Single vs. two steroid injections for carpal tunnel syndrome: a randomised clinical trial

We investigated the efficacy of a single vs. double steroid injections in the treatment of carpal tunnel syndrome (CTS) in a randomised double-blind controlled trial. Patients with idiopathic CTS were randomised into (i) one group receiving a baseline methylprednisolone acetate injection plus a saline injection 8 weeks later and (ii) a second group receiving methylprednisolone acetate injection at baseline and at 8 weeks. The primary outcome was the Global Symptom Score (GSS). Forty patients were recruited. By 40 weeks, the mean GSS improved from 25.6 to 14.1 in the single-injection group whereas from 26.7 to 12.6 in the reinjection group, but there was no significant difference in GSS between the two groups (p = 0.26). There were also no significant differences in terms of electrophysiological and functional outcomes. The results suggest that an additional steroid injection confers no added benefit to a single injection in terms of symptom relief.

Carpal tunnel syndrome: diagnostic usefulness of sonography

PURPOSE: To prospectively evaluate accuracy of sonography for diagnosis of carpal tunnel syndrome (CTS) in patients clinically suspected of having the disease in one or both hands.
MATERIALS AND METHODS: A prospective cohort of 133 patients suspected of having CTS were referred to a teaching hospital between October 2001 and June 2002 for electrodiagnostic study. One hundred twenty patients (98 women, 22 men; mean age, 49 years; range, 19–83 years) underwent sonography within 1 week after electrodiagnostic study. Radiologist was blinded to electrodiagnostic study results. Seventy-five patients had bilateral symptoms; 23 patients, right-hand symptoms; and 22 patients, left-hand symptoms (total, 195 symptomatic hands). Cross-sectional area of median nerve was measured at three levels: immediately proximal to carpal tunnel inlet, at carpal tunnel inlet, and at carpal tunnel outlet. Flexor retinaculum was used as a landmark to margins of carpal tunnel. Optimal threshold levels (determined with classification and regression tree analysis) for areas proximal to and at tunnel inlet and at tunnel outlet were used to discriminate between patients with and patients without disease. Sensitivity, specificity, and false-positive and false-negative rates were derived on the basis of final diagnosis, which was determined with clinical history and electrodiagnostic study results as reference standard.
RESULTS: For right hands, sonography had sensitivity of 94% (66 of 70); specificity, 65% (17 of 26); false-positive rate, 12% (nine of 75); and false-negative rate, 19% (four of 21) (cutoff, 0.09 cm2 proximal to tunnel inlet and 0.12 cm2 at tunnel outlet). For left hands, sensitivity was 83% (53 of 64); specificity, 73% (24 of 33); false-positive rate, 15% (nine of 62); and false-negative rate, 31% (11 of 35) (cutoff, 0.10 cm2 proximal to tunnel inlet).
CONCLUSION: Sonography is comparable to electrodiagnostic study in diagnosis of CTS and should be considered as initial test of choice for patients suspected of having CTS.

Flight costs and fuel composition of a bird migrating in a wind tunnel

We studied the energy and protein balance of a Thrush Nightingale Luscinia luscinia, a small long-distance migrant, during repeated 12-hr long flights in a wind tunnel and during subsequent two-day fueling periods. From the energy budgets we estimated the power requirements for migratory flight in this 26 g bird at 1.91 Watts. This is low compared to flight cost estimates in birds of similar mass and with similar wing shape. This suggests that power requirements for migratory flight are lower than the power requirements for nonmigratory flight. From excreta production during flight, and nitrogen and energy balance during subsequent fueling, the dry protein proportion of stores was estimated to be around 10%. A net catabolism of protein during migratory flight along with that of fat may reflect a physiologically inevitable process, a means of providing extra water to counteract dehydration, a production of uric acid for anti-oxidative purposes, and adaptive changes in the size of flight muscles and digestive organs in the exercising animal.

Variation in energy intake and basal metabolic rate of a bird migrating in a wind tunnel

1. We studied the changes in body mass, metabolizable energy intake rate (ME) and basal metabolic rate (BMR) of a Thrush Nightingale, Luscinia luscinia, following repeated 12-h migratory flights in a wind tunnel. In total the bird flew for 176 h corresponding to 6300 km. This is the first study where the fuelling phase has been investigated in a bird migrating in captivity.

2. ME was very high, supporting earlier findings that migrating birds have among the highest intake rates known among homeotherms. ME was significantly higher the second day of fuelling, indicating a build-up of the capacity of the digestive tract during the first day of fuelling.

3. Further indications of an increase in size or activity level of metabolically active structures during fuelling come from the short-term variation in BMR, which increased over the 2-day fuelling period with more than 20%, and in almost direct proportion to body mass. However, mass-specific BMR decreased over the season.

4. The patterns of mass change, ME and BMR of our focal bird following two occasions of 12-h fasts were the same as after flights, indicating that fast and flight may involve similar physiological processes.

5. The relatively low ME the first day following a flight may be a contributing factor to the well-known pattern that migrating birds during stopover normally lose mass the first day of fuelling.

