1. Fallbericht <ol><li> Der Patient wird für einen Besuch in der gynäkologischen Klinik, die häufig durch das Auftreten von Blutungsstörungen gesetzt. Eine körperliche Untersuchung durchgeführt wird. <ol><li> Wenn als angemessen erachtet, wird der Patient für eine Hysterektomie geplant. Der Papierkram ist bereit, und der Patient wird die Prämedikation für den Tag der Operation gegeben. </li><li> Patienten 60 Jahre und älter müssen zunächst Blutproben und überwacht Elektrokardiographie (oder EKG) vor dem Eingriff. </li></ol></li><li> Am Tag der Operation wird der Patient nicht erlaubt, etwas durch den Mund verbrauchen sechs Stunden vor der Aufnahme. <ol><li> Eine Ausnahme gilt für süße klare Getränke ohne Fruchtfleisch, die bis 2 Stunden erlaubt sind vor Aufnahme gemacht. </li><li> Der Patient nimmt die Prämedikation (t.Paracetemol 1 g + 300 mg + t.Etodolac t.Dexamethason 8 mg) mit dem letzten Drink. </li></ol></li><li> Der Patient wird App zugelassen. eine Stunde vorder geplante Zeitpunkt der Operation. <ol><li> Die Stationsschwester erste bereitet den Patienten für die Chirurgie. </li><li> Der Anästhesist untersucht den Patienten und bereitet die Papiere für die Anästhesie. </li></ol></li><li> Wenn die OP vorbereitet und das Team ist bereit, transportiert der Gynäkologe die Patientin in den Operationssaal. <ol><li> Der Patient liegt auf dem OP-Tisch und wird mit einem chirurgischen Decke. </li><li> Einen Infusionsschlauch, der in der linken Hand angeordnet und 1.000 ml Kochsalzlösung wird gestartet. Überwachungseinrichtung angeschlossen ist. </li><li> Anästhesie mit Propofol und Remifentanil induziert bis Loss Of Consciousness (LOC) auftritt, und gepflegt mit TOF. </li><li> Zur Erleichterung der Intubation wird eine geringe Dosis von Rocuronium (15 mg) verabreicht. </li><li> Direkte Laryngoskopie durchgeführt wird. Wenn es schwierig ist, die Stimmbänder visualisieren, wird die McGrath videolaryngoscop verwendet. Intubation wird anschließend durchgeführt. </li></ol></li><li> Insufflationdes Abdomens wird auf 12 mm Hg CO 2 gestartet. <ol><li> Die Öffnungen befinden. </li><li> Das Verfahren wird gestartet. </li><li> Die Chirurgen gesagt, wenn Train Of Four (TOF)-Verhältnis&gt; 90%, entsprechend der neuromuskulären Blockade ist entwöhnt ist. </li><li> Am Hals des Greifers der Abstand von der Kap auf die Oberfläche der Haut an den Nabel markiert ist. </li><li> Der Greifer ist auf dem OP-Tisch gelegt. Mit Maßband, wird der Abstand zwischen dem Ende des Greifers und dem Hals des Greifers (bei Chirurgen Finger) markiert und dann berechnete Abstand in Zentimetern gemessen. </li></ol></li><li> Die Insufflationen Druck von CO 2 auf 8 mm Hg gesenkt. <ol><li> Am Hals des Greifers der Abstand von der Kap auf die Oberfläche der Haut an den Nabel markiert ist. </li><li> Der Greifer wird am Tisch platziert. Mit Maßband die markierte Strecke wird Zentimetern interpretiert. </li></ol></li><li&gt; CO 2 Insufflation Druck auf 12 mm Hg eingestellt. <ol><li> Tief neuromuskuläre Blockade mit einem Beitrag Tetanische Count (PTC) &lt;2 angelegt. </li><li> Am Hals des Greifers der Abstand von der Kap auf die Oberfläche der Haut an den Nabel markiert ist. </li><li> Der Greifer wird am Tisch platziert. Mit Maßband die markierte Strecke wird Zentimetern gemessen. </li></ol></li><li> CO 2 Einblasdruckes auf 8 mm Hg verringert. <ol><li> Am Hals des Greifers der Abstand von der Kap auf die Oberfläche der Haut an den Nabel markiert ist. </li><li> Am Hals des Greifers der Abstand von der Kap auf die Oberfläche der Haut an den Nabel markiert ist. </li></ol></li><li> Das Verfahren ist beendet. <ol><li> Infusionen von Propofol und Remifentanil sind beendet. </li><li> Der Patient wird geweckt und zog nach seinem Bett. </li><li> Der Patient wird in den Aufwachraum übertragen. </li></ol&gt; </li></ol>

