Prognostic value of electroneurography using the midline method for predicting the development of synkinesis after peripheral facial palsy

OBJECTIVE

The prognostic value of electroneurography (ENoG) for predicting the incidence of synkinesis is reportedly about 40 % using the formal standard method (ENoG-SM). However, the prognostic value of ENoG using the newly developed midline method (ENoG-MM) has not been determined. The aim of this study was to demonstrate the optimal prognostic value and advantages of ENoG-MM for predicting the incidence of synkinesis.

METHODS

Participants were 573 patients treated for peripheral facial palsy including Bell's palsy or Ramsay Hunt syndrome. We investigated the clinical presence of any oral-ocular or ocular-oral synkinesis from the medical records. ENoG-MM and ENoG-SM were performed 10-14 days after symptom onset. In ENoG-MM, compound muscle action potentials were recorded by placing the anode on the mental protuberance and the cathode on the philtrum. In ENoG-SM, electrodes were placed on the nasolabial fold. Synkinesis was clinically assessed at the end of follow-up or at >1 year after onset. The sensitivity and specificity of ENoG values for predicting the incidence of synkinesis were compared between ENoG-MM and ENoG-SM at every 5 % around 40 % (range, 30-50 %).

RESULTS

At every 5 % of ENoG values around 40 %, ENoG-MM provided higher sensitivity and lower specificity for predicting the incidence of synkinesis compared with ENoG-SM. In particular, when the cut-off value was set at 45 %, sensitivity was 100 % and 95.3 % with ENoG-MM and ENoG-SM, respectively.

CONCLUSION

In peripheral facial palsy, ENoG-MM offered higher sensitivity than ENoG-SM for predicting synkinesis. ENoG-MM is useful for screening patients at risk of developing synkinesis. In clinical practice, an ENoG-MM cut-off value of 45 % must be the optimal prognostic value because of the 100 % sensitivity.

Exploring the ultrafast and isomer-dependent photodissociation of iodothiophenes via site-selective ionization

C-I bond extension and fission following ultraviolet (UV, 262 nm) photoexcitation of 2- and 3-iodothiophene is studied using ultrafast time-resolved extreme ultraviolet (XUV) ionization in conjunction with velocity map ion imaging. The photoexcited molecules and eventual I atom products are probed by site-selective ionization at the I 4d edge using intense XUV pulses, which induce multiple charges initially localized to the iodine atom. At C-I separations below the critical distance for charge transfer (CT), charge can redistribute around the molecule leading to Coulomb explosion and charged fragments with high kinetic energy. At greater C-I separations, beyond the critical distance, CT is no longer possible and the measured kinetic energies of the charged iodine atoms report on the neutral dissociation process. The time and momentum resolved measurements allow determination of the timescales and the respective product momentum and kinetic energy distributions for both isomers, which are interpreted in terms of rival 'direct' and 'indirect' dissociation pathways. The measurements are compared with a classical over the barrier model, which reveals that the onset of the indirect dissociation process is delayed by ∼1 ps relative to the direct process. The kinetics of the two processes show no discernible difference between the two parent isomers, but the branching between the direct and indirect dissociation channels and the respective product momentum distributions show isomer dependencies. The greater relative yield of indirect dissociation products from 262 nm photolysis of 3-iodothiophene (cf. 2-iodothiophene) is attributed to the different partial cross-sections for (ring-centred) π∗ ← π and (C-I bond localized) σ∗ ← (n/π) excitation in the respective parent isomers.

Young's double-slit experiment with undulator vortex radiation in the photon-counting regime

Young's double-slit interference experiments with undulator vortex radiation were conducted, focusing on photon-counting regime. To isolate the second harmonic radiation in the ultraviolet range emitted from the helical undulator and achieve successful counting measurements, an ultranarrow bandpass filter was utilized under an extremely low-current mode of the electron storage ring. It was observed that the photon spots on the detector, after passing through the double slits, appeared to be randomly distributed. However, upon integrating these photon spots, it was confirmed that interference fringes with characteristic features of optical vortices, such as dark and broken/distorted stripes in the center, were formed. The reproducibility of these interference fringes was confirmed by calculating the optical path difference for the optical vortex reaching the double slits, as well as the optical path difference resulting from normal double-slit interference. Consequently, these findings indicate that even in the state of a single photon, the radiation emitted spontaneously by a high-energy electron in spiral motion possesses the nature of an optical vortex, characterized by a spiral wavefront.

