我们希望通过"Zukunftsfonds柏林"，联邦教育和研究部通过授予CSB（01 EO 0801），以确认所有的资金组织的"科技基金会柏林"（TSB），大众汽车基金会（Lichtenberg的程序马蒂亚斯恩德雷斯），欧盟（EuStroke，ARISE）和德国研究基金会（NeuroCure，SFB-TR 43）。

1。应急响应在柏林消防大队的调度中心<ol><li>接听来电"112"紧急呼叫。 </li><li>收集有关急救站点，如地址，楼层，名称上的门铃和电话号码信息。输入的数据直接进入电脑控制的应急调度系统（称为伊格尼斯）的工作表</li><li>确定医疗急救为中风紧急情况下，采用新开发的调度算法辨识中风紧急情况（DIASE）。 </li><li>验证急救站点是STEMO通过伊格尼斯的经营区域内。 </li><li>通过一个基于无线的报警系统进行通信警报STEMO。 （在柏林，目前，正规的护理救护车同时报警。）有关应急可用的信息自动通过传真发送。 </li></ol> 2。接到报警传输在消防局<ol><li>一个个人寻呼机信号的ALER吨按提示音。马上去传真机，并采取包含详细的紧急信息的传真。 </li><li>转到STEMO车辆，按主板上的无线电状态按钮3，从而确认收据警报到调度中心。基于GPS的导航系统已经自动接收的路由到患者的位置。 </li><li>当完整的船员在船上（护理人员，神经科和放射技师）驱动STEMO车辆紧急现场。注意:与蓝灯闪烁，警笛现场的做法。因此，要特别注意对其他道路使用者，并遵守有关使用蓝灯和警笛14德国交通法的规定。 </li><li>在到达急诊现场，按下车载收音机上的状态按钮4，从而给调度中心发出的确认。 </li><li>临行前STEMO车辆在紧急现场支付额外注意安全。注意:提防潜在的危险，如发生意外，残暴的人，火灾的危险，行车或有害物质的无抵押景象。 </li></ol> 3。检查病人在急诊网站<ol><li>采用格拉斯哥昏迷量表（GCS）检查的意识。 </li><li>按照结构化的"ABCDE算法"对病人的状况进行初步评估:航空，呼吸，循环，残疾，曝光15。 </li><li>探索病人的病史。如果中风临床怀疑评估的使用健康卒中量表国家研究院​​（NIHSS）症状的严重程度。 </li><li>通过询问病人/证人确定症状的确切发病。 </li><li>查询当前使用的药物主要集中在抗凝治疗。 </li><li>测量并记录生命体征，如心脏加快，血压升高，血糖浓度和血氧饱和度。 </li></ol> 4。插入外设静脉注射（IV）线和进行血液提取<ol><li>适用于上臂止血带。 </li><li>搜索适合手，前臂或肘前静脉。对于IV线的最佳选择是对手背的静脉。 </li><li>消毒皮肤。 </li><li>从留置静脉导管取出针鞘。确保针头斜面朝上。 </li><li>应用牵引远端的静脉，以防止静脉从插管中滚动。 </li><li>将针头插入静脉在20-40℃。血液的回血确认该针尖在静脉内。推进导管断针头插入静脉。 </li><li>用胶带固定导管。 </li><li>取下针头，它丢弃到锐器容器，并连接包含一个笼罩针，使开始从留置静脉导管抽血塑料适配器。 </li><li>使用多个真空采血管的血液试管进行抽血。一些这些血管含有多种n个不同的抗凝添加剂，如EDTA，柠檬酸盐和肝素。血液试管类型为颜色分类:1。紫色为全血细胞计数; 2。蓝色为混凝试验; 3。绿色为电解质，尿素氮等基本血液参数; 4。橙色专门的血清分析。 </li><li>推真空采血管的血液试管放入塑料保持架，使得其橡胶帽被笼罩针头刺穿。 （在的Vacutainer管中的负压迫使血液进入血液试管中。） </li><li>拆下真空采血管管，还充满了血后，并与其他真空采血管试管重复此过程。 </li><li>最后的Vacutainer管中填充后，除去止血带，冲洗留置静脉导管，用生理盐水溶液，并用收锥形关闭该导管。 </li></ol> 5。确定国际标准化比值（INR），用床头床旁的分析仪<ol><li>采取试纸从它包含呃。滑入在由箭头指示的方向引导。 </li><li>就拿柳叶刀和扭曲的保护盖关闭。压在指尖侧的刺血针的前端与按压触发按钮。 </li><li>在15秒内伸出指尖的应用在测试条的目标区域中的血液样品。几秒钟后的结果（INR）被显示。 </li><li>将用过的条和柳叶刀成容器生物危害及利器，分别。 </li></ol> 6。先进的诊断和干预<ol><li>紧随病人转移到STEMO车辆。 </li><li>放置担架上的病人。 </li><li>将紫色的真空采血管的血液试管插入点保健实验室（堀场制作所ABX Micros公司60）。测量额外的血液参数，如血小板计数，总白细胞计数，红细胞计数，血红蛋白浓度，红细胞压积，电解质。 </li><li>将病人的保险卡到T他读卡器（安装在控制室）。 </li><li>呼叫随叫随到的神经放射讨论指征的CT扫描和准备考试。 </li><li>解释的好处和CT扫描的患者的风险。此后，获得知情同意从患者，如果可能的话。 </li><li>启动CT检查。注意:X-射线辐射从CT扫描仪释放。放射技师必须在屏蔽控制室。该STEMO其他工作人员被要求检查，以便在离开车辆，以避免不必要地暴露于X射线辐射（STEMO车辆是导致覆盖）。此外，保护措施（保护眼睛）应适用于病人。 </li><li>通过机载遥测传输基础设施的CT图像，并要求决策有关诊断和治疗的远程放射的支持。 （在STEMO图像由神经科医生的平行分析。） </li><li>询问患者对溶栓therap禁忌Ÿ使用一个标准化的检查清单。 </li><li>解释福利和溶栓治疗可能的风险。如果可能的话告知病人的治疗是临床研究的一部分，并取得知情同意。 </li></ol> 7。重组组织型纤溶酶原激活剂（rtPA治疗或阿替普酶）的管理<ol><li>计算阿替普酶剂量（商品名:ACTILYSE）根据体重可用的最佳逼近。推荐剂量为0.9毫克/公斤体重。最大剂量为90毫克6。 </li><li>利用重组提供的溶剂干燥固体阿替普酶。使用转印插管，这必须垂直引入到管形瓶的橡胶塞，并通过标记在它的中心。 </li><li>溶解干燥固体轻轻搅动。 </li><li>通过给予所计算的总剂量的10％，大剂量注射在1分钟内开始溶栓治疗。守点的记录时间，当推注阿替普酶注射。注意:注意吨Ø即时过敏反应以下管理。准备管理抗过敏药物（ 如抗组织胺药，大剂量糖皮质激素，儿茶酚胺）的情况下的急性过敏性反应。在一般情况下，阿替普酶，应仅由经验丰富的缺血性中风6的治疗医师使用。 </li><li>通过注射泵的注射器不断注入剩余的剂量超过60分钟（后管，以避免注入气泡疏散）。 </li></ol> 8。病人到合适的医院交通<ol><li>做一个先进的通知的最近的医院使用经过认证的卒中单元的急诊室。 </li><li>立即启动交通。沟通所选择的医院通过无线电调度中心。 </li><li>转移到医院在监测神经功能缺损和生命体征。 </li><li>打印并签名的录取通知书（使用Vimed软件）包括Diagnosis，历史学，神经学检查结果，影像学报告（透过UMTS随叫随到的神经放射发送），实验室检查，以及所采取的行动描述的结果。复制CT扫描显示为医院在CD上。 </li><li>在到达医院（按状态键8）提供简洁现在和病人过去的病史，以随叫随到的神经科医生，并在急诊室的主要团队。拱手打印的报告，光盘内容包括CT图像（步骤8.4），与血填充蓝色，绿色和橙色的真空采血管的血液试管（步骤4.9）。 </li></ol> 9。恢复操作准备<ol><li>清洗和消毒手和具有环境管理体系的反应过程中使用的所有设备。 </li><li>报告操作待机状态使用上的板载单选按钮1调度中心。回到当地消防局。 </li></ol>

