作者感谢加布里埃尔. 莱顿修改了本文件的最后草稿。

1. 患者选择
<ol><li>对 FBSS20进行诊断。</li>
	<li>
确保 FBSS 病人符合所有纳入标准, 然后接受 SCS 试验:
	<ol>
<li>慢性腰痛和/或根腿疼痛, 最理想的医疗治疗至少6月。</li>
		<li>持续性疼痛, 尽管3种药物治疗 (扑热息痛, 非甾体抗炎药物, 阿片类药物, 抗惊厥药物等)。</li>
		<li>Lemniscal 通路必须保持至少部分完好 (为麻木覆盖痛苦的区域)。</li>
	</ol>
</li>
	<li>排除 FBSS 患者中 SCS 的排除标准, 如主动感染、药物成瘾或持续戒断、心理禁忌症、低血压的机械原因 (腰痛疼痛、腰椎滑脱、脊柱不稳定和后关节骨关节炎) 和凝血障碍 (由于出血和硬膜外血肿的风险)。通过询问相关问题, 检查病人, 并在必要时检查凝血障碍的相关血液检查, 确保不存在凝血障碍。</li>
</ol>2. 调节专家
<ol><li>如果 FBSS 病人符合公务员事务局的标准, 请向调节专家 (NMS) 咨询。 注意: 我们队的调节专家是一名护士。他完全致力于疼痛和调节, 是 pluridisciplinary 团队的协调员, 其中包括一名心理学家、理疗师和一个专科疼痛护士。</li>
	<li>描述病人疼痛通路的解剖, 解释伤害与神经病理性疼痛的区别。解释不同镇痛和镇痛药物的作用部位。 注意: 重要的是, 病人了解神经性疼痛的性质, 并能区分它与伤害疼痛。一旦病人了解了他们的神经性疼痛的生理学, 他们就准备学习 SCS。</li>
	<li>向病人解释 SCS 的理论概念。这项技术被认为是通过刺激脊髓内大直径传入神经纤维, 根据疼痛门控制理论来抑制慢性疼痛。</li>
	<li>测量的视觉模拟秤 (输精管) 评分21的腿和背部疼痛。</li>
	<li>
解释治疗的目的:
	<ol>
<li>麻木覆盖面的痛苦的区域50到70%。</li>
		<li>减轻疼痛 (输精管评分)。</li>
		<li>减少镇痛和共镇痛药物。</li>
		<li>改善睡眠质量。</li>
		<li>改善生活质量。</li>
		<li>在距离的改善走了。</li>
	</ol>
</li>
	<li>解释 SCS 设备的不同组件 (硬膜外引线、内部脉冲发生器和连接引线到 IPG 的延长线), 让病人操纵他们更好地了解系统。</li>
</ol>3. NMS 建立健康保险档案
<ol><li>在这个文件中描述病人的疼痛特点, 生活质量, 睡眠质量, 还有病人的活动, 步行距离, 镇痛和共镇痛的消费。 注: 根据比利时法律, 精神病学评估是强制性的, 在任何手术前植入异物。精神病学家必须排除任何精神紊乱, 并评估病人的功能能力, 以便能够接受和生活在一个异物。</li>
	<li>将病人的病历和精神评估附在健康保险档案中。</li>
</ol>4. 几列铅的植入
<ol><li>在解释手术过程细节后, 包括并发症 (感染 3–6%; 严重的神经系统并发症 0.54–1.71%; 硬膜外血肿 0.19–0.63%; 脊髓损伤 0.022–0.067%;脑脊液漏 0.05–0.001%)22。 注: 比利时所需的长期试验期被认为是本机构观察到的高感染率 (11%) 的主要原因, 我们目前正在努力解决这一问题。这必须向病人解释。</li>
	<li>除上述风险外, 类似于与其他脊柱程序相关的危险, 解释通常与使用植入物有关的其他风险, 例如对植入材料的过敏或免疫系统反应;通过皮肤或迁移而导致、延伸或神经刺激器侵蚀;在硬膜外空间的铅周围形成活性组织, 可能导致脊髓压迫和瘫痪, 需要手术治疗。发病时间可以从几周到许多年后植入。 注: 经皮背柱刺激术后神经并发症发生率略高 (感染 3–6%; 严重神经并发症 0–2.35%; 硬膜外血肿 0.75%; 脊髓损伤 0.03–2.35%; 脑脊液渗漏 0.3%)22。</li>
