作者社论援助感谢Kayleen韦弗，亚历山大·文丘里，丹尼斯张庭志愿此视频在这篇文章中所使用的数字之一，而华莱士的H. Coulter基金会开展这项工作给予的支持。 MS VOLZ德意志Schmerzgesellschaft EV [德国章疼痛研究国际协会（IASP）博士生奖学金资助。

1。禁忌和特殊注意事项<ol><li>设备安装前，确认参与者没有任何禁忌HD-TDCS。这似乎是合理的假设，这些禁忌症是常规的TDCS的（ 表1）相同。其他特殊的考虑因素，如患者的药物，也应考虑进去。例如，中枢神经系统作用药物可能会发生变化的刺激所期望的效果。 </li><li>彻底检查参与者的头皮皮肤的病变，如削减或炎症标志。避免刺激表明此种病变的头皮区域。此外，应避免刺激患者颅骨缺损或金属植入物。如果试验目的是专门研究这个病患族群，额外的预防措施和特殊剂量代价，应考虑到帐户（ 例如，与计算远期车型）17 </sup&gt;。 </li></ol> 2。物料<ol><li>确保所有必要的材料都是现成的（ 见表2）。 </li><li>在模块化的脑电图（EEG）记录帽嵌入塑料高清肠衣。应该对应于所述中心电极的目标区域，在这个示范的M1，和四个返回电极的半径的协议，是正在研究的基础上的，应调整。在本演示中，我们使用了一个半径约7.5厘米，与中心电极放在M1和返回电极的位置大致对应CZ，F3，T7和P3在国际10-20脑电图系统18。 </li><li>每个刺激会话之前，将传统的TDCS设备（Soterix 1X1低强度的直流电刺激）和多通道刺激适配器，并检查电池是否充电。 “低电池”指示灯将亮起，如果任一设备上，情况并非如此，这表明batteri上课需要更换。检查电池充电后，该设备可以被关闭前才刺激。的现有的TDCS的设备是一个电池供电的设备，提供DC几毫安的强度。的电流控制，而不是一个电压控制的激励器是优选的由于改变电极阻抗。总是鼓励使用电源适配器为安全起见，为了避免意外交付更大的强度。此设备的操作，在我们以前的文章19。常规TDCS的移动设备以通过连接适配器（ 图1）的多通道刺激，直流一起传送的4×1 HD的TDCS的配置允许的所需的区域的神经调节受限制。 </li><li>每次届会前，目视检查电极使用前的异常磨损或损坏的迹象。 HD-TDCS电极可重复使用，但数量有限，申请总量（见探讨Then）的。用于HD-TDCS的电极组件应已被专门设计或测试使用于此目的。在这篇文章中展示的方法使用Ag / AgCl电极烧结环形电极（ 图2）。这些电极的使用，在适当的导电胶和HD塑料外壳结合，已示出，以尽量减少不产生显着的加热9,20的同时在刺激电极电位和pH值的变化，在凝胶中的更改，因此，导致在更安全和更有效的方法，相比其他类型的电极。 </li><li>五Ag / AgCl电极烧结环形电极连接电缆匹配4X1适配器输出线接收机。将所述中心电极的一个限定的刺激的极性为正极或阴极。确保中心电极引线连接到中央接收器插件。然后，剩余的电极连接到周围的插头。应该指出的是中的接收器的插头的返回电极的安排是不关键的，因为它们都将是相同的极性。 </li></ol> 3。测量总的测量和本地化领域的刺激传统TDCS是相同的，正如在我们以前的文章19。将要描述的步骤，再次详细地进一步澄清。 <ol><li>有与会者舒适地坐在椅子上，这可能有头枕。 </li><li>是由感兴趣的研究人员的协议，因为不同地区的结果，在不同的效应的刺激的刺激部位。最常见的是，国际10-20 EEG系统18用于测量头，如下所述。 </li><li>首先，本地化的顶点（CZ）。 <ol><li>为了做到这一点，测量距离从鼻根INION，并划分了一半的距离。鼻根交界处的日现货ê前额和鼻甲骨，和INION的枕骨（ 图3）是最突出的一点。当场标记线，使用油的铅笔或无毒水性标记。 </li><li>其次，测量的左，右耳廓前的点（ 即对耳屏的前方的区域）之间的距离。这个距离除以一半，线当场标记。现在两条线连接，创建一个跨。在这两条线相交的点对应锆。 </li></ol></li><li>根据协议正在研究，确定目标网站的头。 <ol><li>为了刺激初级运动皮层（M1），计算出的距离的20％，从锆石的左侧或右侧耳前点，在锆（图3）开始测量。在此区域中进行更精确的测定，使用的添加剂的方法，如神经导航系统或经颅磁刺激（TMS）可能是合适的。 </li></ol></LI&gt; </ol> 4。皮肤准备<ol><li>准备皮肤刺激部位分离的头发。一个酒精棉球，可以使用以帮助去除皮脂或从头皮的护发产品。不要摩擦皮肤。确保没有皮损。 </li></ol> 5。电极定位设备安装<ol><li>测量头的尺寸和准备皮肤后，发现M1对应的标记。 </li><li>接下来，保持货币供应量M1标记视线，将模块化的脑电记录帽主体的头部，而在标志的中心塑料外壳。在头皮上，在视线要保持货币供应量M1的十字标记，可以将周围的头发之前，HD在它的外壳。确保帽紧贴，但舒适，并调整四个返回塑料外壳的位置。虽然其他的方法当然是可行的，我们在先前的试验16返回电极定位在approximat半径伊利7.5厘米M1。他们的位置大致相当于以锆，F3，T7和P3（ 图4）。然后调整肩带脑电帽。 </li><li>使用测量的​​磁带，确认，研究协议根据电极间的距离是足够的。 </li><li>使用一个木制的棉签结束，通过在塑料壳体中的开口，直到露出头皮头发分开。重复每个外壳下。 </li><li>引入导电凝胶约1.5ml的通过每个塑料壳体的开口部，从上面的头皮表面。在凝胶中的应用，可以实现使用的塑料注射器。小心地避免扩频凝胶以外的周围的塑料外壳，因为这可能导致分流电流不足的电流（ 图5）。 </li><li>接着，其粗糙的表面朝下，朝上表面光滑圆润，位置的Ag / AgCl电极烧结环每个高清塑胶外壳。使用注射器或柱塞作为指导，如果有必要，降低环形电极，直到其位于塑料外壳的基极。 </li><li>添加一些更多的凝胶覆盖电极，然后用与HD塑料外壳提供的上限锁定到位（ 图6）电极。这个上限将保持电极在整个刺激。旋转盖锁定到位。如果塑料盖不容易打开，不要过度使用武力。重新调整电极5.6中所描述的，然后尝试锁定上限到位。 HD塑料外壳帽设计容易，如果Ag / AgCl电极烧结环形电极完全插入，并在其正确的定位。 </li><li>为了减少紧张电极上的电缆，回路他们每个塑料外壳和磁带他们周围的椅子或主体的衣服（ 图7）。 </li><li>圆形端的输出电缆连接到4X1适配器输出端口。 </li><li>使用输入电缆吨Ø连接适配器传统TDCS设备的的4X1多通道刺激。锥插头端输入电缆连接到4X1适配器输入端口和连接传统TDCS设备的输出端口输入电缆的另一端（两个香蕉型插头）。重要的是，电缆中标记为“中心”是一个将定义从中心电极为正极或阴极交付直流极性。请注意，当使用4×1的多通道刺激适配器TDCS的与常规的设备组合有任何开关或按钮，用于选择中心阳极或阴极中心。该极性的香蕉型插头连接器电缆连接的过程中，常规TDCS的设备的输出，如上所述，通过确定。在TDCS的HD-TDCS的“阳极”指的是相对正端的正电流流入身体。另一方面，“阴极”是相对的负端，正电流吨母鸡离开身体。 </li><li>当连接都准备好了，打开两个设备。 </li><li>确保的阻抗值是在一个适当的范围内，通过转动“模式选择”旋钮，的4X1多通道刺激适配器，“扫描”。然后，该装置将扫描电极，在一个时间在显示窗口中显示一个电极的阻抗。可用于“牵头切换”按钮来切换当前在显示屏上的电极的自动切换。可以按下该按钮锁定在所选择的电极上的显示，检查阻抗。然后，它可以被再次按下，以允许移动设备以改变显示的电极。 4X1多通道刺激的适配器设备将测量阻抗在“质量合格单位”。接触的质量被归一化到这些“质量单位”由测试电路的基础上的事实，电极电阻的电极界面的电化学过程21是非线性的，该电极的电阻（阻抗）可以因此，会产生误导。例如，测量电阻显然是完全依赖于测试电流22。较低的“质量合格单位”的价值观是可取的。虽然没有严格的指引可到今天为止，值低于或等于1.50至2.0的“质量合格单位”已被用来作为在以往的研究，截止15,16。 </li></ol>不要激活传统TDCS设备，而4X1多通道刺激适配器是在“扫描”模式（阻抗检查），刺激不会被发送给主题。 <ol start="13"><li>如果阻抗值超越这些要求的限制，打开瓶盖的塑料外壳中的电极呈现高阻抗，并取出烧结环形电极的Ag / AgCl。按照程序，如上所述（ 即 5.4-5.7）调整头发和电极，以获得最佳的阻抗。再次检查的阻抗，正如在5.12。一旦确定了目标质量值来实现，replaCE外壳上的盖子。重复同样的步骤，根据需要的其它电极。最优质量指示可从主体而变化，而是一个更高的质量指标中的一个电极比其他可能表明该电极接触不良。 </li><li>所有电极的阻抗质量一旦被证实为所需的范围内，关闭“模式选择”从“扫描”的4X1多通道刺激适配器，旋钮的“通行证”。此设置允许电流通过电极传递从传统TDCS设备到4X1设备。运营商现在准备开始刺激。 </li></ol> 6。促进<ol><li>确保参与者坐在舒适的椅子上，在刺激保持清醒。 </li><li>现在HD-TDCS采用常规TDCS的设备的控制，在我们以前的文章19所示。确认交付的刺激的持续时间和强度，并调整的移动设备的需要。此外，确定会议（假或主动刺激）的模式。如果假模式选择，该设备将自动提供电流一段时间的30秒。这种方法已经被报道是成功的致盲在常规的TDCS 23和HD-TDCS 15项试验的参与者。 </li><li>启动HD-TDCS会议，按传统TDCS设备的“开始”按钮。的直流强度上升，然后连续光达到目标电流时，“开始”指示灯将闪烁。定时器届时会显示剩余时间，“真正的电流”指示灯将显示当前的传送到中心电极和四个返回电极结合强度。 </li><li>它可能的情况下，受试者表明不适，瘙痒或刺痛在初始刺激期24中 。如果这些症状是太难受了，所以建议的电流强度是马nually斜坡下降0.2-0.5毫安几秒钟，使用“放松”的主题功能，直到感觉舒适。后立即，电流强度应逐渐增加回原剂量。上述的感觉通常倾向于刺激几分钟后消失。 </li></ol> 7。手术后的<ol><li>会话完成后，可以再次测量电阻通过各种渠道，如果需要的话。打开塑料盖，轻轻取出肠衣的Ag / AgCl电极烧结环。如有必要，可使用棉签钝端，以避免揪着电极导线。电极应该用自来水轻轻冲洗，以去除凝胶，然后干燥存放之前。 </li><li>接下来，删除EEG帽与嵌入式的塑料肠衣。不要取出脑电帽的塑料盖封闭，作为参与者的头发可能会被抓的上限和/或外壳。然后应洗涤塑料外壳除去凝胶，并用纸巾干燥。 </li><li>使用纸巾，从主体的头部取出剩余的凝胶。由于该凝胶是水溶性的，也可以使用一些水，以帮助将其删除。 </li><li>建议向参与者填写了一份调查问卷后，每个刺激会话的任何不良事件（ 表3）监控。 </li></ol>

