支持这项工作是由以下资金来源： MAN：NIH 2R01 DC05672-04A2 RHH：美国国立卫生研究院/ NINDS 1K01NS060995的-01A1 RHH：罗伯特·伍德·约翰逊基金会/哈罗德·阿莫斯医学院的发展计划

1。治疗前评估<ol><li>招募患者为研究对象符合资格要求谁。这些标准包括一个单一的，单方面的，左侧大脑半球缺血性中风，不遗余力辅助运动区（SMA），轻度至中度非流利的讲话（定义的能力产生意味深长的话，至少有2-4个字长度的字符串）， 18和75岁之间的中风后至少六个月。 </li><li>此外，所有潜在的患者一定要能说出至少三个波士顿命名测试15，平均至少三张图片的前30项20时，十套图片命名取自斯诺德格拉斯刺激Vanderwart语料库16，达到或超过25 个百分位字的理解和命令波士顿诊断的失语症考试17分测验上的得分。 </li><li>进行医疗检查，检查，以确保患者是H足够ealthy参加学习，接受磁共振成像（MRI）扫描或TMS没有禁忌。 </li></ol> 2。基准测试<ol><li>电池管理标准化的测试在三个不同天，每个病人的语言障碍和赤字在其他认知领域的程度进行评估。测试包括曲奇盗窃图片描述分测验的BDAE 18日 ，BDAE（ 第二版）。分测验为Word理解（基本字歧视）和命令，波士顿命名测试15，台40线图取自斯诺德格拉斯和Vanderwart的刺激图像数据库16和认知语言学快速测试19（CLQT）条。 </li><li>启动一个基准BOLD-fMRI研究中，患者进行图片命名任务口服响应。收集全脑高分辨率T1加权图像一个MPRAGE序列（RT = 1,620毫秒，TE = 3.87毫秒，FA = 15，FOV = 192×256，切片= 160，体素大小= 1毫米）。获取功能的卷使用整个大脑T2 *加权大胆平面回波序列（TR = 3000秒，TE = 35毫秒，FA = 90，FOV = 128×128，片= 31，体素尺寸= 1.875毫米2，切片厚度= 4毫米）。 </li><li>到真正的重复TMS（磁刺激）或一组接收初始假刺激（STMS），然后由磁刺激（图1）的一组接收的随机化患者。 </li></ol> 3。鉴定优化站点刺激<ol><li>为了目标rTMS的皮质网站在精确和准确的方式，使用一个neuronavigational系统（ 如 Brainsight，蒙特利尔，盗贼研究）共同注册全脑高分辨率T1加权像（见2.2以上）的位置的病人和线圈。 rTMS组，确定休息电机通过刺激阈值（RMT）右运动皮层和随后的目视检查20。 </li><l&gt;在实际rTMS治疗，在后下方的方向定位线圈与手柄顺时针方向旋转约45°向下位置。对于假手术组，管理STMS，这样的线圈接点的头部的横向翼的外缘与线圈垂直于头部。在该取向中，运行的峰值磁场平行于颅骨，因而不会产生皮层刺激。 </li><li>六个独立的会议进行了5天（两会进行最后一天，在会话之间有45分钟的休息），辖10分钟，要么接受rTMS（600 1赫兹脉冲强度的90％RMT）或STMS不同地点的右下额叶：对应初级运动皮层（M1）的口，三角叉尾斗鱼收杆（BA 44），前三角部（BA 45），背后三角部（BA 45），腹后收杆（ BA 45），和收杆眼眶（BA 47， 图2）。随机stimulation个站点患者之间的顺序。 </li><li>让患者进行40项的每个TMS会议之前和之后的图片命名任务。斯诺德格拉斯和图片刺激Vanderwart 16项集，皮博迪图片词汇测试21，和国际图片命名项目（IPNP），数据库22。 40项名单必须配合字的长度，频率和语义范畴;在我们的项目中列出了20个项目是小说，而20重复整个测试会评估实践效果。话语应该算作是正确的，如果他们从不同的目标不超过一个音素8。单词表的顺序应该是随机跨学科，每个学科应该接受不同的单词列表，在每次访问。 </li><li>通过执行单样本t-检验比较，在图片命名性能的变化，在每个站点的命名performan的平均变化确定最佳站点中的刺激CE为所有其他站点。接着，比较，在性能上的变化，在最佳站点中的方差性能，所有六个预rTMS的会话;磁刺激后的性能变化，如果是大于两倍的标准偏差的平均值-TMS性能，这是不可能的命名性能中获益是由于重测信度变异9。 </li><li>对于假网站的调查，辖STMS在收杆三角。该地点作为“最佳站点”议定书“第4条中所描述的治疗阶段，假臂。 </li></ol> 4。治疗阶段<ol><li> rTMS治疗或STMS管理的最佳刺激网站十天，在12天期间（刺激每个工作日除去周末）。 </li><li>在第一天的刺激，事件的顺序如下：已对患者进行的功能磁共振成像（并发图片命名，如基线），管理40项命名任务，激发最佳的s伊特用20分钟为1赫兹rTMS的90％RMT或STMS再次，管理命名任务，终于有病人接受第二次的并发功能磁共振成像的图片命名。 </li><li>经过九个两天，该协议包括20分钟的rTMS的会议（1200脉冲），使用1赫兹rTMS的90％RMT或STMS。 </li><li>第10天，1赫兹rTMS的图片命名任务，前面和后面的20分钟，刺激的最佳网站。值得注意的是，图像资料列表显示的日子一到十应该是不同的，但相匹配的频率，单词的长度，和语义类别如上所述。 </li></ol> 5。双和六个月随访<ol><li>两个月后，任rTMS治疗或STMS 10天，重复基线测试（2.1），以及功能磁共振成像与并发画面命名。 </li><li>假手术条件的患者应该过真正的TMS条件，开始与最佳现场调查阶段（图1）。 </li><li>六个月FOL仰角调整10天真正的rTMS的刺激，重复基线测试（如在第2.1步），也有患者接受另一个并发图片命名任务的功能磁共振成像。 </li></ol>