	<li>如果病人没有任何禁忌症, 进行 MRI 排除任何异常的圆锥脊髓投射, 如脊柱闭合不全或其他先天性脊髓异常23。</li>
	<li>在切口前使用单静脉注射 (IV) 剂量的头孢唑啉, 50 毫克/千克, 最多2个 gm, 通过在外围路线放置16克针进行抗生素预防30分钟。</li>
	<li>病人全身麻醉 (使用0.1 µg/千克 Sunfentanil, 2 毫克/千克 Propolipid 1%, 0.3 毫克/千克氯胺酮 (见材料表) 和0.3 毫克/千克罗库溴铵) 和在俯卧位, 定义切口之间的棘突在透视协助下 T10 和 T11 的进程。</li>
	<li>渗透切口部位与5毫升20毫升溶液0.5% 布比卡因和1:200,000 肾上腺素 (见材料表)。</li>
	<li>切开直到胸 aponeuroses 显露。</li>
	<li>解剖旁肌组织两侧的 T10's 冈过程, 并放置牵引器。</li>
	<li>切除冈和棘间韧带, 解剖 T10 的叶片 (每一侧5毫米, craniocaudal 方向为5毫米)。</li>
	<li>在插入铅之前, 执行 T10 的部分椎板切除, 以创造足够的空间, 以允许插入铅 (不需要删除整个叶片)。</li>
	<li>将幻铅插入硬膜外腔, 同时保持 T11 叶片上部的黄韧带的插入完好。 注: 此 T11 叶片用于引导插入到硬膜外的空间。</li>
	<li>在透视指导下, 将潜在顾客尽可能内侧。在透视控制下的 T8–T9 体的投影中放置中线时, 最终引线的位置到达。</li>
	<li>通过做一个单一的打断缝合, 固定棘间韧带的 T11。</li>
	<li>通过使用公司提供的隧道工具, 将您的操作字段的扩展隧道到后面的侧面 (通常是正确的), 然后将它们连接到潜在顾客。</li>
	<li>检查 fluoroscopically, 以确保铅没有移动, 仍然在硬膜外空间, 中线, 在 T8–T9 的投射。</li>
	<li>取出牵引器, 确保没有出血。</li>
	<li>用编织合成可吸收缝合材料的简单打断缝线缝合肌-腱膜性层 (见材料表)。</li>
	<li>将两个内部外部扩展连接到两个外部扩展。隧道他们在皮下脂肪用这样方式他们通过皮肤 15 cm 侧向切口地点出口。 注意: 在手术前与病人讨论侧的选择, 取决于内部脉冲发生器的植入位置。</li>
	<li>用编织合成可吸收缝合材料 (见材料表) 的简单中断缝线包裹本征和外伸并缝合皮下层。</li>
	<li>用较细的可吸收3/0 缝合材料做 dermic subcuticular 缝合 (见材料表), 并应用防腐剂和绷带。在这一步骤中, 管理单 IV 剂量的1g 扑热息痛和100毫克 Tradonal。</li>
</ol>5. 术后试验
<ol><li>放置引线后, 将其连接到外部刺激器, 为期四周。 注意: 这个长的测试期间是比利时法律要求的条件, 以补偿在第二次手术中的脉冲发生器的植入。</li>
	<li>手术后几个小时开始编程。治疗的目的是通过愉快的麻木覆盖痛苦的区域。</li>
	<li>将外部神经刺激器连接到外部引线扩展。</li>
	<li>将临床医生程序员放在外部神经刺激器。打开临床医生程序员, 然后打开神经刺激。首先将脉冲宽度 (密码) 设置为260µs, 速度为60赫兹。</li>
	<li>如果 LP 是双边的, 执行第一次筛选使用保护阴极 (++), 从左上 tripolar 纵向刺激配置 (图 1), 以确定铅的偏侧 (右/左)。</li>