Incorporation of a bromine atom into DNA-related molecules changes their electronic properties

To understand the mechanism underlying the high radio-sensitisation of living cells possessing brominated genomic DNA, X-ray photoelectron spectroscopy (XPS) using synchrotron X-rays with energies of 2000 or 2500 eV was used to study brominated and nonbrominated nucleobases, nucleosides and nucleotides. The bromine atom significantly reduced the energy gap between the valence and conduction states, although the core level states were not greatly affected. This finding was supported by quantum chemical calculation for the nucleobases and nucleosides. Our findings strongly indicate that the energy gaps between the valence and conduction levels of the molecules are significantly reduced by bromination. Furthermore, the brominated molecules are more likely to produce inelastic scattering low energy electrons upon exposure to 2000 or 3000 eV X-rays. This modification of electronic properties around the brominated group may both facilitate electron transfer to the brominated site in DNA and increase the probability of reaction with low energy electrons. These processes can induce DNA damage, presumably resulting in debromination of the uracil moiety and a subsequent cytotoxic effect.

Electronic properties of DNA-related molecules containing a bromine atom

PURPOSE

To clarify the radiosensitization mechanism masking the Auger effect of the cells possessing brominated DNA, the electronic properties of DNA-related molecules containing Br were investigated by X-ray spectroscopy and specific heat measurement.

MATERIALS AND METHODS

X-ray absorption near-edge structure (XANES) and X-ray photoemission spectroscopy (XPS) were used to measure the electronic properties of the nucleotides with and without Br. We determined the specific heat of 5-bromouracil crystals with thymine as a reference molecule at low temperatures of 3-48 K to calculate the microscopic state numbers.

RESULTS

Obtained XANES and XPS spectra indicated that both the lowest unoccupied molecular orbital (LUMO) and the core-levels were not affected by the Br incorporation. The state numbers of 5-bromouracil calculated from the specific heats obtained around 25 K was about 1.5 times larger than that for thymine below 20 K, although the numbers were almost the same below 5 K.

DISCUSSION

Our results suggest that the Br atom may not contribute substantially to the LUMO and core-level electronic states of the molecule, but rather to the microscopic states related to the excitation of lattice vibrations, which may be involved in valence electronic states.

Electron spectroscopic study of nanoplasma formation triggered by intense soft x-ray pulses

Using electron spectroscopy, we investigated the nanoplasma formation process generated in xenon clusters by intense soft x-ray free electron laser (FEL) pulses. We found clear FEL intensity dependence of electron spectra. Multistep ionization and subsequent ionization frustration features are evident for the low FEL-intensity region, and the thermal electron emission emerges at the high FEL intensity. The present FEL intensity dependence of the electron spectra is well addressed by the frustration parameter introduced by Arbeiter and Fennel [New J. Phys. 13, 053022 (2011)].

Photo-ionization and fragmentation of Sc3N@C80 following excitation above the Sc K-edge

We have investigated the ionization and fragmentation of a metallo-endohedral fullerene, Sc₃N@C₈₀, using ultrashort (10 fs) x-ray pulses. Following selective ionization of a Sc (1s) electron (hν = 4.55 keV), an Auger cascade leads predominantly to either a vibrationally cold multiply charged parent molecule or multifragmentation of the carbon cage following a phase transition. In contrast to previous studies, no intermediate regime of C₂ evaporation from the carbon cage is observed. A time-delayed, hard x-ray pulse (hν = 5.0 keV) was used to attempt to probe the electron transfer dynamics between the encapsulated Sc species and the carbon cage. A small but significant change in the intensity of Sc-containing fragment ions and coincidence counts for a delay of 100 fs compared to 0 fs, as well as an increase in the yield of small carbon fragment ions, may be indicative of incomplete charge transfer from the carbon cage on the sub-100 fs time scale.