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作者宣称，他们有没有竞争的财务权益。

院前溶栓治疗可能可以彻底改变特定急性中风治疗。但是，它是治疗递送的成本和资源消耗的方法。一般情况下，一个"保持和播放"，而不是"负载和去"的方法需要由应急手边的具体特征是有道理的。缺血性中风都有保证了"治疗 - 运行"妥协鲜明的特点:急性卒中治疗的好处是巨大的时间依赖性。在缺血性卒中约2,000,000神经元死亡，每分钟16。与应用rtPA静脉注射治疗提高再灌注和良好的功能结果的脑卒中患者17的机会。治疗应尽早开始。现在，它是唯一的证据为基础的，有效的和批准的治疗急性缺血性中风。伴有严重出血的危险，颅内出血等禁忌症的排除是强制性的PRIO<html> r来溶栓治疗。 STEMO设置为证明这个具体的治疗可以安全地管理在院前设置，实际上保险柜时间相比，定期护理8,12。从萨尔州，德国12院前thrombolyses第一的成绩，似乎有希望在这方面13。在这项研究中，沃尔特和他的同事报告说，2008年11月和2011年7月，在100计划中200例（在院前设置，对照组47 53）中，从报警的中位时间的中期分析与随机周后对治疗决策（主要终点），大幅减少了12例院前溶栓:35分钟（IQR 31-39）和76分钟，p &lt;0.0001，中位数差异41分（95％CI为36-48分钟）。总体而言，额外的成本必须针对益处，患者可能经历称重。对于这一点，目前的PHANTOM-S的最终结果将是至关重要的。在这项前瞻性研究（t2/show /"目标="_blank"&gt; http://clinicaltrials.gov/ct2/show/ NCT01382862），周带和不带STEMO值班是随机的，直到228名患者接受静脉应用rtPA在两个治疗组，主要终点-点研究的时间是从报警到溶栓治疗。次要终点包括改良Rankin量表评分三个月后，症状性颅内出血，死亡率和成本效益。本研究结果将有助于决策者是否实施急性缺血性脑卒中的院前溶栓治疗患者的特殊救护车在他们的应急系统。网站具体的修改可能是必要的，例如，在区域与神经科医生远程医疗的短缺可能会提供专业知识，船上的急诊医师，同样，PHANTOM-S研究的结果可能有助于识别区域与病人最可能的好处和成本为当局效力。到目前为止，它不知道院前溶栓是否是最一在特大城市，城市或农村地区18 ppropriate方法。两者合计，院前溶栓似乎是，​​当时间缩短治疗的需要被认真对待一个合乎逻辑的步骤。只有足够动力的研究可能提供的实际好处中风患者的证据。

溶栓与静脉重组组织型纤溶酶原激活剂（rtPA）是唯一被证明有效的治疗急性缺血性中风。溶栓治疗的好处是时间依赖性的。溶栓治疗缺血性脑卒中的疗效时间从症状发作1已过降低。因此，必须避免延误，直到开始治疗。但是，也有院前和院内原因在治疗开始延迟。病人的决定时拨打紧急电话服务和紧急呼叫的时间到达医院的因素，在院前延迟。在医院里，两者的时间减少到CT扫描和溶栓开始之间的时间的CT扫描和仍然充满挑战2。中风宣传活动缩短病人与次紧急呼叫3，但效果只是暂时的，而且需要这种运动的重复。虽然有减少，HOSP的成功例子ITAL延迟4,5许多中心努力保持在规定的60分钟之内从门针。为了避免这种延迟的一种方法可以是在紧急地点， 即院前溶栓具体中风治疗的开始。直到最近，几个要求做出这种方法并不可行。首先，只有经验丰富的医生在中风护理有资格做急性期治疗的决定。其次，计算机断层扫描（CT）是必要的，以排除颅内出血。三，实验室检查应可排除凝血功能障碍6。为了克服这些挑战，中风应急移动（STEMO）构建。这种特殊的救护车都配备了CT扫描仪，定点照护的实验室和远程放射支持7的基础设施。它是由高度专业化的船员组成的经验丰富的神经科医生，柏林消防队的护理人员，和放射技师8操作。在满足法定必需参数，对此语句和柏林医学委员会的要求，每一个参与神经科医生完成急诊医学一个额外的培训。放射科技术人员在完成紧急救护9,10三个月的正规培训。 STEMO已经集成在了柏林消防队提供的公共紧急医疗服务（EMS）。对于符合条件的患者紧急呼叫过程中怀疑中风的识别，专访算法在调度程序级别11开发和集成。在三个月来试点研究中，我们证实安全性和可行性12。我们从洪堡，德国，同事最近发表了他们与在萨尔州13第12院前溶栓治疗的经验。我们相信，使用STEMO院前卒中治疗可以减少报警到针时间相比，定期护理，最终导致改善病人护理。然而，事先充分powere的实施最终​​结果ð研究需要证实这种方法的安全性和有效性。在这里，我们提出在"院前急性神经功能障碍的治疗和医疗护理的优化中风患者"的研究（PHANTOM-S）使用的方法。

