[pt] A velocidade da onda de pulso (VOP) tem sido identificada como o padrão-ouro para avaliação da rigidez arterial e, recentemente, vem sendo reconhecida como um importante indicador no diagnóstico e tratamento de doenças cardiovasculares. Atualmente, já existem dispositivos comerciais capazes de efetuar a medição da VOP, entretanto, ainda exigem um investimento financeiro significativo e alguns requerem um treinamento especializado para seu correto uso. Os, transdutores de pressão atuais são majoritariamente baseados em sensores piezoresistivos, piezoelétricos e capacitivos. Entretanto, pesquisas recentes demostraram que transdutores de pressão que utilizam sensores magnéticos baseados na magnetoimpedância gigante (GMI) apresentam elevada sensibilidade. Tendo em vista que a VOP é um importante indicador do risco de distúrbios cardiovasculares, e considerando os potenciais beneficios dos sensores GMI em relação às demais alternativas, esta tese de doutorado buscou utilizar-se destes elementos sensores a fim de desenvolver um sistema de medição portátil, não-invasivo, de baixo custo, acessível e simples de usar, capaz de efetuar a medição da VOP. Neste intuito, foram desenvolvidos transdutores de alta sensibilidade, baseados nas características de fase da impedância de sensores de Magnetoimpedância Gigante, destinados à medição da velocidade da onda de pulso arterial. A fim de se otimizar as características de desempenho dos transdutores, foram realizadas avaliações teórico-computacionais dos transdutores na configuração em malha aberta e fechada, bem como ensaios experimentais dos protótipos projetados. As caracterizações e ensaios experimentais realizados com o transdutor de pressão em malha aberta resultaram em uma sensibilidade de 59,6 mV/kPa, e resolução de 192,8 Pa para uma média de 30 amostras, na banda de passagem de 1000 Hz. Por outro lado, a configuração em malha fechada apresentou uma sensibilidade de 54,2 mV/kPa, e resolução de 206,0 Pa para uma média de 30 amostras, na banda de passagem de 32 Hz. Tendo em vista os valores de sensibilidade e resolução obtidos, propõe-se empregar o sistema de transdução de pressão que incorpora uma câmara incompressível para amplificação mecânica, na medição de ondas de pulso arterial. Neste protótipo, uma pequena membrana semirrígida localizada na superfície da câmara incompressível é posicionada sobre a superfície da pele, próxima à artéria de interesse. Deste modo, pequenas mudanças de pressão na superfície da pele, causadas pela onda de pulso arterial, provocam uma variação do campo magnético sobre o elemento sensor. Por outra parte, devido à alta sensibilidade apresentada pelo transdutor magnetico (magnetômetro GMI) na configuração de malha aberta (0,2 mV/nT) e de malha fechada (0,19 mV/nT), estes foram usados para medir diretamente a forma de onda do pulso arterial, sem utilizar uma câmara incompressível para transdução mecânica. Nesta medição, considerando a adequada resolução espacial para as demandas anatômicas, utiliza-se um pequeno marcador magnético, envolto por uma fita adesiva hipoalergênica e flexível, aderida á região da pele sobre a artéria de interesse, e aproxima-se o sensor magnético GMI da superfície da pele onde o marcador foi colocado. Finalmente, as configurações propostas foram analisadas e comparadas, a fim de se identificar aquela com melhor desempenho, a qual foi utilizada para medição da VOP. Como o estudo envolve o registro da onda de pulso em participantes da pesquisa, o projeto foi submetido à apreciação e aprovado pela Comissão da Câmara de Ética em Pesquisa da Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio) 045/2020 – Protocolo 83/2020. Espera-se que o dispositivo desenvolvido contribua para o avanço tecnológico do ferramental utilizado no setor da saúde. / [en] Pulse wave velocity (PWV) is considered the gold standard for assessing arterial stiffness and recently, it has been recognized as an important indicator in the diagnosis and treatment of cardiovascular disease. Currently, there are commercial devices capable of measuring PWV, however, significant investments are required and some devices requires