Electroneurography value as an indicator of high risk for the development of moderate-to-severe synkinesis after Bell's palsy and Ramsay Hunt syndrome

Background: The degree of distress caused by the sequelae of peripheral facial nerve palsy usually depends on the severity of synkinesis. Objective: To clarify whether electroneurography (ENoG) can predict the severity of synkinesis after peripheral facial nerve palsy. Materials and methods: One-hundred and fourteen patients treated for facial nerve palsy at our hospital from April 2014-September 2016 were retrospectively reviewed. ENoG was performed 10-16 days after symptom onset. Patients were classified into Groups A (ENoG value 10%-20%, n = 9) and B (ENoG value <10%, n = 21). Eight months after symptom onset, electrophysiological and symptomatic outcomes were evaluated as the aberrant regeneration ratio of the blink reflex and the total synkinesis score of the Sunnybrook facial grading system, respectively. The outcomes of the groups were compared. Results: Group B had a significantly higher median aberrant regeneration ratio (0% versus 87%, p=.015), median total synkinesis score (1 versus 3, p < .001), and incidence of moderate-to-severe synkinesis (0% versus 57.2%, p=.003) than did Group A. Conclusions and significance: Patients with an ENoG value of <10% have higher risks of aberrant regeneration and moderate-to-severe synkinesis than those with an ENoG value of 10%-20%. Patients with ENoG values of <10% may require rehabilitation to prevent synkinesis.

Radiation-Induced Chemical Dynamics in Ar Clusters Exposed to Strong X-Ray Pulses

We show that electron and ion spectroscopy reveals the details of the oligomer formation in Ar clusters exposed to an x-ray free electron laser (XFEL) pulse, i.e., chemical dynamics triggered by x rays. With guidance from a dedicated molecular dynamics simulation tool, we find that van der Waals bonding, the oligomer formation mechanism, and charge transfer among the cluster constituents significantly affect ionization dynamics induced by an XFEL pulse of moderate fluence. Our results clearly demonstrate that XFEL pulses can be used not only to "damage and destroy" molecular assemblies but also to modify and transform their molecular structure. The accuracy of the predictions obtained makes it possible to apply the cluster spectroscopy, in connection with the respective simulations, for estimation of the XFEL pulse fluence in the fluence regime below single-atom multiple-photon absorption, which is hardly accessible with other diagnostic tools.

A new electroneurography as a prognostic tool for marginal mandibular nerve paralysis after parotid gland surgery: A preliminary evaluation

OBJECTIVE

Marginal mandibular nerve paralysis is the most frequent complication of benign parotid tumor surgery and results in cosmetic deformity. The purpose of this study was to develop a new electroneurography method for marginal mandibular nerve paralysis using electroneurography (ENoG) and judge its usefulness for clinical practice.

METHODS

Twenty-seven patients who underwent surgery for benign parotid tumor were enrolled. We proposed and use the mandibular angle method, in which the recording electrode was placed on the skin above the depressor anguli oris muscle while the reference electrode was placed on the skin of the parietal region, and percutaneous electrical stimulation was applied to enclose the mandibular angle that could measure the function of the marginal mandibular nerve solely. Preoperative and postoperative ENoG values were compared in paralytic and non-paralytic patients.

RESULTS

The mean postoperative ENoG value (35.0%) was lower than the preoperative value (90.5%) in paralytic patients, whereas no difference was observed between preoperative (79.3%) and postoperative (69.5%) ENoG values in non-paralytic patients.

CONCLUSION

A new ENoG method (mandibular angle method) was thought to reflect marginal mandibular nerve injury and might be useful for determining the likelihood of paralysis.

Does the ENoG Value of the Orbicularis Oris Muscle Reflect All Facial Nerve Degeneration?

Objectives:

1) Compare electroneuronography (ENoG) values in patients with facial palsy using two different methods, the midline method that records compound muscle action potentials (CMAPs) from the orbicularis oris muscle (the standard muscle for facial ENoG) and five electroneurogram recordings that records five CMAPs from five different facial muscles. 2) Reveal whether the ENoG value obtained with the midline method reflects entire facial nerve degeneration.

