我们要感谢 Wanting Li 女士提供的数字技术支持。这项工作得到了内蒙古医学基金 （2022QNWN0010， 2023SGGZ047， 2023SGGZ0010） 的支持。

该研究得到了中国呼和浩特市内蒙古心理健康中心（内蒙古自治区第三医院、内蒙古自治区脑科医院）学术伦理委员会的批准。所有研究参与者都签署了知情同意书。
1. PSG 程序
<ol><li>数据采集<ol><li>包括根据 DSM-V 诊断的 MDD 患者。 注意：本研究包括 22 名根据 DSM-V 诊断的 MDD 患者。由于受教育程度低，2 例 MDD 患者拒绝参加。因为他们都发现，在认知筛选工具中完成 TMT-B 时，阅读汉字并不容易。</li>
		<li>排除被诊断患有严重痴呆、焦虑、谵妄和其他疾病的参与者，这些疾病使他们无法整晚完成 PSG。</li>
		<li>收集参与者的人口统计数据，包括姓名、国籍、性别、年龄、出生日期、结婚、主诉、症状、主要诊断、病史、科室、体温、脉搏、呼吸频率、血压、身高、体重、体重指数、腹围和上胸围。</li>
		<li>每个参与者都被指示完成 Epworth 睡眠量表16。</li>
	</ol></li>
	<li>连接派生<ol><li>收集参与者的信息后，引导参与者进入睡眠监测室。</li>
		<li>逐步收集脑电图 （EEG）、眼电图 （EOG）、下巴肌电图 （EMG） 和心电图 （ECG） 的所有推导。 注意：参与者应保持他/她的面部、皮肤和头发清洁干燥。</li>
		<li>根据国际 10-20 电极放置系统连接 15 个脑电图电极（图 1）17。</li>
		<li>连接 EOG 的两个派生 （E1， E2），如图 2 所示。</li>
		<li>连接下巴肌电图的三个推导（Chin1、Chin2、ChinZ），如图 3 所示。</li>
		<li>连接 ECG 的两个推导 （+， −），如图 4 所示。</li>
	</ol></li>
	<li>启动数据采集系统<ol><li>双击 设备管理器 启动软件。</li>
		<li>双击 Room 选项并添加参与者的个人信息。 注意：个人信息包括姓名、性别、出生日期、文件名、文件路径等。可以根据需要添加更多详细信息（例如，身高、体重、颈围、医生、技术人员、医院、地址、婚姻状况、职业和监护人 [如果参与者是儿童]）。</li>
		<li>点击 OK 按钮。</li>
		<li>点击 开始录制 按钮。</li>
		<li>单击 校准 按钮并指示参与者根据分步校准程序执行（参见 补充图 1）。 注意： 表 1 中列出了校准分步程序。在校准过程中，应打开远程呼叫系统，以便指导参与者按照医生的指示进行操作。</li>
	</ol></li>
	<li>整夜收集数据<ol><li>整晚将导数保持在正确的位置。 注意：这将由值班技术人员完成。值班技术人员应接受过哮喘、不稳定型心绞痛等疾病的应急管理培训。</li>
	</ol></li>
	<li>后校准<ol><li>唤醒参与者并打开睡眠监测室的灯。</li>
		<li>起床时间通常是早上 6：00。如果参与者在早上 6：00 之前醒来并且不想继续，请停止监控。</li>
		<li>如果参与者在上午 6：00 处于快速眼动 （REM） 睡眠期，请继续监测直到 REM 睡眠期结束。</li>
		<li>再次重复步骤 1.3.5 进行后校准。</li>
		<li>点击 关闭 按钮停止录制。</li>
	</ol></li>
	<li>轻轻去除所有衍生物，以避免皮肤损伤。</li>
	<li>得分<ol><li>双击 ProFusion PSG4 按钮以启动评分系统。</li>
		<li>双击参与者的姓名以选择参与者。</li>
		<li>单击 Scoring 按钮，然后选择 Scoring Automatically 选项，以对睡眠阶段和觉醒进行评分。 注意：睡眠阶段和觉醒根据 AASM 睡眠和相关事件评分手册：规则、术语和技术规范18 进行评分。技术人员也可以手动修改评分。</li>
		<li>单击 Create 按钮并布局结果（图 5）。</li>
	</ol></li>
	<li>定义和方程<ol><li>根据 PSG 数据和波形（如 表 2 所示），获取变量，包括卧床时间 （TIB）、总睡眠时间 （TST）、睡眠潜伏期 （SL）、睡前觉醒 （WASO）、睡眠效率（SE，等于 TST/TB）和 REM 潜伏期。</li>