	<li>用四剩余的左侧 tripolar 纵向刺激配置 (图 2) 对左侧进行快速扫描。在这种单边筛查过程中, 确定了疼痛 metameric 水平的概念。此后, 按照相同的方案扫描右侧 (图 3)。</li>
	<li>最后, 激活刺激配置, 允许更好地麻木覆盖痛苦的腿部区域。 注: 如果存在双边 LP, 则必须对两种不同的刺激配置进行编程, 以获得对两个痛苦区域的最佳麻木覆盖率。</li>
	<li>对于背部疼痛, 使用防护的阴极配置 (图 4), 首先测试引线顶部的横向 tripolar 配置。如果此配置提供的麻木覆盖率不足, 则在阴极周围测试一个 "半花型" 配置四阳极 (图 4)。如果此配置没有提供足够的麻木覆盖和/或痛苦抑制再次, 使用 tripolar 纵向配置, 以验证可能的双边刺激由一个通道 (图 4)。</li>
	<li>微调背部疼痛区域覆盖通过增加密码450µs。这使得扩大刺激范围成为可能。调整40和60赫兹之间的脉冲速率, 以获得最满意的麻木覆盖的痛苦区域。 注: 这些设置是根据经验与这个多列手术铅, 当然可能会因不同的设备或刺激策略 (例如高强度刺激)。有关详细说明, 请参阅程序员快速指南24。</li>
	<li>确保在试验阶段 (比利时1月) 对患者进行密切随访 (至少一周一次), 通过重复步骤5.7、5.8 和 5.9, 检查适当的伤口愈合情况并优化麻木覆盖率。使用无菌技术绷带改变22。教育病人有关新出现的手术部位感染的体征和症状。</li>
	<li>在试用期结束时, 使用锋利的剪刀削减外部伸展与皮肤, 以减少感染的风险, 直到下一个手术程序。</li>
</ol>6. 内部脉冲发生器的植入
<ol><li>如果在一个月的试用期结束时疼痛缓解率高于 50% (比利时报销标准), 获得病人的知情同意, 并设置 IPG 安置日期。疼痛缓解的评估使用输精管刻度22。 注: 在不同地点的优缺点与 NMS 进行讨论后, 患者决定 IPG 安置地点。</li>
	<li>在切口前30分钟使用单静脉剂量的头孢唑啉50毫克/千克, 最多2克, 用16克针进行抗生素预防。</li>
	<li>病人在全身麻醉下 (与步骤4.3 中提到的相同的协议), 做一个7厘米长和2厘米深的切口, 并创建一个口袋里的 IPG 在腹壁脂肪或臀部的外部象限, 根据患者的愿望 (如手术前所述-步骤 6.1)。</li>
	<li>将用于铅植入的背疤 (步骤 4.3), 从周围组织中解剖铅的延伸, 并从外部外伸中断开引线。</li>
	<li>隧道铅的内在延伸朝向 IPG 的植入地点。</li>
	<li>将潜在顾客的内部扩展连接到其 IPG。</li>
	<li>用2/0 和1/0 编织合成可吸收缝合材料的简单打断缝线缝合皮下层。</li>
	<li>用较细的可吸收3/0 缝合材料做真皮 subcuticular 缝合, 并应用防腐剂和绷带。在这一步, 管理单 IV 剂量扑热息痛 1 gm 和 Tradonal 100 毫克。</li>
</ol>7. 术后护理和后续访问
<ol><li>与临床医生的程序员, 设置编程参数, 根据那些工作最好的在试用期 (步骤 5.7)。</li>
	<li>教病人如何使用程序员25。再次解释神经刺激系统的不同组件。教育病人避免需要过度扭动或伸展的活动。</li>
	<li>在任何程序开始之前, 指示病人总是通知任何医护人员他们有植入神经刺激系统。提供有关警告的说明 (CT 扫描、除颤和复律、烙、碎石、MRI、微波消融和安全筛查装置) 和预防措施 (骨骼生长刺激、牙科演习和超声波探头,神经刺激系统的电解、电磁场设备、激光程序、心理程序、放射治疗和家居用品)。</li>
	<li>确保手术后病人的随访, 检查手术部位感染和适当的麻木覆盖率。</li>
</ol>

