High-Resolution Nerve Ultrasound Abnormalities in POEMS Syndrome—A Comparative Study

Background: High-resolution nerve ultrasound (HRUS) has been proven to be a valuable tool in the diagnosis of immune-mediated neuropathies, such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is an important differential diagnosis of CIDP. Until now, there have been no studies that could identify specific HRUS abnormalities in POEMS syndrome patients. Thus, the aim of this study was to assess possible changes and compare findings with CIDP patients. Methods: We retrospectively analyzed HRUS findings in three POEMS syndrome and ten CIDP patients by evaluating cross-sectional nerve area (CSA), echogenicity and additionally calculating ultrasound pattern scores (UPSA, UPSB, UPSC and UPSS) and homogeneity scores (HS). Results: CIDP patients showed greater CSA enlargement and higher UPSS (median 14 vs. 11), UPSA (median 11.5 vs. 8) and HS (median 5 vs. 3) compared with POEMS syndrome patients. However, every POEMS syndrome patient illustrated enlarged nerves exceeding reference values, which were not restricted to entrapment sites. In CIDP and POEMS syndrome, heterogeneous enlargement patterns could be identified, such as inhomogeneous, homogeneous and regional nerve enlargement. HRUS in CIDP patients visualized both increased and decreased echointensity, while POEMS syndrome patients pictured hypoechoic nerves with hyperechoic intraneural connective tissue. Discussion: This is the first study to demonstrate HRUS abnormalities in POEMS syndrome outside of common entrapment sites. Although nerve enlargement was more prominent in CIDP, POEMS syndrome patients revealed distinct echogenicity patterns, which might aid in its differentiation from CIDP. Future studies should consider HRUS and its possible role in determining diagnosis, prognosis and treatment response in POEMS syndrome.

Download Full-text

Nerve Ultrasound as Helpful Tool in Polyneuropathies

Diagnostics ◽

10.3390/diagnostics11020211 ◽

2021 ◽

Vol 11 (2) ◽

pp. 211

Author(s):

Magdalena Kramer ◽

Alexander Grimm ◽

Natalie Winter ◽

Marc Dörner ◽

Kathrin Grundmann-Hauser ◽

...

Keyword(s):

High Resolution ◽

Morphological Changes ◽

Nerve Ultrasound ◽

Laboratory Findings ◽

Morphological Alterations ◽

Immune Mediated ◽

Nerve Enlargement ◽

Underlying Causes ◽

Magnetic Resonance Imaging Mri ◽

Therapy Success

Background: Polyneuropathies (PNP) are a broad field of diseases affecting millions of people. While the symptoms presented are mostly similar, underlying causes are abundant. Thus, early identification of treatable causes is often difficult. Besides clinical data and basic laboratory findings, nerve conduction studies are crucial for etiological classification, yet limited. Besides Magnetic Resonance Imaging (MRI), high-resolution nerve ultrasound (HRUS) has become a noninvasive, fast, economic and available tool to help distinguish different types of nerve alterations in neuropathies. Methods: We aim to describe typical ultrasound findings in PNP and patterns of morphological changes in hereditary, immune-mediated, diabetic, metabolic and neurodegenerative PNP. Literature research was performed in PubMed using the terms ‘nerve ultrasound’, neuromuscular ultrasound, high-resolution nerve ultrasound, peripheral nerves, nerve enlargement, demyelinating, hereditary, polyneuropathies, hypertrophy’. Results: Plenty of studies over the past 20 years investigated the value of nerve ultrasound in different neuropathies. Next to nerve enlargement, patterns of nerve enlargement, echointensity, vascularization and elastography have been evaluated for diagnostic terms. Furthermore, different scores have been developed to distinguish different etiologies of PNP. Conclusions: Where morphological alterations of the nerves reflect underlying pathologies, early nerve ultrasound might enable a timely start of available treatment and also facilitate follow up of therapy success.

Download Full-text

High‐Resolution Nerve Ultrasound to Assess Nerve Echogenicity, Fascicular Count, and Cross‐Sectional Area Using Semiautomated Analysis

Journal of Neuroimaging ◽

10.1111/jon.12717 ◽

2020 ◽

Vol 30 (4) ◽

pp. 493-502

Author(s):

Donata Gamber ◽

Jeremias Motte ◽

Antonios Kerasnoudis ◽

Min‐Suk Yoon ◽

Ralf Gold ◽

...