specialized training for their correct use. Conventional pressure-sensing devices are mainly based on piezoresistive, piezoelectric and capacitive sensors. Recent investigations, however, show that pressure transducer using magnetic sensors based on the giant Magnetoimpedance (GMI) present high-sensitivity. Considering that, PWV is a significant risk factor for future cardiovascular disease and in view of some of the advantages of GMI sensors in relation to another sensing technologies, this doctoral thesis aims to develop a portable measurement system, non-invasive, low-cost, accessible and simple to use, capable of measuring PWV. For this purpose, we have developed a high-sensitivity transducers based on the impedance phase characteristics of GMI sensors, for measuring the arterial pulse wave velocity. In order to improve the performance characteristics of the transducers, computational and theoretical analysis in open and closed loop configuration were performed. The characterizations and experimental tests performed with the open-loop pressure transducer resulted in a sensitivity of 59.6 mV/kPa, and resolution of 192.8 Pa for an average of 30 samples, in the 1000 Hz passband. On the other hand, the closed-loop configuration presented a sensitivity of 54.2 mV/kPa, and a resolution of 206.0 Pa for an average of 30 samples, in the 32 Hz passband. In view of the considerable sensitivity and resolution obtained, it is proposed to employ a pressure transduction system that incorporates an incompressible chamber for mechanical amplification, in the measurement of arterial pulse waves. In this prototype, a small semi-rigid membrane located on the surface of the incompressible chamber is positioned over the surface of the skin, close to the artery of interest. In this way, small pressure changes on the skin surface, caused by the arterial pulse wave, cause a variation of the magnetic field on the sensing element. On the other hand, due to the high sensitivity presented by the magnetic transducer (GMI magnetometer) in the open-loop (0.2 mV/nT) and closed-loop (0.19 mV/nT) configurations, they were used to measure the shape pulse waveform without using an incompressible chamber for mechanical transduction. In this test, considering the adequate spatial resolution for the anatomical demands, a small magnetic marker is used, the magnetic marker is attached to the skin region over the artery of interest, and the GMI magnetic sensor is approached near the marker placed of the skin surface. Finally, the proposed configurations were analyzed and compared in order to identify the one with the best performance, which was used to measure PWV. As the study involves recording the pulse wave in research participants, the project was submitted for consideration and approved by the Research Ethics Committee of the Pontifical Catholic University of Rio de Janeiro (PUC-Rio) 045/2020 – Protocol 83/2020. It is expected that the device developed will contribute to the technological advancement of the tools used in the health sector.

Student Number :9900127Y - MSc (Eng) dissertation - Faculty of Engineering and the Built Environment / Arterial pulse wave analysis studies the wave shape of the blood pressure pulse. The pulse wave provides more information than the extreme systolic and dia- stolic pressures, measured with a cuff sphygmomanometer. The aim of the research is to investigate the design issues in a pulse wave analysis system, and to compare these to a commercially available system. The system was compared and validated by measuring the pulse wave at the radial artery (wrist) using the non-invasive technique of arterial tonometry. The design conformed to the IEC-601 safety standard to ensure patient safety. The data was compared against the data from the commercial system and analysis was performed in the time and frequency domain. The performance of the design suggests that, in some respects, the design was comparable to the commer- cial system, however, a number of performance characteristics fell short of the commercial system. Suggestions have been made to address these problems in further research.