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B., 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=Spinal+cord+stimulation+versus+re-operation+in+patients+with+failed+back+surgery+syndrome:+an+international+multicenter+randomized+controlled+trial+(EVIDENCE+study).">Spinal cord stimulation versus re-operation in patients with failed back surgery syndrome: an international multicenter randomized controlled trial (EVIDENCE study).</a> Neuromodulation: Journal of the International Neuromodulation Society. 14, 330-335 (2011).</li><li>Kapural, L., 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=Comparison+of+10-kHz+High-Frequency+and+Traditional+Low-Frequency+Spinal+Cord+Stimulation+for+the+Treatment+of+Chronic+Back+and+Leg+Pain:+24-Month+Results+From+a+Multicenter,+Randomized,+Controlled+Pivotal+Trial.">Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial.</a> Neurosurgery. 79 (5), 667-677 (2016).</li><li>Remacle, T. Y., Bonhomme, V. L., Renwart, H. J. P., Remacle, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Multicolumn+Lead+Spinal+Cord+Stimulation+on+Low+Back+Pain+in+Failed+Back+Surgery+Patients:+A+Three-Year+Follow-Up.">Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up.</a> Neuromodulation: Technology at the Neural Interface. 20 (7), 668-674 (2017).</li><li>Veizi, E., 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=Spinal+Cord+Stimulation+(SCS)+with+Anatomically+Guided+(3D)+Neural+Targeting+Shows+Superior+Chronic+Axial+Low+Back+Pain+Relief+Compared+to+Traditional+SCS-LUMINA+Study.">Spinal Cord Stimulation (SCS) with Anatomically Guided (3D) Neural Targeting Shows Superior Chronic Axial Low Back Pain Relief Compared to Traditional SCS-LUMINA Study.</a> Pain Medicine (Malden, Mass). 18 (8), 1534-1548 (2017).</li><li>Chan, C., Peng, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome.">Failed back surgery syndrome.</a> Pain Medicine. 12 (4), 577-606 (2011).</li><li>Hawker, G., Mian, S., Kendzerska, T., French, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+adult+pain.">Measures of adult pain.</a> Arthritis Care and Research. 63 (11), 240-252 (2011).</li><li>Deer, T. 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=The+Neurostimulation+Appropriateness+Consensus+Committee+(NACC)+Safety+Guidelines+for+the+Reduction+of+Severe+Neurological+Injury.">The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury.</a> Neuromodulation. 20 (1), 15-30 (2017).</li><li>Gupta, P., Kumar, A., Kumar, A., Goel, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+Spinal+Cord+Anomalies:+A+Pictorial+Review.">Congenital Spinal Cord Anomalies: A Pictorial Review.</a> Current Problems in Diagnostic Radiology. 42 (2), 57-66 (2013).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Medtronic N'VISION&#174; Programmer Quick Guide. , (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Medtronic MyStim&#174; Programmer Quick Guide. , (2014).</li><li>Frey, M. E., Manchikanti, L., Benyamin, R. M., Schultz, D. M., Smith, H. S., Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+cord+stimulation+for+patients+with+failed+back+surgery+syndrome:+a+systematic+review.">Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review.</a> Pain Physician. 12 (2), 379-397 (2009).</li></ol>

