Objective To explore the electrophysiological charaterstics of upper extremities nerves on the patients with Hirayama disease (HD),amyotrophic lateral sclerosis (ALS),and distal cervical spondylotic amyotrophy (DCSA).Methods The data of electrophysiological examination of the upper limbs of 87 patients with HD,83 with ALS and 28 with DCSA were reviewed retrospectively.Seventy-two patients with HD among 87 had unilateral upper limb's amyotrophy and the other 15 ones had bilateral amyotrophy.There were 30 patients had unilater upper limb's amyotrophy and 53 ones had bilateral amyotrophy from the group of patients with ALS; 20 patients with DSCA were affected unilaterally and 8 ones were bilaterally affected.Results Compound muscle action potential (CMAP) evoked by ulnar stimulation had a lower ampititude compared with that evoked by median stimulation in HD patients.In ALS cases that was just the opposite.However,the CMAPs were similar in DCSA cases.The mean ratio of CMAP amplitude by ulnar stimulation to by median stimulation was 0.58±0.40 in HD group; 2.28±1.25 in ALS and 1.31±0.63 in DCSA.The differences in the three groups were statistical significance.The U/M CMAP ratio was less than 0.6in 62 patients with HD,3 with ALS and 1 with DCSA,and more than 1.7 in 73 cases (57 ALS,12 HD and 4 DCSA).Conduction velocities (CV) of the sensory and motor nerves,the amplitude of the sensory nerve action potential in bilateral limbs,and the CMAP amplitude of the unaffected limb were normal in all cases.Conclusion This study could concluded that the severity of amyotropy in hypothenar mucles were higher than that in thenal muscles in patients with HD; there was just opposite in ALS cases and similar in DSCA.

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.

Objective: To observe the effects of acupoint sticking therapy of different dosages and durations on the subjective and objective sleep indicators in insomnia patients.Methods: Ninety-six patients with insomnia due to liver-Qi stagnation and spleen deficiency were divided into a high-dosage 7 d group (25 cases), a high-dosage 14 d group (22 cases), a low-dosage 7 d group (21 cases), and a low-dosage 14 d group (28 cases) using the random numbers generated in a stratified and stage-by-stage manner in combination with the visiting sequence. The four groups all received the same acupuncture treatment, but acupoint sticking therapy varied in dosage and duration. Before and after treatment, the actigraphic readings (total time in bed, total sleep time, sleep efficiency, number of wake bouts, length of wakes after asleep, and sleep latency), Pittsburgh sleep quality index (PSQI) score, and symptoms score of traditional Chinese medicine (TCM) were observed. A correlation analysis was conducted among the subjective and objective indicators. Results: The PSQI score was positively correlated with the total time in bed and total sleep time (P<0.05). After treatment, the sleep latency, PSQI scores, and TCM symptoms scores changed significantly in the four groups (P<0.05). The total sleep time and sleep efficiency gained improvements after treatment in the high-dosage 14 d and low-dosage 14 d groups (P<0.05). The high-dosage acupoint sticking groups had longer total sleep time compared with the low-dosage groups of the same treatment duration (P<0.05). After treatment, the length of wakes after asleep, PSQI scores, and TCM symptoms scores were better in the 14 d groups than in the 7 d groups of the same acupoint sticking dosage (P<0.05). Conclusion: Given the same acupuncture treatment, acupoint sticking therapy of different treatment durations produces different effects on the length of wakes after asleep, PSQI score, and TCM symptoms score in insomnia patients, and the 14-day acupoint sticking treatment is superior to the 7-day treatment.

Methods: Preoperatively, all 160 patients with OVCFs underwent pressure-pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and imaging assessments. Pain intensity and pain-related disability were evaluated before and after PVP. Results: Preoperatively, patients with OVCFs had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy participants (p<0.05). Unlike patients with acute fractures, patients with subacute/chronic OVCFs showed higher TS with or without lower CPM in the pain-free area compared with healthy participants (p<0.05). Postoperatively, RBP occurred in 17 of 160 patients (10.6%). All preoperative covariates with significant differences between the RBP and non-RBP groups were subjected to multivariate logistic regression, showing that intravertebral vacuum cleft, posterior fascia edema, numeric rating pain scale scores for low back pain at rest, and TS were independently associated with RBP (p<0.05). Conclusions Augmented central pain processing may occur in patients with OVCFs, even in the subacute stage, and this preexisting CS may be associated with RBP. Preoperative assessment of TS in pain-free areas may provide additional information for identifying patients who may be at risk of RBP development, which may be beneficial for preventing this complication.

