Sex-Related Differences in Atrial Remodeling in Patients With Atrial Fibrillation: Relationship to Ablation Outcomes

Background: Population studies have demonstrated a range of sex differences including a higher prevalence of atrial fibrillation (AF) in men and a higher risk of AF recurrence in women. However, the underlying reasons for this higher recurrence are unknown. This study evaluated whether sex-based electrophysiological substrate differences exist to account for worse AF ablation outcomes in women. Methods: High-density electroanatomic mapping of the left atrium was performed in 116 consecutive patients with AF. Regional analysis was performed across 6 left atrium segments. High-density maps were created using a multipolar catheter (Biosense Webster) during distal coronary sinus pacing at 600 and 300 ms. Mean voltage and conduction velocity was determined. Complex fractionated signals and double potentials were manually annotated. Results: Overall, 42 (36%) were female, mean age was 61±8 years and AF was persistent in 52%. Global mean voltage was significantly lower in females compared with males at 600 ms (1.46±0.17 versus 1.84±0.15 mV, P <0.001) and 300 ms (1.27±0.18 versus 1.57±0.18 mV, P =0.013) pacing. These differences were seen uniformly across the left atrium. Females demonstrated significant conduction velocity slowing (34.9±6.1 versus 44.1±6.9 cm/s, P =0.002) and greater proportion of complex fractionated signals (9.9±1.7% versus 6.0±1.7%, P =0.014). After a median follow-up of 22 months (Q1–Q3: 15–29), females had significantly lower single-procedure (22 [54%] versus 54 [75%], P =0.029) and multiprocedure (24 [59%] versus 60 [83%], P =0.005) arrhythmia-free survival. Female sex and persistent AF were independent predictors of single and multiprocedure arrhythmia recurrence. Conclusions: Female patients demonstrated more advanced atrial remodeling on high-density electroanatomic mapping and greater post-AF ablation arrhythmia recurrence compared with males. These changes may contribute to sex-based differences in the clinical course of females with AF and in part explain the higher risk of recurrence.

Rehabilitation Training Combined with Jiaji Electroacupuncture Can Promote the Recovery of Muscle Group Function and Improve the Quality of Life in Patients with Upper Limb Peripheral Nerve Injury

This study was designed to probe into the improvement of rehabilitation training combined with Jiaji electroacupuncture intervention on patients with upper limb peripheral nerve injury. A total of 114 patients with peripheral nerve injury of upper limbs in our hospital from August 2017 to November 2019 were collected as the research participants. Among them, 59 in the control group (CG) received rehabilitation training alone, while 65 in the observation group (OG) received rehabilitation training combined with Jiaji electroacupuncture intervention. The therapeutic efficacy, Barthel index, and Fugl–Meyer assessment score, motor nerve conduction velocity, sensory nerve conduction velocity and amplitude, and quality of life (score SF-36) were compared between the two groups before and after treatment. The total effective rate of the OG was markedly higher than that of the CG. After treatment, the Barthel index, Fugl–Meyer assessment score, motor nerve conduction velocity, and sensory nerve conduction velocity and amplitude of the OG were obviously higher than those of the CG, and the SF-36 scores of the OG were higher than those of the CG in 8 dimensions. Rehabilitation training combined with Jiaji electroacupuncture intervention can dramatically promote the recovery of muscle group function and improve the quality of life of patients with upper limb peripheral nerve injury.

Nerve recovery from treatment with a vascularized nerve graft compared to an autologous non-vascularized nerve graft in animal models: A systematic review and meta-analysis

Background Treatment of nerve injuries proves to be a worldwide clinical challenge. Vascularized nerve grafts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous non-vascularized nerve graft. However, there is no adequate clinical evidence for the beneficial effect of vascularized nerve grafts and they are still disputed in clinical practice. Objective To systematically review whether vascularized nerve grafts give a superior nerve recovery compared to non-vascularized nerve autografts regarding histological and electrophysiological outcomes in animal models. Material and methods PubMed and Embase were systematically searched. The inclusion criteria were as follows: 1) the study was an original full paper which presented unique data; 2) a clear comparison between a vascularized and a non-vascularized autologous nerve transfer was made; 3) the population study were animals of all genders and ages. A standardized mean difference and 95% confidence intervals for each comparison was calculated to estimate the overall effect. Subgroup analyses were conducted on graft length, species and time frames. Results Fourteen articles were included in this review and all were included in the meta-analyses. A vascularized nerve graft resulted in a significantly larger diameter, higher nerve conduction velocity and axonal count compared to an autologous non-vascularized nerve graft. However, during sensitivity analysis the effect on axonal count disappeared. No significant difference was observed in muscle weight. Conclusion Treating a nerve gap with a vascularized graft results in superior nerve recovery compared to non-vascularized nerve autografts in terms of axon count, diameter and nerve conduction velocity. No difference in muscle weight was seen. However, this conclusion needs to be taken with some caution due to the inherent limitations of this meta-analysis. We recommend future studies to be performed under conditions more closely resembling human circumstances and to use long nerve defects.