Made available in DSpace on 2016-08-10T10:57:43Z (GMT). No. of bitstreams: 1 Edison Nunes Pereira.pdf: 2680988 bytes, checksum: 2c09ac181f36ff093474c57fcd59da95 (MD5) Previous issue date: 2015-08-11 / In Goiás, the Ecological walk takes place annually and is an unique event for its distance (310km) and dynamics of performance (average of 62km-day for 5 days, average speed 7.6Km-h). Although the beneficial effects of moderate exercise are well known, the effects of intense exercise with long duration, as the Ecological walk, have not been well studied. This study aimed to verify the effects of prolonged exercise in central blood pressure and the correlation of these parameters with age. A total of 25 men were included in the study. The central blood pressure was measure datbaseline (A0), on the 2nd (A2), 3rd (A3) and 4th (A4) days of walk after the daily stop for night rest. The following parameters were measured: peripheral and central systolic and diastolic blood pressure, peripheral and central pulse pressure, pulse pressure amplified, 75% augmentation index, pulse wave velocity and vascular resistance. An oscillometric device from Mobil The Graphi® (IEM Stolber, Germany) was used. To compare the parameters between the daily measurements we used ANOVA for repeated measures followed by Bonferrroni post hoc and Pearson test for correlation. We considered significant p<0.05. We assessed 25 athletes with mean age 45.3±9.1.Central systolic blood pressure, reduced from A0 (113.8±2.1mmHg) to A3 (105.7±1.6mmHg) (p=0.035) and increased from A3 (105.7±1.6mmHg) to A4 (111.5±1.6mmHg) (p=0.006). The central diastolic blood pressure reduced from A0 (80.3±1.9mmHg) to A3 (74.3±1.5mmHg) (p=0.018)and A2 (78.6±1) to A3 (74.3±1.5mmHg) (p=0.036) and increased from A3 (74.3±1.5mmHg) for A4 (78.6±1.7mmHg) (p=0.014). The peripheral systemic blood pressure decreased from A0 (127.9±2.6 mmHg) to A2 (115.6±1.9mmHg) (p=0.002); to A3 (115.6±1.7mmHg) (p=0.003) and A4 (118.6±1.5mmHg) (p=0.007). The peripheral diastolic blood pressure reduced from A0 (78.7±1.9mmHg); from A3 (73.0±1.4mmHg) (p=0.018); A2 (77.4±1.1mmHg) to A3 (73.00±1.4mmHg) (p=0.040); and increased from A3 (73.0±1.4mmHg) to A4 (77.4±1.6mmHg) (p=0.010). The variables correlated with age were the central systemic blood pressure (A0), Peripheral pulse pressure (A3) and pulse wave velocity. Blood pressure decreased in the early days of walking, returning close to baseline at the end of the competition. Pulse wave velocity was strongly correlated with age. / Em Goiás, a caminhada Ecológica ocorre anualmente e é um evento único por sua distância (310 km) e dinâmica de realização (média de 62km-dia em 5 dias, média de 7,6 km-h). Apesar de os efeitos benéficos do exercício moderado serem bem conhecidos, os resultados de exercícios intensos e de longa duração, como a Caminhada Ecológica, ainda não foram muito estudados. O presente estudo teve o objetivo de verificar os efeitos do exercício físico prolongado nos parâmetros da medida central da pressão arterial e correlacionar esses parâmetros com a idade. Participaram do estudo 25 homens. Foi efetuada a medida central da pressão arterial para avaliar a participação (A0), nos 2º (A2), 3º (A3) e 4º (A4) dias de caminhada, após a parada diária para descanso noturno. Com essa medida foram obtidos os seguintes parâmetros: pressão arterial sistólica e diastólica periférica e central, pressão de pulso periférica e central, pressão de pulso amplificada, augmentation índex 75%, velocidade de onda de pulso e resistência vascular. Foi utilizado o dispositivo oscilométrico Mobil O Graphi® (IEM, Stolber, Alemanha). Para a comparação dos parâmetros entre os dias avaliados, foi usada a ANOVA para medidas repetidas, seguida de post hoc de Bonferrroni e para a correlação foi aplicado o teste de Pearson. Considerou-se como significativo p<0,05. Foram considerados 25 atletas com idade média de 45,3±9,1 anos. A medida central da pressão arterial sistólica reduziu de A0 (113,8±2,1mmHg) para A3 (105,7±1,6mmHg) (p=0,035) e aumentou de A3 (105,7±1,6mmHg) para A4 (111,5±1,6mmHg) (p=0,006). A medida central da pressão arterial diastólica diminuiu de A0 (80,3±1,9 mmHg) para A3 (74,2±1,0mmHg)(p=0,018) e A2 (78,2±1,9) para A3 (74,3±1,5mmHg) (p=0,036) e aumentou da A3 (74,3±1,5mmHg) para A4 (78,6±1,7mmHg) (p=0,014). A medida da pressão arterial sistólica periférica apresentou redução de A0 (127,9±2,6mmHg) para A2 (115,6±1,9mmHg) (p=0,002) para A3 (115,6±1,7mmHg) (p=0,003) e para A4 (118,6±1,5mmHg) (p=0,007). A medida periférica da pressão arterial diastólica reduziu de A0 (78,7±1,9mmHg) para A3 (73,0±1,4mmHg) (p=0,018); de A2 (77,4±1,1mmHg) para A3 (73,00±1,4mmHg) (p=0,040) e aumentou de A3 (73,0±1,4mmHg) para A4 (77,4±1,6mmHg) (p=0,010). As variáveis que apresentaram correlação com a idade foram a pressão arterial sistólica central (A0), a pressão de pulso periférica (A3) e a velocidade de onda de pulso. A pressão arterial teve queda nos primeiros dias de caminhada, retornando próxima aos valores basais no final do percurso. A velocidade de onda de pulso correlacionou-se fortemente com a idade.

