Finanziamento sostegno del Motor Neuron Disease Research Institute of Australia (MNDRIA), Sylvia e Charles Viertel Charitable Foundation concessione Ricercatore Clinica, Fondazione Ramaciotti e National Health and Medical Research Council of Australia (codice di autorizzazione del progetto APP1024915) Si ringrazia.

1. Preparazione del paziente <ol><li> Reclutare i pazienti prospetticamente e consecutivamente. Nota: Il seguente protocollo è approvato dalle Sydney West Area Health Service Research comitati etici umani. Il consenso informato è stato fornito da tutti i pazienti. I pazienti sono stati reclutati prospetticamente e consecutivamente dalla clinica ALS / neuromuscolare a Westmead Hospital. </li><li> Determinare l&#39;idoneità dei pazienti con SLA per i test. Escludere i pazienti che non sono diagnosticati con SLA o un disturbo neuromuscolare. </li><li> Escludere pazienti con neuropatia focale coesistente, neuropatia mediano al polso o neuropatia ulnare al gomito. </li><li> Escludere pazienti con neuropatia generalizzata, come polineuropatia diabetica. </li><li> Ampiamente indagare e clinicamente i pazienti di follow-up per confermare la diagnosi di SLA o di disturbi neuromuscolari imitare. </li><li> Assicurarsi che il consenso informato è fornito da tutti i pazienti, compresi SLA e pazienti con disturbi neuromuscolari imitare, per all le procedure neurofisiologici. </li></ol> 2. La valutazione clinica <ol><li> Determinare la stadiazione clinica di tutti i pazienti affetti da SLA mediante la Sclerosi Laterale Amiotrofica Valutazione Funzionale Scale-Revised (ALSFRS-R), punteggio 18. </li><li> Determinare il tasso di progressione della malattia in tutti i pazienti ALS secondo la formula riportata in precedenza; (48-ALSFRS-R) / durata dei sintomi) 19. </li><li> Determinare la forza muscolare in tutti i pazienti che usano scala del Medical Research Council (MRC), valutazione 20. Sviluppare un punteggio totale MRC comprendente arto superiore (abduzione della spalla, del gomito in flessione, estensione del gomito, del polso flessione dorsale, dito rapimento, sequestro pollice, punteggio totale 60) e degli arti inferiori (flessione dell&#39;anca, estensione del ginocchio, flessione dorsale della tibiotarsica, punteggio totale 30) gruppi muscolari . Il punteggio totale MRC deve essere 90 se la forza muscolare è normale. </li><li> Determinare il sito di insorgenza della malattia, definita come bulbare o degli arti, in tutte le SLApazienti. </li></ol> 3. La valutazione neurofisiologica <ol><li> Intraprendere studi di conduzione dei nervi motori sulla mediana e nervi ulnare con un potenziale di azione muscolare composto (CMAP) le risposte registrate dal rapitore breve del pollice (APB), primo interosseo dorsale (FDI) e cifre Minimi rapitore (ADM) muscoli. </li><li> Preparare i siti stimolante al polso, pulendo la superficie della pelle con un gel abrasivo per ridurre la resistenza della pelle, seguito dall&#39;applicazione di un alcool pulire. Impostare la corrente di stimolazione al 20% sopra l&#39;intensità necessaria per produrre una risposta massima CMAP (corrente sovramassimale). </li><li> Assicurarsi che il sito di stimolazione selezionata presenta la soglia più bassa per la stimolazione tale che la conduzione volume è evitata. </li><li> Preparare sito di registrazione sopra ciascun muscolo pulendo la superficie della pelle con un gel abrasivo per ridurre la resistenza della pelle, seguito dall&#39;applicazione di un alcool pulire. </li><li> Registrare le dimensioni del motore Acti compostosul potenziale (CMAP) dalle APB, ADM, e gli IDE muscoli. Le risposte devono essere registrati da 10 millimetri elettrodi disco d&#39;oro posizionate in un accordo di pancia tendine sopra ogni muscolo. In particolare, posizionare l&#39;elettrodo attivo sul punto medio della rispettiva muscolare garantire un negativo decollo della risposta CMAP, mentre elettrodo di riferimento per essere posizionato sopra la base del pollice (APB e registrazioni IDE CMAP) e base di cifre 5 (per ADM registrazioni CMAP). </li><li> Impostare la distanza tra il catodo e l&#39;elettrodo stimolante attivo per APB e ADM dell&#39;atto motorio composto potenziali risposte a 5 cm e la distanza dal FDI a 8 cm. </li><li> Posizionare la piastra di terra neutra elettrobisturi sul dorso della mano, tra stimolante e G1 elettrodo con gel conduttivo per ridurre artefatti. Prima dell&#39;applicazione della terra neutro preparare il sito pulendo la superficie della pelle con un gel abrasivo per ridurre la resistenza della pelle, seguito dall&#39;applicazione di un alcool pulire. </li><li>Assicurarsi che le impostazioni del filtro sono compresi tra 3 Hz (filtro a bassa frequenza) e 10 KHz (filtro ad alta frequenza). </li><li> Assicurarsi che la velocità di scansione è impostato su 20 msec, o 2 msec / divisione. </li><li> Assicurarsi che la sensibilità per le risposte CMAP registrazione è impostato su 5 mV. </li><li> Controllo temperatura al sito di stimolazione durante lo studio e assicurarsi che la temperatura arto viene mantenuta a 32 ° C. </li></ol> 4. Analisi e interpretazione <ol><li> Misura di base-picco ampiezze CMAP (mV) sui muscoli APB, FDI e ADM nei pazienti affetti da SLA e le malattie neuromuscolari comandi mimici. </li><li> Calcolare l&#39;indice di divisione mano (Figura 1) moltiplicando l&#39;ampiezza CMAP registrata sui muscoli APB e gli IDE, e dividendo il prodotto per l&#39;ampiezza CMAP registrato sopra il muscolo ADM, come segue: SI = APB CMAP * FDI CMAP _________________________ &amp; #160; ADM CMAP </li><li> Determinare l&#39;utilità diagnostica dell&#39;indice mano divisa confrontando i valori SI tra i pazienti affetti da SLA e di disordine mimici controlli patologici neuromuscolari secondo gli standard di rendicontazione di accuratezza diagnostica (STARD) criteri. </li><li> Determinare ottimali valori di cutoff diagnostici per l&#39;indice di divisione mano utilizzando il ricevitore operativo caratteristico (ROC) curve. Derive curva ROC tracciando la sensibilità (asse y) e 1-specificty (asse x) per i valori SI derivati ​​da SLA e pazienti con disturbi neuromuscolari. </li></ol>