作者没有什么可透露的。

最近的研究表明, SCS 可以可靠地改善 FBSS 患者的不同疼痛成分, 提高他们的生活质量 (如睡眠质量和体力活动), 这些好处是持续的长期随访3,17,18,19。
根据疼痛的定位, 我们使用不同的方法。当患者只有单边 LP, 经皮穿刺8接触铅放置在后脊髓硬膜外空间透视成像和最终位置的?...

失败的背部手术综合征 (FBSS) 指脊柱手术后持续的慢性疼痛。在建立 FBSS 之前, 其他条件, 如持续神经根压迫, 永久性神经根损伤作为原压缩或手术的结果, 蛛网膜炎, 错误的初步诊断, 并记录机械原因腰痛 (如脊柱不稳定, 后关节骨关节炎, spondylolysthesis, 腰痛疼痛), 应排除1,2,3。FBSS 患者可能有严重或残疾的神经病理性疼痛, 该综合征是令人不安的, 因为它是慢性和抗常规治疗。其发病率和患病率与类风湿性关节炎4相似。因此, 它是5工业化社会的一个巨大负担。
脊髓刺激 (scs) 背侧硬膜外引线可用于治疗背部疼痛 (BP) 和腿部疼痛 (LP) 的 FBSS 患者, 虽然 SCS 疼痛缓解机制尚未充分调查。根据 Melzack 和帕特里克墙在1965年首次提出的门控理论, 大脑监视着一个微小神经网络的活动, 它沿脊髓的背角分布, 受伤害调节, 而且非伤害传入6。当强烈的触觉刺激被应用到同一个地方7,8时, 这些复杂电路在脊髓的浅背角负责减轻在身体的一个特定位置的痛苦。然而, 一些研究表明, SCS 不仅依赖于这个理论。据报道, 几种神经递质 (乙酰胆碱、伽玛丁酸和血清素) 在 SCS 机制9、10、11、12以及许多脑区都有作用。13,14和不同的脊髓纤维15。
SCS 设备包括硬膜外引线、内部脉冲发生器 (IPG) 和用于将引线连接到 IPG 的扩展电缆。刺激设置由外部遥控器调整。可使用两种电极, 即经皮穿刺和手术导通。
在过去发表的研究 (包括证据研究16) 中, SCS 在改善 FBSS 根 LP 成分方面的功效已经得到证实, 最近两项新技术已证明对 BP 的治疗是有效的。成分, 这是众所周知的是顽固的 SCS。第一个是高频刺激17。第二个是手术用的3,18。前者的主要缺点是, 他们的电池需要更频繁的充电和编程优化是挑战的更长的 "洗涤" 时间19。后者的技术比经皮高频刺激技术更具侵入性, 因为它需要一个小的椎板切除术, 使得围手术麻木在局部麻醉下具有挑战性, 尽管可能3。事实上, 这个程序可以在局部麻醉下进行, 辅以有意识镇静或脊椎麻醉3。在我们的机构, 当针对 FBSS 患者的背部疼痛, 我们把这样的手术线索通过一个小椎板切除在10胸水平与病人全麻。3年随访18, 证明了该方法与多列导线治疗 FBSS 患者的 LP 和 BP 的持久疗效。下面给出了我们的方法的详细协议。

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			<td>external Neurostimulator (eNs)&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
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			<td>Trousse de colonne lombaire CHR Citadelle (Procedure pack)&#160;</td>
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			<td>&#160;Medtronic Inc., MN, USA</td>
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			<td>Primeadvanced surescan mri neurostimulator&#160;</td>
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			<td>Smith&#38;Nephew</td>
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			<td>MyStim Programmer</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
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			<td>&#160;Medtronic Inc., MN, USA</td>
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			<td>3M Deutschland GmbH</td>
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			<td>Medtronic Inc., MN, USA</td>
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treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation

失败的背部手术综合征 (FBSS) 指脊柱手术后持续的慢性疼痛。脊髓刺激的背侧硬膜外引线可用于治疗背部和腿部疼痛的 FBSS 患者。本文提出了在 FBSS 患者中应用脊髓刺激术治疗线索的详细方案。在我们的部门, 病人在全身麻醉下, 我们在硬膜外的空间, 通过一个小椎板切除在10胸部水平的铅。铅的放置后, 一个1月的试用期与外部的铅。如果在这1月的刺激试验结束时止痛大于 50% (比利时报销标准要求), 则将内部脉冲发生器置于皮肤下, 并在第二个手术过程中与铅连接。我们已经证明, 使用这种技术在严格选择的 FBSS 患者可以显著改善背部疼痛, 腿部疼痛, 病人的活动, 和生活质量持续一段时间。

在我中心, 比利时列日的 Citadelle, 最近在调节18发表了一项前瞻性的, 非随机的, 对照研究62例被植入多列铅的连续 FBSS 患者。所有患者都曾进行过脊柱手术, 已筛查可能导致其疼痛的次要原因, 并对最佳的医疗治疗是不难的。在全身麻醉的透视控制下, 62 例患者在中线位置 T8-T9 的投射中放置了几列手术线索。在试验期结束时, 五十四例患者 (87%) 有 > 50% 的疼?...

Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

多列铅脊髓刺激术后腰痛的治疗

本文提出了一种利用脊髓刺激治疗失败后手术患者神经病理性腰痛的方法。

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be ...

treating-low-back-pain-failed-back-surgery-patients-with-multicolumn

Research

JoVE Journal

Behavior

14.4K 次观看.  CHR Citadelle. 本文提出了一种利用脊髓刺激治疗失败后手术患者神经病理性腰痛的方法。

视频: Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

Functional Magnetic Resonance Imaging (fMRI) with Auditory Stimulation in Songbirds