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Pain. 14, 371-383 (2013).</li><li>Datta, A., Bikson, M., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+in+patients+with+skull+defects+and+skull+plates:+high-resolution+computational+FEM+study+of+factors+altering+cortical+current+flow.">Transcranial direct current stimulation in patients with skull defects and skull plates: high-resolution computational FEM study of factors altering cortical current flow.</a> Neuroimage. 52, 1268-1278 (2010).</li><li>Reilly, E. L., Niedermeyer, E., Lopes da Silva, F. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ch.+7.">Ch. 7.</a> Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. , 139-141 (2004).</li><li>DaSilva, A. F., Volz, M. S., Bikson, M., Fregni, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrode+positioning+and+montage+in+transcranial+direct+current+stimulation.">Electrode positioning and montage in transcranial direct current stimulation.</a> J. Vis. Exp. (51), e2744 (2011).</li><li>Datta, A., Elwassif, M., Bikson, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bio-heat+transfer+model+of+transcranial+DC+stimulation:+comparison+of+conventional+pad+versus+ring+electrode.+Conference+proceedings.">Bio-heat transfer model of transcranial DC stimulation: comparison of conventional pad versus ring electrode. Conference proceedings.</a> , 670-673 (2009).</li><li>Merrill, D. R., Bikson, M., Jefferys, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrical+stimulation+of+excitable+tissue:+design+of+efficacious+and+safe+protocols.">Electrical stimulation of excitable tissue: design of efficacious and safe protocols.</a> J. Neurosci. Methods. 141, 171-198 (2005).</li><li>Hahn, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methods+for+extra-low+voltage+transcranial+direct+current+stimulation:+Current+and+time+dependent+impedance+decreases.">Methods for extra-low voltage transcranial direct current stimulation: Current and time dependent impedance decreases.</a> Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology. , (2012).</li><li>Gandiga, P. C., Hummel, F. C., Cohen, L. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+DC+stimulation+(tDCS):+a+tool+for+double-blind+sham-controlled+clinical+studies+in+brain+stimulation.">Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation.</a> Clin. Neurophysiol. 117, 845-850 (2006).</li><li>Brunoni, A. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+on+reporting+and+assessment+of+adverse+effects+associated+with+transcranial+direct+current+stimulation.">A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation.</a> Int. J. Neuropsychopharmacol. 14, 1133-1145 (2011).</li><li>Palm, U., Keeser, D., Schiller, C., Fintescu, Z., Nitsche, M., Reisinger, E., Padberg, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Skin+lesions+after+treatment+with+transcranial+direct+current+stimulation+(tDCS).">Skin lesions after treatment with transcranial direct current stimulation (tDCS).</a> Brain Stimul. 1, 386-387 (2008).</li><li>Datta, A., Baker, J. M., Bikson, M., Fridriksson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Individualized+model+predicts+brain+current+flow+during+transcranial+direct-current+stimulation+treatment+in+responsive+stroke+patient.">Individualized model predicts brain current flow during transcranial direct-current stimulation treatment in responsive stroke patient.</a> Brain Stimul. 4, 169-174 (2011).</li><li>Antal A, T. D., Poreisz, C., Paulus, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Towards+unravelling+task-related+modulations+of+neuroplastic+changes+induced+in+the+human+motor+cortex.">Towards unravelling task-related modulations of neuroplastic changes induced in the human motor cortex.</a> Eur. J. Neurosci. 26, 2687-2691 (2007).</li><li>Datta, A., Elwassif, M., Battaglia, F., Bikson, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+current+stimulation+focality+using+disc+and+ring+electrode+configurations:+FEM+analysis.">Transcranial current stimulation focality using disc and ring electrode configurations: FEM analysis.</a> J. Neural Eng. 5, 163-174 (2008).</li></ol>

，自动对焦，MS VOLZ MF Villamar达席尔瓦和F Fregni的声明没有利益冲突有关对这篇文章。纽约市立大学有刺激与M Bikson的无创脑和A​​达塔作为发明者的知识产权。中号Bikson和A达塔权益在Soterix医药公司