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Il presente studio riporta sulla utilità diagnostica dell&#39;indice scissione mano nella SLA, un romanzo biomarcatore diagnostico neurofisiologico. Il SI distingue in modo affidabile la SLA da malattie neuromuscolari, con un valore ottimale di cut-off diagnostico di 5.2. La riduzione del SI è più importante agli arti-insorgenza pazienti affetti da SLA. È importante sottolineare che una parte sostanziale di pazienti affetti da SLA che sono stati classificati nella categoria diagnostica &quot;possibile&quot; secondo ...

La mano divisa, si riferisce ad atrofia preferenziale del gruppo complesso tenare dei muscoli intrinseci della mano [adduttore breve del pollice (APB) e il primo interosseo dorsale (FDI)], con relativa conservazione dei muscoli ipotenar, ed è una caratteristica clinica specifica e precoce di amiotrofica sclerosi laterale (ALS) 1-4. La constatazione che il segno di divisione mano è specifico per la SLA, suggerisce un ruolo potenziale per il segno di divisione mano come un biomarcatore diagnostico in ALS 3. Quantificazione del segno di divisione mano, attraverso lo sviluppo di un nuovo biomarcatore neurofisiologico, può inoltre aiuti nella SLA diagnosi. In particolare, l&#39;indice di divisione mano (SI), che quantifica il fenomeno di divisione mano, è ottenuto moltiplicando il composto potenziale d&#39;azione muscolare (CMAP) Ampiezza registrati sui muscoli complessi tenare (APB e gli IDE), e dividendo il prodotto per l&#39;ampiezza CMAP registrato nel ipmuscoli othenar (vale a dire il mignolo rapitore, ADM) 5. La diagnosi di SLA si basa in gran parte su criteri basati clinicamente che comprende una combinazione di superiore e inferiore del motoneurone firma 6. Tali criteri, tuttavia, sono stati considerati insensibile soprattutto nello stabilire una diagnosi di SLA nelle prime fasi del processo patologico 7-10. Una recente modifica dei criteri diagnostici sono stati sviluppati 11, e sebbene questi criteri sembrano aumentare la sensibilità diagnostica 12-16, la sensibilità aumento sembra limitata a bulbare insorgenza ALS pazienti 15. In assenza di un test patognomonico, la diagnosi di SLA può ritardare significativamente 8. In definitiva, l&#39;istituzione di terapie neuroprotettive e il reclutamento negli studi clinici può essere ritardato, forse al di là del periodo critico finestra terapeutica 9, 17. Di conseguenza, lautilità diagnostica del SI è stato valutato in modo prospettico nei pazienti con SLA sporadica.