	</ol></li>
</ol>2. 使用认知筛查工具
<ol><li>双击 THINC-it 按钮，在计算机上启动软件，输入个人信息，并指导参与者逐步完成每个子测试。<ol><li>单击 Chinese 按钮以选择简体中文版本。</li>
		<li>单击 加 按钮以添加新参与者。</li>
		<li>在相应的空白处输入姓名、年龄、性别、惯用手、教育水平和位置。</li>
		<li>单击 BEGIN TEST 按钮逐步开始子测试（参见 补充图 2）。</li>
	</ol></li>
	<li>完成感知缺陷问卷（PDQ-5，主观认知缺陷）。<ol><li>大声朗读“在过去 7 天内，您多久一次难以组织事情”，并指导参与者选择 5 个回答选项之一：过去 7 天内从不、很少（一次或两次）、有时（3 - 5 次）、经常（大约每天一次）和非常频繁（每天一次以上）。</li>
		<li>大声朗读“在过去 7 天内，您多久难以集中精力阅读的内容”， 并指导参与者从步骤 2.2.1 中描述的 5 个回答选项中选择一个。</li>
		<li>大声朗读“在过去 7 天内，除非您查阅，否则您多久忘记一次日期”， 并指示参与者从步骤 2.2.1 中描述的 5 个回答选项中选择一个。</li>
		<li>大声朗读“在过去 7 天内，您多久忘记一次电话交谈后所说的内容”， 并指示参与者从步骤 2.2.1 中描述的 5 个回答选项中选择一个。</li>
		<li>大声读出：「在过去的 7 天里，你多久觉得自己的大脑完全空白了？」 并指示参与者从步骤 2.2.1 中描述的 5 个响应选项中选择一个。</li>
		<li>单击 OK 按钮开始其他子测试。</li>
	</ol></li>
	<li>完成观察者测试（SPO，注意力反射）。<ol><li>点击 教程 按钮和 下一步 按钮阅读分步说明。</li>
		<li>单击 Start （开始） 按钮开始 SPO 测试。 注意：SPO 测试用于评估注意力;参与者需要尽快触摸突然出现的符号。 注意：该软件将自动在屏幕上显示最佳反应时间（毫秒）、正确响应、最长连胜和索引。</li>
		<li>单击 OK 按钮开始下一个子测试。</li>
	</ol></li>
	<li>完成符号检查测试（SC，工作记忆的反射）。<ol><li>单击 Tutorial 和 Next 按钮阅读分步说明。</li>
		<li>点击 Start 开始 按钮开始 SC 测试。 注意：SC 测试用于评估工作记忆。参与者需要在计时器用完之前识别隐藏的符号，并调用下一个隐藏的符号。该软件将自动在屏幕上显示 最快反应时间（毫秒）、正确答案、最长连胜 和 索引 。</li>
		<li>单击 OK 按钮开始下一个子测试。</li>
	</ol></li>
	<li>完成密码破译器测试（CB，反映信息处理速度）。<ol><li>单击 Tutorial 和 Next 按钮阅读分步说明。</li>
		<li>点击 Start 开始 按钮开始 CB 测试。 注意：CB 测试用于评估信息处理速度。参与者需要点击正确的符号以适合指定的圆圈（每个符号都被标识为圆圈内的某个数字）。该软件将在屏幕上自动显示 最快反应时间（毫秒）、正确的节点、最长的条纹以及 索引 。</li>
		<li>点击 OK 按钮进入下一个子测试。</li>
	</ol></li>
	<li>完成 TMT-B（轨迹，执行功能的反映）。<ol><li>单击 Tutorial 和 Next 按钮阅读分步说明。</li>
		<li>点击 Start 开始 按钮开始 CB 测试。 注意：Trails 测试用于评估执行功能。参与者需要在不抬起手指的情况下从一个字符开始画一条线到数字 1，然后从数字 1 继续到另一个字符，然后从这个字符继续到数字 2，一直持续到数字 9，尽可能快。该软件会自动在屏幕上显示 完成时间（毫秒）、错误、最长条纹和索引。</li>
		<li>单击 OK 按钮完成最后一个子测试。 注意：软件将自动显示参与者在每次测试中的表现;下载这些结果。</li>
	</ol></li>
</ol>3. 统计分析
<ol><li>使用学生 t 检验来评估组差异。执行 Pearson 相关性分析以评估睡眠质量与认知功能之间的关系。将 P < 0.05 视为具有统计显著性。 注：所有统计分析均使用 SPSS 25.0 版进行。</li>
</ol>