<ol>
	<li>Jones, R. K., Caldwell, J. E., Sorin, C. B., Brull, J., Soto, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reversal+of+Profound+Rocuronium-induced+Blockade+with+Sugammadex.">Reversal of Profound Rocuronium-induced Blockade with Sugammadex.</a> Anesthesiology. 109, 816-824 (2008).</li><li>Berg, H., Roed, J., Viby-Mogensen, J., Mortensen, C. R., Enfbaek, J., Skovgaard, L. T., Krintel, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+neuromuscular+block+is+a+risk+factor+for+post-operative+pulmonary+complications:+A+prospective,+randomized,+and+blinded+study+of+postoperative+pulmonary+complications+after+atracurium,+vecuronium+and+pancuronium.">Residual neuromuscular block is a risk factor for post-operative pulmonary complications: A prospective, randomized, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium.</a> Acta Anaesthesiol. Scand. 41, 1095-1103 (1997).</li><li>Abrishami, A., Ho, J., Wong, J., Yin, L., Chung, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sugammadex,+a+selective+reversal+medication+for+preventing+postoperative+residual+neuromuscular+blockade.">Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.</a> The Cochrane Collaborations. , (2009).</li><li>Plaud, B., Debaene, B., Donati, F., Marty, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+Paralysis+after+Emergence+from+Anesthesia.">Residual Paralysis after Emergence from Anesthesia.</a> Anesthesiology. 112, 1013-1022 (2010).</li><li>Lee, D. W., Kim, M. J., Lee, Y. K., Lee, H. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+Intraabdominal+Pressure+Affect+Development+of+Subcutaneous+Emphysema+at+Gynecologic+Laparoscopy?.">Does Intraabdominal Pressure Affect Development of Subcutaneous Emphysema at Gynecologic Laparoscopy?.</a> Minimally Invasive Gynecology. , 761-765 (2011).</li><li>Sandhu, T., Yamada, S., Ariyakachon, V., Chakrabandhu, T., Chongruksut, W., Ko-iam, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low-pressure+pneumoperitoneum+versus+standard+pneumoperitoneum+in+laparoscopic+cholecystectomy,+a+prospective+randomized+clinical+trial.">Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial.</a> Surg. Endosc. 23, 1044-1047 (2009).</li><li>Sarli, L., Coisti, R., Sansebastiano, G., Trivelli, M., Roncoroni, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+randomized+trial+of+low-pressure+pneumoperitoneum+for+reduction+of+shoulder-tip+pain+following+laparoscopy.">Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.</a> British Journal of Surgery. 87, 1161-1165 (2000).</li><li>Kandil, T. S., El Hefnawy, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shoulder+pain+following+laparoscopic+cholecystectomy:+factors+affecting+the+incidence+and+severity.">Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity.</a> J. Laparoendosc. Adv. Surg. Tech. A. 8, 677-682 (2010).</li><li>Mulier, J. P., Dillemans, B. R. S., Crombach, M., Missant, C., Sels, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+the+abdominal+pressure+volume+relationship.">On the abdominal pressure volume relationship.</a> The internet Journal of Anesthesiology. 21, (2009).</li><li>Srvastava, A., Niranjan, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Secrets+of+safe+laparoscopic+surgery:+Anaesthetic+and+surgical+considerations.">Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations.</a> J. Minim. Access. Surg. 6, 91-94 (2010).</li><li>Grosse-Sundrup, M., Henneman, J. P., Sandberg, W. S., Bateman, B. T., Uribe, J. V., Nguyen, N. T., 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=Intermediate+acting+non-depolarizing+neuromuscular+blocking+agents+and+risk+of+postoperative+respiratory+complications:+prospective+propensity+score+matched+cohort+study.">Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study.</a> BMJ. 345, e6329 (2012).</li><li>Kaneko, G., Miyajima, A., Yazawa, S., Yuge, K., Kikuchi, E., Asanuma, H., Nakagawa, K., Oya, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+the+predictor+of+prolonged+operative+time+during+laparoscopic+radical+prostatectomy?.">What is the predictor of prolonged operative time during laparoscopic radical prostatectomy?.</a> Int. J. Urol. 20 (3), 330-336 (2012).</li><li>Drahonovsky, J., Haakova, L., Otcenasek, M., Krofta, L., Kucera, E., Feyereisl, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+randomized+comparison+of+vaginal+hysterectomy,+laparoscopically+assisted+vaginal+hysterectomy,+and+total+laparoscopic+hysterectomy+in+women+with+benign+uterine+disease.">A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease.</a> Eur. J. Obstet. Gynecol. Reprod. Biol. 148 (2), 172-176 (2010).</li></ol>