<table border="1">
	<tbody>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td>Drug</td>
		</tr>
		<tr>
			<td>Alteplase (rtPA)</td>
			<td>Boehringer-Ingelheim</td>
			<td></td>
			<td>Licensed drug</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td>Table 1. Alteplase. Alteplase (tissue-Plasminogen Activator) is the only licensed drug for acute ischemic stroke that has proven effectiveness within 4.5 hr of symptom onset in randomized controlled trials.</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td>Device</td>
		</tr>
		<tr>
			<td>ABX micros 60</td>
			<td>Horiba Medical</td>
			<td></td>
			<td>Point-of-care laboratory</td>
		</tr>
		<tr>
			<td>CereTom</td>
			<td>NeuroLogica</td>
			<td></td>
			<td>CT-Scanner</td>
		</tr>
		<tr>
			<td>CoaguChek XSPlus</td>
			<td>Roche</td>
			<td></td>
			<td>Handheld blood analyzer</td>
		</tr>
		<tr>
			<td>EBA 20</td>
			<td>HettichLab</td>
			<td></td>
			<td>centrifuge</td>
		</tr>
		<tr>
			<td>FastPack System</td>
			<td>Qualigen</td>
			<td></td>
			<td>Point-of-care immunoassay</td>
		</tr>
		<tr>
			<td>i-STAT</td>
			<td>Abbot</td>
			<td></td>
			<td>Handheld blood analyzer</td>
		</tr>
		<tr>
			<td>OptiStat</td>
			<td>Siemens</td>
			<td></td>
			<td>Contrast agent delivery system</td>
		</tr>
		<tr>
			<td>Pilot A2</td>
			<td>Fresenius</td>
			<td></td>
			<td>Infusion pump</td>
		</tr>
		<tr>
			<td>TGL 12.250 4 x 2 BL</td>
			<td>MAN</td>
			<td></td>
			<td>Vehicle chassis</td>
		</tr>
		<tr>
			<td>Van body</td>
			<td>Fahrtec Systeme GmbH</td>
			<td></td>
			<td>Custom-built</td>
		</tr>
		<tr>
			<td>Vimed COMM</td>
			<td>MEYTEC GmbH</td>
			<td></td>
			<td>Video communication system</td>
		</tr>
		<tr>
			<td>Vimed GATEWAY</td>
			<td>MEYTEC GmbH</td>
			<td></td>
			<td>Network solution</td>
		</tr>
		<tr>
			<td>Vimed STEMO-DOC</td>
			<td>MEYTEC GmbH</td>
			<td></td>
			<td>Documentation software</td>
		</tr>
		<tr>
			<td>Vimed TELEMED</td>
			<td>MEYTEC GmbH</td>
			<td></td>
			<td>Equipment for telemedicine</td>
		</tr>
		<tr>
			<td>Vimed WEB-ENTRY</td>
			<td>MEYTEC GmbH</td>
			<td></td>
			<td>Teleradiology</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td>Table 2. Table of specific equipment. The software solution used in the ambulance was developed by a partner of the STEMO-consortium, MEYTEC GmbH, Germany. MEYTEC designed and implemented the overall technical solution. The entire system can be obtained from the partner MEYTEC under the name VIMED STEMO.</td>
		</tr>
	</tbody>
</table>

prehospital thrombolysis: a manual from berlin

在急性缺血性中风，从症状发作到干预时间是一个决定性的预后因素。为了减少这个时间，院前溶栓在紧急现场将是优选的。然而，除了神经系统的专业知识和实验室检查计算机断层扫描（CT）扫描是必要的，以排除出血性中风前溶栓治疗。因此，一个专门的救护车配备有CT扫描仪和护理点的实验室设计和建造。此外，新的行程确定面试算法的开发，并在柏林紧急医疗服务实现的。自2011年2月疑似中风在柏林消防大队的调度中心的标识提示部署此救护车，中风应急移动（STEMO）。到达目的地后，神经科医师，在经历了中风护理和急诊医学额外的培训，需要神经系统检查。如果行程被怀疑CT扫描前cludes颅内出血。在CT-扫描遥感地传输到待命的神经放射。如果患者的凝血状态是正常的，病人的病历显示没有禁忌症，院前溶栓治疗是根据目前的指导方针（静脉重组组织型纤溶酶原激活剂，静脉应用​​rtPA，阿替普酶，ACTILYSE）应用。 此后病人运送到最近的医院接受进一步治疗strokeaetiology和评估认证的卒中单元。试点阶段之后，周随机分为或不STEMO护理块。主要终点这项研究的是时间从报警到溶栓治疗的开始。我们推测，报警到处理时间可以减少至少20分钟，相比常规护理。