Methods:

Forty patients with facial palsy were enrolled. CMAPs were recorded using the midline method, in which the anode was placed on the mental protuberance and the cathode was placed on the philtrum. Additionally, five electroneurogram recordings were obtained by placing the anode on the skin of the parietal region and five cathodes on the skin over five facial muscles (frontalis, orbicularis oculi, nasalis, orbicularis oris, and depressor anguli oris muscles). ENoG values recorded using the two methods were compared.

Results:

The ENoG values of the five facial muscles did not differ from those obtained using the midline method. The total ENoG value calculated by summing five CMAPs from five facial muscles, which is considered to reflect total facial nerve degeneration, was not significantly different from that using midline methods; moreover, a strong positive correlation coefficient (r = 0.87) was found between them.

Conclusions:

The midline ENoG method that records CMAP from the orbicularis oris muscle reflects entire facial nerve degeneration. The ENoG value calculated from the orbicularis oris muscle might be suitable to evaluate the total prognosis of facial palsy.

The midline electroneurography method for facial palsy reflects total nerve degeneration

CONCLUSION

The midline electroneurography (ENoG) method might reflect total facial nerve degeneration.

OBJECTIVE

We compared ENoG values in patients with facial palsy using two different methods, the midline method and five electroneurogram recordings, to reveal whether the ENoG value obtained with the midline method reflects total facial nerve degeneration.

METHODS

Forty patients with facial palsy were enrolled. Compound muscle action potentials (CMAPs) were recorded using the midline method, in which the anode was placed on the mental protuberance and the cathode was placed on the philtrum. Additionally, five electroneurogram recordings were obtained by placing the anode on the skin of the parietal region and five cathodes on the skin over five facial muscles (frontalis, orbicularis oculi, nasalis, orbicularis oris, and depressor anguli oris muscles). ENoG values recorded using the two methods were compared.

RESULTS

The ENoG values of the five facial muscles did not differ from those obtained using the midline method. The total ENoG value calculated by summing five CMAPs from five facial muscles, which is considered to reflect total facial nerve degeneration, was not significantly different from that using midline methods; moreover, a strong positive correlation coefficient (r = 0.87) was found between them.

Size-dependent ultrafast ionization dynamics of nanoscale samples in intense femtosecond x-ray free-electron-laser pulses

All matter exposed to intense femtosecond x-ray pulses from the Linac Coherent Light Source free-electron laser is strongly ionized on time scales competing with the inner-shell vacancy lifetimes. We show that for nanoscale objects the environment, i.e., nanoparticle size, is an important parameter for the time-dependent ionization dynamics. The Auger lifetimes of large Ar clusters are found to be increased compared to small clusters and isolated atoms, due to delocalization of the valence electrons in the x-ray-induced nanoplasma. As a consequence, large nanometer-sized samples absorb intense femtosecond x-ray pulses less efficiently than small ones.

A novel electroneurography method in facial palsy

CONCLUSION

The novel midline electroneurography (ENoG) method may have advantages over the standard method in terms of ease of electrode setting, and the ENoG value may be a useful prognostic factor.

OBJECTIVE

We compared ENoG performed in patients with facial palsy using two different methods--the new midline method and standard method--in terms of the amplitudes of the compound muscle action potentials(CMAPs) and relationship between the ENoG value and clinical course.

METHODS

A total of 64 patients with facial palsy were enrolled. CMAPs were recorded using the midline method, in which the recording electrodes were placed on the mental protuberance and philtrum over the orbicularis oris muscle, and the standard method, in which the recording electrodes were set close to the nasolabial fold. Percutaneous electrical stimulation was applied to the main trunk of the facial nerve.The amplitudes of the CMAPs and the relationship between the ENoG value and the period to full recovery from the facial palsy were compared.

RESULTS

The midline method had larger CMAP amplitudes on both sides and a stronger negative correlation in the relationship between the ENoG value and period to full recovery from palsy than the standard method statistically.