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<html> Direkt Berechnung des Arbeitsvolumens für laparoskopische Chirurgie ist schwierig, aber die Beziehung zwischen Insufflieren CO 2-Druck-und Bauch-Volumen ist leichter zu messen 9. Hier stellen wir ein Verfahren, um die chirurgischen Greifers zu verwenden, um den Raum innerhalb des Bauches schätzen während Insufflation, als eine Alternative zu dem Verfahren zum Aufzeichnen des Volumens insufflierten CO 2. Diese Messungen haben gezeigt, dass es möglich ist, eine...

Neuromuskuläre Blocker werden üblicherweise zur Intubation zu erleichtern, und, während der Narkose, die Operation zu erleichtern. Die Verwendung von pharmakologischen Mitteln zu einer tiefen Entspannung während der laparoskopischen Verfahren erzielen lässt der Chirurg entweder auf dem gleichen Niveau von CO 2 Insufflation gehen und nutzen sie besser chirurgischen Bedingungen oder Absenken des Einblasens von Druck, um das Risiko von chirurgischen Komplikationen zu verringern. Mehrere Studien haben die positive Wirkung der Absenkung der Betriebsdruck 5,6,7 gezeigt. Ein Symptom, das oft nach einer laparoskopischen Hysterektomie gesehen wird, Schulterschmerzen, die oft als ein großes Problem und die wichtigste Frage wird festgestellt, wenn man mit dem Patienten Follow-up. 8 Laproscopic myomectomy oder Hysterektomie wird in der Regel empfohlen, wenn konservative Methoden, um die Symptome von Uterusmyomen verursacht Kontrolle scheitern. An unserer Hochschule sind diese Verfahrendurchgeführt bei einer Insufflation CO 2-Druck von 12 mm Hg. Es gibt zwei sehr erfahrenen Gynäkologen Durchführung aller gynäkologischen Fällen. Alle unsere Fälle sind narkotisiert mit Propofol und Remifentanil und Intubation wird oft mit einer niedrigen Dosis von Rocuronium (15 mg) erleichtert. Aus unserer täglichen klinischen Arbeit haben wir Schulterschmerzen als einer der am meisten störenden Nebenwirkungen nach einer laparoskopischen Hysterektomie, die von der Literatur 8 unterstützt wird identifiziert. Studien haben gezeigt, dass die Verringerung der intraabdominellen Druck kann auch die Schmerzen in der Schulter. In dem Bemühen, die CO 2-Insufflation Druck zu reduzieren, war eines unserer Anliegen vor, wenn das OP-Feld und Sichtbarkeit während des Verfahrens beeinträchtigen würde. Der Versuch, den Überblick während des Verfahrens zu ermitteln, haben wir eine Methode, um den intraabdominalen Arbeitsraum zu vergleichen. Allerdings kann es sehr schwierig, die genaue intraabdominalen Volumen innerhalb eines Patienten während sur überwachenGery. In einer belgischen Studie wurde die Volumen-Druck-Beziehung beschrieben worden, aber die Autoren der Studie festgestellt, dass es große individuelle Unterschiede zwischen 9. Um eine zuverlässige Aussage des intraabdominellen Raum zu erhalten, verwenden wir den Abstand von der Landzunge auf der Haut als Metrik.

deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy

Schulterschmerzen ist eine häufig berichtete Symptom nach laparoskopischen Eingriffen wie Hysterektomie oder myomectomy, und neuere Studien haben gezeigt, dass eine Senkung der Insufflationsdruck während der Operation kann das Risiko von postoperativen Schmerzen zu reduzieren. In dieser Pilotstudie wird ein Verfahren zum Messen des intraabdominalen Platz für den Chirurgen während laproscopy dargestellt, um zu prüfen, ob die Entspannung durch tiefe neuromuskuläre Blockade erzeugt kann die Arbeitszeit chirurgischen Raum ausreichend zu erhöhen, um eine Verringerung des CO 2 zu ermöglichen Insufflationsdruck. 8 mm Hg und 12 mm Hg: Verwenden der laparoskopischen Greifer wird der Abstand von der Kap auf die Haut an zwei verschiedenen Drücken gemessen Insufflation. Nach den ersten Messungen eine neuromuskuläre Blockierungsmittel (Rocuronium) wird dem Patienten verabreicht, und die intra-abdominale Volumen erneut gemessen. Pilot-Daten von 15 Patienten gesammelt zeigt, daß die intra-abdominale Raum mit 8 mm Hg mit blockade ist vergleichbar mit dem intra-abdominalen Raum bei 12 mm Hg ohne Blockade gemessen. Die Auswirkungen der neuromuskulären Blockade war nicht mit Patienten Körpergröße, Gewicht, BMI und Alter korreliert. So kann mit neuromuskulären Blockade zu einem stetigen Volumen zu halten bei gleichzeitiger Reduzierung Insufflationsdruck produzieren verbesserte Behandlungsergebnisse.