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作者宣称，他们有没有竞争经济利益。

这篇文章的目的是详细的操作步骤为确定一个响应目标网站在右半球在慢性非流​​利性失语患者。通过这样做，我们有能刺激目标区域治疗，刺激语言能力的影响进行评估，并使用低频rTMS的命名和流利的慢性非流利性失语患者引起长期的改善。我们的方式复制和扩展使用前调查，最引人注目Naeser，同事8的方法。重要的是，像一些事先调查8,12,13,23，我们已经观察到，大多数患者...

失语收购亏损的语言能力是一种常见的，往往使人衰弱的后果行程2。虽然一定程度上是典型的急性脑卒中后失语症恢复，许多患者至少经历某种程度的持续出现赤字，并且，现有语言疗法通常被认为是只温和有效地促进恢复3-5。近年来，非侵入性的刺激技术的出现，如经颅磁刺激（TMS）作为中风后赤字各种潜力的治疗方法，包括失语。 TMS采用电磁感应原理，和涉及迅速熔剂的磁场的产生，在一个线圈。当线圈被放置在邻近的被摄体的头部，磁场穿透头皮和头骨，诱导潜在的皮质神经元中的电流是足够的去极化神经细胞膜和基因率动作电位3。 TMS的参数，如频率，强度和脉冲数，可以是多种多样的，以引起不同的神经生理，行为和感知效果4,5。重复TMS（磁刺激）必须管理的一系列脉冲，以预定频率产生的影响，可以长久刺激的应用。目前的实验证据表明，在低频rTMS的交付（0.5-2赫兹）往往灶性降低大脑皮层的兴奋性，而高频刺激已与大脑皮层的兴奋3有密切关系。磁刺激已探索作为治疗各种神经和精神疾病，最显着的凹部6。 越来越多的证据表明，低频rTMS治疗与慢性中风引起的失语者，可用于提高语言恢复。 Naeser和同事7,8率先采用1赫兹inhibitoRY rTMS治疗20分钟，每周五天四个右手的患者与慢性非流利性失语两周右额下回。显着改善的命名进行了观察，持续至少8个月完成后，刺激8。随后，我们复制和扩大这些成果，并已经证明，1 Hz的刺激导致在命名和自发的讲话引起慢性非流利失语症患者9-11持续改善。令人鼓舞的是，像这样的小规模研究的结果已被复制与慢性中风12例患者在进一步调查中，以及在亚急性中风失语13例。 非流利性失语患者前TMS研究中的一个重要的和几乎无处不在的特点是有益的刺激效果，似乎是特定网站。采用的方法最初受雇于Naeser和他的同事，最rTMS的调查已被用来促进语言恢复有针对性的正确的收杆三角1（布罗德曼区45）。事实上，最近的证据表明，刺激其他地区的右额下回可能是无效的，甚至可能产生有害影响语文成绩14，强调需要仔细的个体识别的最佳刺激点。 建立的方法由Naeser和同事8时，我们正在进行调查研究的影响抑制rTMS的额下回语言能力，还考察了地形特异的rTMS治疗效果在右额叶。在这篇文章中，我们提供了详细描述了如何刺激的最佳网站可以识别患者与慢性非流利性失语。然后，我们描述的治疗rTMS的管理和解释瓯的ŗ技术评估刺激的功效，加强在这一人群中的语言恢复。