Wingbeat frequency and the body drag anomaly: wind-tunnel observations on a thrush nightingale (Luscinia Luscinia) and a teal (Anas crecca)

A teal (Anas crecca) and a thrush nightingale (Luscinia luscinia) were trained to fly in the Lund wind tunnel for periods of up to 3 and 16 h respectively. Both birds flew in steady flapping flight, with such regularity that their wingbeat frequencies could be determined by viewing them through a shutter stroboscope. When flying at a constant air speed, the teal's wingbeat frequency varied with the 0.364 power of the body mass and the thrush nightingale's varied with the 0.430 power. Both exponents differed from zero, but neither differed from the predicted value (0.5) at the 1 % level of significance. The teal continued to flap steadily as the tunnel tilt angle was varied from -1° (climb) to +6° (descent), while the wingbeat frequency declined progressively by about 11%. In both birds, the plot of wingbeat frequency against air speed in level flight was U-shaped, with small but statistically significant curvature. We identified the minima of these curves with the minimum power speed (Vmp) and found that the values predicted for Vmp, using previously published default values for the required variables, were only about two-thirds of the observed minimum-frequency speeds. The discrepancy could be resolved if the body drag coefficients (CDb) of both birds were near 0.08, rather than near 0.40 as previously assumed. The previously published high values for body drag coefficients were derived from wind-tunnel measurements on frozen bird bodies, from which the wings had been removed, and had long been regarded as anomalous, as values below 0.01 are given in the engineering literature for streamlined bodies. We suggest that birds of any size that have well-streamlined bodies can achieve minimum body drag coefficients of around 0.05 if the feet can be fully retracted under the flank feathers. In such birds, field observations of flight speeds may need to be reinterpreted in the light of higher estimates of Vmp. Estimates of the effective lift:drag ratio and range can also be revised upwards. Birds that have large feet or trailing legs may have higher body drag coefficients. The original estimates of around CDb=0.4 could be correct for species, such as pelicans and large herons, that also have prominent heads. We see no evidence for any progressive reduction of body drag coefficient in the Reynolds number range covered by our experiments, that is 21600-215 000 on the basis of body cross-sectional diameter.

Data mining analysis of an urban tunnel pressure drop based on CFD data

An accurate estimation of pressure drop due to vehicles inside an urban tunnel plays a pivotal role in tunnel ventilation issue. The main aim of the present study is to utilize computational intelligence technique for predicting pressure drop due to cars in traffic congestion in urban tunnels. A supervised feed forward back propagation neural network is utilized to estimate this pressure drop. The performance of the proposed network structure is examined on the dataset achieved from Computational Fluid Dynamic (CFD) simulation. The input data includes 2 variables, tunnel velocity and tunnel length, which are to be imported to the corresponding algorithm in order to predict presure drop. 10-fold Cross validation technique is utilized for three data mining methods, namely: multi-layer perceptron algorithm, support vector machine regression, and linear regression. A comparison is to be made to show the most accurate results. Simulation results illustrate that the Multi-layer perceptron algorithm is able to accurately estimate the pressure drop.

A mixed mode low profile solar tunnel dryer for canarium indicum nuts

Canarium indicum nuts are dried and consumed widely across the Pacific Region. Traditional methods of drying offer little process control resulting in highly variable product quality and loss. A more reliable and effective drying technology is required but the technology must suit local conditions. This paper describes a low profile solar tunnel dryer designed for batch drying of small quantities of the nuts. Prototypes have been tested. Experimental results indicate that drying temperatures are within the range to achieve good kernel quality and that the desired final moisture content for safe storage could be achieved after 30 hours of exposure.

A new method for resolving uncertainty of energy requirements in large water breathers: The 'mega-flume' seagoing swim-tunnel respirometer

Body size is a key determinant of metabolic rate, but logistical constraints have led to a paucity of energetics measurements from large water-breathing animals. As a result, estimating energy requirements of large fish generally relies on extrapolation of metabolic rate from individuals of lower body mass using allometric relationships that are notoriously variable. Swim-tunnel respirometry is the 'gold standard' for measuring active metabolic rates in water-breathing animals, yet previous data are entirely derived from body masses <10 kg - at least one order of magnitude lower than the body masses of many top-order marine predators. Here, we describe the design and testing of a new method for measuring metabolic rates of large water-breathing animals: a c. 26 000 L seagoing 'mega-flume' swim-tunnel respirometer. We measured the swimming metabolic rate of a 2·1-m, 36-kg zebra shark Stegostoma fasciatum within this new mega-flume and compared the results to data we collected from other S. fasciatum (3·8-47·7 kg body mass) swimming in static respirometers and previously published measurements of active metabolic rate measurements from other shark species. The mega-flume performed well during initial tests, with intra- and interspecific comparisons suggesting accurate metabolic rate measurements can be obtained with this new tool. Inclusion of our data showed that the scaling exponent of active metabolic rate with mass for sharks ranging from 0·13 to 47·7 kg was 0·79; a similar value to previous estimates for resting metabolic rates in smaller fishes. We describe the operation and usefulness of this new method in the context of our current uncertainties surrounding energy requirements of large water-breathing animals. We also highlight the sensitivity of mass-extrapolated energetic estimates in large aquatic animals and discuss the consequences for predicting ecosystem impacts such as trophic cascades.

Applying bi-directional evolutionary structural optimisation method for tunnel reinforcement design considering nonlinear material behaviour

In the empirical methods for reinforcement design of underground excavations, an even distribution of rock bolts is generally recommended. This work proves that this design is not necessarily optimal and shows how the state-of-the-art reinforcement design could be improved through topology optimisation techniques. The Bidirectional Evolutionary Structural Optimisation (BESO) method has been extended to consider nonlinear material behaviour. An elastic perfectly-plastic Mohr-Coulomb model is utilised for both original rock and reinforced rock. External work along the tunnel wall is considered as the objective function. Various in situ stress conditions with different horizontal stress ratios and different geostatic stress magnitudes are investigated through several examples. The outcomes show that the proposed approach is capable of improving tunnel reinforcement design. Also, significant difference in optimal reinforcement distribution for the cases of linear and nonlinear analysis results proves the importance of the influence of realistic nonlinear material properties on the final outcome.