<table border="0" cellpadding="0" cellspacing="0">
	<colgroup>
		<col />
		<col />
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	</colgroup>
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:125px;"></td>
			<td style="width:120px;"></td>
			<td style="width:136px;"></td>
			<td style="width:203px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Abrasive gel (Nu Prep)</td>
			<td>Weaver and Company</td>
			<td>N-TA\/P\H-3 ENG</td>
			<td>Skin preperation</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td colspan="2">(www.doweaver.com)</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Alcohol wipe</td>
			<td>Triad Disposables</td>
			<td>103101</td>
			<td>Skin preperation</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td colspan="2">(www.triad-group.net)</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Recording gel (Ten20 Conductive gel)</td>
			<td>Weaver and Company</td>
			<td>N-TA\/P\H-3 ENG</td>
			<td>Recording motor responses</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td colspan="2">(www.doweaver.com)</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Amyotrophic lateral sclerosis rating scale-revised questionnaire</td>
			<td>Publication&#160;</td>
			<td>Experimental builder</td>
			<td>Stage disease</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td colspan="2">(see Methods and References)</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Medical Research Council muscle strength scale</td>
			<td>Medical Research Council-UK</td>
			<td>Experimental builder</td>
			<td>Stage disease</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td colspan="2">(see Methods and References)</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td colspan="2" height="20" style="height:20px;">Table of equipment used</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name of the equipment used</td>
			<td>Company</td>
			<td>Catalog number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Nerve conduction machine (Synergy/Nicolet EDX)</td>
			<td>CareFusion (www.carefusion.com/medical-products/neurology)</td>
			<td>SA110106M</td>
			<td>To measure split hand index</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Synergy software</td>
			<td>CareFusion</td>
			<td>765654679</td>
			<td>To measure split hand index</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td colspan="3">(www.carefusion.com/medical-products/neurology)</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Tem millimeter gold cup disc electrodes</td>
			<td>Grass Technologies</td>
			<td>F-E5GH-60</td>
			<td>To record motor responses</td>
		</tr>
		<tr height="20">
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			<td colspan="2">(www.grasstechnologies.com)</td>
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			<td height="20" style="height:20px;">Neural earth plate</td>
			<td>Westmead Hospital</td>
			<td>Experimental builder</td>
			<td>To record limb temperature</td>
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			<td height="20" style="height:20px;">Thermometer</td>
			<td>Westmead Hospital</td>
			<td>Experimental builder</td>
			<td>To record limb temperature</td>
		</tr>
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utility of dissociated intrinsic hand muscle atrophy in the diagnosis of amyotrophic lateral sclerosis

Il fenomeno di divisione mano si riferisce a sprecare predominante della tenari muscoli ed è una caratteristica precoce e specifico della sclerosi laterale amiotrofica (SLA). Un indice romanzo diviso mano (SI) è stato sviluppato per quantificare il fenomeno di divisione mano, e la sua utilità diagnostica è stata valutata in pazienti con SLA. L&#39;indice di spaccatura mano è stata ottiene dividendo il prodotto del potenziale d&#39;azione muscolare composto (CMAP) Ampiezza registrato il brevis del pollice e del primo dorsali muscoli interossei dal ampiezza CMAP registrato il rapitore muscolo del mignolo. Al fine di valutare l&#39;utilità diagnostica dell&#39;indice divisione mano, pazienti affetti da SLA sono stati valutati in modo prospettico ei loro risultati sono stati confrontati con pazienti con disturbi neuromuscolari. L&#39;indice di spaccatura mano era significativamente ridotta nella SLA rispetto ai pazienti con disturbi neuromuscolari (P &lt;0,0001). Arto-insorgenza pazienti con SLA hanno mostrato la maggiore riduzione dell&#39;indice di divisione mano, e un valoredi 5,2 o meno differenziati in modo affidabile la SLA da altre malattie neuromuscolari. Di conseguenza, l&#39;indice di divisione mano sembra essere un biomarker diagnostico romanzo per ALS, facilitando forse una diagnosi precoce.