Das Pilot-Studie mit 15 Patienten durchgeführt, um die Auswirkungen der tiefen neuromuskulären Blockade während der laparoskopischen Chirurgie zu bewerten. Die hier dargestellten Methode wurde verwendet, um Messungen der intra-abdominalen Raum in Patienten in der laparoskopischen Hysterektomie (Abbildung 1) zu erhalten. 12 mm Hg Druck ohne tiefe neuromuskuläre Blockade, 12 mm Hg mit Blockade, 8 mm Hg ohne Blockade und 8 mm Hg mit Blockade: In jedem Patienten wurden Messu...

Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Dieser Artikel stellt eine Methode zur Messung der Lautstärke während der Arbeitszeit Bauch laproscopic myomectomy mit der chirurgischen Greifers und wendet diese Technik, um Pilot-Daten, ob tiefe neuromuskuläre Blockade (NMB) kann die Verwendung von niedrigeren Insufflationsdruck ermöglichen zu erhalten. Reduzierte Insufflationsdruck während laproscopic Chirurgie hat sich gezeigt, um postoperative Schmerzen zu reduzieren und somit die Verwendung von NMB während der Operation kann verbessert Behandlungsergebnisse ermöglichen.

Tief neuromuskuläre Blockade führt zu einer größeren Intraabdominelle Volume Während Laparoskopie

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

deep-neuromuscular-blockade-leads-to-larger-intraabdominal-volume

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13.0K Aufrufe.  Aleris-Hamlet Hospitals, Soeborg, Denmark. Dieser Artikel stellt eine Methode zur Messung der Lautstärke während der Arbeitszeit Bauch laproscopic myomectomy mit der chirurgischen Greifers und wendet diese Technik, um Pilot-Daten, ob tiefe neuromuskuläre Blockade (NMB) kann die Verwendung von niedrigeren Insufflationsdruck ermöglichen zu erhalten. Reduzierte Insufflationsdruck während laproscopic Chirurgie hat sich gezeigt, um postoperative Schmerzen zu reduzieren und somit die Verwendung von NMB während der...

Serie: Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

Intra-Operative Behavioral Aufgaben in Awake Humans Undergoing Deep Brain Stimulation Chirurgie

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

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Medizin

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic efficacy. Since patient pain patterns can be unique, a common stimulation configuration is the placement of two leads in parallel in the dorsal epidural space. This construct provides flexibility in steering stimulation current mediolaterally over the dorsal column to achieve better pain-paresthesia overlap. Using a mathematical model with an accurate fiber diameter distribution, we studied the ability of dual parallel leads to steer stimulation between adjacent contacts on dual parallel leads using (1) a single source system, and (2) a multi-source system, with a dedicated current source for each contact. The volume conductor model of a low-thoracic spinal cord with epidurally-positioned dual parallel (2 mm separation) percutaneous leads was first created, and the electric field was calculated using ANSYS, a finite element modeling tool. The activating function for 10 um fibers was computed as the second difference of the extracellular potential along the nodes of Ranvier on the nerve fibers in the dorsal column. The volume of activation (VOA) and the central point of the VOA were computed using a predetermined threshold of the activating function. The model compared the field steering results with single source versus dedicated power source systems on dual 8-contact stimulation leads. The model predicted that the multi-source system can target more central points of stimulation on the dorsal column than a single source system (100 vs. 3) and the mean steering step for mediolateral steering is 0.02 mm for multi-source systems vs 1 mm for single source systems, a 50-fold improvement. The ability to center stimulation regions in the dorsal column with high resolution may allow for better optimization of paresthesia-pain overlap in patients.

Using a mathematical model of spinal cord stimulation, we found that a multi-source system with independent power sources for each contact can target more central points of stimulation on the dorsal column (100 vs 3) and has 50-fold more field steering resolution (0.02mm vs 1mm) than a single-source system.