Although blood viscosity is an important component in determining vascular function, it is often assumed constant. Emerging evidence linking individual differences in viscosity to cardiovascular disease casts doubt on this assumption. The purpose of this study was to determine the contribution of whole blood viscosity to key measures of vascular function. To address this aim as comprehensively as possible, first, whole blood viscosity was compared with traditional risk factors for cardiovascular disease. Then flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (cfPWV), and carotid artery compliance were calculated either with or without blood viscosity taken into account. Lastly, we tested whether the removal of blood viscosity could influence well-established associations between age and vascular function. Blood viscosity and vascular function were measured in 97 adults ranging in age from 18-63 years. No significant differences were observed between whole blood viscosity and traditional risk factors for cardiovascular disease. Whole blood viscosity was not significantly correlated with FMD, cfPWV, and carotid compliance. As expected, age was positively correlated with cfPWV (r=0.65, p<0.001) and negatively correlated with FMD (r=-0.21, p<0.05) and carotid compliance (r=-0.45, p<0.01). Even after controlling for viscosity, these relationships remained statistically significant (cfPWV r=0.65, p<0.001; FMD r=-0.24, p<0.05; carotid compliance r=-0.44, p<0.05). These results indicate that whole blood viscosity does not appear to significantly impact measures of vascular function and that the rationale for including whole blood viscosity in the calculation of vascular function remains weak. / text

Vascular stiffening is defined as the reduced ability of the blood vessels to expand in response to an increase in blood pressure. Vascular stiffening is often not appreciated as a disease in and of itself but is important to recognize because it is considered a predictor of many cardiovascular disease states. Mechanisms of vascular stiffening remain largely unknown; however the immune system has been found to play major roles in cardiovascular disease and arterial remodeling. This dissertation therefore seeks to illustrate the role of the adaptive immune system in vascular stiffening. This has been done by modeling vascular stiffness in transgenic mice lacking an adaptive immune system as well as immunosuppression in normal mice using a novel method to stimulate regulatory T cells with a cytokine immune complex. We have found that inhibition of the immune system by the use of a genetic knockout (RAG 1 ⁻/⁻ mice) or suppression of an existing immune system with an IL-2/anti-IL-2 complex reduces the development of angiotensin II-induced vascular stiffening. This dissertation supports the role of the adaptive immune system, and particularly CD4⁺T cells, in the development of vascular stiffening as well as the protective roles of Tregs in the disease. It also highlights the use of the IL-2/anti-IL-2 complex as a new potential therapy for vascular stiffness. Therapeutics that suppress adaptive immune function may be beneficial in the treatment of vascular stiffening.

To assess the relationships of body mass index (BMI) on arterial stiffness at rest and post-maximal treadmill graded exercise testing (GXT). Forty-four apparently healthy, young adult males (22.1 ± 0.48 years) were recruited and divided into either a healthy weight (H, ≤24.9 kg/m2), overweight (OV, 24.9-29.9 kg/m2) or obese (OB, ≥29.9 kg/m2) group based on BMI. All subjects underwent arterial stiffness (carotid-femoral pulse wave velocity, cfPWV), blood pressure (BP), pulse pressure (PP), mean arterial pressure (MAP) and body composition (bioelectrical impedance analysis, BIA) measurements at rest. Following the GXT, measures of arterial stiffness (cfPWV) and BP were acquired. Resting measures of cfPWV, BMI, systolic BP, diastolic BP, MAP, and PP were significantly (p <0.05) greater in OV and OB compared with H. Compared with OV, OB had a greater BMI. Relative peak oxygen consumption (VP2peak) was greater in H compared with OV and OB (p<0.05). systolic BP was positively associated, whereas VO2peak was inversely related to cfPWV (p<0.05). No significant inter-group interactions were observed with cfPWV after the GXT. However, interactions were observed for SBP, DBP and PP (p<0.05). In young men with varying BMI, SBP and VO2peak were associated with resting cfPWV. However, similar cardiovascular responses were observed between groups after a maximal GXT.