二月八日至4月30 2011年，共有152科在STEMO车辆进行治疗。知情同意从77例获得。四十五名病人（58％）的患者急性缺血性中风和23（51％）接受rtPA治疗。使用STEMO平均报警到针时间相比，98分钟的连续50例患者的控制队列62分钟thrombolysed在柏林在2010年。在rtPA治疗治疗的患者两（9％）遭遇了症状性颅内出血和住院的患者（4％），一人死亡。技术故障由一个CT功能障碍和两个延迟的CT图像传输12。 <img alt="图1" fo:content-width="5in" fo:src="/files/ftp_upload/50534/50534fig1highres.jpg" src="/files/ftp_upload/50534/50534fig1.jpg" /> 图1:打电话到针时间。谁收到炎急性缺血性卒中患者的比较<html>苏纤溶酶原激活剂（tPA）。 STEMO治疗的患者（n = 23）与在医院治疗的患者在2010年（N = 50）。框显示标准差（SD）与代表的意思是号召针时间（62分钟与98分钟）行;晶须表明在2个SD分布宽度。基于韦伯等人的12个数据<a href="https://www.jove.com/files/ftp_upload/50534/50534fig1highres.jpg" target="_blank">点击这里查看大图</a> 。 <img alt="图2" fo:content-width="5in" fo:src="/files/ftp_upload/50534/50534fig2highres.jpg" src="/files/ftp_upload/50534/50534fig2.jpg" /> 图2。STEMO整体概念。，主要集中在通过STEMO回应中风突发事件应对环境管理体系的流程图。根据由Audebert，HJ STEMO（行程-EINSATZ美孚）的原设计进行修改。中风EINSATZ美孚）。PDF"目标="_blank"&gt; http://tsb-berlin.de /媒体/上传/ zukunfsfonds / STEMO_（行程-EINSATZ美孚）。PDF。 <a href="https://www.jove.com/files/ftp_upload/50534/50534fig2highres.jpg" target="_blank">点击这里查看大图</a> 。

Watch this Scientific Journal Video about Prehospital Thrombolysis: A Manual from Berlin at JoVE.com

Prehospital Thrombolysis: A Manual from Berlin

疑似中风在柏林消防大队的调度中心鉴定提示了CT配备救护车的部署。如果缺血性中风确认和禁忌症不包括院前溶栓应用。

院前溶栓治疗:从柏林手册

In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis ...

prehospital-thrombolysis-a-manual-from-berlin

Research

JoVE Journal

Medicine

20.5K 次观看.  Charité - Universitätsmedizin Berlin. 疑似中风在柏林消防大队的调度中心鉴定提示了CT配备救护车的部署。如果缺血性中风确认和禁忌症不包括院前溶栓应用。 

视频: Prehospital Thrombolysis: A Manual from Berlin

Modeling Stroke in Mice - Middle Cerebral Artery Occlusion with the Filament Model

Stroke is among the most frequent causes of death and adult disability, especially in highly developed countries. However, treatment options to date are very limited. To meet the need for novel therapeutic approaches, experimental stroke research frequently employs rodent models of focal cerebral ischaemia. Most researchers use permanent or transient occlusion of the middle cerebral artery (MCA) in mice or rats.
Proximal occlusion of the middle cerebral artery (MCA) via the intraluminal suture technique (so called filament or suture model) is probably the most frequently used model in experimental stroke research. The intraluminal MCAO model offers the advantage of inducing reproducible transient or permanent ischaemia of the MCA territory in a relatively non-invasive manner. Intraluminal approaches interrupt the blood flow of the entire territory of this artery. Filament occlusion thus arrests flow proximal to the lenticulo-striate arteries, which supply the basal ganglia. Filament occlusion of the MCA results in reproducible lesions in the cortex and striatum and can be either permanent or transient. In contrast, models inducing distal (to the branching of the lenticulo-striate arteries) MCA occlusion typically spare the striatum and primarily involve the neocortex. In addition these models do require craniectomy. In the model demonstrated in this article, a silicon coated filament is introduced into the common carotid artery and advanced along the internal carotid artery into the Circle of Willis, where it blocks the origin of the middle cerebral artery. In patients, occlusions of the middle cerebral artery are among the most common causes of ischaemic stroke. Since varying ischemic intervals can be chosen freely in this model depending on the time point of reperfusion, ischaemic lesions with varying degrees of severity can be produced. Reperfusion by removal of the occluding filament at least partially models the restoration of blood flow after spontaneous or therapeutic (tPA) lysis of a thromboembolic clot in humans.
In this video we will present the basic technique as well as the major pitfalls and confounders which may limit the predictive value of this model.