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 <td>Name of Reagent/Material</td>
 <td>Company</td>
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 <tr>
 <td>Rapid transcranial magnetic stimulator</td>
 <td>Magstim</td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td>3.0 Trio Scanner</td>
 <td>Siemens</td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td>8 channel head coil</td>
 <td>Siemens</td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td>Brainsight neuronavigational system</td>
 <td>Rogue Research</td>
 <td></td>
 <td></td>
 </tr>
 </tbody>
</table>

utilizing repetitive transcranial magnetic stimulation to improve language function in stroke patients with chronic non-fluent aphasia

经颅磁刺激（TMS）已被证明能显着改善与非流利性失语患者语言功能的。在这个实验中，我们展示了低频重复性TMS（rTMS的）管理与慢性非流利性失语患者的最佳刺激的部位在右半球。电池管理标准化语言措施，以评估基准性能。其后患者随机分为接受真正的rTMS治疗或初始假刺激。在现实的刺激患者经过现场调查阶段，包括了一系列的六个rTMS的会话管理五天的刺激传递到不同的站点在右额叶每个会话期间。每个站点发现会话由600脉冲1赫兹rTMS治疗，之前和之后的图片命名任务。 CAND刺激引起的命名能力的瞬态变化程度比较IDATE网站，我们能够找到的区域为每个病人的最佳响应。然后我们管理rTMS的这个网站在治疗阶段。患者在治疗期间，共经历了10天的刺激，在短短两周的每个会话由1赫兹rTMS的交付90％的静息运动阈值的20分钟。刺激配对的功能磁共振成像命名任务上的第一个和最后一个天的治疗。处理后的阶段完成后，在基线的语言电池重复2个月和6个月后，刺激，以便确定rTMS的性能引起的变化。 fMRI的命名任务还多次治疗后2个月和6个月。谁是病人随机分为假臂的研究进行假现场发现，假治疗，功能磁共振成像研究命名，并重复语言测试后两个月完成假治疗。深水患者，然后到真正的刺激臂跨越，完成真正的网站发现，真正的treatm耳鼻喉科，功能磁共振成像，两个刺激后六个月语言测试。

在本次调查的现场调查阶段，大多数但不是所有的患者反应最佳图片命名任务，刺激的右三角14杆收杆。根据我们的经验，患者图片命名上的表现是一贯促进刺激腹后收杆三角方面（图3）。 标准化语言评估长期改善性能， 如图4所示。此图显示的结果在其中一个有代表性的病人的BNT和BDAE的（命名分类小节）图片命名精度rTMS的治疗后，随着时?...

Watch this Scientific Journal Video about Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia at JoVE.com

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

我们探索利用重复经颅磁刺激（rTMS的）改善慢性中风和非流利性失语患者的语言能力。识别一个网站为每一个病人的右额下回响应最佳刺激后，我们针对这个网站在10天的rTMS治疗。

利用重复经颅磁刺激改善脑卒中患者的语言功能与慢性非流利性失语

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

utilizing-repetitive-transcranial-magnetic-stimulation-to-improve

Research

JoVE Journal

Medicine

17.6K 次观看.  University of Pennsylvania. 我们探索利用重复经颅磁刺激（rTMS的）改善慢性中风和非流利性失语患者的语言能力。识别一个网站为每一个病人的右额下回响应最佳刺激后，我们针对这个网站在10天的rTMS治疗。

视频: Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

利用经颅磁刺激，以研究人类的神经肌肉系统

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

科研

医学

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

血管功能在慢性肾脏疾病的评估

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Home-Based Transcranial Direct Current Stimulation Device Development: An Updated Protocol Used at Home in Healthy Subjects and Fibromyalgia Patients