关键步骤 启动程序之前，要检查的方面 刺激开始之前，研究人员应确保参与者都有HD-TDCS无禁忌表1列出了一些重要的考虑因素加以考虑，并总结了最重要的禁忌症，包括在场的金属植入物或设备的头部，严重脑损伤或明显的皮损。研究者应该检查后者的存在而内4X1环的周长准备放置电极。如果存在这样的病变，我们不建议应用技术。 ，虽然皮损未见报道当使用HD在这篇文章中所示的电极和外壳，这是很重要的，皮肤损害被报道后，连续几个会话传统TDCS 3的交付，尤其是如果进行的爱岭期为14天25。 在颅骨或脑实质内的金属植入物或缺陷的存在下，可以显着地修改电流流过17,26和导致刺激与预期以外的皮层区域。出于安全原因，应避免刺激患者的植入式医疗设备。相对禁忌证包括癫痫或中风病史的存在，除非是专门研究集中研究这些条件。 HD-TDCS的应避免在孕妇，由于缺乏数据安全性。 这是非常重要的TDCS的常规的移动设备的4×1的多通道刺激适配器连接时，检查电缆的极性。如果不这样做，可能会导致向参与者提供了错误类型的刺激。请确保电缆标记为“中心”，这往往可能是红色的，是插入到正确的终端（ 阳极或阴极）。 操作员也应目视检查Ag / AgCl电极烧结环形电极电解产物的沉积证据每次使用前，如果表示替换它们。每个活动的刺激会话后，电化学反应的产品往往建立在粗糙的表面上的底部电极。出于这个原因，它是建议设在各电极的中心的4×1配置在两个活动的刺激会。其后，其可旋转，用作返回电极之一。一旦在一组的五个电极担任所述中心电极的两倍，它是推荐使用一组新的电极。它是直接标记每个电极和记录的使用次数，以旋转它们以协调的方式。除了耐受性，电极的（有限的）旋转的目的还在于，以避免一个高阻抗的情况下，电流不会被平分ACROSS四个返回电极。操作者是负责刺激前检查接触质量（如解释步骤5.12至5.14），并确保没有异常高电阻值的观察到的。 它可能发生，参与者将他们的头过高或无意地拉电缆和打跑或打破他们。出于这个原因，它是最好的循环每根电缆周围的塑料外壳和磁带的4X1适配器输出电缆的表面（ 即椅子或参与者的衣服）。 如果需要的话，它可能会局部麻醉剂添加在头皮上，以防止潜在的不舒服的感觉，并提高盲法研究参与者。但是，应该牢记，与HD-TDCS，虽然皮肤灼伤尚未见报道，有可能是一个小理论这种不利影响的风险和局部麻醉剂的使用可能会阻止参与者从r刺激时eporting。在这个演示中，以及在我们以前的研究中，我们没有使用任何不适的局部麻醉剂一般报道为轻度。 正如上文所述，为了有最佳的效果，这是非常重要的，以防止电气凝胶扩散限制范围之外的塑料壳体。否则，电流的威力分流从一个电极到另一个。 刺激时的重要考虑因素 除非这是必须作为研究设计的一部分，主体不应该睡觉，阅读或其他分心的刺激会话期间。这是很重要的，因为它已被报道，强烈的认知努力，无聊或睡觉，肌肉活化和其他活动，导致皮质兴奋性的变化可能导致改变的相对影响的常规TDCS的27。 在开始的s目前的的timulation，为了防止从突然起动电流的流动，该设备的副作用自动斜向上和向下超过30秒的一段时间。出于同样的原因，没有“通行证”和“扫描”模式之间切换，而常规的TDCS设备产生电流。它始终是可取，定期询问受试者是否他们感到舒适的过程中，为了使确定的刺激进行安全。 刺激易感人群，包括儿童患者，可能需要调整剂量。 在手术后的实用方面 为了进一步收集证据的安全性和监视HD-TDCS效果，我们建议使用产生不利影响的问卷调查，如表3所示，应在每次会议后传送给各参赛者。确保屏幕的存在下最常见的adveRSE效果与HD-TDCS，如不适，刺痛，瘙痒和烧灼感。此外，这些数据的意义，可以提高，还要求进行定量主观分数。这可以实现具有数字刻度为患者报告的强度或严重程度的不利影响，例如，从1到5，或1至10个。同样重要的是提供副作用后每个假会话。这使得比较主动和假刺激相关的副作用的频率。对于传统的TDCS，已经报道了一些副作用，假手术组24就是一个例子，头痛更加频繁。 可能的修改对于HD-4X1 TDCS，刺激方案可能会涉及不同的目标位置，电流极性和力度，以及环半径设计。作为一般规则，增加4X1环直径increa本身的渗透深度和最大强度下的环28。反之，减少环半径增加focality的，但会降低引起大脑电场。因此，最佳剂量为每指示进一步调查是必要的。 虽然本文集中在4×1型圈HD-TDCS的，也可以使用其他电极的部署，如4×2和3×3（双带），等等。虽然HD-TDCS提供了很多定制选项，定位和制备电极，这里所描述的方法，应该跟着只使用硬件和配件已专门进行了测试，此目的。这包括HD塑料外壳设计，凝胶，和电极要特别注意。例如，电极以外的Ag / AgCl电极的烧结环也进行了测试，以提供直流，例如银颗粒，银/氯化银颗粒，银/氯化银光盘和橡胶颗粒9。然而，Ag和橡胶颗粒电极诱导D转换的pH值，温度和电极电位增加所有电极的Ag / AgCl环和光盘除外。因此，出现的Ag / AgCl环形电极可能是一种有效和安全的方法。在未来，也可能被用来修改本文中所描述的方法，提供干预措施，如颅交流电刺激。 限制此时，4X1环极性HD-TDCS皮质兴奋的作用尚不清楚。虽然神经生理学的研究报告说，1.0 mA和2.0 mA的正极4X1环HD-TDCS导致大脑皮质的兴奋性增加在健康受试者13,14，专门针对HD-TDCS研究的证据之前，还需要更广泛的身体任何概括作出。此外，值得注意的是，皮层的兴奋性调制的影响，采用4×1型圈HD-TDCS的可能是时间依赖性的，到达他们的豌豆Ķ刺激结束后并不会立即14,16后的几分钟。因此，为了获得准确的结果，可能需要在不同的时间点上，顺序评估以下的干预。

经颅直流电刺激（TDCS的）是一种非侵入性脑刺激技术能够修改神经元静息膜电位和自发的神经元放电的水平面积的刺激，以及在相互连接的神经网络1包括内源性的μ-阿片样物质的系统2，从而调节大脑皮质的兴奋性。 TDCS的神经调节作用，其成本低，简单的应用和便携性结合，导致其广泛的用途，在过去的十年中，在各种各样的设置。这些包括神经生理学研究，认知和行为干预，病人的研究，评估疾病，如慢性疼痛，抑郁，偏头痛，中风，帕金森氏症，耳鸣3。然而，使用大焊盘，最常见的是在25至35厘米2，刺激大脑皮质位于betwee相对广泛的领域提供直流（DC）进行在阳极和阴极4。因此，焦距刺激目标皮层区域，不涉及邻近的解剖区的刺激，是难以实现的，使用这种技术。有几种方法进行了研究，以“塑造”电流通过改变电极间距离5，增加/减少焊盘尺寸减少/增加皮层区域的调制下的电极6。然而，进一步目标电流流，同时努力避免电极之间的电流分流7,8保持兴趣。 高清晰度（HD）TDCS是一个新开发的干预，使用较小的阵列，专门设计的电极9。已经过测试，不同的配置，可对其进行修改，以提高目标刺激10。其中之一是4×1的环形结构中，一个蒙太奇使用覆盖目标皮层包围的区域的中心电极由四个返回电极4。所述中心电极定义的刺激的极性为正极或阴极，和返回电极的半径限于接受兴奋性调制的区域。脑建模研究表明，该区域的皮层进行调制使用4×1 HD-TDCS的配置是相比更受限制的标准双极常规TDCS的蒙太奇4。此外，其focality是强大的组织（建模）参数11。临床神经生理学研究证实焦点电流输送12使用4X1环的经颅电刺激。 该干预的潜在的应用是类似于常规TDCS的。使用4X1环HD-TDCS超过初级运动皮层（M1）报告皮质兴奋性的变化，13后效应可能会拖垮这些传统TDCS 14诱导的行为和神经生理学的研究。目前的研究，使用4X1环HD-TDCS支持其耐受性强度高达2.0毫安（MA）交付长达二十分钟时，在健康受试者13-15和病人16。虽然HD-TDCS的良好的耐受性，重要的是，仅使用的装置和电极，已为此目的专门测试。 这篇文章的目的是提供一个系统的HD-TDCS的4X1-环电极使用示范。刺激的M1被选的，因为它是最常见的蒙太奇中使用不同的临床研究设置。然而，描述的方法可以适应针对大脑的其他区域，如背外侧前额叶皮层（DLPFC）。将显示在这里，执行正确的电极定位很简单但很重要的，以便准确地刺激目标皮层区域。我们希望这个示范将有助于支持和增加严谨未来HD-TDCS试验中，这种新颖的干预的机制和应用程序，提供了进一步的证据。

