND group and 76.9%, 17.3%, and 7.7% of patients in the non-PND group, respectively, and the results were significantly different (P < 0.05). The rate of postoperative neurological deficits was higher when the tumor was located in the thoracolumbar junction (T11-L2) than other segments (L2-S; P = 0.009). For immunostaining study, CD34-positive rate was significantly different between the two groups (P = 0.013). CONCLUSION: The absence of preoperative lower extremity pain, presence of sensory and motor disturbances, and tumor location in the thoracolumbar junction (T11-L2) are the predictors of postoperative neurological deficits. Age, sex, duration of the disorders, diabetes, preoperative VAS score, preoperative SF-36 score, tumor length, and tumor-occupied ratio are not related to postoperative neurological deficits. On immunostaining of tumors, CD34-negative results are related to the development of postoperative neurological deficits. LEVEL OF EVIDENCE: 4.

Feasibility of Screw Placement in the Occipital Condyle of Chinese Patients for Occipitocervical Arthrodesis: A Cadaveric Study.

AIM: The feasibility of computed tomography (CT) and two-dimensional (2D) reconstruction-guided screw placement in the occipital condyle (OC) of Chinese patients was investigated. MATERIAL AND METHODS: Twenty (40 OCs) fresh cadaveric specimens with intact superior cervical spine and occipital bones were placed in the prone position. Simulated screw placement was achieved by placing 4.0 mm diameter virtual screws with the help of the 2D reconstruction CT scan image technology. Maximal screw length, angulation in the sagittal and transverse planes, and medial and cranial base OC entry points were determined and recorded. Actual screw placement was achieved by similar placement; actual position and angulation were determined by postoperative CT scanning. RESULTS: Screws were successfully inserted in 36 of 40 (90%) OCs. Four ruptures of the medial OC wall were on the left side. Actual screw placement did not damage the hypoglossal canal, and no screws pierced the medial or lateral OC walls. Females displayed significantly smaller left and right maximum screw lengths than males (p < 0.05); no other significant gender differences were noted. CONCLUSION: The results can feasibly accommodate 4-mm OC screws for OA treatment. As in other populations, OC shape and size is smaller in females and varies in Chinese individuals, necessitating individualized imaging for good outcomes.

Neuroanatomical evidence of the melanocortin-4 receptor expression in the mesencephalic periaqueductal gray innervating renal tissues.

To determine the neuronal connections in the periaqueductal gray (PAG) is important for studying modulation of neuronal activity of PAG to influence sympathetic responses. We had characterized projections from the left kidney to the midbrain PAG in adult male melanocortin-4 receptor (MC4R)-green fluorescent protein (GFP) transgenic mice by using retrograde tracing techniques of pseudorabies virus (PRV)-614 for direct visualization under two-photon immunofluorescence microscope. We found that injections of PRV-614 into the kidney resulted in retrograde infection of neurons in the ventrolateral sub-areas of PAG, and PRV-614/MC4R-GFP double-labeled neurons were detected in the ventrolateral sub-areas of PAG. These results indicated that a subpopulation of ventrolateral PAG neurons innervating renal tissues expressed MC4R, suggesting that deep brain stimulation of the ventrolateral PAG may influence renal function by melanocortinergic pathway.

Enterobacter cloacae infection after anterior cervical decompression and fusion: case study and literature review.

Wound infection after anterior cervical decompression and fusion can lead to disastrous consequences despite a low incidence rate. Although Gram-positive bacteria such as Staphylococcus aureus are the most common pathogenic bacteria, some rare bacteria such as conditional pathogenic bacteria may also result in such a condition. To the best of our knowledge, E. cloacae-caused acute infection after anterior cervical decompression and fusion has not been reported. Here, we report an E. cloacae-caused acute infection after anterior vertical decompression and fusion. This infection was eventually controlled by virtue of an early diagnosis and the correspondingly-adopted anti-infection, internal fixation removal, and drainage treatments. Exploring the reasons underlying acute infection after anterior cervical decompression and fusion caused by rare bacteria, particularly E. cloacae, by analyzing this case was the basic therapeutic principle in this study. We believe that the therapeutic principle for E. cloacae-caused wound infection after anterior cervical internal fixation is basically consistent with that for other bacterium-caused wound infections after spinal internal fixation. Sufficient drainage, the adoption of sensitive antibacterials, and internal fixation removal as early as possible when necessary are the essential measures in infection control.

Mast Quadrant-assisted minimally invasive modified transforaminal lumbar interbody fusion: single incision versus double incision.

BACKGROUND: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF) with a small single posterior median incision. METHODS: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group). The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI) scores, Visual Analog Scale (VAS) scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. RESULTS: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01). The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05). CONCLUSIONS: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

The correlation between ossification of the nuchal ligament and pathological changes of the cervical spine in patients with cervical spondylosis.