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and molecular approaches allow the investigation of either different stimuli on few neurons, or one stimulus in large parts of the brain, blood oxygenation level dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) allows combining both advantages, i.e. compare the neural activation induced by different stimuli in the entire brain at once. fMRI in songbirds is challenging because of the small size of their brains and because their bones and especially their skull comprise numerous air cavities, inducing important susceptibility artifacts. Gradient-echo (GE) BOLD fMRI has been successfully applied to songbirds 1-5 (for a review, see 6). These studies focused on the primary and secondary auditory brain areas, which are regions free of susceptibility artifacts. However, because processes of interest may occur beyond these regions, whole brain BOLD fMRI is required using an MRI sequence less susceptible to these artifacts. This can be achieved by using spin-echo (SE) BOLD fMRI 7,8 . In this article, we describe how to use this technique in zebra finches (Taeniopygia guttata), which are small songbirds with a bodyweight of 15-25 g extensively studied in behavioral neurosciences of birdsong. The main topic of fMRI studies on songbirds is song perception and song learning. The auditory nature of the stimuli combined with the weak BOLD sensitivity of SE (compared to GE) based fMRI sequences makes the implementation of this technique very challenging.

Functional Magnetic Resonance Imaging fMRI with Auditory Stimulation in Songbirds

This article shows an optimized procedure for imaging of the neural substrates of auditory stimulation in the songbird brain using functional Magnetic Resonance Imaging (fMRI). It describes the preparation of the sound stimuli, the positioning of the subject and the acquisition and subsequent analysis of the fMRI data.

功能磁共振成像（fMRI）技术与听觉刺激鸣禽

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and ...

科研

行为学

Use of the Operant Orofacial Pain Assessment Device (OPAD) to Measure Changes in Nociceptive Behavior

We present an operant system for the detection of pain in awake, conscious rodents. The Orofacial Pain Assessment Device (OPAD) assesses pain behaviors in a more clinically relevant way by not relying on reflex-based measures of nociception. Food fasted, hairless (or shaved) rodents are placed into a Plexiglas chamber which has two Peltier-based thermodes that can be programmed to any temperature between 7 &deg;C and 60 &deg;C. The rodent is trained to make contact with these in order to access a reward bottle. During a session, a number of behavioral pain outcomes are automatically recorded and saved. These measures include the number of reward bottle activations (licks) and facial contact stimuli (face contacts), but custom measures like the lick/face ratio (total number of licks per session/total number of contacts) can also be created. The stimulus temperature can be set to a single temperature or multiple temperatures within a session. The OPAD is a high-throughput, easy to use operant assay which will lead to better translation of pain research in the future as it includes cortical input instead of relying on spinal reflex-based nociceptive assays.

Use of the Operant Orofacial Pain Assessment Device OPAD to Measure Changes in Nociceptive Behavior

We present a user-friendly, high-throughput operant system for the evaluation of pain behaviors in awake, conscious rodents. The Orofacial Pain Assessment Device (OPAD) can assess pain through a reward/conflict paradigm thus providing a more humane way of testing. This protocol will yield more clinically relevant and translational data from rodents.

使用操作性口面疼痛评估设备（OPAD）测量伤害行为的变化

We present an operant  system for the detection of pain in awake, conscious rodents. The Orofacial  Pain Assessment Device (OPAD) assesses pain behaviors ...

Stimulating the Lip Motor Cortex with Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. Researchers have used single-pulse and repetitive TMS to stimulate the lip representation in the motor cortex. The excitability of the lip motor representation can be investigated by applying single TMS pulses over this cortical area and recording TMS-induced motor evoked potentials (MEPs) via electrodes attached to the lip muscles (electromyography; EMG). Larger MEPs reflect increased cortical excitability. Studies have shown that excitability increases during listening to speech as well as during&#160;viewing speech-related movements. TMS can be used also to disrupt the lip motor representation. A 15-min train of low-frequency sub-threshold repetitive stimulation has been shown to suppress motor excitability for a further 15-20 min. This TMS-induced disruption of the motor lip representation impairs subsequent performance in demanding speech perception tasks and modulates auditory-cortex responses to speech sounds. These findings are consistent with the suggestion that the motor cortex contributes to speech perception. This article describes how to localize the lip representation in the motor cortex and how to define the appropriate stimulation intensity for carrying out both single-pulse and repetitive TMS experiments.

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception.&#160; This article describes how to record motor evoked potentials (MEPs) from the lip muscles and how to disrupt the motor lip representation using repetitive TMS.