<table border="1">
	<tbody>
		<tr>
			<td>Name of Reagent/Material</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>One conventional tDCS device (Soterix 1x1 Low-intensity DC Stimulator)</td>
			<td>Soterix Medical Inc., New York, NY, USA</td>
			<td>1300A</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>One 4x1 Multichannel Stimulation Adapter</td>
			<td>Soterix Medical Inc., New York, NY, USA</td>
			<td>4X1-C2</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Four 9V batteries</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Many manufacturers available</td>
		</tr>
		<tr>
			<td>One modular electroencephalogram recording cap</td>
			<td>EASYCAP GmbH, Germany</td>
			<td>EASYCAP</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Five Ag/AgCl sintered ring electrodes</td>
			<td>Stens Biofeedback Inc., San Rafael, CA, USA</td>
			<td>EL-TP-RNG Sintered</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Five specially-designed plastic casings and their respective caps</td>
			<td>Soterix Medical Inc., New York, NY, USA</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>One plastic plunger</td>
			<td>Soterix Medical Inc., New York, NY, USA</td>
			<td>PSYR-5</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Cables</td>
			<td>Soterix Medical Inc., New York, NY, USA</td>
			<td>CSIN-X2 Input Cable, CSOP-D5 Output Cable</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>One measuring tape</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Many manufacturers available</td>
		</tr>
		<tr>
			<td>One wooden cotton swab</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Many manufacturers available</td>
		</tr>
		<tr>
			<td>Electrically conductive gel (Sigma Gel)</td>
			<td>Parker Laboratories, New Jersey, NJ, USA</td>
			<td>15-25</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>One 3- or 5-ml syringe</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Many manufacturers available</td>
		</tr>
		<tr>
			<td>Adhesive tape</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Many manufacturers available</td>
		</tr>
		<tr>
			<td>Paper towels</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Many manufacturers available</td>
		</tr>
	</tbody>
</table>

technique and considerations in the use of 4x1 ring high-definition transcranial direct current stimulation (hd-tdcs)

最近已经开发高清晰度的经颅直流电刺激（HD-TDCS的）已经作为一种非侵入性脑刺激的方法，增加通过使用较小的“高清晰度”的电极阵列的电流发送到大脑的准确性，而不是较大的焊盘电极常规TDCS。目标是通过激励电极放置在预定的配置。这些是配置4X1环。在这种方法中，一个中心环电极（阳极或阴极），覆盖在该目标的皮层区域包围的四个返回的电极包围的区域的刺激。交货的HD-TDCS 4X1环是能够在健康受试者和患者诱导显着的神经生理学和临床效果。此外，其耐受性支持所进行的研究，使用强度高为2.0毫安，不超过20分钟。 虽然HD-4X1 TDCS是简单PERFOR米，正确的电极定位是很重要的，以便准确地刺激目标皮层区域，并发挥其神经调节作用。已专门进行了测试，HD-TDCS的电极和硬件的使用是关键的安全性和耐受性。鉴于大多数发表的研究在HD-4X1 TDCS有针对性的初级运动皮层（M1），特别是对疼痛相关的结果，这篇文章的目的是系统地描述其使用为M1的刺激，以及考虑应采取安全和有效的刺激。然而，这里所述的方法可以适用于其它高清晰度的TDCS的配置和皮质目标。