评估重度抑郁症患者的睡眠质量和认知功能

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作者没有什么可披露的。

这个由两部分组成的协议包含需要注意的关键步骤。对于 PSG 来说，得分是最重要的一步;因此，PSG 技术人员需要获得认证和经验。此外，在 PSG 之前，技术人员和参与者之间的沟通是必要的，因为患者在 PSG 期间可能会感到不舒服并退出。对于认知筛查工具，关键步骤是使用数字化设备评估认知功能。医生需要逐步介绍这些程序，以确保参与者理解它们。此外，如果参与者表现不佳是由于不熟悉?...

重度抑郁症 （MDD） 是一种严重的情绪障碍，会导致严重的发病率和死亡率，影响全球超过 3 亿人1。MDD 的特征是情绪低落、驱动力减退、失去兴趣以及自残或自杀的想法2。认知症状和睡眠障碍 （SD） 是 MDD 的两种非情绪相关症状 3,4。先前的研究表明，MDD 患者 SD 的患病率为 60-90%，而中国人群中这些患者的睡眠障碍患病率为 85.22%5。
尽管很少有研究调查认知症状与 SD 之间的因果关系，但初步证据表明 MDD6 个体的睡眠障碍与认知症状之间存在显着关联。例如，Cha 等人 3 发现，主观睡眠质量可以预测主观认知表现和客观认知障碍，这部分是由抑郁严重程度介导的。Biddle 等人 7 还发现，在患有 MDD 的老年男性中，通过活动记录仪测量的睡眠效率 （SE） 不佳与认知功能较差相关，与抑郁严重程度无关。观察到的差异可能是由方法学差异引起的。 
在这些文献中，研究人员使用了各种工具来评估睡眠和认知。匹兹堡睡眠质量指数 （PSQI） 通常被选为主观工具。还使用了体动图设备。然而，PSG 被认为是检测睡眠障碍8 （sleep disorders） 的金标准，是一种敏感、客观的 SD 评估9。据我们所知，在关于 MDD 患者睡眠与认知之间关系的研究中，很少有人使用 PSG 来评估睡眠质量。
MDD 中的认知症状可能是多维的，在某些情况下通过新的药理学策略来解决10,11。近年来出现了几种适用于 MDD 的认知评估工具12。THINC集成工具（THINC-it，以下简称认知筛查工具）是由Hou et al.13开发的经过验证的认知筛查工具，由一份主观问卷（感知缺陷问卷，PDQ-5）和四项客观认知测试（选择反应时间、1-back、数字符号替换和Trail making part-B）组成。它被认为是检测 MDD14 患者认知缺陷的一种省时、可接受的方法。还有另外两种常用工具用于评估 MDD 患者的认知功能：精神病学认知障碍筛查 D （SCIP-D） 和双相情感障碍评定中的认知主诉 （COBRA）12。前者是缺乏自我指导测试的客观工具，后者是缺乏客观版本的主观工具。这些工具之间的构成测试也有所不同。SCIP-D 由五个客观测试组成：语言学习、工作记忆、语言流利度、延迟记忆和处理速度。COBRA 包括执行功能、处理速度和注意力、语言学习和记忆以及视觉记忆12。最近开发的中文版认知筛查工具已被证实是评估中国 MDD15 患者认知缺陷的良好工具。因此，使用认知筛查工具软件和 PSG，目前的研究试图揭示 MDD 患者认知症状与 SD 之间的关系。