刺激唇部运动皮层与经颅磁刺激

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. ...

Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil

Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses electromagnetic coils to stimulate areas of the brain non-invasively. Deep transcranial magnetic stimulation (dTMS) with the Brainsway H1-coil system specifically is a type of rTMS indicated for treating patients with major depressive disorder (MDD) who are resistant to medication. The unique H1-coil design of this device is able to stimulate neuronal pathways that lie deeper in the targeted brain areas than those reached by conventional rTMS coils. dTMS is considered to be low-risk and well tolerated, making it a viable treatment option for people who have not responded to medication or psychotherapy trials for their depression.
Randomized, sham-control studies have demonstrated that dTMS produces significantly greater improvement in depressive symptoms than sham dTMS treatment in patients with major depression that has not responded to antidepressant medication. In this paper, we will review the methodology for treating major depression with dTMS using an H1-coil.

Here we present a protocol outlining the methodology for treatment of Major Depressive Disorder using the deep Transcranial Magnetic Stimulation (dTMS) system.

临床治疗抑郁症的深层重复经颅磁刺激使用Brainsway H1线圈

Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses ...

Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to progressive loss of motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. To evaluate these potential deficits in severely physically impaired ALS patients, eye-tracking is a promising means to conduct cognitive tests. The present article focuses on how eye movements, an indirect means of communication for physically disabled patients, can be utilized to allow for detailed neuropsychological assessment. The requirements, in terms of oculomotor parameters that have to be met for sufficient eye-tracking in ALS patients are presented. The properties of stimuli, including type of neuropsychological tests and style of presentation, best suited to successfully assess cognitive functioning, are also described. Furthermore, recommendations regarding procedural requirements are provided. Overall, this methodology provides a reliable, easy to administer and fast approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS. The only confounding factor might be deficits in voluntary eye movement control in a subset of ALS patients.

Cognitive deficits are common in about one third of patients with amyotrophic lateral sclerosis, a neurological condition leading to progressive impairments in speech and movement abilities. To conduct cognitive tests in patients unable to speak or write a reliable and easy to administer eye-tracking paradigm was developed.

眼跟踪控制，以评估患者的认知功能与肌萎缩性脊髓侧索硬化症

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to ...

Using Laser Doppler Imaging and Monitoring to Analyze Spinal Cord Microcirculation in Rat

Laser Doppler flowmetry (LDF) is a noninvasive method for blood flow (BF) measurement, which makes it preferable for measuring microcirculatory alterations of the spinal cord. In this article, our goal was to use both Laser Doppler imaging and monitoring to analyze the change of BF after spinal cord injury. Both the laser Doppler image scanner and the probe/monitor were being employed to obtain each readout. The data of LDPI provided a local distribution of BF, which gave an overview of perfusion around the injury site and made it accessible for comparative analysis of BF among different locations. By intensely measuring the probing area over a period of time, a combined probe was used to simultaneously measure the BF and oxygen saturation of the spinal cord, showing overall spinal cord perfusion and oxygen supply. LDF itself has a few limitations, such as relative flux, sensitivity to movement, and biological zero signal. However, the technology has been applied in clinical and experimental study due to its simple setup and rapid measurement of BF.

Here we present a combination of laser Doppler perfusion imaging (LDPI) and laser Doppler perfusion monitoring (LDPM) to measure spinal cord local blood flows and oxygen saturation (SO2), as well as a standardized procedure for introducing spinal cord trauma on rat.

激光多普勒成像与监测在大鼠脊髓微循环分析中的应用

Laser Doppler flowmetry (LDF) is a noninvasive method for blood flow (BF) measurement, which makes it preferable for measuring microcirculatory ...

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

脊髓损伤后下肢电刺激训练的模式

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Brain State-dependent Brain Stimulation with Real-time Electroencephalography-Triggered Transcranial Magnetic Stimulation

The effect of a stimulus to the brain depends not only on the parameters of the stimulus but also on the dynamics of brain activity at the time of the stimulation. The combination of electroencephalography (EEG) and transcranial magnetic stimulation (TMS) in a real-time brain state-dependent stimulation system allows the study of relations of dynamics of brain activity, cortical excitability, and plasticity induction. Here, we demonstrate a newly developed method to synchronize the timing of brain stimulation with the phase of ongoing EEG oscillations using a real-time data analysis system. This real-time EEG-triggered TMS of the human motor cortex, when TMS is synchronized with the surface EEG negative peak of the sensorimotor &#181;-alpha (8-14 Hz) rhythm, has shown differential corticospinal excitability and plasticity effects. The utilization of this method suggests that real-time information about the instantaneous brain state can be used for efficacious plasticity induction. Additionally, this approach enables personalized EEG-synchronized brain stimulation which may lead to the development of more effective therapeutic brain stimulation protocols.