<html>如果电极的适当位置和阻抗值是在一个适当的范围之内，直流从阳极流动的多个阴极（阳极中心的4×1 HD-TDCS的）的持续时间的刺激。目标电流强度将交付由传统TDCS设备，并显示在“真正的电流”指标。同样，如果选择假模式，设备将自动停止其开始提供直流约30秒后，指示灯会显示停止直流交货的（ 图8）。 这是常见的瘙痒，刺痛或轻微的烧灼感的刺激开始时参与者报告。假和积极HD-TDCS 15,16期间经常观察到这些现象，并应表明DC是交付打算。然而，他们通常倾向于消失后的最初几分钟的刺激。 内容“&gt;因此它通常是假设的脑区有更多的电流流更可能要被调制而区域或可忽略不计的小电流流将不被直接的影响。的焦点的电流流动所产生的4×1-HD-TDCS的。将预计将产生局部的神经调节。计算模型4,14,15所示，HD-TDCS的4×1型圈的查询结果，在大鼠脑刺激相比，与传统的TDCS的（ 图9）。据报道由Datta 等人。4,11，皮质兴奋调制引起的4×1型圈HD-TDCS的面积限制在环内周边，并根据所述中心电极的电场的峰值，相比之下，传统TDCS的，引起刺激不同的其它地区，如同侧的时间和双边额叶，电场达到顶峰的两个电极之间的中间，而不是在它们下面。 HD-TDCS是一种新型吨echnique，因此其影响还没有被研究尽可能广泛的传统TDCS。然而，其潜在的应用是相似的，与其他人仍然有待探索。当前研究使用4X1环HD-TDCS显示，在健康志愿者中，它可以显着降低热和冷的感觉阈值，导致轻微的镇痛效果寒痛阈值（ 图10）15。此外，它可以引起大脑皮质兴奋性的显着变化，测量使用诱发电位13,14（ 图11）马达。在纤维肌痛患者，诱导活性的4×1型圈HD-TDCS的感受的疼痛显着降低（ 图12），并显着增加的机械检测阈值相比，假16。 HD-TDCS和传统TDCS的比较研究，以阐明每个干预的影响将是重要的。然而，单一的10分钟sessio<html> n的正极HD-TDCS在2.0毫安已经报道Kuo 等人 ，14日至发挥更加突出，更持久的兴奋后的效果和更容忍的刺激比传统的TDCS（ 图13），支持其在研究和潜在的使用在临床设置。 <img alt="图1" src="/files/ftp_upload/50309/50309fig1.jpg"/> 图1 4×1多通道刺激适配器（左）连接到常规的TDCS的装置（右）。 <img alt="图2" src="/files/ftp_upload/50309/50309fig2.jpg" /> 图2。Ag / AgCl电极烧结环形电极，光滑圆润（黑色）和粗糙的表面。电极连接到接收器上的4×1适配器的输出电缆的匹配。 tp_upload/50309/50309fig3.jpg“/&gt; 图3。解剖地标（左）和初级运动皮层（M1）的本地化基础上的国际10-20脑电图系统（右）。 <img alt="图4" src="/files/ftp_upload/50309/50309fig4.jpg" /> 图4。建议定位为10-20脑电图系统的基础上的高清电极。其他的蒙太奇也可进行测试。 <img alt="图5" src="/files/ftp_upload/50309/50309fig5.jpg" /> 图5。电气凝胶应用（左）。为了防止电流从电极之间的分流，应小心，以避免超越极限的塑料外壳（右）电气凝胶传播。 <img alt="图6" src="/files/ftp_upload/50309/50309fig6.jpg" /> 图6，P塑料外壳的环形电极，水表。电极的表面粗糙应朝下，且表面光滑圆润的脸了。环形电极应被降低，直到其位于塑料外壳（左）的基极和盖锁定在适当位置（右）。 <img alt="图7" src="/files/ftp_upload/50309/50309fig7.jpg" /> 图样品4X1 HD-TDCS设置。 <img alt="图8" src="/files/ftp_upload/50309/50309fig8.jpg" /> 图8的活性（左）和假（右）的模式下，通过常规的TDCS的设备发送 。从达席尔瓦等19。 <img alt="图9" fo:content-width="6in" fo:src="/files/ftp_upload/50309/50309fig9highres.jpg" src="/files/ftp_upload/50309/50309fig9.jpg" /> 图9所示。<html>计算模型比较初级运动皮层4X1环HD-TDCS（上图）和传统TDCS使用标准双极海绵蒙太奇（下同）之间。 <a href="https://www.jove.com/files/ftp_upload/50309/50309fig9large.jpg" target="_blank">点击这里查看大图</a> 。 <img alt="图10" src="/files/ftp_upload/50309/50309fig10.jpg" /> 图10。热和冷的感觉阈值和冷疼痛阈值测量前（预）和后（POST）4X1环HD-TDCS在健康受试者。协议包括交付2mA的活性正极HD-TDCS或假刺激初级运动皮层20分钟。 ，修改从Borckardt 等。15。 <a href="https://www.jove.com/files/ftp_upload/50309/50309fig10large.jpg" target="_blank">点击这里查看大图</a> 。 p_upload/50309/50309fig11.jpg“/&gt; 图11。4X1环HD-TDCS的影响对运动诱发电位（MEP）在健康受试者幅度。协议包括交付1mA的活性正极HD-TDCS或假刺激初级运动皮层20分钟。 MEP的刺激之前和之后测量的，和后者的幅度归一化到基线。威威表示标准偏差。修改从Caparelli Daquer 等 13。 <img alt="图12" src="/files/ftp_upload/50309/50309fig12.jpg" /> 图12。4X1环HD-TDCS纤维肌痛患者自觉疼痛的影响。患者被要求对他们的整体疼痛，使用可视化的数值规模之前，立即刺激后30分钟。该协议包括活跃的正极和阴极HD-TDCS，单会议交付的左侧初级运动皮层（3219米A 20分钟）和假刺激。威威表示标准误差。 Villamar 等16修改。 <img alt="图13" src="/files/ftp_upload/50309/50309fig13.jpg" /> 图13。使用传统TDCS和4X1环HD-TDCS正极和阴极刺激引起的后遗症比较。运动诱发电位（MEP）振幅测量之前和之后交付传统的TDCS或HD-4X1 TDCS 10分钟为2mA。顺序进行评估，评估的时间过程中的后遗症。 MEP波幅刺激后的归一化基线。修改Kuo 等 14。 <table border="1" fo:keep-together.within-page="always"><tbody><tr><td fo:width="1in" rowspan="15"> 你有没有...... </td><td fo:width="4in"> TMS / TDCS有不良反应？ </td></tr><tr><td>有seizuRE？ </td></tr><tr><td>有不明原因的意识丧失？ </td></tr><tr><td>患了中风？ </td></tr><tr><td>有头部严重受伤？ </td></tr><tr><td>有手术到你的头上？ </td></tr><tr><td>有任何脑，神经系统疾病？ </td></tr><tr><td>患有任何疾病，可能造成脑损伤？ </td></tr><tr><td>你患有频繁或严重头痛吗？ </td></tr><tr><td>你有任何金属头（外口），如弹片，手术的剪辑，或焊接的片段吗？ </td></tr><tr><td>你有任何植入式医疗设备，如心脏起搏器或医疗泵？ </td></tr><tr><td>你服用任何药物吗？ </td></tr><tr><td>你怀孕了，或者是你性活跃，不知道你是否可能怀孕吗？ </td></tr><tr><td>有谁在你的家人有癫痫吗？ </td></tr><tr><td>你需要任何进一步的TDCS / HD-TDCS或及其相关风险的解释？ </td></tr></tbody></table> 表1中。 TDCS / HD-TDCS前筛查禁忌症和特殊考虑。 <table border="1" fo:keep-together.within-page="always"><tbody><tr><td fo:width="1in" rowspan="14"> 物料 </td><td fo:width="4in">一个传统TDCS设备</td></tr><tr><td>一个的4X1多通道刺激适配器</td></tr><tr><td>四节9伏电池</td></tr><tr><td>一个模块化脑电图记录帽</td></tr><tr><td>五Ag / AgCl电极烧结环形电极</td></tr><tr><td>五种特别设计的HD塑胶外壳及彼等各自之上限</td></tr><tr><td>一个塑料柱塞</td></tr><tr><td>电缆</td></tr><tr><td>其中一个卷尺</td></tr><tr><td>一个木制棉签</td></tr><tr><td>导电凝胶</td></tr><tr><td>一个3 - 或5-ml注射器</td></tr><tr><td>胶带</td></tr><tr><td>纸巾</td></tr></tbody></table> 表2中。材料。 <table border="1" fo:keep-together.within-page="always"><tbody><tr><td>你有没有遇到以下任何症状或副作用？ </td><td>在下面的空白处输入一个值（1-4）。 1缺席 2 - 轻度 3 - 中等 4严重</td><td>如果有的话，你认为这是关系到HD-TDCS？ 1 - 无 2 - 远程 3可能 4可能 5正定</td><td>笔记</td></tr><tr><td>头痛</td><td></td><td></td><td></td></tr><tr><td>颈部疼痛</td><td></td><td></td><td></td></tr><tr><td>头皮疼痛</td><td></td><td></td><td></td></tr><tr><td>头皮灼伤</td><td></td><td></td><td></td></tr><tr><td>刺痛</td><td></td><td></td><td></td></tr><tr><td>皮肤发红</td><td></td><td></td><td></td></tr><tr><td>睡意</td><td></td><td></td><td></td></tr><tr><td>难以集中</td><td></td><td></td><td></td></tr><tr><td>急性情绪变化</td><td></td><td></td><td></td></tr><tr><td>其他（请注明）： </td><td></td><td></td><td></td></tr></tbody></table> 表3中。继HD-TDCS的不利影响筛查。

