وقد تم دعم هذا العمل من قبل المعهد الوطني للصحة ، والمعهد القومي للصمم واضطرابات التواصل الأخرى ، منحة R01DCO09890 - 02 ، المؤسسة الكندية للابتكار (CFI - LOF # 15704) ، ومؤسسة كونوت ، جامعة تورنتو. فإن الكتاب أود أن أشكر سينثيا Didion ، ميلى كوروفيلا ، رودي كريستا وSynhorst وري للحصول على المساعدة في جمع البيانات وتحليلها ، وكارا أولمان لإنشاء مقاطع الفيديو. وأدلى الرسوم المتحركة عن طريق نشر شجرة الأزرق ( <a href="http://www.bluetreepublishing.com/">http://www.bluetreepublishing.com/</a> ) هو مطلب يستند SPA SMASH والبرمجيات ويمكن الحصول عليها عن طريق الاتصال الخضراء في الأردن jgreen4@unl.edu. زيارة مختبراتنا : بصلي مختبر الفعل (سونيبروك مركز العلوم الصحية في تورنتو ، كندا) : <a href="http://www.sunnybrook.ca/research/?page=sri_groups_bulb_home">http://www.sunnybrook.ca/research/؟page=sri_groups_bulb_home</a> خطاب مختبر الإنتاج (جامعة نبراسكا لنكولن) : <a href="http://spl.unl.edu">http://spl.unl.edu</a>

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Psychobiol. 48, 16-28 (2006).</li><li>Yunusova, Y., Green, J., Mefferd, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+Assessment+for+AG500,+Electromagnetic.">Accuracy Assessment for AG500, Electromagnetic.</a> Articulograph. J. Speech Lang. Hear.Res. 52, 556-570 (2009).</li><li>Beukelman, D., Yorkston, K., Hakel, M., Dorsey, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Speech Intelligibility Test. , (2007).</li><li>Lyall, R. A., Donaldson, N., Polkey, M. I., Leigh, P. N., Moxham, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Respiratory+muscle+strength+and+ventilatory+failure+in+amyotrophic+lateral+sclerosis.">Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis.</a> Brain. 124, 2000-2013 (2001).</li><li>Sapienza, C. M., Stathopoulos, E. T., Brown, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Speech+breathing+during+reading+in+women+with+vocal+nodules.">Speech breathing during reading in women with vocal nodules.</a> J. Voice. 11, 195-201 (1997).</li><li>Hakkesteegt, M. M., Brocaar, M. P., Wieringa, M. H., Feenstra, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+age+and+gender+on+the+dysphonia+severity+index.+A+study+of+normative+values.">Influence of age and gender on the dysphonia severity index. A study of normative values.</a> Folia Phoniatr. Logop. 58, 264-273 (2006).</li><li>Hakkesteegt, M. M., Brocaar, M. P., Wieringa, M. H., Feenstra, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationship+between+perceptual+evaluation+and+objective+multiparametric+evaluation+of+dysphonia+severity.">The relationship between perceptual evaluation and objective multiparametric evaluation of dysphonia severity.</a> J. Voice. 4, 529-542 (2007).</li><li>Robert, D., Pouget, J., Giovanni, A., Azulay, J. P., Triglia, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+voice+analysis+in+the+assessment+of+bulbar+involvement+in+amyotrophic+lateral+sclerosis.">Quantitative voice analysis in the assessment of bulbar involvement in amyotrophic lateral sclerosis.</a> Acta Otolaryngol. 119, 724-731 (1999).</li><li>Hardin, M. A., Demark, D. R. V. a. n., Morris, H. L., Payne, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correspondence+between+nasalance+scores+and+listener+judgments+of+hypernasality+and+hyponasality.">Correspondence between nasalance scores and listener judgments of hypernasality and hyponasality.</a> Cleft Palate Craniofac J. 29, 346-351 (1992).</li><li>Delorey, R., Leeper, H. A., Hudson, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+velopharyngeal+functioning+in+subgroups+of+individuals+with+amyotrophic+lateral+sclerosis.">Measures of velopharyngeal functioning in subgroups of individuals with amyotrophic lateral sclerosis.</a> J. Med. Speech Lang. Pathol. 7, 19-31 (1999).</li><li>Tasko, S. M., Westbury, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Speed-curvature+relations+for+speech-related+articulatory+movement.">Speed-curvature relations for speech-related articulatory movement.</a> J. Phon. 32, 65-80 .</li><li>Yunusova, Y., Green, J. R., Lindstrom, M. J., Bal, L. J., Pattee, G. 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الإعلان عن أي تضارب في المصالح.