A new method for measuring compound muscle action potentials in facial palsy: a preliminary study

To establish a simple, reproducible procedure for studying facial motor nerve conduction (MNC), we determined the optimal electrode position to record evoked compound muscle action potentials (CMAPs) from perioral muscles in normal subjects. We examined three new electrode positions in which the electrode connected to the one input of the amplifier was placed on the mental protuberance, and the one connected to the other input was placed on the skin over the orbicularis oris muscle (the philtrum, mouth angle, or lower lip). We then compared the morphology and amplitudes of the CMAPs, right-left differences, and the reproducibility of CMAP amplitudes with recordings taken from the standard electrode position in which one electrode was placed on the nasolabial fold closely lateral to the ala nasi, and the other was placed on the skin over the orbicularis oris. Percutaneous supramaximal electrical stimulation was applied to the main trunk of the facial nerve. All three of the new recording positions showed greater amplitudes and more obvious biphasic CMAPs than the standard method. Positioning the electrode connected to the negative input on the philtrum was optimal in terms of right-left differences and the reproducibility of CMAP amplitudes. Therefore, this midline recording is a simple, reproducible method for calculating the CMAP amplitude ratio. However, prior to clinical use of this procedure, analyses of patients with facial palsy are required.

Patient dose estimation for multi-detector-row CT examinations

The spread of Multi-detector-row computed tomography (MDCT) has been remarkable. Here, various organ and tissue doses were evaluated with six types of MDCT scanners in common use in Japan; using thermoluminescence dosimeters and anthropomorphic phantoms under condition of routine clinical examinations of the chest in adult and child, of the head in child and of the abdomen-pelvis in adult. Estimated lung doses and averaged effective dose in chest examinations were 19.2 +/- 2.03 mGy and 9.54 +/- 0.90 mSv for the adult and 15.7 +/- 1.88 mGy and 7.42 +/- 0.82 mSv for the child phantom, respectively. The numerical difference between effective dose and organ or tissue doses was about 2-2.5 times. For the adult abdomen-pelvis examinations, averaged effective dose was 13.0 +/- 3.72 mSv. Averaged effective dose for the child head examinations was 2.6 +/- 1.32 mSv. In one case, the dose approached 80 mGy for the brain in the head examination, giving a difference from the effective dose of 10 times or more.

Spontaneous resolution of 2,3-bis-fluoren-9-ylidenesuccinic acid induced by achiral guest inclusion

The racemic title host compound (1) formed homochiral inclusion crystals (conglomerate) of 1 with acetone, while heterochiral inclusion crystals (racemate) were obtained when complexed with ethyl acetate. Upon treatment of the homochiral inclusion crystals of 1 with gaseous acetyl chloride in the solid state, optically active 2,3-bis(fluorenylidene)succinic anhydride (3) was obtained in high optical purity.

Dynamic changes in area 1 somatosensory cortex during transient sensory deprivation: a preliminary study

To investigate the neural plasticity in the somatosensory cortex, changes in somatosensory evoked potentials (SSEPs) during finger ischemia were evaluated and compared with those affected by touch or movement interference. Somatosensory evoked potentials were recorded in the vicinity of the central sulcus in four patients with intractable epilepsy. During electrical stimulation to a selected finger, ischemic anesthesia was induced in another finger. Effects of tactile or movement interference were examined during electrical stimulation to the selected finger by applying tactile stimulation to or inducing voluntary movement of the other finger. Dynamic SSEPs were recorded during varying levels of sensory deprivation and different types of interference, and the dynamic nature of the SSEP changes within an individual was studied in detail. Somatosensory evoked potential changes appeared during finger ischemia and tended to persist during the postischemic stage, which is indicative of sensory plasticity and the maintenance of new conditioning. Amplitudes of the early and late cortical components increased when complete finger anesthesia was induced-a sign of the unmasking phenomenon. Amplitudes of early cortical SSEPs decreased when ischemic anesthesia was incomplete, similar to the findings when tactile or movement interference was applied. Surrounding inhibition, therefore, may become dominant before the unmasking phenomenon appears in early cortical SSEPs.

