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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic sclerosis &#40;SSc&#41; is a rheumatic disease characterized by inflammation&#44; vascular injury and fibrosis&#46; Median nerve &#40;MN&#41; entrapment in the carpal tunnel &#40;CT&#41; seems to be frequent in patients with SSc<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Ultrasound &#40;US&#41; evaluation of MN in SSc patients was only performed in few studies and conclusions were not linear<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to compare specific MN US parameters between patients with SSc and a group of control subjects&#46; Additionally&#44; in the group of SSc patients&#44; we also assessed the correlation between the US measurements and clinical variables of the disease&#46; For this purpose&#44; we conducted a cross-sectional study comprising 48 SSc patients&#44; 39 females &#40;81&#46;3&#37;&#41;&#44; followed-up in our Rheumatology Unit with mean age of 56&#46;98 &#177; 12&#46;73 years and mean disease duration of 9&#46;77 &#177; 6&#46;12 years&#46; The control group included 45 healthy subjects&#44; 37 females &#40;82&#46;2&#37;&#41;&#44; paired for age &#40;p&#61;0&#46;146&#41; and gender &#40;p&#61;0&#46;904&#41;&#46; All individuals were Caucasian&#46; Exclusion criteria were age &#60;18 years&#44; body mass index &#62;30&#44; previous wrist trauma or local corticosteroid injection&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Subjects were consecutively evaluated in our Department&#46; MN cross-sectional area &#40;MNA&#41; and perimeter &#40;MNP&#41; of both sides of each person were measured at the level of the CT inlet in the transverse plane between the scaphoid tubercle and the pisiform bone&#46; All measurements were performed by the same observer using a 15<span class="elsevierStyleHsp" style=""></span>MHz linear probe of a General Electric LOGIQ S8 US &#40;image settings&#58; frequency 15<span class="elsevierStyleHsp" style=""></span>MHz&#44; gain 67 and depth 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; Additionally&#44; in the patients group&#44; modified Rodnan skin score &#40;mRSS&#41;&#44; the hand mobility &#40;HAMIS&#41; and the SSc Severity Scale &#40;SScSS&#41; were also calculated&#46; For simplification of comparative analysis&#44; we present the results using the mean MNA and MNP of combined right and left sides&#46; Statistical analysis included Chi-Square test&#44; Mann-Whitney U-test&#44; Kruskal-Wallis and Spearman correlation coefficient&#46; Statistical significance was defined as P value &#60;0&#46;05&#46; The study was performed following the Declaration of Helsinki principles and informed consent was obtained from all subjects&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We evaluated by US a total of 186 MN&#46; Possible confounding variables as proportion of diabetes and CT surgery were similar between groups &#40;p&#61;0&#46;803 and p&#61;0&#46;339&#44; respectively&#41;&#46; Median of MNA and MNP were significantly higher in SSc patients &#40;7&#46;5 mm<span class="elsevierStyleSup">2</span> &#91;6&#46;6 to 9&#46;5&#93; and 13&#46;8<span class="elsevierStyleHsp" style=""></span>mm &#91;12&#46;4 to 15&#93;&#44; respectively&#41; &#40;median &#91;interquartile range&#93;&#41; compared with controls &#40;7&#46;0 mm<span class="elsevierStyleSup">2</span> &#91;6 to 8&#93; and 12&#46;9<span class="elsevierStyleHsp" style=""></span>mm &#91;11&#46;7 to 14&#93;&#44; respectively&#41; &#40;p&#61;0&#46;021 and p&#61;0&#46;018&#44; respectively&#41;&#46; Among SSc patients group&#44; a positive correlation was found between mRSS and both MNA &#40;Spearman&#39;s rho&#61;0&#46;335&#44; p&#61;0&#46;02&#41; and MNP values &#40;rho&#61;0&#46;336&#44; p&#61;0&#46;02&#41;&#46; There was no correlation between MN US parameters and age&#44; disease duration&#44; HAMIS or SScSS&#46; MNA and MNP were also similar in relation to gender and subset of disease &#40;p&#62;0&#46;05&#41;&#46; However&#44; median of MNA and MNP were significantly different between the 3 phases of skin involvement&#44; being higher in patients in the edematous phase &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Our study showed an increased MNA and MNP in SSc patients in comparison with controls while few data available from previous studies yielded mixed results<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Contrarily to Bandinelli F et al<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> who did not find any correlation between MN US measurements and SSc clinical features&#44; we found some interesting correlations&#46; In our study&#44; patients in the edematous phase of skin involvement and patients with higher skin thickness assessed by mRSS showed higher MNA and MNP values&#46; The presence of tissue edema and thick skin may contribute as mechanical factors for MN entrapment in the CT&#46; Larger studies are needed to draw definite conclusions&#46;</p></span>"
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Letter to the Editor
Median nerve ultrasound findings in systemic sclerosis patients: How do they relate to clinical features of the disease?
Hallazgos ecográficos del nervio mediano en pacientes con esclerosis sistémica: ¿cómo se comparan con aspectos clínicos de la enfermedad?
Joana Sousa-Neves
Autor para correspondencia
joanasvsneves@gmail.com

Corresponding author.