تظاهر هنا لدينا بروتوكول شامل لتقييم البصلي (خطاب) خلل في المرض. وتستخدم البيانات التي تم الحصول عليها من هذا البروتوكول لاكتساب فهم أعمق للكيفية التي يؤثر المرض إنتاج الكلام. كما تستخدم هذه البيانات لتحديد التدابير الأكثر حساسية من تطور المرض. على الرغم من أن هذا البروتوكول حاليا يجري استخدامها لأغراض البحث ، سيتم الاستفادة من نتائج هذا البحث لتطوير نهج أكثر فعالية من حيث التكلفة ومجدية سريريا لتحديد مشاركة الصلبية.

<ul style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> معدات / برمجيات </li><li style=";text-align:right;direction:rtl"> نظام الديناميكية الهوائية تصويتي (PAS) ، KayPENTAX ، لينكولن بارك ، ونيوجيرسي ، الولايات المتحدة الأمريكية. </li><li style=";text-align:right;direction:rtl"> فلاش مدمج مسجل (مثلا ، PMD660) </li><li style=";text-align:right;direction:rtl"> الجودة المهنية الميكروفون ، </li><li style=";text-align:right;direction:rtl"> SPL متر ، Extech الآلات </li><li style=";text-align:right;direction:rtl"> MDVP ، KAYPentax </li><li style=";text-align:right;direction:rtl"> Nasometer ، موديل 6400 ، KAYPentax </li><li style=";text-align:right;direction:rtl"> النسر النظام الرقمي ، الحركة التحليل كورب </li><li style=";text-align:right;direction:rtl"> WAVE ، شمال الرقمي المؤتمر الوطني العراقي ، كندا </li></ul>

a protocol for comprehensive assessment of bulbar dysfunction in amyotrophic lateral sclerosis (als)

طرق محسنة لتقييم اختلال بصلي ضرورية لتسريع تشخيص الخلل بصلي في المرض ، لتوقع تطور المرض عبر النظم الفرعية على الكلام ، ومعالجة الحاجة الماسة لاتخاذ تدابير حساسة بالنسبة لنتائج التجارب الجارية العلاج التجريبي. لتلبية هذه الحاجة ، ونحن الحصول على التشكيلات طولية من ضعف في بصلي 100 شخص استنادا إلى تقييم شامل الأجهزة المستندة إلى أن التدابير الهدف الغلة. باستخدام أساليب فعالة لقياس السلوكيات ذات الصلة خطاب مهم جدا في حقل الذي اعتمد أساسا على موضوعي الأشكال السمعية ، الحسية ، وتقييم الخطاب 1. بروتوكول لدينا تقييم مقاييس الأداء في جميع النظم الفرعية للكلمة ، والتي تشمل الجهاز التنفسي ، وتصويتي (الحنجرة) ، resonatory (شراعي بلعومي) ، وتلفظي. وينقسم النظام الفرعي تلفظي في مكونات الوجه (الفك والشفة) ، واللسان. واقترح بحث سابق أن كل نظام فرعي خطاب يستجيب بشكل مختلف للأمراض العصبية ، مثل المرض. ويهدف البروتوكول الحالي لاختبار أداء كل نظام فرعي خطاب مستقل اعتبارا من النظم الفرعية الأخرى ممكن. يتم تقييم الفرعية الكلام في سياق التغيرات العالمية لمزيد من الأداء التعبير. هذه المتغيرات على مستوى الخطاب وتشمل نظام معدل وضوح الكلام والتعبير. البروتوكول يتطلب الأجهزة المتخصصة ، والبرمجيات التجارية والعرف. يتم تقييم الفرعية الجهاز التنفسي ، وتصويتي ، وresonatory باستخدام ضغط التدفق (الأيرودينامية) والأساليب الصوتية. يتم تقييم الفرعي تلفظي باستخدام 3D تقنيات تتبع الحركة. وقد التدابير الموضوعية التي تستخدم لقياس ضعف بصلي راسخة في الأدب الحديث وتظهر حساسية للتغيرات في وظيفة بصلي مع تطور المرض. نتيجة للتقييم هو ، عبر النظام الفرعي - شاملة أداء الشخصية لكل مشارك. يستخدم الوضع ، بالمقارنة مع نفس التدابير التي تم الحصول عليها من الاصحاء ، لأغراض التشخيص. حاليا ، نحن اختبار حساسية وخصوصية هذه التدابير لتشخيص المرض وتوقع معدل تطور المرض. في المدى الطويل ، من المتوقع أن endophenotype أكثر دقة من المرض بصلي المستمدة من هذا العمل لتعزيز الجهود في المستقبل لتحديد مواضع المرض الوراثي للوتحسين نوعية التشخيص والعلاج من هذا المرض ككل. ويمكن استخدام التقييم الموضوعي الذي يتجلى في هذا الفيديو لتقييم مجموعة واسعة من عاهات الكلام الحركية ، بما في ذلك تلك المتصلة السكتة الدماغية ، وإصابات في الدماغ ، والتصلب المتعدد ، ومرض باركنسون.