Watch this Scientific Journal Video about Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation HD-tDCS at JoVE.com

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation HD-tDCS

高清晰度颅直流电刺激（HD-TDCS），与其4X1环蒙太奇，是一种无创脑刺激技术，结合传统TDCS增加focality的神经调节作用。本文提供了一个系统的示范使用HD-4X1 TDCS，需要考虑安全和有效的刺激。

技术和注意事项在使用4X1环高清晰度的经颅直流电刺激（HD-TDCS）

High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases ...

technique-considerations-use-4x1-ring-high-definition-transcranial

Research

JoVE Journal

Medicine

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)

37.4K 次观看.  Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School. 高清晰度颅直流电刺激（HD-TDCS），与其4X1环蒙太奇，是一种无创脑刺激技术，结合传统TDCS增加focality的神经调节作用。本文提供了一个系统的示范使用HD-4X1 TDCS，需要考虑安全和有效的刺激。

视频: Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation HD-tDCS

Programmed Electrical Stimulation in Mice

Genetically-modified mice have emerged as a preferable animal model to study the molecular mechanisms underlying conduction abnormalities, atrial and ventricular arrhythmias, and sudden cardiac death.1 Intracardiac pacing studies can be performed in mice using a 1.1F octapolar catheter inserted into the jugular vein, and advanced into the right atrium and ventricle. Here, we illustrate the steps involved in performing programmed electrical stimulation in mice. Surface ECG and intracardiac electrograms are recorded simultaneously in the atria, atrioventricular junction, and ventricular myocardium, whereas intracardiac pacing of the atrium is performed using an external stimulator. Thus, programmed electrical stimulation in mice provides unique opportunities to explore molecular mechanisms underlying conduction defects and cardiac arrhythmias.

Programmed electrical stimulation provides the ability to determine conduction properties of the heart, and the possibility to induce and terminate cardiac arrhythmias using various pacing protocols. Using a transvenous catheter, intracardiac electrogram recordings can be obtained in mice following programmed electrical stimulation protocols to identify arrhythmogenic substrates.

程控电刺激小鼠

Genetically-modified mice have emerged as a preferable animal model to study the molecular mechanisms underlying conduction abnormalities, atrial and ...

科研

医学

X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging

X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a significant concern, particularly in pediatric applications. Pediatrics procedures are in general much more complex than those performed on adults and thus are on average four to eight times longer1. Furthermore, children can undergo up to 10 fluoroscopic procedures by the age of 10, and have been shown to have a three-fold higher risk of developing fatal cancer throughout their life than the general population2,3.
We have shown that radiation dose can be significantly reduced in adult cardiac procedures by using our scanning beam digital x-ray (SBDX) system4-- a fluoroscopic imaging system that employs an inverse imaging geometry5,6 (Figure 1, Movie 1 and Figure 2). Instead of a single focal spot and an extended detector as used in conventional systems, our approach utilizes an extended X-ray source with multiple focal spots focused on a small detector. Our X-ray source consists of a scanning electron beam sequentially illuminating up to 9,000 focal spot positions. Each focal spot projects a small portion of the imaging volume onto the detector. In contrast to a conventional system where the final image is directly projected onto the detector, the SBDX uses a dedicated algorithm to reconstruct the final image from the 9,000 detector images.
For pediatric applications, dose savings with the SBDX system are expected to be smaller than in adult procedures. However, the SBDX system allows for additional dose savings by implementing an electronic adaptive exposure technique. Key to this method is the multi-beam scanning technique of the SBDX system: rather than exposing every part of the image with the same radiation dose, we can dynamically vary the exposure depending on the opacity of the region exposed. Therefore, we can significantly reduce exposure in radiolucent areas and maintain exposure in more opaque regions. In our current implementation, the adaptive exposure requires user interaction (Figure 3). However, in the future, the adaptive exposure will be real time and fully automatic.
We have performed experiments with an anthropomorphic phantom and compared measured radiation dose with and without adaptive exposure using a dose area product (DAP) meter. In the experiment presented here, we find a dose reduction of 30%.