Made available in DSpace on 2015-07-22T20:49:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26. Added 1 bitstream(s) on 2015-08-11T03:25:40Z : No. of bitstreams: 1 Publico-068.pdf: 848593 bytes, checksum: faea7296d3b3e87c6a1212049c181df8 (MD5) / Introdução: A Síndrome de Marfan (SM) é uma doença de herança autossômica dominante decorrente de mutações no gene da fibrilina 1 no cromossomo 15, e pode apresentar manifestações esqueléticas, oculares, cardiovasculares entre outras. A velocidade de onda de pulso(VOP) é utilizada como um índice da elasticidade e rigidez arterial e está relacionada as propriedades elásticas da parede vascular. A pratica de exercício é limitada para esta população. Objetivo: Avaliar o efeito agudo de exercício submáximo em pacientes portadores de SM sem dilatação da aorta ou no máximo com dilatação leve deste vaso e o comportamento das variáveis fisiológicas. Casuística e Método: A VOP e variáveis fisiológicas foram avaliadas antes e após a realização de um esforço submáximo em 33 pacientes com SM e 18 controles. Resultados: A VOP no grupo com SM foi de 8,51±0,58 m/s no repouso e de 9,10±0,63 m/s ao final do exercício (p=0,002) e no grupo controle de 8,07±0,35 m/s no repouso e 8,98±0,56 m/s ao final (p=0,004). A análise comparativa da VOP entre os grupos controle e os pacientes com SM no repouso (p=0,519) e ao final do esforço (p=0,866) não se mostrou diferente. Os valores finais da freqüência cardíaca do grupo controle ficaram 10% acima dos indivíduos com SM (p = 0,01). A pressão arterial sistólica final foi superior no grupo controle (p=0,02). O lactato não se mostrou diferente e o tempo de exercício foi superior no grupo controle(p=0,01). Conclusão: O comportamento da distensibilidade aórtica foi semelhante, nos pacientes com SM sem ou com dilatação leve da aorta, ao grupo controle. Todavia as respostas cronotrópicas e pressóricas foram inferiores. / Purpose: Marfan syndrome is a dominant autosomal disease provoked by mutations of gene of fibrillin 1, chromosome 15, and may exhibit skeletal, ocular, cardiovascular and other manifestations. Pulse wave velocity (PWV) is used as a measure of arterial elasticity and rigidity and is related to the elastic properties of the vascular wall. As the practice of exercise is limited in this population, it was of our interest to analyze the acute effect of moderate to intensive exercise on patients with Marfan syndrome with either no dilatation of the aorta or a maximum of mild dilatation of this vessel. Methods: PWV and physiological variables were evaluated before and after the performance of sub-maximal exercise in 33 patients with Marfan syndrome and 18 controls. Results: PWV in the group with Marfan syndrome was 8.51±0.58 m/s at rest and 9.10±0.63 m/s at the end of the exercise (p=0.002); in the control group, PWV was 8.07±0.35 m/s at rest and 8.98±0.56 m/s at the end of exercise (p=0.004). The comparative analysis between groups regarding PWV at rest (p=0.519) and at the end of exercise (p=0.866) revealed no statistically significant differences. The final heart rate values in the control group were 10% higher than values in the group with Marfan syndrome (p = 0.01). Final systolic arterial pressure was higher in the control group (p=0.02). There was no difference in lactate between groups. Exercise time was greater in the control group (p=0.01). Conclusions: The behavior of aortic distensibility was similar in the patients with Marfan syndrome without or with mild dilatation of the aorta to that of the control group. The chronotropic and pressure responses were lower in patients than in control group. / TEDE / BV UNIFESP: Teses e dissertações

This study was aimed at determining whether the digital volume pulse waveform using the Pulse Sensor can be used to extract features related to arterial compliance. The Pulse Sensor, a low-cost photoplethysmograph, measures green light reflection in the finger and generates output, which is indicative of blood flow and can be read by the low-cost Arduino UNO™. The Pulse Sensor code was modified to increase the sampling frequency and to capture the data in a file, which is subsequently used for waveform analysis using programs written in the R system. Waveforms were obtained using the Pulse Sensor during two 30-s periods of seated rest, in each of 44 participants, who were between the ages of 20 and 80 years. For each cardiac cycle, the first four derivatives of the waveform were calculated and low-pass filtered by convolution before every differentiation step. The program was written to extract 19 features from the pulse waveform and its derivatives. These features were selected from those that have been reported to relate to the physiopathology of hemodynamics. Results indicate that subtle features of the pulse waveform can be calculated from the fourth derivative. Feature misidentification occurred in cases of saturation or low voltage and resulted in outliers; therefore, trimmed means of the features were calculated by automatically discarding the outliers. There was a high efficiency of extraction for most features. Significant relationships were found between several of the features and age, and systolic, diastolic, and mean arterial blood pressure, suggesting that these features might be employed to predict arterial compliance. Further improvements in experimental design could lead to a more detailed evaluation of the Pulse Sensor with respect to its capability to predict factors related to arterial compliance.