Filamentous occlusion of the Middle cerebral artery is a common model for studying ischemic stroke in mice.

建模在小鼠体内的行程 - 中东与灯丝模型大脑中动脉闭塞

Stroke is among the most frequent causes of death and adult disability, especially in highly developed countries. However, treatment options to date are ...

科研

医学

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

危重病人中的应用手册肌力测试:下肢肌力测量方法

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia

There is accumulating evidence, that ischemic preconditioning - a non-damaging ischemic challenge to the brain - confers a transient protection to a subsequent damaging ischemic insult. We have established bilateral common carotid artery occlusion as a preconditioning stimulus to induce early ischemic tolerance to transient focal cerebral ischemia in C57Bl6/J mice. In this video, we will demonstrate the methodology used for this study.

There is accumulating evidence, that ischemic preconditioning (PC) &#x2013; a non-damaging ischemic challenge to the brain - confers a transient protection to a subsequent damaging ischemic insult. We established bilateral common carotid artery occlusion (BCCAO) as a preconditioning stimulus to induce early ischemic tolerance (IT) to transient focal cerebral ischemia (induced by middle cerebral artery occlusion, MCAO) in C57Bl6/J mice.

双侧颈总动脉闭塞足够的预处理刺激诱导局灶性脑缺血早期缺血耐受

There is accumulating evidence, that ischemic preconditioning - a non-damaging ischemic challenge to the brain - confers a transient protection to a ...

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily life, despite similar visual deficits. We assume this could be due to variable development of compensatory strategies such as altered visual scanning behavior. Scanning compensatory therapy (SCT) is studied as part of the visual training after infarction next to vision restoration therapy. SCT consists of learning to make larger eye movements into the blind field enlarging the visual field of search, which has been proven to be the most useful strategy1, not only in natural search tasks but also in mastering daily life activities2. Nevertheless, in clinical routine it is difficult to identify individual levels and training effects of compensatory behavior, since it requires measurement of eye movements in a head unrestrained condition. Studies demonstrated that unrestrained head movements alter the visual exploratory behavior compared to a head-restrained laboratory condition3. Martin et al.4 and Hayhoe et al.5 showed that behavior demonstrated in a laboratory setting cannot be assigned easily to a natural condition. Hence, our goal was to develop a study set-up which uncovers different compensatory oculomotor strategies quickly in a realistic testing situation: Patients are tested in the clinical environment in a driving simulator. SILAB software (Wuerzburg Institute for Traffic Sciences GmbH (WIVW)) was used to program driving scenarios of varying complexity and recording the driver's performance. The software was combined with a head mounted infrared video pupil tracker, recording head- and eye-movements (EyeSeeCam, University of Munich Hospital, Clinical Neurosciences).
The positioning of the patient in the driving simulator and the positioning, adjustment and calibration of the camera is demonstrated. Typical performances of a patient with and without compensatory strategy and a healthy control are illustrated in this pilot study. Different oculomotor behaviors (frequency and amplitude of eye- and head-movements) are evaluated very quickly during the drive itself by dynamic overlay pictures indicating where the subjects gaze is located on the screen, and by analyzing the data. Compensatory gaze behavior in a patient leads to a driving performance comparable to a healthy control, while the performance of a patient without compensatory behavior is significantly worse. The data of eye- and head-movement-behavior as well as driving performance are discussed with respect to different oculomotor strategies and in a broader context with respect to possible training effects throughout the testing session and implications on rehabilitation potential.

Patients with visual deficits after stroke report about different constraints in daily life most likely due to variable compensatory strategies, which are difficult to differentiate in clinical routine. We present a clinical set-up which allows measurement of different compensatory head- and eye-movement-strategies and evaluating their effects on driving performance.