OBJECTIVETo identify whether there is significant changes between the cervical neutral F-waves and cervical flexion F-waves in the patients with Hirayama disease.

METHODSThis study was performed on 25 normal subjects and 22 male patients with identified Hirayama disease (age: 15 to 44 years; height: 165 to 183 cm; duration: 6 to 240 months) between May 2010 and March 2014. Both cervical flexion F-wave (cervical flexion 45 °, 30 minutes) and conventional F-waves to median nerve stimulation and to ulnar nerve stimulation were performed in all subjects bilaterally.

RESULTSwere analyzed by t-test or Fisher exact probability.

RESULTSIn the normal subjects, all measurements of the bilateral F-waves didn't have any difference between the cervical flexion position and the cervical neutral position. On the cervical neutral position, the persistence (t = 5.209, P = 0.000), average latencies (t = 4.731, P = 0.022) and minimal latencies (t = 23.843, P = 0.006) of ulnar F-wave on the symptomatic heavier side from the patients with identified Hirayama disease were significantly lower or longer than those from the normal subjects, and the repeat F-waves were found in 3 patients (13.6%). On the symptomatic lighter side, the ulnar F-waves only had lower persistence (t = 22.306, P = 0.001) along with 5 repeat F-waves. Only lower persistence were found in the median F-wave on the both side (higher side t = 23.696, P = 0.000; lighter side t = 23.998, P = 0.000), along with 5 (22.7%) repeat F-waves on the symptomatic heavier side and 6 (27.3%) ones on the symptomatic lighter side. After cervical flexion maintaining 30 minutes, the increased maximal amplitudes (t = -2.552, P = 0.019), average amplitudes (t = -3.322, P = 0.003), duration (t = -3.323, P = 0.00), persistence (t = -2.604, P = 0.017) and frequency of repeat F-waves (9/22, 41%) (P = 0.044) were found on the symptomatic heavier side of ulnar F-wave, and 5 of 10 absent ulnar F-wave on the cervical neutral position were also recover. The median F-wave on the symptomatic heavier side mainly had increased maximal amplitude (t = -3.847, P = 0.001), average amplitudes (t = -2.188, P = 0.040) and persistence (t = -2.421, P = 0.025), and 1 of 6 absent median F-wave on the cervical neutral position were also recover after cervical flexion.

CONCLUSIONThe cervical flexion F-waves have significant regular changes compared to the cervical neutral F-waves in patients with Hirayama diseases, especially maximal and average amplitudes of F-waves.

Adolescent ; Adult ; Humans ; Male ; Neck ; Range of Motion, Articular ; Spinal Muscular Atrophies of Childhood ; physiopathology ; Ulnar Nerve ; Young Adult

Objective To explore the role of S1 root stimulation H-reflex in evaluating the efficacy of lumbar disc hernia-tion (LDH). Methods 95 LDH patients (55 males, 40 females) who had underwent discectomy for the lumber herniated discs were recruited in this research from January 2014 to January 2016. The average was (40.5±6.7) years, ranged 17-60 years. The vi-sual analogue scale (VAS) scores and the MOS item short from health survey (SF-36) scale was evaluated in preoperative, day 7, 3 month and 1 year after operation, respectively. Meanwhile, the S1 H-reflex and routine H-reflex were taken before operation and 1 year of postoperation. Results The subjects were divided into two groups according to the results of the preoperative S1 H-reflex:①60 patients with S1 present group, the H-M interval was significantly longer (8.1±1.2) ms, 47 of those with routine H-reflex and the latency was prolonged (31.8 ± 2.5) ms, 13 of those with absent routine H-reflex. 32 among 60 patients H-M interval was short-en before operation (7.8 ± 1.0) ms in 1 year follow-up, and there was statistically significant (P=0.001);the latency of conventional H-reflex was shorter than that of preoperation (28.5 ± 2.3) ms in 20 patients, there was statistical difference (P=0.023);the H-re-flexes were detected in the 6 patients from that 13 with absent routine H-reflex.②35 patients absent group, of which 30 cases of conventional H reflex disappeared, only 5 had normal routine H-reflex and the latency was prolonged (31.2 ± 3.0) ms. There were no H-wave patterns detected in 18 patients with H-reflexed one year later, and there was no significant difference in the H-reflex latency (31.0 ± 3.1) ms. All patient's VAS scores and SF-36 were significantly improved from preoperation to postoperation. Both scores were no difference between two groups in 7 d of post surgery. The mean VAS score of two groups: 3 months (1.7 ± 1.0) points, (2.1 ± 1.2) points (t=2.618, P=0.010), and 1 year (1.3 ± 0.9) points, (1.8 ± 1.1)( t=3.311, P=0.002). SF-36 in two groups:3 months (28.9 ± 5.6) points, (33.2 ± 5.5) points ( t=-2.670, P=0.008), 1 year (23.2 ± 6.2), (30.2 ± 5.6) (t=-3.012, P=0.001). Conclusion The patients with LDH had detected S1 H-reflex before surgery which indicated the minor leisure in intravertebral nerves, so that nerve can get better recovery and functional score of postoperation, it could objectively evaluate the efficacy of LDH surgery.