Keyword(s):

High Resolution ◽

Cross Sectional Area ◽

Sectional Area ◽

Nerve Ultrasound ◽

Cross Sectional

Download Full-text

079 Nerve ultrasound cross sectional area does not correlate with electrodiagnostic carpal tunnel severity in the very elderly

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.78 ◽

2018 ◽

Vol 89 (6) ◽

pp. A32.2-A32

Author(s):

Eoin Mulroy ◽

Luciana Pelosi

Keyword(s):

Elderly Patients ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Age Group ◽

Sectional Area ◽

Very Elderly ◽

Nerve Ultrasound ◽

Cross Sectional ◽

Nerve Enlargement

IntroductionUltrasound measurement of median nerve cross-sectional area (CSA) at the wrist has emerged as an accurate and useful complement to electrophysiology in the diagnosis of carpal tunnel syndrome (CTS).AANEM, 2012 A number of studies have also shown a positive correlation between median nerve CSA and electrodiagnostic severity. After noting absence of the expected nerve enlargement on ultrasound in some very elderly patients, we sought to correlate nerve ultrasound and electrodiagnostic findings in a very elderly population and to compare this with a population of younger patients.MethodsWe undertook a retrospective review of electrophysiology and ultrasound data collected during routine clinical practice at our institution over a 13 month period. The correlation between electrodiagnostic severity and median nerve CSA at the wrist in patients aged 40–65 years (59 patients, 70 hands) was compared with a population of very elderly patients aged ≥80 years (33 patients, 40 hands). The sensitivity of nerve ultrasound for the detection of CTS was calculated for both groups.ResultsIn the 40–65 years age group, there was a strong positive correlation between electrodiagnostic severity and median nerve CSA (r=0.79, p<0.01). In patients aged over 80 years, there was no significant correlation between the two techniques (r=0.09, p=0.57). Compared to ‘gold standard’ electrophysiologic tests, nerve ultrasound sensitivity for the detection of CTS was 98% in the 40–65 years age group and 62% in the very elderly group.ConclusionThe absence of expected median nerve enlargement in very elderly patients with electrodiagnostic evidence of CTS may reflect a different pathophysiologic response to distal median nerve entrapment in advanced age. Our data also suggests that nerve CSA measurement alone may not be a reliable tool for the detection of CTS in the very elderly. Further studies of its diagnostic accuracy in very elderly patients are warranted.

Download Full-text

High-resolution scanning electron microscopy of thin-film magnetic media of magnetic recording disk

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100131309 ◽

1992 ◽

Vol 50 (2) ◽

pp. 1334-1335

Author(s):

K. Ogura ◽

H. Nishioka ◽

N. Ikeo ◽

T. Kanazawa ◽

J. Teshima

Keyword(s):

Thin Film ◽

Fine Structure ◽

High Resolution ◽

Magnetic Recording ◽

High Performance ◽

Magnetic Hysteresis ◽

Grain Structure ◽

Magnetic Media ◽

Cross Sectional ◽

Resolution Observation

Structural appraisal of thin film magnetic media is very important because their magnetic characters such as magnetic hysteresis and recording behaviors are drastically altered by the grain structure of the film. However, in general, the surface of thin film magnetic media of magnetic recording disk which is process completed is protected by several-nm thick sputtered carbon. Therefore, high-resolution observation of a cross-sectional plane of a disk is strongly required to see the fine structure of the thin film magnetic media. Additionally, observation of the top protection film is also very important in this field.Recently, several different process-completed magnetic disks were examined with a UHR-SEM, the JEOL JSM 890, which consisted of a field emission gun and a high-performance immerse lens. The disks were cut into approximately 10-mm squares, the bottom of these pieces were carved into more than half of the total thickness of the disks, and they were bent. There were many cracks on the bent disks. When these disks were observed with the UHR-SEM, it was very difficult to observe the fine structure of thin film magnetic media which appeared on the cracks, because of a very heavy contamination on the observing area.

Download Full-text

High-resolution transmission electron microscopic study of highly oxygen doped silicon layer

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100155438 ◽

1989 ◽

Vol 47 ◽

pp. 692-693

Author(s):

H. Takaoka ◽

M. Tomita ◽

T. Hayashi

Keyword(s):

High Resolution ◽

Oxygen Concentration ◽

Silicon Layer ◽

Detailed Structure ◽

Electron Microscopic ◽

Cross Sectional ◽

Transmission Electron ◽

Doped Silicon ◽

Argon Ion

High resolution transmission electron microscopy (HRTEM) is the effective technique for characterization of detailed structure of semiconductor materials. Oxygen is one of the important impurities in semiconductors. Detailed structure of highly oxygen doped silicon has not clearly investigated yet. This report describes detailed structure of highly oxygen doped silicon observed by HRTEM. Both samples prepared by Molecular beam epitaxy (MBE) and ion implantation were observed to investigate effects of oxygen concentration and doping methods to the crystal structure.The observed oxygen doped samples were prepared by MBE method in oxygen environment on (111) substrates. Oxygen concentration was about 1021 atoms/cm3. Another sample was silicon of (100) orientation implanted with oxygen ions at an energy of 180 keV. Oxygen concentration of this sample was about 1020 atoms/cm3 Cross-sectional specimens of (011) orientation were prepared by argon ion thinning and were observed by TEM at an accelerating voltage of 400 kV.