驾驶模拟诊所:测试视觉与视野缺损的患者在日常活动中的探索行为

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

Patient Derived Cell Culture and Isolation of CD133+ Putative Cancer Stem Cells from Melanoma

Despite improved treatments options for melanoma available today, patients with advanced malignant melanoma still have a poor prognosis for progression-free and overall survival. Therefore, translational research needs to provide further molecular evidence to improve targeted therapies for malignant melanomas. In the past, oncogenic mechanisms related to melanoma were extensively studied in established cell lines. On the way to more personalized treatment regimens based on individual genetic profiles, we propose to use patient-derived cell lines instead of generic cell lines. Together with high quality clinical data, especially on patient follow-up, these cells will be instrumental to better understand the molecular mechanisms behind melanoma progression.
Here, we report the establishment of primary melanoma cultures from dissected fresh tumor tissue. This procedure includes mincing and dissociation of the tissue into single cells, removal of contaminations with erythrocytes and fibroblasts as well as primary culture and reliable verification of the cells' melanoma origin.
Recent reports revealed that melanomas, like the majority of tumors, harbor a small subpopulation of cancer stem cells (CSCs), which seem to exclusively fuel tumor initiation and progression towards the metastatic state. One of the key markers for CSC identification and isolation in melanoma is CD133. To isolate CD133+ CSCs from primary melanoma cultures, we have modified and optimized the Magnetic-Activated Cell Sorting (MACS) procedure from Miltenyi resulting in high sorting purity and viability of CD133+ CSCs and CD133- bulk, which can be cultivated and functionally analyzed thereafter.

Patient Derived Cell Culture and Isolation of CD133+ Putative Cancer Stem Cells from Melanoma

This article describes the preparation of freshly obtained melanoma tissue into primary cell cultures, and how to remove contaminations of erythrocytes and fibroblasts from the tumor cells. Finally, we describe how CD133+ putative melanoma stem cells are sorted from the CD133- bulk using Magnetic Activated Cell Sorting (MACS).

来自患者的细胞培养和分离的CD133<sup&gt; +</sup&gt;假定的肿瘤干细胞的恶性黑色素瘤

Despite improved treatments options for melanoma available today, patients with advanced malignant melanoma still have a poor prognosis for ...

Assessment of Cardiac Function and Myocardial Morphology Using Small Animal Look-locker Inversion Recovery (SALLI) MRI in Rats

Small animal magnetic resonance imaging is an important tool to study cardiac function and changes in myocardial tissue. The high heart rates of small animals (200 to 600 beats/min) have previously limited the role of CMR imaging. Small animal Look-Locker inversion recovery (SALLI) is a T1 mapping sequence for small animals to overcome this problem 1. T1 maps provide quantitative information about tissue alterations and contrast agent kinetics. It is also possible to detect diffuse myocardial processes such as interstitial fibrosis or edema 1-6. Furthermore, from a single set of image data, it is possible to examine heart function and myocardial scarring by generating cine and inversion recovery-prepared late gadolinium enhancement-type MR images 1.
	The presented video shows step-by-step the procedures to perform small animal CMR imaging. Here it is presented with a healthy Sprague-Dawley rat, however naturally it can be extended to different cardiac small animal models.

Assessment of Cardiac Function and Myocardial Morphology Using Small Animal Look-locker Inversion Recovery SALLI MRI in Rats

Contrast enhanced cardiac magnetic resonance (CMR) imaging allows comprehensive in vivo assessment of the heart in small animal models of cardiovascular disease. Here we detail the procedures to perform CMR imaging, reconstruction and analysis using Small Animal Lock-Locker Inversion Recovery (SALLI) in rats.

使用小动物看更衣室反转恢复（SALLI）的MRI大鼠心脏功能和心肌形态学评估

Small animal magnetic resonance  imaging is an important tool to study cardiac function and changes in myocardial  tissue. The high heart rates of small ...

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes.
The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.

The aim of this article is to describe the methodology of exclusively endoscopic cadaveric middle ear dissection. Moreover, we aim to provide a comprehensive guide to endoscopic middle ear anatomy.

Transcanal 内窥镜下耳部手术发现中耳解剖: 解剖手册

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal ...