Watch this Scientific Journal Video about A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS at JoVE.com

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

وهناك حاجة إلى تقييم موضوعي للآليات الفسيولوجية التي تدعم خطاب لرصد ظهور المرض والتقدم في الأشخاص الذين يعانون المرض وتحديد الآثار العلاج في التجارب السريرية. في هذا الفيديو ، نقدم شامل ، والأجهزة القائمة على بروتوكول لقياس الأداء الحركي في خطاب السكان السريرية.

بروتوكول لتقييم شامل لبصلي الضعف في التصلب الوحشي الضموري (ALS)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression ...

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A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)

34.0K Views.  University of Toronto. وهناك حاجة إلى تقييم موضوعي للآليات الفسيولوجية التي تدعم خطاب لرصد ظهور المرض والتقدم في الأشخاص الذين يعانون المرض وتحديد الآثار العلاج في التجارب السريرية. في هذا الفيديو ، نقدم شامل ، والأجهزة القائمة على بروتوكول لقياس الأداء الحركي في خطاب السكان السرير?...

Video: A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

Intraspinal Cell Transplantation for Targeting Cervical Ventral Horn in Amyotrophic Lateral Sclerosis and Traumatic Spinal Cord Injury

Respiratory compromise due to phrenic motor neuron loss is a debilitating consequence of a large proportion of human traumatic spinal cord injury (SCI) cases 1 and is the ultimate cause of death in patients with the motor neuron disorder, amyotrophic laterals sclerosis (ALS) 2.
ALS is a devastating neurological disorder that is characterized by relatively rapid degeneration of upper and lower motor neurons. Patients ultimately succumb to the disease on average 2-5 years following diagnosis because of respiratory paralysis due to loss of phrenic motor neuron innnervation of the diaphragm 3. The vast majority of cases are sporadic, while 10% are of the familial form. Approximately twenty percent of familial cases are linked to various point mutations in the Cu/Zn superoxide dismutase 1 (SOD1) gene on chromosome 21 4. Transgenic mice 4,5 and rats 6 carrying mutant human SOD1 genes (G93A, G37R, G86R, G85R) have been generated, and, despite the existence of other animal models of motor neuron loss, are currently the most highly used models of the disease.
Spinal cord injury (SCI) is a heterogeneous set of conditions resulting from physical trauma to the spinal cord, with functional outcome varying according to the type, location and severity of the injury 7. Nevertheless, approximately half of human SCI cases affect cervical regions, resulting in debilitating respiratory dysfunction due to phrenic motor neuron loss and injury to descending bulbospinal respiratory axons 1. A number of animal models of SCI have been developed, with the most commonly used and clinically-relevant being the contusion 8.
Transplantation of various classes of neural precursor cells (NPCs) is a promising therapeutic strategy for treatment of traumatic CNS injuries and neurodegeneration, including ALS and SCI, because of the ability to replace lost or dysfunctional CNS cell types, provide neuroprotection, and deliver gene factors of interest 9.
Animal models of both ALS and SCI can model many clinically-relevant aspects of these diseases, including phrenic motor neuron loss and consequent respiratory compromise 10,11. In order to evaluate the efficacy of NPC-based strategies on respiratory function in these animal models of ALS and SCI, cellular interventions must be specifically directed to regions containing therapeutically relevant targets such as phrenic motor neurons. We provide a detailed protocol for multi-segmental, intraspinal transplantation of NPCs into the cervical spinal cord ventral gray matter of neurodegenerative models such as SOD1G93A mice and rats, as well as spinal cord injured rats and mice 11.