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			<td>Compumedics</td>
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association between sleep quality and cognitive symptoms in patients with major depressive disorder

认知症状和睡眠障碍 （SD） 是重度抑郁症 （MDD） 的常见非情绪相关症状。在临床实践中，认知症状和 SD 都与 MDD 进展有关。然而，只有少数研究调查了 MDD 患者认知症状与 SD 之间的联系，并且只有初步证据表明情绪障碍患者的认知症状与 SD 之间存在显着关联。本研究调查了重度抑郁症患者的认知症状与睡眠质量之间的关系。纳入 MDD 患者 （n = 20）;他们的平均汉密尔顿抑郁量表 17 评分为 21.95 （±2.76）。使用金标准多导睡眠图 （PSG） 评估睡眠质量，并使用经过验证的 THINC 集成工具 （认知筛查工具） 评估 MDD 患者的认知功能。总体而言，结果显示认知筛查工具的总分与睡眠潜伏期、睡后觉醒和睡眠效率之间存在显着相关性。这些发现表明，认知症状与 MDD 患者的睡眠质量差有关。

参与者的男女比例为 11/9。所有个体的年龄在 35.35 ± 6.83 岁之间，受教育程度在 14.80 ± 3.29 岁之间，汉密尔顿抑郁量表-17 （HAMD-17） 评分为 21.95 分± 2.76 分，SE 为 76.71 ± 8.57%。关于认知筛查工具得分，PDQ-5、SPO、SC、CB、TMT-B 和总分分别为 1756.35 ± 395.49、2046.75 ± 684.45、852.15 ± 651.81、845.75 ± 641.15、911.45 ± 619.13 和 4140.80 ± 1298.14 分（表 2）。
图 5</stron...

Read this Scientific Article Protocol about Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression at JoVE.com

作者聚焦：揭示睡眠障碍与抑郁症认知症状之间的联系

在这里，我们提出了一个方案，用于调查重度抑郁症患者认知症状与睡眠质量之间的关系。使用 THINC 集成工具和多导睡眠图评估认知症状和睡眠质量。

重度抑郁症患者睡眠质量与认知症状的相关性

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both ...

在这项研究中，金标准多导睡眠图用于评估睡眠质量，经过验证的认知筛查工具用于评估重度抑郁症患者的认知功能。思考最近开发的中文版连接筛查工具已被证实是评估中国重度抑郁症患者结缔缺陷的良好工具。目前的研究揭示了重度抑郁症患者的认知症状与睡眠障碍之间的密切关系。

association-between-sleep-quality-cognitive-symptoms-patients-with

Research

JoVE Journal

Medicine

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

525 次观看.  Sleep Medicine Center of Inner Mongolia Mental Health Center (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region). 在这项研究中，金标准多导睡眠图用于评估睡眠质量，经过验证的认知筛查工具用于评估重度抑郁症患者的认知功能。思考最近开发的中文版连接筛查工具已被证实是评估中国重度抑郁症患者结缔缺陷的良好工具。目前的研究揭示了重度抑郁症患者的认知症状与睡眠障碍之间的密切关系。

视频: 作者聚焦：揭示睡眠障碍与抑郁症认知症状之间的联系

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.
Method:
Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.
Results:
Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.
Conclusions:
The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

This video demonstrates a novel capsulorhexis technique in modern cataract surgery. Capsulorhexis is the most difficult and important part of phacoemulsification surgery.