STUDY DESIGN: A retrospective clinical data analysis. OBJECTIVE: This study was conducted to investigate the correlation between ossification of the nuchal ligament (ONL) and pathological changes of the cervical spine in patients with cervical spondylosis. SUMMARY OF BACKGROUND DATA: ONL can usually be found in cervical spondylosis. Thus, it is important to find the correlation between ONL and pathological changes of the cervical spine in patients with cervical spondylosis. METHODS: The medical records of 100 patients with cervical spondylosis with the local type of ONL (ONL group) and 50 patients with cervical spondylosis only (control group) were reviewed. Data analysis included patients' sex, age, location of ONL, maximum cord compression level, osteophyte height ratio, and grade of cervical intervertebral disc degeneration. Radiological features were evaluated by lateral plain radiography and magnetic resonance imaging. RESULTS: In total, 69.0% of subjects in the ONL group had ONL located at the maximum cord compression level; there was no difference based on sex (P = 0.248). The value of the osteophyte height ratio was higher at the ONL level than at its superior and inferior adjacent segments (P < 0.001). The osteophyte height ratio was also significantly different at the C4-C5 (P < 0.001) and C5-C6 (P = 0.008) levels between the ONL group and the control group. There was a significant difference in distribution of intervertebral disc degeneration grading between the ONL level and superior adjacent segments (P = 0.028), as well as inferior adjacent segments (P = 0.049). The distribution of intervertebral disc degeneration grading at the C5-C6 level between patients whose location of ONL and maximum cord compression level were both at C5-C6 and patients whose maximum cord compression level was at C5-C6 in the control group was also significantly different (P = 0.035). CONCLUSION: The location of ONL commonly corresponds to the most stenotic level of the spinal canal. The location of ONL also correlates with the level of osteophyte formation and intervertebral disc degeneration, indicating that ONL has correspondence to instability-related cervical pathological changes in cervical spondylosis.

Abnormal flexor carpi radialis H-reflex as a specific indicator of C7 as compared with C6 radiculopathy.

OBJECTIVE: The H-reflex of the flexor carpi radialis (FCR H-reflex) has not been commonly used for the diagnosis of cervical radiculopathy when compared with the routinely tested soleus H-reflex. Although both S1 and S2 roots innervate the soleus, the H-reflex is selectively related to S1 nerve root function clinically. Flexor carpi radialis is also innervated by two nerve roots which are C6 and C7. Although they are among the most common roots involved in cervical radiculopathy, few studies reported if the attenuation of the FCR H-reflex is caused by lesions affecting C7 or C6 nerve roots, or both. We aimed to identify whether an abnormal FCR H-reflex was attributed to the C7 or C6 nerve root lesion, or both. The sensitivities of needle electromyography, FCR H-reflex, and provocative tests in unilateral C7 or C6 radiculopathy were also compared in this study. METHODS: A concentric needle electrode recorded bilateral FCR H-reflexes in 41 normal subjects (control group), 51 patients with C7 radiculopathy, and 54 patients with C6 radiculopathy. Clinical, radiological, and surgical approaches identified the precise single cervical nerve root involved in all patient groups. The H-reflex and M-wave latencies were measured and compared bilaterally. Abnormal FCR H-reflex was defined as the absence of the H-reflex or a side-to-side difference over 1.5 milliseconds which was based on the normal side-to-side difference of the H-reflex latency of 16.9 milliseconds (SD = 1.7 milliseconds) from the control group. We also determined standard median and ulnar conduction and needle electromyography. The provocative tests included bilateral determination of the Shoulder Abduction and Spurling's tests in all radiculopathy group patients. RESULTS: Abnormal FCR H-reflexes were recorded in 45 (88.2%) of C7 radiculopathy group patients, and 2 (3.7%) of C6 radiculopathy group patients (P < 0.05). Needle electromyography was abnormal in 41 (80.4%) of C7 radiculopathy patients and 43 (79.6%) of C6 radiculopathy patients. Provocative tests were positive in 15 (29.4%) of C7 radiculopathy patients and 25 (46.3%) of C6 radiculopathy patients. CONCLUSIONS: Flexor carpi radialis H-Reflex provides a sensitive assessment of evaluating the C7 spinal reflex pathway. Clinically, a combination of the FCR H-reflex with needle electromyography may yield the highest level of diagnostic information for evaluating clinical cases of C7 radiculopathy.

Electrophysiological differences between Hirayama disease, amyotrophic lateral sclerosis and cervical spondylotic amyotrophy.

BACKGROUND: Hirayama disease (HD), amyotrophic lateral sclerosis (ALS) or cervical spondylotic amyotrophy (CSA) may result in atrophy of intrinsic hand and forearm muscles. The incidence of HD is low, and it is rarely encountered in the clinical setting. Consequently, HD is often misdiagnosed as ALS or CSA. It is important to differentiate these diseases because HD is caused by a benign focal lesion that is limited to the upper limbs. METHODS: The thenar and hypothenar compound muscle action potential (CMAP) amplitude of the upper limbs of 100 HD, 97 ALS and 32 CSA cases were reviewed; 35 healthy individuals were included as controls. Seventy-eight percent, 38% and 69% of patients with HD, ALS or CSA had unilateral involvement; the remaining patients were affected bilaterally. Thenar and hypothenar CMAP amplitude evoked by ulnar stimulation was compared with CMAP evoked by median stimulation. RESULTS: The ulnar/median CMAP ratio was found to be lower in HD (0.55 ± 0.41, P<0.0001), higher in ALS (2.28 ± 1.15, P<0.0001) and no different in CSA (1.21 ± 0.53, P>0.05) compared with the normal range from previous studies (0.89-1.60) and with the healthy controls (1.15 ± 0.23). Conduction velocities of the sensory and motor nerves, the amplitude of the sensory nerve action potential, and the CMAP amplitude of the unaffected limb were all normal. CONCLUSIONS: The hand muscles were differentially affected between patients with HD, ALS and CSA. The ulnar/median CMAP ratio could be used to distinguish these three diseases.