Neural precursor transplantation is a promising strategy for protecting and/or replacing lost/dysfunctional cervical phrenic motor neurons in spinal cord injury (SCI) and the motor neuron disorder, amyotrophic laterals sclerosis (ALS). We provide a protocol for cell delivery to cervical spinal cord ventral horn in rodent models of ALS and SCI.

داخل النخاع زرع الخلايا لاستهداف القرن بطني عنق الرحم في التصلب الجانبي وصدمة إصابة النخاع الشوكي

Respiratory compromise due to phrenic motor neuron loss is a debilitating consequence of a large proportion of human traumatic spinal cord injury (SCI) ...

Clinical Testing and Spinal Cord Removal in a Mouse Model for Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder resulting in progressive degeneration of motoneurons. Peak of onset is around 60 years for the sporadic disease and around 50 years for the familial disease. Due to its progressive course, 50% of the patients die within 30 months of symptom onset. In order to evaluate novel treatment options for this disease, genetic mouse models of ALS have been generated based on human familial mutations in the SOD gene, such as the SOD1 (G93A) mutation. Most important aspects that have to be evaluated in the model are overall survival, clinical course and motor function. Here, we demonstrate the clinical evaluation, show the conduction of two behavioural motor tests and provide quantitative scoring systems for all parameters. Because an in depth analysis of the ALS mouse model usually requires an immunohistochemical examination of the spinal cord, we demonstrate its preparation in detail applying the dorsal laminectomy method. Exemplary histological findings are demonstrated. The comprehensive application of the depicted examination methods in studies on the mouse model of ALS will enable the researcher to reliably test future therapeutic options which can provide a basis for later human clinical trials.

Clinical Testing and Spinal Cord Removal in a Mouse Model for Amyotrophic Lateral Sclerosis ALS

A mouse model for amyotrophic lateral sclerosis (ALS) is examined clinically and behaviorally. As a prerequisite for an accompanying immunohistological analysis the preparation of the spinal cord is depicted in detail.

السريرية اختبار وإزالة العمود الفقري الحبل في الفأر نموذج لتصلب الأنسجة العضلية الجانبية (ALS)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder resulting in progressive degeneration of motoneurons. Peak of onset is around 60 ...

Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis

The split hand phenomenon refers to predominant wasting of thenar muscles and is an early and specific feature of amyotrophic lateral sclerosis (ALS). A novel split hand index (SI) was developed to quantify the split hand phenomenon, and its diagnostic utility was assessed in ALS patients. The split hand index was derived by dividing the product of the compound muscle action potential (CMAP) amplitude recorded over the abductor pollicis brevis and first dorsal interosseous muscles by the CMAP amplitude recorded over the abductor digiti minimi muscle. In order to assess the diagnostic utility of the split hand index, ALS patients were prospectively assessed and their results were compared to neuromuscular disorder patients. The split hand index was significantly reduced in ALS when compared to neuromuscular disorder patients (P&#60;0.0001). Limb-onset ALS patients exhibited the greatest reduction in the split&#160;hand index, and a value of 5.2 or less reliably differentiated ALS from other neuromuscular disorders. Consequently, the split&#160;hand index appears to be a novel diagnostic biomarker for ALS, perhaps facilitating an earlier diagnosis.

