The NDTF selected only those studies that met all quality criteria and were considered suitable as a clinical resource for NCS metrics. The literature is, however, limited and these findings should be confirmed by larger, multicenter collaborative efforts. Muscle Nerve 54: 371-377, 2016.

3. Maynard AJ, Aitken RJ, Butz T, et al: Safe handling of nanotechnology. Nature 2006;444:267-9 4. Hardman RA: A toxicological review of quantum dots: toxicity depends on physico-chemical and environmental factors. Environ Health Perspect 2006;114:165-72 5. 2. Marchant GE, Sylvester DJ: Transnational models for regulation of nanotechnology. J Law Med Ethics 2006;34:714-25 3. Renn O, Roco MC: Nanotechnology and the need for risk governance.The Authors Respond: We highly appreciate the comments by Shah et al. We also regret that we have not cited their paper 1 as one of the references in our article. 2 Both their work 1 and ours 2 have definitely contributed substantially to increasing the credibility of myofascial trigger point (MTrPs). The former has further confirmed the energy crisis hypothesis, 3 and the latter has proven the correlation between MTrP and endplate noise.

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Rigorous criteria enable identification of high-quality studies dealing with nerve conduction reference values. This represents the first step toward the overarching goal of recommending NCS techniques and reference values for electrodiagnostic medicine. Muscle Nerve 54: 366-370, 2016.

The purpose of this collective review is to outline the predisposing factors in the development of pressure ulcers and to identify a pressure ulcer prevention program. The most frequent sites for pressure ulcers are areas of skin overlying bony prominences. There are four critical factors contributing to the development of pressure ulcers: pressure, shearing forces, friction, and moisture. Pressure is now viewed as the single most important etiologic factor in pressure ulcer formation. Prolonged immobilization, sensory deficit, circulatory disturbances, and poor nutrition have been identified as important risk factors in the development of pressure ulcer formation. Among the clinical assessment scales available, only two, the Braden Scale and Norton Scale, have been tested extensively for reliability and/or validity. The most commonly used risk assessment tools for pressure ulcer formation are computerized pressure monitoring and measurement of laser Doppler skin blood flow. Pressure ulcers can predispose the patient to a variety of complications that include bacteremia, osteomyelitis, squamous cell carcinoma, and sinus tracts. The three components of pressure ulcer prevention that must be considered in any patient include management of incontinence, nutritional support, and pressure relief. The pressure relief program must be individualized for non-weight-bearing individuals as well as those that can bear weight. For those that can not bear weight and passively stand, the RENAISSANCE Mattress Replacement System is recommended for the immobile patient who lies supine on the bed, the stretcher, or operating room table. This alternating pressure system is unique because it has three separate cells that are not interconnected. It is specifically designed so that deflation of each individual cell will reach a ZERO PRESSURE during each alternating pressure cycle. The superiority of this system has been documented by comprehensive clinical studies in which this system has been compared to the standard hospital bed as well as to two other commercially available pressure relief mattresses. The most recent advance in pressure ulcer prevention is the development of the ALTERN8* seating system. This seating system provides regular periods of pressure relief and stimulation of blood flow to skin areas while users are seated. By offering the combination of pressure relief therapy and an increase in blood flow, the ALTERN8* reportedly creates an optimum pressure ulcer healing environment. Foam is the most commonly used material for pressure reduction and pressure ulcer prevention and treatment for the mobile individual. For those immobilized individuals who can achieve a passive standing position, a powered wheelchair that allows the individual to achieve a passive standing position is recommended. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased blander pressure, enhanced orthost...

A survey of 400 gastroenterological endoscopists was carried out to determine what kinds of overuse syndromes they suffer from as a result of doing endoscopic procedures. The response rate was 72%. Thumb pain, hand pain, elbow pain, low back pain, and possibly shoulder pain all appear to be caused by endoscopy to at least some extent. Physicians who perform the most procedures tend to have the highest risk of developing such problems. Age, sex, practice setting, and hobbies did not seem to have an impact on the overuse conditions identified. These conditions are most likely due to the equipment and technique of endoscopy. Further study is needed to determine the anatomic lesions causing the various pain states, so that they can be treated or prevented.

Buschbacher RM: Sural and saphenous 14-cm antidromic sensory nerve conduction studies. Am J Phys Med Rehabil 2003;82:421-426. Objective: To create a large database of normal values for the sural and saphenous nerve conduction studies and to compare the results for the two nerves.Design: Using a 14-cm antidromic technique, data were collected for onset latency, peak latency, onset-to-peak amplitude, peak-to-peak amplitude, area, duration, side-to-side variability, and between-nerve variability. A total of 230 subjects were included in the study.Results: For the sural nerve, the upper limits of normal, defined as the 97th percentile of observed values, for onset latency, peak latency, and duration were 3.6, 4.5, and 2.1 msec, respectively. The comparable values for the saphenous nerve were 3.8, 4.4, and 1.9 msec, respectively. The lower limits of normal (third percentile) for sural onset-topeak amplitude and peak-to-peak amplitude were 4 and 4 V. The comparable values for the saphenous study were 2 and 1 V. The upper limit of normal difference in onset latency between the two nerves was: saphenous 0.7 msec longer than sural or sural 0.3 msec longer than saphenous. The corresponding values for peak latency were: 0.6 and 0.5 msec.Conclusion: Normal ranges are presented for a large database of subjects for the sural and saphenous nerve conduction studies.