Repeatability of nerve conduction measurements derived entirely by computer methods

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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).</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

Novel zinc finger motif in the basal transcriptional machinery : three-dimensional NMR studies of the nucleic acid binding domain of transcriptional elongation factor TFIIS

Transcriptional elongation provides a key control point in the regulation of eukaryotic gene expression. Here we describe homonuclear and lSN-heteronuclear 3D NMR studies of the nucleic acid binding domain of human transcriptional elongation factor TFIIS. This domain contains a Cys4 ZnZ+- binding site with no homology to previously characterized Cys4, Cysa, or Cysz-His2 Zn fingers. Complete lH and I5N NMR resonance assignment of a 50-residue TFIIS peptideZnz+ complex is obtained. Its solution structure, as determined by distance geometry/simulated annealing (DG/SA) calculations, exhibits a novel three-stranded antiparallel p-sheet (designated the Zn ribbon). Analogous sequence motifs occur in a wide class of proteins involved in RNA or DNA transactions, including human basal transcriptional initiation factor TFIIE. A three-dimensional model of the TFIIE Cys4 domain is obtained by DG-based homology modeling. The role of the TFIIS Zn ribbon in the control of eukaryotic transcriptional elongation is discussed