Electrophysiological assessment of peripheral nerves and neuro-muscular junctions in patients following self-poisoning with paraquat

Paraquat is neurotoxic. We aimed to study the electrophysiological effects of peripheral nerves and neuromuscular junction (NMJ) in the survivors of paraquat poisoning. A cohort study was conducted on patients following paraquat poisoning. Controls were recruited. The assessments were performed around one and six weeks after the exposure. Motor nerve conduction velocity (MNCV), amplitude of compound muscle action potential (CMAP), sensory nerve conduction velocity (SNCV), F-wave studies, cardiovascular response to different stimuli, sympathetic skin response (SSR) studies, and exercise modified supramaximal slow repetitive stimulation (RNS) and electromyography (EMG) were performed. There were 28 (21 males) patients and 56 controls. The mean (SD) age of the patients and the controls were 29 (12) and 31 (11) years. Significant impairment at the first assessment in the SNCV of ulnar nerve, amplitude of ulnar nerve CMAP on distal stimulation, and F-wave occurrence in median, ulnar and tibial nerves; change of systolic blood pressure three minutes after standing and SSR amplitude ( vs controls) was observed. All parameters reverted to normal at six weeks after the exposure. There was electrophysiological evidence for somatic nerve, autonomic, and NMJ dysfunction following acute paraquat poisoning which was not seen at six weeks after the exposure.

NEUROPHYSIOLOGICAL EFFECT OF LOW LEVEL LASER THERAPY ON ULNAR NERVE

Low level laser therapy is widely used in managing pain and inflammation in musculoskeletal ailments. Its effect on Peripheral nervous system and its function is not yet clearly studied. Objective: To analyze the neurophysiological effect of Low level laser irradiation on ulnar nerve MATERIALS AND METHODS: Sixty healthy subjects with age group between 20-30 years of both genders were recruited in this experimental study design.. The procedure was clearly explained to the subjects and informed consent was obtained. They were assigned randomly to either Ga. As.Laser group or Sham laser group. All the subject’s were positioned in supine lying with the irradiated dominant hand kept at 135 degrees of flexion. Ground electrode was placed over the thenar eminence. The subject's skin (electrode placement area) was degreased for proper transmission of laser. Nerve conduction velocity was recorded Antidromically. A 904nm diode laser was used to irradiate the skin overlying the ulnar nerve behind the medial epicondyle of the humerus for 20 secs. The laser was set to deliver continuous energy at 4.0 J/cm².Antidromically action potential, peak to peak amplitude, onset latency, nerve conduction velocity was recorded before and after irradiation of the ulnar nerve. RESULT: The study revealed that there was a significant difference in onset Latency (P=0.0021) but there was no significant difference in Nerve conduction velocity (P=0.2738) and PPA (P=1.0000) between laser group and sham laser group. CONCLUSIONS: Low level laser irradiation of skin overlying the ulnar nerve resulted in a significant increase in latency in this study. This increase in latency corresponds to a decrease in sensory nerve conduction velocity and could help explain the alleged pain relieving effects of low level laser irradiation.

A COMPARISON OF FUNCTIONAL ASSESSMENT OF PRE- AND POSTSURGICAL CARPAL TUNNEL SYNDROME USING BOSTON CARPAL TUNNEL QUESTIONNAIRE AND NERVE CONDUCTION STUDY: A PROSPECTIVE STUDY FROM A TERTIARY CENTER OF SOUTH INDIA

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome of median nerve causing frequent disability especially among working populations. Boston Carpal Tunnel Questionnaire and Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after surgical release of carpal tunnel. OBJECTIVES: To assess functional outcome of patients with Carpal Tunnel Syndrome after surgery as assessed by Boston Carpel Tunnel Questionnaire and Electrophysiological study. METHODS: A prospective observational study conducted over a period of one year (January 2017 to January 2018). The study was conducted among consecutive 31 electrophysiological conrmed carpal tunnel syndrome attending the outpatient department of Physical Medicine and Rehabilitation, Government Medical College, Thiruvananthapuram. All patients underwent open carpal tunnel release. Functional outcome was assessed using Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at interval of 3 weeks, 6weeks and 3 months postoperatively. Electrophysiological study assessed using nerve conduction study both preoperatively and 3 weeks post operatively. Data was entered in Microsoft excel and analyzed using SPSS statistical software. RESULTS: The study involves 31 conrmed cases of Carpal tunnel syndrome patients. Mean Boston Carpal Tunnel Questionnaire (BCTQ) score preoperatively was 58.52 ± 12.73 which was markedly improved postoperatively at 3weeks with mean score of 29.77±6.68. At 6 weeks and 3 month follow up period it was reduced respectively to mean score of 23.94±4.23 and 22.94±4.62. Preoperative NCS shows decreased conduction velocity with mean nerve sensory velocity (NSV) score 21.51±8.19 and mean nerve motor velocity (NMV) score of 20.72±8.81 which statistically improved following surgery with mean NSV score of 32.04±9.01 and mean NML score of 33.78±8.1. Correlation between pre- and post-operative BCTQ and NCS parameters shows positive correlation with latency and negative correlation with amplitude and conduction velocity. Increased latency and decreased conduction velocity associated with higher BCTQ score with signicant 'p' value (p<0.05). CONCLUSION: There is statistically signicant improvement of functional outcome following carpal tunnel release surgery assessed through Boston Carpal Tunnel Questionnaire and Electrophysiological ndings