Median nerve ultrasound cross sectional area and wrist-to-forearm ratio in relation to carpal tunnel syndrome related axonal damage and patient age

Abstract Objective: Primary objective was to retrospectively examine the effects of patient age and carpal tunnel syndrome (CTS) related axon loss on median nerve (MN) high resolution ultrasound (HRUS) in younger and older patients. HRUS parameters evaluated in this study were MN cross sectional area at the wrist (CSA) and wrist-to-forearm ratio (WFR). Methods: The material comprised 467 wrists of 329 patients. The patients were categorized into younger (<65 years) and older (≥65 years) groups. Patients with moderate to extreme CTS were included in the study. Axon loss of the MN was assessed by needle EMG and graded by the interference pattern (IP) density. The association between axon loss and CSA and WFR was studied. Results: The older patients had smaller mean CSA and WFR values compared to the younger patients. CSA correlated positively to the CTS severity only in the younger group. However, WFR correlated positively to CTS severity in both groups. In both age groups, CSA and WFR correlated positively with IP reduction. Conclusions: Our study complemented recent findings on the effects of patient age on the CSA of the MN. However, although the MN CSA did not correlate with the CTS severity in older patients, the CSA increased in respect to the amount of axon loss. Also, as a new result, we presented the positive association of WFR with CTS severity among older patients. Significance: Our study supports the recently speculated need for different MN CSA and WFR cut-off values for younger and older patients in assessing the severity of CTS. With older patients, WFR may be a more reliable parameter to assess the CTS severity than the CSA. CTS related axonal damage of the MN is associated to additional nerve enlargement at the carpal tunnel intel site

4D fibrous materials: characterising the deployment of paper architectures

Deployment of folded paper architecture using a fluid medium as the morphing stimulus presents a simple and inexpensive methodology capable of self-actuation; where the underlying principles can be translated to develop smart fibrous materials capable of programmable actuations. In this study we characterise different paper architectures and their stimuli mechanisms for folded deployment; including the influence of porosity, moisture, surfactant concentration, temperature, and hornification. We observe that actuation time decreases with paper grammage; through the addition of surfactants, and when the temperature is increased at the fluid-vapour interface. There is a clear effect of hydration, water transport and the interaction of hydrogen bonds within the fibrous architecture which drives the deployment of the folded regions. The importance of fibre volume fraction and functional fillers in shape recovery was also observed, as well as the effect of a multilayer composite paper system. The design guidelines shown here will inform the development of synthetic fibrous actuators for repeated deployment.</p