This paper describes real-time electroencephalography-triggered transcranial magnetic stimulation to study and modulate human brain networks.

脑状态依赖性脑刺激与实时脑脑图触发颅内磁刺激

The effect of a stimulus to the brain depends not only on the parameters of the stimulus but also on the dynamics of brain activity at the time of the ...

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also impacts exercise capacity and forms a vicious circle in which it further aggravates the condition of patients and accelerates disease progression. As a functional holistic exercise, traditional Chinese exercises (TCE) play an important role in the rehabilitation of COPD on the basis of adjusting the breath and performing coordinated movements. This study investigates the effects of prescribed pulmonary exercises (which are modified from TCE) on exercise capacity of upper and lower limbs, endurance exercise capacity, and quality of life in stable COPD patients. The goal is to determine the accessibility of these prescribed exercises in COPD rehabilitation. Participants are randomly divided into a non-exercise control group (CG) or prescribed pulmonary exercise group (PG) at a ratio of 1: 1. The PG receives intervention for 60 min twice per day, 7 days a week, for a total of 3 months. The intensity is measured using the Borg category-ratio 10 scale and with a heart-rate monitor. Then, an exercise capacity test and quality of life questionnaire are scheduled at 1 week before and after the formal intervention. After 3 months of intervention, the 30 s arm curl test, 30 s sit-to-stand test, 6 min walking test, and quality of life show significant improvement in COPD patients (p &#60; 0.05). These findings indicate that prescribed pulmonary exercises can be applied as alternative, convenient, and effective home- and community-based exercises for stable COPD patients.

Presented here is a protocol to investigate the effects of home-based prescribed pulmonary exercise in stable chronic obstructive pulmonary disease (COPD) patients, which is modified based on traditional Chinese exercises according to dyspnea and limited exercise capacity observed in COPD patients.

稳定慢性阻塞性肺病患者家庭处方肺运动

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also ...

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

The vestibular system provides information about head movement and mediates reflexes that contribute to balance control and gaze stabilization during daily activities. Vestibular sensors are located in the inner ear on both sides of the head and project to the vestibular nuclei in the brainstem. Vestibular dysfunction is often due to an asymmetry between input from the two sides. This results in asymmetrical neural inputs from the two ears, which can produce an illusion of rotation, manifested as vertigo. The vestibular system has an impressive capacity for compensation, which serves to rebalance how asymmetrical information from the sensory end organs on both sides is processed at the central level. To promote compensation, various rehabilitation programs are used in the clinic; however, they primarily use exercises that improve multisensory integration. Recently, visual-vestibular training has also been used to improve the vestibulo-ocular reflex (VOR) in animals with compensated unilateral lesions. Here, a new method is introduced for rebalancing the vestibular activity on both sides in human subjects. This method consists of five unidirectional rotations in the dark (peak velocity of 320&#176;/s) toward the weaker side. The efficacy of this method was shown in a sequential, double-blinded clinical trial in 16 patients with VOR asymmetry (measured by the directional preponderance in response to sinusoidal rotations). In most cases, VOR asymmetry decreased after a single session, reached normal values within the first two sessions in one week, and the effects lasted up to 6 weeks. The rebalancing effect is due to both an increase in VOR response from the weaker side and a decrease in response from the stronger side. The findings suggest that unidirectional rotation can be used as a supervised rehabilitation method to reduce VOR asymmetry in patients with longstanding vestibular dysfunction.

A new rehabilitation method is presented for rebalancing the vestibular system in patients with asymmetric responses, which consists of unidirectional rotations toward the weaker side. By directly modifying the vestibular pathway rather than enhancing the multisensory aspects of compensation, asymmetry can be normalized within 1-2 sessions and show lasting effects.

使用单向旋转改善前庭功能障碍患者的前庭系统不对称性

The vestibular system provides information about head movement and mediates reflexes that contribute to balance control and gaze stabilization during ...