Dorsal Column Lenkbarkeit mit Dual Parallel Leads mit Dedicated Power Sources: ein Rechenmodell

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

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

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

Mit Hilfe Transkranielle Magnetstimulation auf die menschliche neuromuskuläre System zu studieren

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

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

Bau von Dampfkammern verwendet, um Mäuse zu Alkohol Expose Während der Equivalent aller drei Trimester der Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

Klinische Bewertung der Spatiotemporal Gangparameter bei Patienten und ältere Erwachsene

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

Mit Saccadometry mit Deep Brain Stimulation Normale und Pathologische Funktion des Gehirns zu studieren

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure. At the same time, the recruitment of intrapulmonary arteriovenous anastomoses (IPAVA) during exercise may contribute to gas exchange impairment and/or prevent large increases in pulmonary artery pressure.
We describe two techniques to evaluate pulmonary diffusion and circulation at rest and during exercise. The first technique uses multiple-fraction of inspired oxygen (FIO2) DLCO breath holds to determine Vc and Dm at rest and during exercise. Additionally, echocardiography with intravenous agitated saline contrast is used to assess IPAVAs recruitment.
Representative data showed that the DLCO, Vc, and Dm increased with exercise intensity. Echocardiographic data showed no IPAVA recruitment at rest, while contrast bubbles were seen in the left ventricle with exercise, suggesting exercise-induced IPAVA recruitment.
The evaluation of pulmonary capillary blood volume, membrane diffusing capacity, and IPAVA recruitment using echocardiographic methods is useful to characterize the ability of the lung vasculature to adapt to the stress of exercise in health as well as in diseased groups, such as those with pulmonary arterial hypertension and chronic obstructive pulmonary disease.

To assess the pulmonary diffusion and vasculature responses to exercise, we describe the multiple-inspired oxygen diffusion capacity technique to determine capillary blood volume and membrane diffusing capacity, as well as agitated saline contrast echocardiography to assess the recruitment of intrapulmonary arteriovenous anastomoses.

Beurteilung der Lungen Kapillarblutentnahmesystem Volumen, Membrandiffusionskapazität und Intrapulmonale arteriovenöse Anastomosen während des Trainings

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

Laparoskopie-Endoskopie Kooperative Chirurgie zur Behandlung von Magen-Darm-Stromatumoren

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

Funktionsbeurteilung des Spenderherzens während der Ex-situ-Perfusion : Erkenntnisse aus Druck-Volumen-Schleifen und Oberflächenechokardiographie

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...

Using Nicotine in a Silica-Exposed Mouse Model to Promote Lung Epithelial-Mesenchymal Transition

Smoking and exposure to silica are common among occupational workers, and silica is more likely to injure the lungs of smokers than non-smokers. The role of nicotine, the primary addictive ingredient in cigarettes, in silicosis development is unclear. The mouse model employed in this study was simple and easily controlled, and it effectively simulated the effects of chronic nicotine ingestion and repeated exposure to silica on lung fibrosis through epithelial-mesenchymal transition in human beings. In addition, this model can help in the direct study of the effects of nicotine on silicosis while avoiding the effects of other components in cigarette smoke.
After environmental adaptation, mice were injected subcutaneously with 0.25 mg/kg nicotine solution into the loose skin over the neck every morning and evening at 12 h intervals over 40 days. Additionally, crystalline silica powder (1-5 &#181;m) was suspended in normal saline, diluted to a suspension of 20 mg/mL, and dispersed evenly using an ultrasonic water bath. The isoflurane-anesthetized mice inhaled 50 &#181;L of this silica dust suspension through the nose and were awoken via chest massage. Silica exposure was administrated daily on days 5-19.
The double-exposed mouse model was exposed to nicotine and then silica, which matches the exposure history of workers who are exposed to both harmful factors. In addition, nicotine promoted pulmonary fibrosis through epithelial-mesenchymal transformation (EMT) in mice. This animal model can be used to study the effects of multiple factors on the development of silicosis.

This study describes a mouse model to study the synergistic effect of nicotine on the progression of pulmonary fibrosis in experimental silicosis mice. The dual-exposure mouse model simulates the pathological progression in the lung after simultaneous exposure to nicotine and silica. The methods described are simple and highly reproducible.

Verwendung von Nikotin in einem Kieselsäure-exponierten Mausmodell zur Förderung des Übergangs von Lungenepithel zu mesenchym

Smoking and exposure to silica are common among occupational workers, and silica is more likely to injure the lungs of smokers than non-smokers. The role ...