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blocking in single ber electromyography (SFEMG), and the fatigable weakness experienced by the patient Its value is that it provides the same information as a decremental response to slow repetitive stimulation in muscles that are not technically accessible to nerve conduction studies without the diagnostic rigor required for SFEMG evaluation The traditional EDX tool used to identify a postsynaptic DNMT is the decremental response to slow repetitive stimulation274 276 Slow repetitive stimulation refers to rates 5 Hz, with 2 or 3 Hz typically used Under normal circumstances, compound muscle action potentials (CMAPs) of the same amplitude will occur inde nitely due to the safety margin of the endplate potential (EPP), which will be subsequently described When the safety margin is lost by the combined stresses of slow repetitive stimulation and by presynaptic, synaptic, or postsynaptic dysfunction, NMT failure may occur at one or many myoneural junctions With slow repetitive stimulation, a train of ve to 10 stimuli is delivered depending on laboratory preference

The following steps use many components of Windows XP Professional and the Recovery Console To fully understand the les, folders, and Registry components that are involved, be sure to read the Registry section in 15 of Mike Meyers A+ Guide to Managing and Troubleshooting PCs Microsoft has also gathered invaluable information in their Knowledge Base articles (a component of TechNet) The following lab steps incorporate valuable information from Knowledge Base articles 307545 and 309531 As previously mentioned, Web sites change over time, so if you don t nd these exact articles, use your favorite search engine and locate similar articles related to the Recovery Console and repairing the Registry

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Five stimuli are adequate to identify the decremental response Although 10 stimuli are more uncomfortable, these improve recognition of the typical pathological pattern and serve to reduce the possibility of a technically induced false-positive diagnosis A decrement may not be evident in response to the initial stimulus train In most traditional testing paradigms, the muscle tested is then exercised in an attempt to induce postexercise exhaustion and increase the diagnostic yield Recently, this practice has been called into question in view of the time and discomfort associated with this approach in comparison to the relatively low additional diagnostic yield277 With this maneuver, only modest increases in the incidence and severity of decrement occur To elicit postexercise exhaustion, the tested muscle is exercised for 1 minute Subsequent stimulus trains are delivered at 30-second intervals until a signi cant decrement occurs or 3 4 minutes elapse The study is considered positive if a >10% decrement is identi ed by measuring either CMAP amplitude or area Comparison is made between the rst and the smallest (typically

12345678910 2 mV 5 ms StimMode: Train / Single Stim Freq: 3 Hz Stim Dur: 02 ms Stim Site: Time: 16:51:22 Comment: Pot Peak Amp No Amp Decr mV %

Manage object pointers Free memory when leaving scope Manage resource objects (eg, RFs & rfs) Call Close() when leaving scope Manage a reference to a resource object (eg, RFs & rfs) Call Close() when leaving scope Manage an array of object pointers Free all memory when leaving scope (Prefer RArray) Automatic management of generic objects

a) Some preparation may be required to complete the steps to corrupt and restore your Registry folders Open My Computer, then select Tools | Folder Options and click the View tab Turn on Show hidden les and folders, turn off Hide extensions for known le types, and turn off Hide protected operating system les (Recommended) Click OK b) Boot to the Recovery Console, and after logging on as Administrator, type the following commands at the prompt:

1 2 3 4 5 6 7 8 9 10 761 618 513 484 447 451 433 450 442 466 0 19 33 36 41 41 43 41 42 39

No in Train: Stim Rjct:

4520 3330 2810 2580 2420 2240 2220 2230 2230 2280

MD C:\%SYSTEMROOT%\TMP COPY C:\%SYSTEMROOT%\SYSTEM32\CONFIG\SYSTEM C:\%SYSTEMROOT%\TMP\SYSTEMBAK DELETE C:\%SYSTEMROOT%\SYSTEM32\CONFIG\SYSTEM EXIT

LManagedXXX/LCleanedupXXX objects goes out of scope In the following example, the handle to the file server and to an open file are automatically closed and released when the function ends:

Area Decr %

0 26 38 43 46 50 51 51 51 50

Figure 23 3 Typical pattern of a pathological decremental response to slow repetitive stimulation

c) At this point the Recovery Console closes and Windows restarts Allow Windows XP to boot normally Did anything inhibit the normal loading and startup of Windows XP _______________ d) Boot to the Recovery Console once again, log on as Administrator, and type the following commands at the prompt:

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