Triterpene constituents from the stem bark of Pinus luchuensis and their DNA topoisomerase II inhibitory effect

Nine lanostane and serratane-type triterpenes including two unknown compounds were isolated from the stem bark of Pinus luchuensis. These new compounds were characterized as 3-oxolanost-9(11)-ene-24S,25-diol (1) and 29-acetoxy-3beta-methoxyserrat-14-en-21alpha-ol (2) on the basis of spectroscopic evidence. Some of these triterpenes were tested for the inhibitory effect on DNA topoisomerase II activity. Compound 1 showed a slightly less potent inhibitory activity with an IC(50) value of 186 microM.

Skin and epidural recording of spinal somatosensory evoked potentials following median nerve stimulation: correlation between the absence of spinal N13 and impaired pain sense

A clinical lesion study and intraoperative epidural recordings were made to test the origin and clinical significance of the spinal N13 and P13 of somatosensory evoked potentials (SEP) that follow median nerve stimulation. Intraoperatively, the respective peak latencies of spinal P13 and N13 coincided with those of the N1 component of the dorsal cord potential and its phase reversed positivity. On both the ventral and dorsal sides of the cervical epidural space, maximal amplitude was at the C5 vertebral level to which nerve input from the C6 dermatome is the main contributor. The modality of sensory impairment in the hand dermatome was examined in selected patients with cervical lesions, who showed such normal conventional SEP components as Erb N9, far-field P9, P11, P14, N18 and cortical N20, with or without loss of spinal N13. Statistically, the loss of spinal N13 was associated with decrease of pain sensation in the C6 dermatome. This was interpreted as being due to damage to the central grey matter of the cord, including the dorsal horn. Our results suggest the spinal N13 and P13 originate from the same source in the C6 spinal cord segment and that they are good indicators for the detection of centromedullary cervical cord damage.

Generation of auditory brain stem responses (ABRs). III. Effects of lesions of the superior olive, lateral lemniscus and inferior colliculus on the ABR in guinea pig

Auditory brain stem potentials were recorded between the skull (vertex) and a non-cephalic reference in guinea pig before and after making discrete lesions of the auditory pathway in the pons and midbrain. Lesions of the superior olivary complex were accompanied by attenuation of P3 and N3 to contralateral input. Lesions of the lateral lemniscus were accompanied by attenuation of N3 to contralateral input. Lesions of the lateral portion of the pons adjacent to the lateral superior olivary nucleus were accompanied by attenuation of P4 to ipsilateral input. Lesions of the inferior colliculus were without effect on the ABR. These data are interpreted as supporting the hypothesis that each component of the ABR arises from a focal region of the brain stem auditory pathway.

Generation of auditory brain stem responses (ABRs). I. Effects of injection of a local anesthetic (procaine HCI) into the trapezoid body of guinea pigs and cat

Auditory brain stem potentials were recorded between the skull and a non-cephalic reference electrode in anesthetized guinea pigs before and after the injection of a local anesthetic agent (procaine HCI) into the trapezoid body from a ventral approach. All components except P1, N1 and P2 were affected; N2 was delayed; P3 and N3 were lost; P4 was both broadened in duration and shortened in latency; N4 was attenuated in amplitude. All of these changes were temporary and recovery of the components occurred. Identification of the altered components was aided by their latency and amplitude changes as a function of both stimulus intensity and rate. This study implicates the trapezoid body as contributing to the generation of auditory brain stem components beginning with N2.

Generation of auditory brain stem responses (ABRs). II. Effects of surgical section of the trapezoid body on the ABR in guinea pigs and cat

Auditory brain stem potentials were recorded between the skull and a non-cephalic reference electrode in guinea pig and cat before and after midline section of the trapezoid body from a ventral approach. The ABR after complete section was altered: N2 was delayed, P3 and N3 were lost, P4 and N4 were shortened in latency but only N4 was attenuated in amplitude. With partial section of the trapezoid body the amplitude of P3 was linearly related to the extent of the section. Recordings from the surface of the trapezoid body before and after section revealed a loss of activity contralateral to the ear stimulated and a preservation of activity ipsilateral to the section. Binaural interaction in P4 and N4 was attenuated in a linear manner as a function of the extent of trapezoid body section. This study suggests that auditory brain stem structures contralateral to the midline of the trapezoid body generate components N2, P3, N3, N4, whereas auditory structures ipsilateral to the midline generate components P1, N1, P2 and P4.