Fenotipo clinico In totale, 44 pazienti affetti da SLA sono stati studiati, di cui il 76% (N = 33) sono stati classificati come definita o probabile e il 24% (N = 11) come possibili ALS secondo i criteri Awaji 11. La diagnosi di SLA è stata confermata nel &quot;possibile&quot; coorte dopo ampie indagini e follow-up clinico per un massimo di 3 anni e il 53% sono morti durante questo periodo. Malattia bulbare insorgenza era evidente nel 41%, mentre arti-insorgenza nel 59% de...

Watch this Scientific Journal Video about Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis at JoVE.com

Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis

Atrofia dissociata dei muscoli intrinseci della mano, definita la mano divisa, sembra essere una caratteristica specifica della sclerosi laterale amiotrofica (SLA). Di conseguenza, un test neurodiagnostic romanzo, definito l&#39;indice di divisione mano, è stato sviluppato per quantificare il fenomeno clinico della mano divisa, che la differenzia ALS da disturbi mimici.

Utilità di dissociata intrinseca mano Atrofia muscolare nella diagnosi di Sclerosi Laterale Amiotrofica

The split hand phenomenon refers to predominant wasting of thenar muscles and is an early and specific feature of amyotrophic lateral sclerosis (ALS). A ...

utility-dissociated-intrinsic-hand-muscle-atrophy-diagnosis

Research

JoVE Journal

Medicine

31.2K Views.  Westmead Hospital.  Atrofia dissociata dei muscoli intrinseci della mano, definita la mano divisa, sembra essere una caratteristica specifica della sclerosi laterale amiotrofica (SLA). Di conseguenza, un test neurodiagnostic romanzo, definito l'indice di divisione mano, è stato sviluppato per quantificare il fenomeno clinico della mano divisa, che la differenzia ALS da disturbi mimici. 

Video: Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression across speech subsystems, and for addressing the critical need for sensitive outcome measures for ongoing experimental treatment trials. To address this need, we are obtaining longitudinal profiles of bulbar impairment in 100 individuals based on a comprehensive instrumentation-based assessment that yield objective measures. Using instrumental approaches to quantify speech-related behaviors is very important in a field that has primarily relied on subjective, auditory-perceptual forms of speech assessment1. Our assessment protocol measures performance across all of the speech subsystems, which include respiratory, phonatory (laryngeal), resonatory (velopharyngeal), and articulatory. The articulatory subsystem is divided into the facial components (jaw and lip), and the tongue. Prior research has suggested that each speech subsystem responds differently to neurological diseases such as ALS. The current protocol is designed to test the performance of each speech subsystem as independently from other subsystems as possible. The speech subsystems are evaluated in the context of more global changes to speech performance. These speech system level variables include speaking rate and intelligibility of speech.
The protocol requires specialized instrumentation, and commercial and custom software. The respiratory, phonatory, and resonatory subsystems are evaluated using pressure-flow (aerodynamic) and acoustic methods. The articulatory subsystem is assessed using 3D motion tracking techniques. The objective measures that are used to quantify bulbar impairment have been well established in the speech literature and show sensitivity to changes in bulbar function with disease progression. The result of the assessment is a comprehensive, across-subsystem performance profile for each participant. The profile, when compared to the same measures obtained from healthy controls, is used for diagnostic purposes. Currently, we are testing the sensitivity and specificity of these measures for diagnosis of ALS and for predicting the rate of disease progression. In the long term, the more refined endophenotype of bulbar ALS derived from this work is expected to strengthen future efforts to identify the genetic loci of ALS and improve diagnostic and treatment specificity of the disease as a whole. The objective assessment that is demonstrated in this video may be used to assess a broad range of speech motor impairments, including those related to stroke, traumatic brain injury, multiple sclerosis, and Parkinson disease.

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

Objective assessments of the physiological mechanisms that support speech are needed to monitor disease onset and progression in persons with ALS and to quantify treatment effects in clinical trials. In this video, we present a comprehensive, instrumentation-based protocol for quantifying speech motor performance in clinical populations.