Dissociated atrophy of intrinsic hand muscles, termed the split hand, appears to be a specific feature of amyotrophic lateral sclerosis (ALS).&#160;Consequently, a novel neurodiagnostic test, termed the split hand&#160;index, was developed to quantify the clinical phenomenon of the split hand, which differentiated ALS from mimic disorders.

فائدة تنفصل الجوهرية ضمور العضلات اليد في تشخيص التصلب الجانبي الضموري

The split hand phenomenon refers to predominant wasting of thenar muscles and is an early and specific feature of amyotrophic lateral sclerosis (ALS). A ...

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research. Because the testing is computer-based, test performance can be analyzed in traditional or novel ways and data can be directly entered into research or clinical databases. The MSPT could be widely disseminated to clinicians in practice settings who are not connected to clinical trial performance sites or who are practicing in rural settings, drastically improving access to clinical trials for clinicians and patients. The MSPT could be adapted to out of clinic settings, like the patient&#8217;s home, thereby providing more meaningful real world data. The MSPT represents a new paradigm for neuroperformance testing. This method could have the same transformative effect on clinical care and research in MS as standardized computer-adapted testing has had in the education field, with clear potential to accelerate progress in clinical care and research.

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report methodologic details on a new test, the Multiple Sclerosis Performance Test (MSPT). This new approach to the objective of quantification of MS related disability provides a computer-based platform for precise, valid measurement of MS severity.

والتصلب المتعدد اختبار الأداء (MSPT): أداة تقييم الإعاقة باد المستندة

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the ...

A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data

This report describes a novel Stata-based application of trigonometric regression modelling to 55 years of multiple sclerosis relapse data from 46 clinical centers across 20 countries located in both hemispheres. Central to the success of this method was the strategic use of plot analysis to guide and corroborate the statistical regression modelling. Initial plot analysis was necessary for establishing realistic hypotheses regarding the presence and structural form of seasonal and latitudinal influences on relapse probability and then testing the performance of the resultant models. Trigonometric regression was then necessary to quantify these relationships, adjust for important confounders and provide a measure of certainty as to how plausible these associations were. Synchronization of graphing techniques with regression modelling permitted a systematic refinement of models until best-fit convergence was achieved, enabling novel inferences to be made regarding the independent influence of both season and latitude in predicting relapse onset timing in MS. These methods have the potential for application across other complex disease and epidemiological phenomena suspected or known to vary systematically with season and/or geographic location.

Combining plot analysis with trigonometric regression is a robust method for exploring complex, cyclical phenomena such as relapse onset timing in multiple sclerosis (MS). This method enabled unbiased characterisation of seasonal trends in relapse onset permitting novel inferences around the influence of seasonal variation, ultraviolet radiation (UVR) and latitude.

A طريقة المثلثية نمذجة الموسمية التغيير تظاهر مع التصلب المتعدد الانتكاس البيانات

This report describes a novel Stata-based application of trigonometric regression modelling to  55 years of multiple sclerosis relapse data from 46 ...

A Quick Phenotypic Neurological Scoring System for Evaluating Disease Progression in the SOD1-G93A Mouse Model of ALS

The SOD1-G93A transgenic mouse is the most widely used animal model of amyotrophic lateral sclerosis (ALS). At ALS TDI we developed a phenotypic screening protocol, demonstrated in video herein, which reliably assesses the neuromuscular function of SOD1-G93A mice in a quick manner. This protocol encompasses a simple neurological scoring system (NeuroScore) designed to assess hindlimb function. NeuroScore is focused on hindlimb function because hindlimb deficits are the earliest reported neurological sign of disease in SOD1-G93A mice. The protocol developed by ALS TDI provides an unbiased assessment of onset of paresis (slight or partial paralysis), progression and severity of paralysis and it is sensitive enough to identify drug-induced changes in disease progression. In this report, the combination of a detailed manuscript with video minimizes scoring ambiguities and inter-experimenter variability thus allowing for the protocol to be adopted by other laboratories and enabling comparisons between studies taking place at different settings. We believe that this video protocol can serve as an excellent training tool for present and future ALS researchers.