一种新型撕囊技术，使用剪切力与Cystotome

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye....

科研

医学

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment (RMCA) in Individuals with Chronic Spinal Cord Injury

During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination is disrupted by spinal cord injury (SCI), control of respiratory muscles innervated below the injury level is compromised1,2 leading to respiratory muscle dysfunction and pulmonary complications. These conditions are among the leading causes of death in patients with SCI3. Standard pulmonary function tests that assess respiratory motor function include spirometrical and maximum airway pressure outcomes: Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Maximal Inspiratory Pressure (PImax) and Maximal Expiratory Pressure (PEmax)4,5. These values provide indirect measurements of respiratory muscle performance6. In clinical practice and research, a surface electromyography (sEMG) recorded from respiratory muscles can be used to assess respiratory motor function and help to diagnose neuromuscular pathology. However, variability in the sEMG amplitude inhibits efforts to develop objective and direct measures of respiratory motor function6. Based on a multi-muscle sEMG approach to characterize motor control of limb muscles7, known as the voluntary response index (VRI)8, we developed an analytical tool to characterize respiratory motor control directly from sEMG data recorded from multiple respiratory muscles during the voluntary respiratory tasks. We have termed this the Respiratory Motor Control Assessment (RMCA)9. This vector analysis method quantifies the amount and distribution of activity across muscles and presents it in the form of an index that relates the degree to which sEMG output within a test-subject resembles that from a group of healthy (non-injured) controls. The resulting index value has been shown to have high face validity, sensitivity and specificity9-11. We showed previously9 that the RMCA outcomes significantly correlate with levels of SCI and pulmonary function measures. We are presenting here the method to quantitatively compare post-spinal cord injury respiratory multi-muscle activation patterns to those of healthy individuals.

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment RMCA in Individuals with Chronic Spinal Cord Injury

The purpose of this publication is to present our original work on a multi-muscle surface electromyographic approach to quantitatively characterize respiratory muscle activation patterns in individuals with chronic spinal cord injury using vector-based analysis.

评价呼吸肌慢性脊髓损伤个人使用呼吸电机控制评估（RMCA）

During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination ...

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 ...

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic conditions. As part of a diagnostic assessment, the early detection of postural deficits is important so that appropriate and targeted interventions can be prescribed. The Sensory Organization Test (SOT) on the EquiTest determines an individual&#39;s use of the sensory systems (somatosensory, visual, and vestibular) that are responsible for postural control. Somatosensory and visual input are altered by the calibrated sway-referenced support surface and visual surround, which move in the anterior-posterior direction in response to the individual&#39;s postural sway. This creates a conflicting sensory experience. The Motor Control Test (MCT) challenges postural control by creating unexpected postural disturbances in the form of backwards and forwards translations. The translations are graded in magnitude and the time to recover from the perturbation is computed.
Intermittent claudication, the most common symptom of peripheral arterial disease, is characterized by a cramping pain in the lower limbs and caused by muscle ischemia secondary to reduced blood flow to working muscles during physical exertion. Claudicants often display poor balance, making them susceptible to falls and activity avoidance. The Ankle Brachial Pressure Index (ABPI) is a noninvasive method for indicating the presence of peripheral arterial disease and intermittent claudication, a common symptom in the lower extremities. ABPI is measured as the highest systolic pressure from either the dorsalis pedis or posterior tibial artery divided by the highest brachial artery systolic pressure from either arm. This paper will focus on the use of computerized dynamic posturography in the assessment of balance in claudicants.

Individuals with intermittent claudication exhibit poor balance compared to healthy controls. Computerized dynamic posturography is an objective method for measuring an individual's postural responses to balance disturbances. This provides an objective reflection of the person&#x2019;s ability to respond to situations under which sensory stimuli are altered and unexpected perturbations occur.