We are developing a dynamic adaptive exposure technique using our scanning beam digital X-ray system. Rather than exposing an object uniformly, the exposure is adapted depending on the opacity of the object. Here we show an experiment on an anthropomorphic phantom that resulted in a dose saving of 30%.

通过自适应曝光的减少剂量X射线透视影像

X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a ...

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 ...

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

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing.

We explore the use of repetitive transcranial magnetic stimulation (rTMS) to improve language abilities in patients with chronic stroke and non-fluent aphasia. After identifying a site in the right frontal gyrus for each patient that responds optimally to stimulation, we target this site during ten days of rTMS treatment.

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 ...

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As such, primary or &#39;neuronal-like&#39; cell culture systems are commonly utilized. While&#160;these systems are relatively easy to work with, and are useful model systems in which various functional outcomes (such as cell death) can be readily quantified, the examined outcomes and pathways in cultured immature neurons (such as excitotoxicity-mediated cell death pathways) are not necessarily the same as those observed in mature brain, or in intact tissue. Therefore, there is the need to develop models in which cellular mechanisms in mature neural tissue can be examined. We have developed an in vitro technique that can be used to investigate a variety of molecular pathways in intact nervous tissue. The technique described herein utilizes rat cortical tissue, but this technique can be adapted to use tissue from a variety of species (such as mouse, rabbit, guinea pig, and chicken) or brain regions (for example, hippocampus, striatum, etc.). Additionally, a variety of stimulations/treatments can be used (for example, excitotoxic, administration of inhibitors, etc.). In conclusion, the brain slice model described herein can be used to examine a variety of molecular mechanisms involved in excitotoxicity-mediated brain injury.

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

We have developed a brain slice model which can be used to examine molecular mechanisms involved in excitotoxicity-mediated brain injury.&#160;This technique generates viable mature brain tissue and reduces animal numbers required for experimentation, whilst keeping the neuronal circuitry, cellular interactions, and postsynaptic compartments partly intact.

脑Microslices的兴奋性刺激作为<em&gt;在体外</em&gt;中风模型

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As ...

High-definition Fourier Transform Infrared (FT-IR) Spectroscopic Imaging of Human Tissue Sections towards Improving Pathology

High-definition Fourier Transform Infrared (FT-IR) spectroscopic imaging is an emerging approach to obtain detailed images that have associated biochemical information. FT-IR imaging of tissue is based on the principle that different regions of the mid-infrared are absorbed by different chemical bonds (e.g., C=O, C-H, N-H) within cells or tissue that can then be related to the presence and composition of biomolecules (e.g., lipids, DNA, glycogen, protein, collagen). In an FT-IR image, every pixel within the image comprises an entire Infrared (IR) spectrum that can give information on the biochemical status of the cells that can then be exploited for cell-type or disease-type classification. In this paper, we show: how to obtain IR images from human tissues using an FT-IR system, how to modify existing instrumentation to allow for high-definition imaging capabilities, and how to visualize FT-IR images. We then present some applications of FT-IR for pathology using the liver and kidney as examples. FT-IR imaging holds exciting applications in providing a novel route to obtain biochemical information from cells and tissue in an entirely label-free non-perturbing route towards giving new insight into biomolecular changes as part of disease processes. Additionally, this biochemical information can potentially allow for objective and automated analysis of certain aspects of disease diagnosis.

High-definition Fourier Transform Infrared FT-IR Spectroscopic Imaging of Human Tissue Sections towards Improving Pathology

Fourier Transform Infrared (FT-IR) spectroscopic imaging is a fast and label-free approach to obtain biochemical data sets of cells and tissues. Here, we demonstrate how to obtain high-definition FT-IR images of tissue sections towards improving disease diagnosis.

高清傅立叶变换人体组织切片红外（FT-IR）光谱成像对提高病理

High-definition Fourier Transform Infrared (FT-IR) spectroscopic imaging is an emerging approach to obtain detailed images that have associated ...

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).

一个协议，用于远程监督经颅直流电刺激（TDCS）在多发性硬化症的使用（MS）

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

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 ...

Modified Technique for the Use of Neonatal Murine Hearts in the Langendorff Preparation

The use of the ex-vivo retrograde perfused heart has long been a cornerstone of ischemia-reperfusion investigation since its development by Oskar Langendorff over a century ago. Although this technique has been applied to mice over the last 25 years, its use in this species has been limited to adult animals. Development of a successful method to consistently cannulate the neonatal murine aorta would allow for the systematic study of the isolated retrograde perfused heart during a critical period of cardiac development in a genetically modifiable and low-cost species. Modification of the Langendorff preparation enables cannulation and establishment of reperfusion in the neonatal murine heart while minimizing ischemic time. Optimization requires a two-person technique to permit successful cannulation of the newborn mouse aorta using a dissecting microscope and a modified commercially available needle. The use of this approach will reliably establish retrograde perfusion within 3 min. Because the fragility of the neonatal mouse heart and ventricular cavity size prevents direct measurement of intraventricular pressure generated using a balloon, use of a force transducer connected by a suture to the apex of the left ventricle to quantify longitudinal contractile tension is necessary. This method allows investigators to successfully establish an isolated constant-flow retrograde-perfused newborn murine heart preparation, permitting the study of developmental cardiac biology in an ex-vivo manner. Importantly, this model will be a powerful tool to investigate the physiological and pharmacological responses to ischemia-reperfusion in the neonatal heart.

The present protocol describes aortic cannulation and retrograde perfusion of the ex-vivo neonatal murine heart. A two-person strategy, using a dissecting microscope and a blunted small gauge needle, permits reliable cannulation. Quantification of longitudinal contractile tension is achieved using a force transducer connected to the apex of the left ventricle.