Download Full-text

High-Resolution Cryo-Electron Microscopy of Biological Macromolecules

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100179385 ◽

1990 ◽

Vol 48 (1) ◽

pp. 126-127

Author(s):

Yoshinori Fujiyoshi

Keyword(s):

Electron Microscopy ◽

High Resolution ◽

Diffraction Pattern ◽

Superfluid Helium ◽

Copper Phthalocyanine ◽

Optical Diffraction ◽

Irradiation Damage ◽

Biological Macromolecules ◽

Cross Sectional ◽

Instrumental Resolution

The resolution of direct images of biological macromolecules is normally restricted to far less than 0.3 nm. This is not due instrumental resolution, but irradiation damage. The damage to biological macromolecules may expect to be reduced when they are cooled to a very low temperature. We started to develop a new cryo-stage for a high resolution electron microscopy in 1983, and successfully constructed a superfluid helium stage for a 400 kV microscope by 1986, whereby chlorinated copper-phthalocyanine could be photographed to a resolution of 0.26 nm at a stage temperature of 1.5 K. We are continuing to develop the cryo-microscope and have developed a cryo-microscope equipped with a superfluid helium stage and new cryo-transfer device.The New cryo-microscope achieves not only improved resolution but also increased operational ease. The construction of the new super-fluid helium stage is shown in Fig. 1, where the cross sectional structure is shown parallel to an electron beam path. The capacities of LN2 tank, LHe tank and the pot are 1400 ml, 1200 ml and 3 ml, respectively. Their surfaces are placed with gold to minimize thermal radiation. Consumption rates of liquid nitrogen and liquid helium are 170 ml/hour and 140 ml/hour, respectively. The working time of this stage is more than 7 hours starting from full LN2 and LHe tanks. Instrumental resolution of our cryo-stage cooled to 4.2 K was confirmed to be 0.20 nm by an optical diffraction pattern from the image of a chlorinated copper-phthalocyanine crystal. The image and the optical diffraction pattern are shown in Fig. 2 a, b, respectively.

Download Full-text

A Working Method for Adapting the (SEM) Scanning Electron Microscope to Produce (STEM) Scanning Transmission Electron Microscope Images

ISTFA 2002: Conference Proceedings from the 28th International Symposium for Testing and Failure Analysis ◽

10.31399/asm.cp.istfa2002p0093 ◽

2002 ◽

Author(s):

Edward Coyne

Keyword(s):

Electron Microscope ◽

High Resolution ◽

Scanning Electron Microscope ◽

Integrated Circuits ◽

Theoretical Idea ◽

Cross Sectional ◽

Additional Advantage ◽

Transmission Electron ◽

Resolution Element ◽

Scanning Electron

Abstract This paper describes the problems encountered and solutions found to the practical objective of developing an imaging technique that would produce a more detailed analysis of IC material structures then a scanning electron microscope. To find a solution to this objective the theoretical idea of converting a standard SEM to produce a STEM image was developed. This solution would enable high magnification, material contrasting, detailed cross sectional analysis of integrated circuits with an ordinary SEM. This would provide a practical and cost effective alternative to Transmission Electron Microscopy (TEM), where the higher TEM accelerating voltages would ultimately yield a more detailed cross sectional image. An additional advantage, developed subsequent to STEM imaging was the use of EDX analysis to perform high-resolution element identification of IC cross sections. High-resolution element identification when used in conjunction with high-resolution STEM images provides an analysis technique that exceeds the capabilities of conventional SEM imaging.

Download Full-text

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

Revista de Chimie ◽

10.37358/rc.17.12.6023 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2987-2991

Author(s):

Cristina Iordache ◽

Bogdan Vascu ◽

Eugen Ancuta ◽

Rodica Chirieac ◽

Cristina Pomirleanu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Temporomandibular Joint ◽

Final Analysis ◽

Cross Sectional Study ◽

Joint Disease ◽

Sectional Study ◽

Cross Sectional ◽

Immune Parameters ◽

Immune Mediated

Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders accounting for significant disability and impaired quality of life. The aim of our study was to assess inflammatory and immune parameters in patients with TMJ arthritis related to rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify potential relation with severity and dysfunction of TMJ pathology. We performed a cross-sectional study in a cohort of 433 consecutive RA, 32 JIA, 258 AS, and 103 PsA. Only patients presenting with clinically significant TMJ involvement (273) related to their rheumatic condition were included in the final analysis. TMJ involvement is traditionally described in chronic inflammatory rheumatic disorders, particularly in patients with higher levels of inflammation as detected in rheumatoid arthritis and psoriatic arthritis. Disease activity and severity, as well as biological and positive serological assessments (rheumatoid factor, anti-cyclic citrullinated peptide, IL-1) remain significant determinants of the severity of TMJ arthritis.

Download Full-text