Background To evaluate the diagnostic accuracy of the median-to-ulnar nerve ratio (MUR) and the median-to-ulnar nerve difference (MUD) in patients with carpal tunnel syndrome (CTS). Methods In this study, 32 patients with CTS and 32 healthy volunteers were evaluated. All participants received a series of tests and ultrasound examination for the evaluation of the following criteria: cross-sectional area of the median nerve at the pisiform level (CSA-P), swelling ratio (SR), MUR, MUD, and flattening ratio (FR). Results CSA-P, SR, MUR, and MUD were all significantly larger in the patients with CTS than in the healthy volunteers. The areas under the receiver operator characteristic curves of MUD, MUR, CSA-P, and SR were 0.78, 0.75, 0.70, and 0.61 respectively. MUD had higher sensitivity (84%) than MUR, CSA-P, and SR (sensitivity: 63, 63, and 53%, respectively). Conclusions By using the ulnar nerve area at the pisiform level as an internal control parameter, the MUD and MUR methods showed higher diagnostic accuracy than SR in patients with CTS. Further application of these methods in research and clinical settings is recommended. Trial registration Clinicaltrial.gov NCT03033173. Registered 18 January 2017. Retrospectively registered.

To explore the pathogenic mineral formation in a huge cardiolith isolated from the left heart atrium of an 80-year-old male patient, field emission scanning electron microscopy (FE-SEM) was used to analyze the topographic microstructure and perform elemental mapping in a cross-section of the cardiac calcified deposit after dissection. Environmental SEM equipped with an energy dispersive X-ray spectrometer (EDS) was also used to investigate the composition and spatial distribution of elements in the cross-section, and fiberoptic Raman spectroscopy was used to reidentify the chemical composition of designated positions. The results indicated that calcium hydroxyapatite and cholesterol were the main components of the cardiac calculus. The plate-like structures of calcium hydroxyapatite were unevenly spread over the cholesterol of the cardiac calculus. The calcium hydroxyapatite-rich area exhibited higher amounts of C, O, P, and Ca elements as well as trace amounts of N, Na, Mg, and Al, whereas the major concentration of C, minor concentrations of N and O, and trace amounts of P and Ca were observed in the cholesterol-rich area. Hypercholesterolemia associated with calcification of this cardiac calculus was proposed. Both FE-SEM and ESEM energy dispersive X-ray microanalyses were performed directly, for the first time, to provide useful information on the microstructural characteristics and spatial distribution of elements on the surface of human cardiac calculi.

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