This video protocol describes a sensitive, reliable, and quick method for evaluating the neuromuscular deficits in a transgenic mouse model of amyotrophic lateral sclerosis.

A السريع المظهري العصبية نظام تسجيل النقاط لتقييم مرض في التقدم SOD1-G93A نموذج الفأر من ALS

The SOD1-G93A transgenic mouse is the most widely used animal model of amyotrophic lateral sclerosis (ALS). At ALS TDI we developed a phenotypic screening ...

A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS)

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses low amplitude direct currents to alter cortical excitability. With well-established safety and tolerability, tDCS has been found to have the potential to ameliorate symptoms such as depression and pain in a range of conditions as well as to enhance outcomes of cognitive and physical training. However, effects are cumulative, requiring treatments that can span weeks or months and frequent, repeated visits to the clinic. The cost in terms of time and travel is often prohibitive for many participants, and ultimately limits real-world access. 
Following guidelines for remote tDCS application, we propose a protocol that would allow remote (in-home) participation that uses specially-designed devices for supervised use with materials modified for patient use, and real-time monitoring through a telemedicine video conferencing platform. We have developed structured training procedures and clear, detailed instructional materials to allow for self- or proxy-administration while supervised remotely in real-time. The protocol is designed to have a series of checkpoints, addressing attendance and tolerability of the session, to be met in order to continue to the next step. The feasibility of this protocol was then piloted for clinical use in an open label study of remotely-supervised tDCS in multiple sclerosis (MS). This protocol can be widely used for clinical study of tDCS.

A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation tDCS in Multiple Sclerosis MS

The goal of this pilot study is to describe a protocol for the remotely-supervised delivery of transcranial direct current stimulation (tDCS) so that the procedure maintains standards of in-clinic practice, including safety, reproducibility, and tolerability. The feasibility of this protocol was tested in participants with multiple sclerosis (MS).

بروتوكول لاستخدام الإشراف عن بعد، عبر الجمجمة مباشرة الحالي تحفيز (tDCS) في التصلب المتعدد (MS)

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses low amplitude direct currents to alter cortical ...

Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Lateral pancreaticojejunostomy (LPJ) has shown good postoperative outcomes in patients with painful, morphine dependent, chronic pancreatitis (CP). The recent rise of robotic and laparoscopic pancreatic surgery has found benefits such as reduced time to functional recovery. Few studies have reported on the feasibility, technique and outcome of robotic LPJ, especially including transection of the gastroduodenal artery. The present study describes the main steps for robotic LPJ in a patient with painful chronic pancreatitis with a dilated main pancreatic duct. The patient underwent robotic LPJ. The LPJ anastomosis is performed using a running suture technique in a longitudinal side-to-side manner. Routinely, the gastroduodenal artery is transected to drain the entire length of the main pancreatic duct. The patient is in French position; 7 trocars are placed (4 robotic, 2 laparoscopic assistants, 1 liver-retractor). After docking of the robot system, the omental bursa is opened, and the right gastroepiploic artery and vein are ligated at their base at the lower border of the pancreas. Intraoperative ultrasonography is performed in order to determine trajectory of the dilated main pancreatic duct which is opened for its entire length after the gastroduodenal artery has been suture ligated both cranially and caudally from the main pancreatic duct. A Roux limb is created, and a latero-lateral PJ is fashioned using several 3-0 barbed sutures. A stapled jejuno-jejunostomy is created at sufficient distance from the pancreatic anastomosis, aided by a 50 cm suture. The described technique for robotic LPJ is a complex but feasible operation for patients with treatment refractory CP and a dilated main pancreatic duct. Due to its complexity, implementation in high volume centers with extensive experience with CP surgery may improve outcomes.