Sucrose Preference and Novelty-Induced Hypophagia Tests in Rats using an Automated Food Intake Monitoring System

The prevalence and incidence of depressive disorders are rising worldwide, affecting about 322 million individuals, underlining the need for behavioral studies in animal models. In this protocol, to study depression-like and anhedonic behavior in rats, the established sucrose preference and novelty-induced hypophagia tests are combined with an automated food and liquid intake monitoring system. Prior to testing, in the sucrose preference paradigm, male rats are trained for at least 2 days to consume a sucrose solution in addition to tap water. During the test, rats are again exposed to water and sucrose solution. Consumption is registered every second by the automated system. The ratio of sucrose to total water intake (sucrose preference ratio) is a surrogate parameter for anhedonia. In the novelty-induced hypophagia test, male rats undergo a training period in which they are exposed to a palatable snack. During training, rodents show a stable baseline snack intake. On test day, the animals are transferred from home cages into a fresh, empty cage representing a novel unknown environment with access to the known palatable snack. The automated system records the total intake and its underlying microstructure (e.g., latency to approaching the snack), providing insight into anhedonic and anxious behaviors. The combination of these paradigms with an automated measuring system provides more detailed information, along with higher accuracy by reducing measuring errors. However, the tests use surrogate parameters and only depict depression and anhedonia in an indirect manner.

Presented here is a protocol to study depression-like and anhedonic behavior in rats. It combines two well-established behavioral methods, the sucrose preference and novelty-induced hypophagia tests, with an automated food and liquid intake monitoring system, to indirectly investigate rodent behavior using surrogate parameters.

使用自动食物摄入量监测系统对大鼠的蔗糖偏好和新奇诱导性低吞咽测试

The prevalence and incidence of depressive disorders are rising worldwide, affecting about 322 million individuals, underlining the need for behavioral ...

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney transplantation and physicians. Patients provide information such as vital signs, well-being, and medication intake via smartphone apps. The information is transferred directly into a database and electronic health record at the kidney transplant center, which is used for routine patient care and research. Physicians can send an updated medication plan and laboratory data directly to the patient app via this secure platform. Other features of the app are medical messages and video consultations. Consequently, the patient is better-informed, and self-management is facilitated. In addition, the transplant center and the patient's local nephrologist automatically exchange notes, medical reports, laboratory values, and medication data via the platform. A telemedicine team reviews all incoming data on a dashboard and takes action, if necessary. Tools to identify patients at risk for complications are under development. The platform exchanges data via a standardized secure interface (Health Level 7 (HL7), Fast Healthcare Interoperability Resources (FHIR)). The standardized data exchange based on HL7 FHIR guarantees interoperability with other eHealth solutions and allows rapid scalability to other chronic diseases. The underlying data protection concept is in concordance with the latest European General Data Protection Regulation. Enrollment started in February 2020, and 131 kidney transplant recipients are actively participating as of July 2020. Two large German health insurance companies are currently funding the telemedicine services of the project. The deployment for other chronic kidney diseases and solid organ transplant recipients is planned. In conclusion, the platform is designed to enable home monitoring and automatic data exchange, empower patients, reduce hospitalizations, and improve adherence, and outcomes after kidney transplantation.

The MACCS platform&#160;is a comprehensive telemedicine concept aiming at better outcomes after kidney transplantation by sharing key medical information between patients and physicians. A telemedicine team reviews incoming data to detect potential complications and to improve adherence in kidney transplant recipients to achieve better long-term outcomes.

数字家庭-肾移植后患者的监测:MACCS平台

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney ...

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Percutaneous transcatheter edge-to-edge reconstruction of the mitral valve is a safe and well-established therapy for severe symptomatic mitral regurgitation in patients with high surgical risk. Echocardiographic guidance in addition to fluoroscopy is the gold standard and should be performed using a standardized technique.
This article lays out our reproducible step by step echocardiographic guide including views, measurements as well as highlighting possible difficulties that may arise during the procedure.
This article provides detailed and chronological echocardiographic views for each step of the procedure, especially preferences between 2D and 3D imaging. If needed, pulse wave, continuous wave and color doppler measurements are described. Furthermore, as there are no official recommendations for the quantification of mitral regurgitation during the percutaneous edge-to-edge-repair procedure, advice is also included for echocardiographic quantification after grasping the mitral leaflets and after device deployment. In addition, the article deals with important echocardiographic views to prevent and deal with possible complications during the procedure.
Echocardiographic guidance during transcatheter mitral valve repair is mandatory. A structured approach improves the collaboration between interventionist and imager and is indispensable for a safe and effective procedure.

This protocol presents in detail how to perform real-time echocardiographic guidance during transcatheter mitral valve repair. The fundamental views and the necessary measurements are described for each stage of the procedure.

院前溶栓治疗:从柏林手册

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