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

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

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

血管功能在慢性肾脏疾病的评估

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

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-rTMS work should include sham-controlled studies to confirm its clinical efficacy in MDD.

Here we outline the procedure for MRI-guided repetitive transcranial magnetic stimulation to the dorsomedial prefrontal cortex as an experimental treatment for major depressive disorder.

MRI引导dmPFC-rTMS治疗作为治疗难治性抑郁症

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial ...

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

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

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

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

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

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in obstructive sleep apnea (OSA). Target-controlled infusion (TCI) of the sedative propofol was combined with real-time monitoring of the depth of sedation using bispectral analysis.
In an observational study 57 patients (mean age 44.8 years, &#177; SD 10.5; mean apnea hypopnea Index (AHI) 30.8/hr, &#177; SD 21.6, mean BMI 28.2 kg/m2, &#177; SD 5.3) underwent cardiorespiratory polysomnography followed by DISE with TCI and bispectral analysis. Sleep was induced solely by the intravenous infusion of propofol with a TCI-pump, with an initial target plasma level of 2.0 &#181;g/ml. Under continuous monitoring of the patient&#39;s respiration, state of consciousness and value of the bispectral analysis, the target plasma propofol level was raised in steps of 0.2 &#181;g/ml/2 min until the desired depth of sedation was reached. The mean value of the bispectral analysis at the target depth of sedation was determined and the obstruction patterns during DISE-TCI-bispectral analysis then classified according to the VOTE-system. Subsequently the results were analyzed according to polysomnographic and anthropometric data. The occurrence of multilevel obstruction sites across all degrees of severity of OSA clarifies the need for sleep endoscopy prior to upper airway surgery.
The advantage of this technique is the reproducibility of the protocol even for heterogeneous groups of patients. In addition, the gradual controlled and standardized increase of the plasma level of propofol with real-time control of the bispectral index leads to a precisely controllable depth of sedation. The DISE-TCI-bispectral analysis procedure is a step towards a required reproducible protocol of sleep endoscopy &#8212; capable of standardization. However it is not yet known whether these observed obstruction patterns also correspond to findings in natural sleep.

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

The aim of this study was to establish a standardized protocol for sleep endoscopy to differentiate obstruction patterns in obstructive sleep apnea (OSA). Target-controlled infusion (TCI) of the sedative was combined with real-time monitoring of the depth of sedation using bispectral analysis.

药物引起的与靶控输注（TCI）和双频分析阻塞性睡眠呼吸暂停睡眠内窥镜（DISE）

The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in ...

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of disorders of consciousness, disrupted higher brain function, and verbal disturbances. As a consequence of an insufficient ability to communicate, objective evaluations are needed from family members, medical staff, and caregivers. One such evaluation is the assessment of functioning brain areas. Recently, multimodal brain imaging has been used to explore the function of damaged brain areas. [18F]-fluorodeoxyglucose positron emission tomography-computed tomography ([18F]FDG-PET/CT) is a successful tool for examining brain function. However, the assessment of brain glucose metabolism based on [18F]FDG-PET/CT is not standardized and depends on several varying parameters, as well as the patient&#39;s condition. Here, we describe a series of semiquantitative assessment protocols for a region-of-interest (ROI) image analysis using self-produced [18F]FDG tracers in patients with sTBI. The protocol focuses on screening the participants, preparing the [18F]FDG tracer in the hot lab, scheduling the acquisition of [18F]FDG-PET/CT brain images, and measuring glucose metabolism using the ROI analysis from a targeted brain area.

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

[18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography is useful for studying glucose metabolism related to brain function. Here, we present a protocol for an [18F]FDG tracer set-up and semiquantitative assessment of the region-of-interest analysis for targeted brain areas associated with clinical manifestations in patients with severe traumatic brain injury.

[18f] fdg 示踪剂在重型颅脑损伤患者中的半定量评价

Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of ...

Using a Chemical Biopsy for Graft Quality Assessment

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

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

使用化学活检进行移植质量评估

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