Objective　To establish Huashan diagnostic criteria and clinical classification system for Hirayama disease.Methods　Retrospective analysis 359 cases of puberty onset,upper extremity muscle atrophy as main clinical manifestations,and complete clinical data from September 2007 to August 2018.There were 348 males and 11 females(31.6:1 male and female)in this group.The average age of onset was 16.7±2.2 years,the average age of visits was 19.2±4.5 years,and the average duration of treatment was 29.3±45.4 months.Descriptive study of the clinical manifestations,radiologic and neurophysiological findings of this group of patients,the Huashan clinical diagnostic criteria of Hirayama disease were established by including 100% of the clinical manifestations,imaging and neurophysiological findings.According to the following parameters,the clinical classification system of Hirayama disease was proposed.The parameters specifically included:the muscle atrophy involves the upper limbs,whether the quadriplegia was active or hyperactive,the Babinski sign positive and other pyramidal tract damage,whether it was accompanied by sensory dysfunction such as upper limb numbness,muscle atrophy location,and the progress of clinical symptoms or electrophysiological examination within 6 months.Thirty patients were randomly selected from the above 359 cases.Four orthopedic surgeons who were not involved in the classification system completed the clinical classification within the specified time.The Kappa value was used for the credibility evaluation.Results　The Huashan diagnostic criteria of Hirayama disease included clinical manifestations,imaging examinations and neurophysiological examinations.The main diagnostic indicators were:1)occult onset puberty,more common in men;2)localized muscle atrophy and weakness in the upper extremities;3)compared with the cervical neutral MRI,the MRI of cervical flexion showed that spinal cord was significantly shift forward and the anterior spinal cord was narrowed or disappeared.4)MRI T2 weighting of the cervical flexion showed cyst-wall separation behind the spinal cord;5)Neurophysiological examination showed that the affected muscles were neurogenic damage.6)The affected parts are limited to the middle and lower neck segment.At the same time,it was necessary to combine imaging and neurophysiological manifestations to distinguish cervical spondylosis with upper limb muscle atrophy and motor neuron disease.According to the clinical characteristics of different patients,Hirayama disease can be divided into type I-III.Type I:72.1%,one-sided upper limb or one upper limb-based hand inner muscle and forearm muscle atrophy.According to whether progress of symptoms or electrophysiological examination was seen in the past 6 months,type I can be divided into:Ia.stable period.Regular follow-up assessment was recommended.If the disease progressed,to wear a cervical collar was suggested;surgery could be done if necessary;Ib.progression period,it was recommended to use a cervical collar,and regularly evaluate,if patients could not wear cervical collar for long,it was recommended to operate.Type II:14.2%,unilateral upper limb or one upper limb-based hand inner muscle and forearm muscle atrophy with pyramidal tract injury.Surgery was recommended.Type II:13.7%,atypical Hirayama disease,including upper limb proximal muscle atrophy,symmetrical double upper limb muscle atrophy,and sensory disturbances associated with upper limb numbness.Wear a cervical collar,and follow-up and assess closely,and choose surgical treatment if necessary.The credibility evaluation showed that the average Kappa value of the classification was 0.732(0.688-0.834),which is a basic credibility.Conclusion　The Huashan diagnostic criteria of Hirayama disease was conducive to the early diagnosis.The clinical classification system of Hirayama disease has good credibility and good clinical intervention guidance value.