Un protocollo per la valutazione completa della disfunzione bulbare nella Sclerosi Laterale Amiotrofica (SLA)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression ...

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Medicina

Intraspinal Cell Transplantation for Targeting Cervical Ventral Horn in Amyotrophic Lateral Sclerosis and Traumatic Spinal Cord Injury

Respiratory compromise due to phrenic motor neuron loss is a debilitating consequence of a large proportion of human traumatic spinal cord injury (SCI) cases 1 and is the ultimate cause of death in patients with the motor neuron disorder, amyotrophic laterals sclerosis (ALS) 2.
ALS is a devastating neurological disorder that is characterized by relatively rapid degeneration of upper and lower motor neurons. Patients ultimately succumb to the disease on average 2-5 years following diagnosis because of respiratory paralysis due to loss of phrenic motor neuron innnervation of the diaphragm 3. The vast majority of cases are sporadic, while 10% are of the familial form. Approximately twenty percent of familial cases are linked to various point mutations in the Cu/Zn superoxide dismutase 1 (SOD1) gene on chromosome 21 4. Transgenic mice 4,5 and rats 6 carrying mutant human SOD1 genes (G93A, G37R, G86R, G85R) have been generated, and, despite the existence of other animal models of motor neuron loss, are currently the most highly used models of the disease.
Spinal cord injury (SCI) is a heterogeneous set of conditions resulting from physical trauma to the spinal cord, with functional outcome varying according to the type, location and severity of the injury 7. Nevertheless, approximately half of human SCI cases affect cervical regions, resulting in debilitating respiratory dysfunction due to phrenic motor neuron loss and injury to descending bulbospinal respiratory axons 1. A number of animal models of SCI have been developed, with the most commonly used and clinically-relevant being the contusion 8.
Transplantation of various classes of neural precursor cells (NPCs) is a promising therapeutic strategy for treatment of traumatic CNS injuries and neurodegeneration, including ALS and SCI, because of the ability to replace lost or dysfunctional CNS cell types, provide neuroprotection, and deliver gene factors of interest 9.
Animal models of both ALS and SCI can model many clinically-relevant aspects of these diseases, including phrenic motor neuron loss and consequent respiratory compromise 10,11. In order to evaluate the efficacy of NPC-based strategies on respiratory function in these animal models of ALS and SCI, cellular interventions must be specifically directed to regions containing therapeutically relevant targets such as phrenic motor neurons. We provide a detailed protocol for multi-segmental, intraspinal transplantation of NPCs into the cervical spinal cord ventral gray matter of neurodegenerative models such as SOD1G93A mice and rats, as well as spinal cord injured rats and mice 11.

Neural precursor transplantation is a promising strategy for protecting and/or replacing lost/dysfunctional cervical phrenic motor neurons in spinal cord injury (SCI) and the motor neuron disorder, amyotrophic laterals sclerosis (ALS). We provide a protocol for cell delivery to cervical spinal cord ventral horn in rodent models of ALS and SCI.

Intraspinale trapianto di cellule cervicali targeting per corno ventrale nella Sclerosi Laterale Amiotrofica e le lesioni traumatiche del midollo spinale

Respiratory compromise due to phrenic motor neuron loss is a debilitating consequence of a large proportion of human traumatic spinal cord injury (SCI) ...

Clinical Testing and Spinal Cord Removal in a Mouse Model for Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder resulting in progressive degeneration of motoneurons. Peak of onset is around 60 years for the sporadic disease and around 50 years for the familial disease. Due to its progressive course, 50% of the patients die within 30 months of symptom onset. In order to evaluate novel treatment options for this disease, genetic mouse models of ALS have been generated based on human familial mutations in the SOD gene, such as the SOD1 (G93A) mutation. Most important aspects that have to be evaluated in the model are overall survival, clinical course and motor function. Here, we demonstrate the clinical evaluation, show the conduction of two behavioural motor tests and provide quantitative scoring systems for all parameters. Because an in depth analysis of the ALS mouse model usually requires an immunohistochemical examination of the spinal cord, we demonstrate its preparation in detail applying the dorsal laminectomy method. Exemplary histological findings are demonstrated. The comprehensive application of the depicted examination methods in studies on the mouse model of ALS will enable the researcher to reliably test future therapeutic options which can provide a basis for later human clinical trials.