Background/objectives There are few studies investigating the long-term association between childhood blood pressure (BP) and adult cardiovascular remodeling. We seek to examine the effect of elevated childhood BP on cardiovascular remodeling in early or middle adulthood.Methods We used the "Beijing BP Cohort Study", where 1259 subjects aged 6-18 years old were followed over 24 years from childhood (1987) to early or middle adulthood (2011). Anthropometric measures and BP were obtained at baseline and follow-up examinations. Carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured to assess cardiovascular remodeling in early or middle adulthood. Multiple logistic regression models were used to assess the odds ratio (OR) and 95% confidence interval (CI) for cardiovascular remodeling.Results 82 out of 384 children with elevated BP (21.4%) had adult hypertension. Compared to those with normal BP, children with elevated BP were at 2.1 times (95% CI: 1.4-3.1) likely to develop hypertension in early or middle adulthood. Compared to those with normal BP, children with elevated BP were at higher OR of developing high cfPWV (OR = 1.8, 95% CI = 1.3-2.4), high cIMT (1.4, 1.0-1.9), or high LVMI (1.4, 1.0-1.9) in early or middle adulthood. The ORs for remodeling (for any measures) were 1.4 (0.9-2.0) in early adulthood for children age 6-11 years, and 1.6 (1.1-2.4) in middle adulthood for those aged 12-18 years.Conclusions Children with elevated BP from 6 years old have accelerated remodeling on both cardiac and arterial system in early or middle adulthood.

<p>Carpal tunnel syndrome (CTS) is one of the most prevalent work-related musculoskeletal disorders of the upper extremity yet its etiology remains elusive. Nerve hypervascularization has been proposed as a pathophysiological change in CTS and can be measured using high resolution sonography of intraneural blood flow. The purpose of this study was to determine the effects of deviated wrist postures and fingertip force on the intraneural blood flow velocity of the median nerve proximal to the wrist crease. Ten participants experiencing the classic symptoms of CTS and nine healthy volunteers were recruited and underwent qualitative assessments (Phalen’s test, Katz hand diagram, Levine’s CTS questionnaire). Intraneural blood flow velocity was measured in five wrist postures (flexion 30°, flexion 15°, neutral, extension 15°, extension 30°) with and without a middle digit fingertip press (0N, 6N). A control (N=9) group and a CTS symptomatic (N=9) group were determined, in addition to a CTS individual (N=1) that required a separate analysis. A significant main effect of force was found (F_1,16= 28.039, p < 0.0005) with the mean peak velocity being greater with force (3.56 cm/s) than without force (2.81 cm/s). Wrist posture had a main effect (F_4,64= 3.163, p < 0.020) with flow velocity as neutral (2.87 cm/s) was significantly lower than flexion 30° (3.37 cm/s), flexion 15°(3.27 cm/s) and extension 30° (3.29 cm/s). There was no significant difference in peak blood flow velocity between the two experimental groups, CTS symptomatic (3.34 cm/s) and control (3.03 cm/s) (F_1,16= 4.121, p < 0.059). The results suggest that both force and non-neutral wrist postures may acutely induce vascular changes previously associated with CTS. The quantification of reactive median nerve hypervascularity should be investigated further as it has potential to be both a reliable diagnostic technique and a non-invasive assessment of CTS risk.</p> / Master of Science in Kinesiology