Objective: To understand the current situation and regulatory effectiveness of daylighting and artificial lighting in primary and secondary school classrooms in Shanghai, so as to provide a basis for enhancing the visual environment of school classrooms. Methods: From April 2021 to December 2023, the daylighting and artificial lighting conditions of classrooms in 1 735 regular primary and secondary schools currently in operation in Shanghai were monitored, and the qualified rate of each indicator was calculated. The Chisquare test or Fisher exact probability method were used to compare the differences in qualification rates across different educational stages, regions, school type, both before and after the implementation of regulatory measures. The regulatory measures included convene interview, propaganda and education, supervision order, supervisory opinion paper, rectification requests and offenses and punishment. Results: The qualified rate of daylighting and artificial lighting in primary and secondary school classrooms was 30.1%, with a qualified daylighting rate of 85.6% and a qualified artificial lighting rate of 32.9%. There was no statistically significant differences in the qualified rate of daylighting and artificial lighting in primary and secondary schools (32.4%，28.1%；χ2=3.76，P＞0.05). However, statistically significant differences were found in the qualified rate of daylighting and artificial lighting in urban and rural school classrooms (32.6%，26.7%), as well as in public and private schools (31.4%, 20.6%) (χ2=6.99，9.92，P＜0.05). Following the implementation of regulatory measures, the qualified rate of classroom daylighting and artificial lighting improved from 30.1% to 83.2%, while the respective qualified rates of daylighting and artificial lighting increased from 85.6% to 91.1% and 32.9% to 90.5%. Compared to the preimplementation period, the qualified rate of classroom daylighting and artificial lighting, as well as the respective rates of daylighting and artificial lighting, all showed statistically significant differences after the implementation of regulatory measures (χ2=995.29，25.34，1 219.87，P<0.01). Conclusions Effective regulatory measures can promote enhanced classroom daylighting and artificial lighting. Attention should be paid to improving classroom artificial lighting, in order to provide students with enhanced visual environment.

Methods: Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were recorded in 48 patients with TOLF (hybrid 20 vs. en bloc 28) during surgery. Patients were categorized based on MEP/SEP improvement, deterioration, or no change, and MEP/SEP improvement rates were measured in the improvement group. Furthermore, all patients were assessed using the Ashworth and modified Japanese Orthopedic Association scores. Results: The incidences of both MEP/SEP improvement (21.4% vs. 25.0%, p=0.772) and deterioration (21.4% vs. 20.0%, p=0.904) were similar between the en bloc and hybrid laminectomy groups, and no difference in preoperative and postoperative clinical assessments was observed between the two groups (p>0.05). In four patients (4/28, 14.3%) undergoing en bloc laminectomy, MEP amplitudes initially increased after OLF removal but gradually decreased. This delayed MEP reduction did not occur in the hybrid laminectomy group. Furthermore, more patients undergoing en bloc laminectomy had CFL than those undergoing hybrid laminectomy (46.4% vs. 15.0%, p=0.023). In the improvement group, the hybrid laminectomy group exhibited higher MEP improvement rates in the bilateral abductor hallucis than the en bloc laminectomy group (left side: 213.4%±35.9% vs. 152.5%±41.0%, p=0.028; right side: 201.2%±32.0% vs. 145.2%±46.3%, p=0.043). Conclusions Compared with en bloc laminectomy, hybrid laminectomy may be a safe and effective method for treating multilevel TOLF, potentially reducing intraoperative spinal cord irritation and CFL and causing relatively better functional recovery.

Methods: Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were recorded in 48 patients with TOLF (hybrid 20 vs. en bloc 28) during surgery. Patients were categorized based on MEP/SEP improvement, deterioration, or no change, and MEP/SEP improvement rates were measured in the improvement group. Furthermore, all patients were assessed using the Ashworth and modified Japanese Orthopedic Association scores. Results: The incidences of both MEP/SEP improvement (21.4% vs. 25.0%, p=0.772) and deterioration (21.4% vs. 20.0%, p=0.904) were similar between the en bloc and hybrid laminectomy groups, and no difference in preoperative and postoperative clinical assessments was observed between the two groups (p>0.05). In four patients (4/28, 14.3%) undergoing en bloc laminectomy, MEP amplitudes initially increased after OLF removal but gradually decreased. This delayed MEP reduction did not occur in the hybrid laminectomy group. Furthermore, more patients undergoing en bloc laminectomy had CFL than those undergoing hybrid laminectomy (46.4% vs. 15.0%, p=0.023). In the improvement group, the hybrid laminectomy group exhibited higher MEP improvement rates in the bilateral abductor hallucis than the en bloc laminectomy group (left side: 213.4%±35.9% vs. 152.5%±41.0%, p=0.028; right side: 201.2%±32.0% vs. 145.2%±46.3%, p=0.043). Conclusions Compared with en bloc laminectomy, hybrid laminectomy may be a safe and effective method for treating multilevel TOLF, potentially reducing intraoperative spinal cord irritation and CFL and causing relatively better functional recovery.