Clinical Testing and Spinal Cord Removal in a Mouse Model for Amyotrophic Lateral Sclerosis ALS

A mouse model for amyotrophic lateral sclerosis (ALS) is examined clinically and behaviorally. As a prerequisite for an accompanying immunohistological analysis the preparation of the spinal cord is depicted in detail.

Test clinici e la rimozione del midollo spinale in un modello murino di sclerosi laterale amiotrofica (SLA)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder resulting in progressive degeneration of motoneurons. Peak of onset is around 60 ...

Real-time Digital Imaging of Leukocyte-endothelial Interaction in Ischemia-reperfusion Injury (IRI) of the Rat Cremaster Muscle

Ischemia-reperfusion injury (IRI) has been implicated in a large array of pathological conditions such as cerebral stroke, myocardial infarction, intestinal ischemia as well as following transplant and cardiovascular surgery.1 Reperfusion of previously ischemic tissue, while essential for the prevention of irreversible tissue injury, elicits excessive inflammation of the affected tissue. Adjacent to the production of reactive oxygen species, activation of the complement system and increased microvascular permeability, the activation of leukocytes is one of the principle actors in the pathological cascade of inflammatory tissue damage during reperfusion.2, 3 Leukocyte activation is a multistep process consisting of rolling, firm adhesion and transmigration and is mediated by a complex interaction between adhesion molecules in response to chemoattractants such as complement factors, chemokines, or platelet-activating factor.4
While leukocyte rolling in postcapillary venules is predominantly mediated by the interaction of selectins5 with their counter ligands, firm adhesion of leukocytes to the endothelium is selectin-controlled via binding to intercellular adhesion molecules (ICAM) and vascular cellular adhesion molecules (VCAM).6, 7 
Gold standard for the in vivo observation of leukocyte-endothelial interaction is the technique of intravital microscopy, first described in 1968.8
Though various models of IRI (ischemia-reperfusion injury) have been described for various organs, 9-12 only few are suitable for direct visualization of leukocyte recruitment in the microvascular bed on a high level of image quality.8 
We here promote the digital intravital epifluorescence microscopy of the postcapillary venule in the cremasteric microcirculation of the rat 13 as a convenient method to qualitatively and quantitatively analyze leukocyte recruitment for IRI-research in striated muscle tissue and provide a detailed manual for accomplishing the technique. We further illustrate common pitfalls and provide useful tips which should enable the reader to truly appreciate, and safely perform the method.
In a step by step protocol we depict how to get started with respiration controlled anesthesia under sufficient monitoring to keep the animal firmly anesthetized for longer periods of time. We then describe the cremasteric preparation as a thin flat sheet for outstanding optical resolution and provide a protocol for leukocyte imaging in IRI that has been well established in our laboratories.

Real-time Digital Imaging of Leukocyte-endothelial Interaction in Ischemia-reperfusion Injury IRI of the Rat Cremaster Muscle

Digital intravital epifluorescence microscopy of postcapillary venules in the cremasteric microcirculation is a convenient method to gain insights into leukocyte-endothelial interaction in vivo in ischemia-reperfusion injury (IRI) of striated muscle tissue. We here provide a detailed protocol to safely perform the technique and discuss its applications and limitations.

In tempo reale Imaging digitale di leucociti-endotelio in ischemia-riperfusione (IRI) del muscolo Cremaster Rat

Ischemia-reperfusion injury (IRI) has been implicated in a large array of pathological conditions such as cerebral stroke, myocardial infarction, ...

Tibial Nerve Transection - A Standardized Model for Denervation-induced Skeletal Muscle Atrophy in Mice

The tibial nerve transection model is a well-tolerated, validated, and reproducible model of denervation-induced skeletal muscle atrophy in rodents. Although originally developed and used extensively in the rat due to its larger size, the tibial nerve in mice is big enough that it can be easily manipulated with either crush or transection, leaving the peroneal and sural nerve branches of the sciatic nerve intact and thereby preserving their target muscles. Thus, this model offers the advantages of inducing less morbidity and impediment of ambulation than the sciatic nerve transection model and also allows investigators to study the physiologic, cellular and molecular biologic mechanisms regulating the process of muscle atrophy in genetically engineered mice. The tibial nerve supplies the gastrocnemius, soleus and plantaris muscles, so its transection permits the study of denervated skeletal muscle composed of fast twitch type II fibers and/or slow twitch type I fibers. Here we demonstrate the tibial nerve transection model in the C57Black6 mouse. We assess the atrophy of the gastrocnemius muscle, as a representative muscle, at 1, 2, and 4 weeks post-denervation by measuring muscle weights and fiber type specific cross-sectional area on paraffin-embedded histologic sections immunostained for fast twitch myosin.