, Marcos Cerqueira, Carmo Afonso, Filipa Teixeira
Rheumatology Department, Conde de Bertiandos Hospital, Ponte de Lima, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic sclerosis &#40;SSc&#41; is a rheumatic disease characterized by inflammation&#44; vascular injury and fibrosis&#46; Median nerve &#40;MN&#41; entrapment in the carpal tunnel &#40;CT&#41; seems to be frequent in patients with SSc<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Ultrasound &#40;US&#41; evaluation of MN in SSc patients was only performed in few studies and conclusions were not linear<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to compare specific MN US parameters between patients with SSc and a group of control subjects&#46; Additionally&#44; in the group of SSc patients&#44; we also assessed the correlation between the US measurements and clinical variables of the disease&#46; For this purpose&#44; we conducted a cross-sectional study comprising 48 SSc patients&#44; 39 females &#40;81&#46;3&#37;&#41;&#44; followed-up in our Rheumatology Unit with mean age of 56&#46;98 &#177; 12&#46;73 years and mean disease duration of 9&#46;77 &#177; 6&#46;12 years&#46; The control group included 45 healthy subjects&#44; 37 females &#40;82&#46;2&#37;&#41;&#44; paired for age &#40;p&#61;0&#46;146&#41; and gender &#40;p&#61;0&#46;904&#41;&#46; All individuals were Caucasian&#46; Exclusion criteria were age &#60;18 years&#44; body mass index &#62;30&#44; previous wrist trauma or local corticosteroid injection&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Subjects were consecutively evaluated in our Department&#46; MN cross-sectional area &#40;MNA&#41; and perimeter &#40;MNP&#41; of both sides of each person were measured at the level of the CT inlet in the transverse plane between the scaphoid tubercle and the pisiform bone&#46; All measurements were performed by the same observer using a 15<span class="elsevierStyleHsp" style=""></span>MHz linear probe of a General Electric LOGIQ S8 US &#40;image settings&#58; frequency 15<span class="elsevierStyleHsp" style=""></span>MHz&#44; gain 67 and depth 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; Additionally&#44; in the patients group&#44; modified Rodnan skin score &#40;mRSS&#41;&#44; the hand mobility &#40;HAMIS&#41; and the SSc Severity Scale &#40;SScSS&#41; were also calculated&#46; For simplification of comparative analysis&#44; we present the results using the mean MNA and MNP of combined right and left sides&#46; Statistical analysis included Chi-Square test&#44; Mann-Whitney U-test&#44; Kruskal-Wallis and Spearman correlation coefficient&#46; Statistical significance was defined as P value &#60;0&#46;05&#46; The study was performed following the Declaration of Helsinki principles and informed consent was obtained from all subjects&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We evaluated by US a total of 186 MN&#46; Possible confounding variables as proportion of diabetes and CT surgery were similar between groups &#40;p&#61;0&#46;803 and p&#61;0&#46;339&#44; respectively&#41;&#46; Median of MNA and MNP were significantly higher in SSc patients &#40;7&#46;5 mm<span class="elsevierStyleSup">2</span> &#91;6&#46;6 to 9&#46;5&#93; and 13&#46;8<span class="elsevierStyleHsp" style=""></span>mm &#91;12&#46;4 to 15&#93;&#44; respectively&#41; &#40;median &#91;interquartile range&#93;&#41; compared with controls &#40;7&#46;0 mm<span class="elsevierStyleSup">2</span> &#91;6 to 8&#93; and 12&#46;9<span class="elsevierStyleHsp" style=""></span>mm &#91;11&#46;7 to 14&#93;&#44; respectively&#41; &#40;p&#61;0&#46;021 and p&#61;0&#46;018&#44; respectively&#41;&#46; Among SSc patients group&#44; a positive correlation was found between mRSS and both MNA &#40;Spearman&#39;s rho&#61;0&#46;335&#44; p&#61;0&#46;02&#41; and MNP values &#40;rho&#61;0&#46;336&#44; p&#61;0&#46;02&#41;&#46; There was no correlation between MN US parameters and age&#44; disease duration&#44; HAMIS or SScSS&#46; MNA and MNP were also similar in relation to gender and subset of disease &#40;p&#62;0&#46;05&#41;&#46; However&#44; median of MNA and MNP were significantly different between the 3 phases of skin involvement&#44; being higher in patients in the edematous phase &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Our study showed an increased MNA and MNP in SSc patients in comparison with controls while few data available from previous studies yielded mixed results<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Contrarily to Bandinelli F et al<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> who did not find any correlation between MN US measurements and SSc clinical features&#44; we found some interesting correlations&#46; In our study&#44; patients in the edematous phase of skin involvement and patients with higher skin thickness assessed by mRSS showed higher MNA and MNP values&#46; The presence of tissue edema and thick skin may contribute as mechanical factors for MN entrapment in the CT&#46; Larger studies are needed to draw definite conclusions&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fibrotic &#40;n&#61;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Atrophic &#40;n&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Median MNA &#40;mm2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;25 &#91;7&#46;5 to 11&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;25 &#91;6&#46;5 to 8&#46;4&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Median MNP &#40;mm2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;5 &#91;13&#46;5 to 16&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;4 &#91;12&#46;4 to 13&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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