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the cerebral cortex by a low-intensity direct current. tDCS is a low-cost technique with minimal adverse effects and easy application. This neurostimulation method has a promising future to improve pain therapy, treatment of neuropsychiatric disorders, and physical rehabilitation.
Current studies demonstrate the benefits of using tDCS over consecutive multiple sessions. However, the daily displacement to the specialized centers, travel costs, and disruptions to daily activities are some of the difficulties faced by patients. Thus, to be more comfortable, easy-to-use, and not disrupt daily commitments, a home-based tDCS was designed. Therefore, the objective of this study was to evaluate the feasibility of a portable tDCS device for home use in healthy subjects and fibromyalgia patients.
Despite increased tDCS use and a reasonably large body of research on the effects across a range of clinical conditions, there is a limited amount of research on developing secure devices that guarantee the dose and contain a block system to avoid excessive use. Therefore, we used a tDCS device with a security system to permit daily use for 20 minutes with a minimal interval of 12 hours between sessions. A programmer preconfigures the equipment, which has a neoprene cap that allows the electrode positions in any assembly, according to individualized protocols for treatments or research. After, researchers can assess the effectiveness of treatment, and its adherence using information kept in the device software.
Results suggest that the device is feasible for home use, with proper monitoring of adherence and contact impedance. There were reports of a few adverse effects, which do not differ from those reported in the literature in studies with the treatment under direct supervision.

This study provides an updated home-based tDCS protocol that enables subjects to receive the beneficial effects of tDCS at home with an easy to use device with settings to control the use and dosage, enhancing the feasibility for long-term use at home.

基于家庭的经颅直流电刺激装置的研制: 在家庭中使用的最新协议在健康和纤维肌痛患者中的应用

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the ...

Updated Technique for Reliable, Easy, and Tolerated Transcranial Electrical Stimulation Including Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) is a noninvasive method of neuromodulation using low-intensity direct electrical currents. This method of brain stimulation presents several potential advantages compared to other techniques, as it is noninvasive, cost-effective, broadly deployable, and well-tolerated provided proper equipment and protocols are administered. Even though tDCS is apparently simple to perform, correct administration of the tDCS session, especially the electrode positioning and preparation, is vital for ensuring reproducibility and tolerability. The electrode positioning and preparation steps are traditionally also the most time consuming and error-prone. To address these challenges, modern tDCS techniques, using fixed-position headgear and pre-assembled sponge electrodes, reduce complexity and setup time while also ensuring that the electrodes are consistently placed as intended. These modern tDCS methods present advantages for research, clinic, and remote-supervised (at home) settings. This article provides a comprehensive step-by-step guide for administering a tDCS session using fixed-position headgear and pre-assembled sponge electrodes. This guide demonstrates tDCS using commonly applied montages intended for motor cortex and dorsolateral prefrontal cortex (DLPFC) stimulation. As described, selection of the head size and montage-specific headgear automates electrode positioning. Fully assembled pre-saturated snap-electrodes are simply affixed to the set position snap-connectors on the headgear. The modern tDCS method is shown to reduce setup time and reduce errors for both novice and expert operators. The methods outlined in this article can be adapted to different applications of tDCS as well as other forms of transcranial electrical stimulation (tES) such as transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS). However, since tES is application specific, as appropriate, any methods recipe is customized to accommodate subject, indication, environment, and outcome specific features.

When administering transcranial direct current stimulation (tDCS), reproducible electrode preparation and placement are vital for a tolerated and effective session. The purpose of this article is to demonstrate updated modern setup procedures for the administration of tDCS and related transcranial electrical stimulation techniques, such as transcranial alternating current stimulation (tACS).

用于可靠、简单和耐受的颅内电刺激（包括颅内直流刺激）的更新技术

Transcranial direct current stimulation (tDCS) is a noninvasive method of neuromodulation using low-intensity direct electrical currents. This method of ...