The tibial nerve transection model is a well-tolerated, validated, and reproducible model of skeletal muscle atrophy. The model surgical protocol is described and demonstrated in C57Black6 mice. &#160;

Resezione del nervo tibiale - Un modello standardizzato per Denervation indotta scheletrico atrofia muscolare nei topi

The tibial nerve transection model is a well-tolerated, validated, and reproducible model of denervation-induced skeletal muscle atrophy in rodents. ...

High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases in children and adults. These antibodies have been used to guide diagnosis and treatment. Cell-based assays have improved the detection of antibodies in patient serum. They are based on the surface expression of brain antigens on eukaryotic cells, which are then incubated with diluted patient sera followed by fluorochrome-conjugated secondary antibodies. After washing, secondary antibody binding is then analyzed by flow cytometry. Our group has developed a high-throughput flow cytometry live cell-based assay to reliably detect antibodies against specific neurotransmitter receptors. This flow cytometry method is straight forward, quantitative, efficient, and the use of a high-throughput sampler system allows for large patient cohorts to be easily assayed in a short space of time. Additionally, this cell-based assay can be easily adapted to detect antibodies to many different antigenic targets, both from the central nervous system and periphery. Discovering additional novel antibody biomarkers will enable prompt and accurate diagnosis and improve treatment of immune-mediated disorders.

Over the recent years, live cell-based assays have been used successfully to detect antibodies against surface and conformational antigens. Here, we describe a method using high-throughput flow cytometry enabling the analysis of large cohorts of patients. Detection of novel antibodies will improve diagnosis and treatment of immune-mediated disorders.

High-throughput Citometria a Flusso test cellulare per individuare gli anticorpi per N-metil-D-aspartato Receptor o dopamina-2 recettore nel siero umano

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases ...

Ischemic Tissue Injury in the Dorsal Skinfold Chamber of the Mouse: A Skin Flap Model to Investigate Acute Persistent Ischemia

Despite profound expertise and advanced surgical techniques, ischemia-induced complications ranging from wound breakdown to extensive tissue necrosis are still occurring, particularly in reconstructive flap surgery. Multiple experimental flap models have been developed to analyze underlying causes and mechanisms and to investigate treatment strategies to prevent ischemic complications. The limiting factor of most models is the lacking possibility to directly and repetitively visualize microvascular architecture and hemodynamics. The goal of the protocol was to present a well-established mouse model affiliating these before mentioned lacking elements. Harder et al. have developed a model of a musculocutaneous flap with a random perfusion pattern that undergoes acute persistent ischemia and results in ~50% necrosis after 10 days if kept untreated. With the aid of intravital epi-fluorescence microscopy, this chamber model allows repetitive visualization of morphology and hemodynamics in different regions of interest over time. Associated processes such as apoptosis, inflammation, microvascular leakage and angiogenesis can be investigated and correlated to immunohistochemical and molecular protein assays. To date, the model has proven feasibility and reproducibility in several published experimental studies investigating the effect of pre-, peri- and postconditioning of ischemically challenged tissue.

The window of the murine dorsal skinfold chamber presented visualizes a zone of acute persistent ischemia of a musculocutaneous flap. Intravital epi-fluorescence microscopy permits for direct and repetitive assessment of the microvasculature and quantification of hemodynamics. Morphologic and hemodynamic results can further be correlated with histological and molecular analyses.

Ischemica lesioni dei tessuti nel Skinfold Camera del mouse Dorsale: un modello lembo cutaneo per Indagare Ischemia acuta persistente

Despite profound expertise and advanced surgical techniques, ischemia-induced complications ranging from wound breakdown to extensive tissue necrosis are ...

