{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:00:16Z","timestamp":1789077616925,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP22K15738"],"award-info":[{"award-number":["JP22K15738"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["20FC1030"],"award-info":[{"award-number":["20FC1030"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Extrapolated reference values (E\u2010Ref) procedure is a new method for determining the cutoff value without collecting the control data. We tried to apply this method to determine the cutoff value for the distal motor latency of the median nerve (median DML). During this process, we found two pitfalls of the E\u2010Ref method. First, the E\u2010Ref procedure did not correctly work when the DML values measured with 0.1\u2009ms accuracy frequently took on tie values. Second, the result was influenced by the proportion of abnormal values. This study investigated these issues.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data of the median DML were extracted from our laboratory database. To solve the problem of tie values, we tried a wider post\u2010smoothing window in the original E\u2010Ref method. We also devised a modified method conducting pre\u2010smoothing. To see the effect of the proportion of abnormal data, we simulated many datasets having different proportion of abnormal data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 1016 DML values were identified. False deflections due to tie values were often identified as the E\u2010Ref point using the original methods even using a wider window, resulting in unrealistically low values. Modified method was free from this drawback. For all methods, the E\u2010Ref value increased as the proportion of abnormal values increased.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The problem of tie values, a pitfall of the E\u2010Ref method, might be solved by pre\u2010smoothing the data. The E\u2010Ref value is influenced by the proportion of the normal data, and datasets containing less than 20% abnormal data may achieve appropriate results.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.28338","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T10:29:02Z","timestamp":1736159342000},"page":"435-441","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pitfalls of the E\u2010Ref Procedure: Tie Values and the Proportion of the Abnormal Data"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8897-1845","authenticated-orcid":false,"given":"Keisuke","family":"Tachiyama","sequence":"first","affiliation":[{"name":"Department of Neurology Teikyo University School of Medicine  Tokyo Japan"},{"name":"Department of Clinical Neuroscience and Therapeutics Hiroshima University Graduate School of Biomedical and Health Sciences  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6948-6040","authenticated-orcid":false,"given":"Takamichi","family":"Kanbayashi","sequence":"additional","affiliation":[{"name":"Department of Neurology Teikyo University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Kawabata","sequence":"additional","affiliation":[{"name":"Central Laboratory Teikyo University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Hoshino","sequence":"additional","affiliation":[{"name":"Central Laboratory Teikyo University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Miyaji","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Medicine Yokohama City University Graduate School of Medicine  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Neurology Teikyo University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience and Therapeutics Hiroshima University Graduate School of Biomedical and Health Sciences  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2410-9468","authenticated-orcid":false,"given":"Masahiro","family":"Sonoo","sequence":"additional","affiliation":[{"name":"Department of Neurology Teikyo University School of Medicine  Tokyo Japan"},{"name":"Department of Orthoptics, Faculty of Medical Technology Teikyo University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25606"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1963.03060110068020"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000161"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.10.12.1045"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnp.2018.02.005"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.2.153"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-019-04145-2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.4.817"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199602)19:2<140::AID-MUS3>3.0.CO;2-E"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0266-7681(98)80010-7"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260578"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-4598(200008)23:8<1280::AID-MUS20>3.0.CO;2-Y"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.21617"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25203"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880121106"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199601)19:1<48::AID-MUS6>3.0.CO;2-8"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-017-8637-2"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199901)22:1<88::AID-MUS13>3.0.CO;2-C"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.28338","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T14:26:17Z","timestamp":1745245577000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.28338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/mus.28338"],"URL":"https:\/\/doi.org\/10.1002\/mus.28338","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]},"assertion":[{"value":"2024-04-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}