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF) is the most common form of arrhythmia. Atrial remodeling is considered the most critical mechanism for the presence and development of atrial fibrillation. Also, atrial remodeling can lead to the enlargement and dysfunction of the left atrium (LA), resulting in thrombosis and heart failure. Functional changes in left atrial strain and strain rate occur before structural alterations and are closely associated with structural remodeling and left atrial fibrosis. These parameters are sensitive biomarkers for atrial function. Cardiac magnetic resonance feature tracking (CMR-FT) is a novel, non-invasive, post-processing technique that can evaluate left atrial strain and strain rate. The CMR-FT was utilized in this investigation to assess the bilateral atrium strain rate in individuals with paroxysmal AF. Modifications in each segmental strain were evaluated using segmental analysis. The CMR-FT is recommended for non-invasive evaluations in the clinical assessment of atrial strain among existing strain imaging techniques. Further, it is a flexible parameter measurement with good reproducibility, high soft-tissue resolution, and post-processing based on standard cine balanced steady-state free precision (bSSFP) long-axis images without requiring a new sequence acquisition.

The atrial function is associated with the strain and strain rate. The cardiac magnetic resonance feature tracking (CMR-FT) technique was used in this study to quantify left and right atrial global and segmental longitudinal strain and strain rate in individuals with paroxysmal atrial fibrillation.

通过心血管磁共振特征跟踪估计阵发性心房颤动患者的双侧心房功能

Atrial fibrillation (AF) is the most common form of arrhythmia. Atrial remodeling is considered the most critical mechanism for the presence and ...

Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional mapping of language areas for surgical decision-making is usually done invasively by electrical direct cortical stimulation (DCS), which is used to identify the organization of the crucial cortical and subcortical structures within each patient. Accurate preoperative non-invasive mapping aids surgical planning, reduces time, costs, and risks in the operating room, and provides an alternative for patients not suitable for awake craniotomy. Non-invasive imaging methods like MRI, fMRI, MEG, and PET are currently applied in presurgical design and planning. Although anatomical and functional imaging can identify the brain regions involved in speech, they cannot determine whether these regions are critical for speech. Transcranial magnetic stimulation (TMS) non-invasively excites the cortical neuronal populations by means of electric field induction in the brain. When applied in its repetitive mode (rTMS) to stimulate a speech-related cortical site, it can produce speech-related errors analogous to those induced by intraoperative DCS. rTMS combined with neuronavigation (nrTMS) enables neurosurgeons to preoperatively assess where these errors occur and to plan the DCS and the operation to preserve the language function. A detailed protocol is provided here for non-invasive speech cortical mapping (SCM) using nrTMS. The proposed protocol can be modified to best fit the patient- and site-specific demands. It can also be applied to language cortical network studies in healthy subjects or in patients with diseases that are not amenable to surgery.

Navigated repetitive transcranial magnetic stimulation is a highly efficient non-invasive tool for mapping speech-related cortical areas. It helps in designing brain surgery and speeds up the direct cortical stimulation conducted during the surgery. This report describes how to perform speech cortical mapping reliably for preoperative evaluation and research.

用于语音皮质映射的导航重复经颅磁刺激的研究设计

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional ...

针灸刺激耳朵以缓解 COPD 患者的睡眠障碍

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic respiratory symptoms. It has a wide spectrum of complications, and sleep disorders, as part of it, are common in severe cases, especially in elderly patients. Long-term lack of sleep may lead to the aggravation of the original disease, reducing patients' quality of life. Benzodiazepines are mainly used for symptomatic treatment of COPD combined with sleep disorders. However, such drugs have the side effect of respiratory central inhibition and could probably aggravate hypoxia symptoms. Auricular acupuncture is a special method of treating physical and psychosomatic dysfunctions by stimulating specific points in the ear. This article explains the specific methods of clinical operation of auricular acupuncture in detail, including assessment of patient eligibility, medical devices used, acupuncture points, course of treatment, post-treatment care, responses to emergencies, etc. The Pittsburgh sleep quality index (PSQI) and chronic obstructive pulmonary disease assessment scale (CAT) were used as the observational index of this method. So far, clinical reports have proved that auricular acupuncture has a definite curative effect in the treatment of COPD combined with sleep disorders, and its advantages of simple operation, few adverse reactions are worthy of further study and promotion, which provide a reference for the clinical treatment of such diseases.

作者聚焦：利用中医耳针疗法改善睡眠障碍 

This protocol introduces an effective method to improve the sleep condition of patients with chronic obstructive pulmonary disease and alleviate cough symptoms by using auricular acupuncture techniques to percutaneously stimulate specific acupoints in the patients' ears.