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Unilateral facial paralysis is a common disease that is associated with significant functional, aesthetic and psychological issues. Though idiopathic facial paralysis (Bell&#8217;s palsy) is the most common diagnosis, patients can also present with a history of physical trauma, infectious disease, tumor, or iatrogenic facial paralysis. Early repair within one year of injury can be achieved by direct nerve repair, cross-face nerve grafting or regional nerve transfer. It is due to muscle atrophy that in long lasting facial paralysis complex reconstructive methods have to be applied. Instead of one single procedure, different surgical approaches have to be considered to alleviate the various components of the paralysis.
The reconstruction of a spontaneous dynamic smile with a symmetric resting tone is a crucial factor to overcome the functional deficits and the social handicap that are associated with facial paralysis. Although numerous surgical techniques have been described, a two-stage approach with an initial cross-facial nerve grafting followed by a free functional muscle transfer is most frequently applied. In selected patients however, a single-stage reconstruction using the motor nerve to the masseter as donor nerve is superior to a two-stage repair. The gracilis muscle is most commonly used for reconstruction, as it presents with a constant anatomy, a simple dissection and minimal donor site morbidity.
Here we demonstrate the pre-operative work-up, the post-operative management, and precisely describe the surgical procedure of single-stage microsurgical reconstruction of the smile by free functional gracilis muscle transfer in a step by step protocol. We further illustrate common pitfalls and provide useful tips which should enable the reader to truly comprehend the procedure. We further discuss indications and limitations of the technique and demonstrate representative results.

The use of the masseteric nerve as donor nerve represents a single-stage alternative to the criterion standard two-stage procedure of cross-facial nerve grafting and free muscle transfer in facial paralysis. We provide a detailed description to safely perform this technique with a gracilis muscle transfer and discuss indications and limitations.

Single-stage dinamico Rianimazione del Sorriso in Irreversible paralisi facciale da Free Transfer Muscle funzionale

Unilateral facial paralysis is a common disease that is associated with significant functional, aesthetic and psychological issues. Though idiopathic ...

A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data

This report describes a novel Stata-based application of trigonometric regression modelling to 55 years of multiple sclerosis relapse data from 46 clinical centers across 20 countries located in both hemispheres. Central to the success of this method was the strategic use of plot analysis to guide and corroborate the statistical regression modelling. Initial plot analysis was necessary for establishing realistic hypotheses regarding the presence and structural form of seasonal and latitudinal influences on relapse probability and then testing the performance of the resultant models. Trigonometric regression was then necessary to quantify these relationships, adjust for important confounders and provide a measure of certainty as to how plausible these associations were. Synchronization of graphing techniques with regression modelling permitted a systematic refinement of models until best-fit convergence was achieved, enabling novel inferences to be made regarding the independent influence of both season and latitude in predicting relapse onset timing in MS. These methods have the potential for application across other complex disease and epidemiological phenomena suspected or known to vary systematically with season and/or geographic location.

Combining plot analysis with trigonometric regression is a robust method for exploring complex, cyclical phenomena such as relapse onset timing in multiple sclerosis (MS). This method enabled unbiased characterisation of seasonal trends in relapse onset permitting novel inferences around the influence of seasonal variation, ultraviolet radiation (UVR) and latitude.

Un metodo di trigonometrica Modellazione di variazione stagionale dimostrata con sclerosi multipla recidiva dati

This report describes a novel Stata-based application of trigonometric regression modelling to  55 years of multiple sclerosis relapse data from 46 ...

Design, Fabrication, and Administration of the Hand Active Sensation Test (HASTe)

The concept of personalizing neurologic rehabilitation, based on individual impairments, has experienced a recent surge. In parallel, the number of outcome measures of upper extremity motor performance has grown. However, clinicians and researchers lack practical, quantitative measures of the hand&#8217;s natural role as a receptor of the environment. The Hand Active Sensation Test (HASTe), developed by Williams and colleagues in 2006, is a valid and reliable measure of haptic performance. Though not available commercially, the HASTe can be fabricated from inexpensive materials, and it has been used successfully to identify impairments in haptic touch in individuals with stroke. (Williams, 2006). This paper presents the methods of design and fabrication of the HASTe testing kit, as well as a visual screen to be used during administration, and instructions for the tests administration and scoring.

Design, Fabrication, and Administration of the Hand Active Sensation Test HASTe

The Hand Active Sensation Test (HASTe) is a valid and reliable measure of haptic performance, which has been used successfully to identify impaired haptic touch in individuals with stroke. The purpose of this paper is to describe the design, fabrication and administration of the HASTe.

Progettazione, fabbricazione, e Amministrazione della Mano attiva Sensation Test (HASTE)

The concept of personalizing neurologic rehabilitation, based on individual impairments, has experienced a recent surge. In parallel, the number of ...