Robotic lateral pancreaticojejunostomy (RLPJ) may be used in patients with painful, morphine dependent, chronic pancreatitis and a dilated main pancreatic duct. We describe a standardized and reproducible technique for RLPJ, which includes transection of the gastroduodenal artery.

بانكريتيكوجيجونوستومي الجانبية الروبوتية للتهاب البنكرياس المزمن

Lateral pancreaticojejunostomy (LPJ) has shown good postoperative outcomes in patients with painful, morphine dependent, chronic pancreatitis (CP). The ...

Using a Chemical Biopsy for Graft Quality Assessment

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated with an increased survival rate and greater quality of patient&#8217;s life when compared to conventional dialysis. Regrettably, transplantology suffers from a lack of reliable methods for organ quality assessment. Standard diagnostic techniques are limited to macroscopic appearance inspection or invasive tissue biopsy, which do not provide comprehensive information about the graft. The proposed protocol aims to introduce solid phase microextraction (SPME) as an ideal analytical method for comprehensive metabolomics and lipidomic analysis of all low molecular compounds present in kidneys allocated for transplantation. The small size of the SPME probe enables performance of a chemical biopsy, which enables extraction of metabolites directly from the organ without any tissue collection. The minimum invasiveness of the method permits execution of multiple analyses over time: directly after organ harvesting, during its preservation, and immediately after revascularization at the recipient&#8217;s body. It is hypothesized that the combination of this novel sampling method with a high-resolution mass spectrometer will allow for discrimination of a set of characteristic compounds that could serve as biological markers of graft quality and indicators of possible development of organ dysfunction.

The protocol presents utilization of the chemical biopsy approach followed by comprehensive metabolomic and lipidomic analysis for quality assessment of kidney grafts allocated for transplantation.

استخدام خزعة كيميائية لتقييم جودة الكسب غير المشروع

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated ...

Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla

The overall goal of this article is to demonstrate a state-of-the-art ultrahigh field (UHF) magnetic resonance (MR) protocol of the brain at 7.0 Tesla in multiple sclerosis (MS) patients. MS is a chronic inflammatory, demyelinating, neurodegenerative disease that is characterized by white and gray matter lesions. Detection of spatially and temporally disseminated T2-hyperintense lesions by the use of MRI at 1.5 T and 3 T represents a crucial diagnostic tool in clinical practice to establish accurate diagnosis of MS based on the current version of the 2017 McDonald criteria. However, the differentiation of MS lesions from brain white matter lesions of other origins can sometimes be challenging due to their resembling morphology at lower magnetic field strengths (typically 3 T). Ultrahigh field MR (UHF-MR) benefits from increased signal-to-noise ratio and enhanced spatial resolution, both key to superior imaging for more accurate and definitive diagnoses of subtle lesions. Hence, MRI at 7.0 T has shown encouraging results to overcome the challenges of MS differential diagnosis by providing MS-specific neuroimaging markers (e.g., central vein sign, hypointense rim structures and differentiation of MS grey matter lesions). These markers and others can be identified by other MR contrasts other than T1 and T2 (T2*, phase, diffusion) and substantially improve the differentiation of MS lesions from those occurring in other neuroinflammatory conditions such as neuromyelitis optica and Susac syndrome. In this article, we describe our current technical approach to study cerebral white and grey matter lesions in MS patients at 7.0 T using different MR acquisition methods. The up-to-date protocol includes the preparation of the MR setup including the radio-frequency coils customized for UHF-MR, standardized screening, safety and interview procedures with MS patients, patient positioning in the MR scanner and acquisition of dedicated brain scans tailored for examining MS.

Here, we present a protocol to acquire magnetic resonance (MR) images of multiple sclerosis (MS) patient brains at 7.0 Tesla. The protocol includes preparation of the setup including the radio-frequency coils, standardized interview procedures with MS patients, subject positioning in the MR scanner and MR data acquisition.

التصوير بالرنين المغناطيسي للتصلب المتعدد في 7.0 تسلا

The overall goal of this article is to demonstrate a state-of-the-art ultrahigh field (UHF) magnetic resonance (MR) protocol of the brain at 7.0 Tesla in ...