この作品は、資金調達の次のソースによってサポートされています： MAN：NIH 2R01 DC05672-04A2 RHH：NIH / NINDS 1K01NS060995-01A1 RHH：ロバート·ウッド·ジョンソン財団/ハロルドアモス医療ファカルティ·ディベロップメント·プログラム

1。前処理の評価<ol><li>研究のための資格要件を満たしているリクルート患者。これらの基準は、非流暢発話を（意味のある言葉を生産する能力と、少なくとも2-4ワード長の文字列として定義）軽度から中等度、（SMA）補足運動野を惜しみシングル、一方的な、左半球虚血性脳卒中を含む18と75歳から少なくとも6ヶ月の間に脳卒中後。 </li><li> Snodgrassから撮影した写真の命名刺激の10セットを提示するときに加えて、すべての潜在的な患者は20のうち、ボストンネーミングテスト15、少なくとも3枚の平均で最初の30項目の少なくとも三つの名前を付けることができなければならないとVanderwartコーパス16、ボストン診断失語症検査17単語の理解とコマンドのサブテストで25 パーセンタイルで、または上記のスコア。 </li><li>患者は、Hであることを確認するための医療スクリーニング検査を行ってealthy十分な研究に参加、および磁気共鳴イメージング（MRI）スキャンまたはTMSを受けに禁忌がないことをします。 </li></ol> 2。ベースラインテスト<ol><li>他の認知領域における各患者の言語障害と障害の程度を評価するために、3つの別々の日に標準化された一連のテストを管理します。テストはBDAE 18のクッキー·セフト·絵の説明サブテスト、BDAE（第2エド。）Wordの理解のためのサブテスト（基本単語差別）とコマンド、ボストンネーミングテスト15は 、SnodgrassとVanderwartから取ら40線画刺激のセットが含ま画像データベース16と、認知言語クイックテスト19（CLQT）。 </li><li>患者は経口応答でピクチャ命名タスクを実行するには、ベースラインBOLD-fMRIの研究を開始します。 MPRAGEシーケンスで高解像度全脳T1強調画像を収集する（RT = 1,620ミリ秒、TE = 3.87ミリ秒、FA = 15、FOV = 192×256、スライス= 160、ボクセルサイズ= 1ミリメートル3）。 T2 *加重BOLD echoplanarシーケンス（TR = 3,000秒、TE = 35ミリ秒、FA = 90、FOV = 128×128、スライス= 31、ボクセルサイズ= 1.875ミリメートル2、スライス厚=全脳を用いた機能的なボリュームを獲得4ミリメートル）。 </li><li>実際の反復TMS（rTMSの）またはrTMSの（図1）に続いて、最初の偽刺激（STMS）を、投与群を受け取るいずれかのグループに患者をランダム化。 </li></ol> 3。刺激の最適部位の同定<ol><li>精密かつ正確に皮質サイトへのrTMSのをターゲットにするためには、位置が（ 例えば Brainsight、ローグリサーチ、モントリオール）への共同登録の高解像度全脳T1強調画像（上記の2.2を参照）neuronavigationalシステムを使用患者とコイルの。 rTMSのグループの場合、右の運動皮質とその後の目視検査20〜刺激を介して、安静時運動閾値（RMT）を決定。 </li><lI&gt;本当のrTMSの間、東洋後部と劣る方向にハンドルが付いているコイルの下方への位置から時計回りに約45°である。偽グループの場合、コイル接点頭の横翼のみ外縁ように頭にコイルに垂直でSTMSを管理します。このオリエンテーションでは、ピークの磁場は、頭蓋骨と平行に走るので、皮質刺激を生成しません。 </li><li> 5日間（2つのセッションがセッション間で45分間の休憩で、最終日に実施）にわたって行われ6つの別々のセッションでは、10のどちらかにrTMSの数分（90％RMTの強度で1 Hzで600パルス）またはSTMSの管理右劣っ前頭葉の異なる部位：口に対応する一次運動野（M1）、パルスがopercularis（BA 44）、前三角部（BA 45）、背側後部三角部（BA 45）、腹側後部三角部（ BA 45）、および眼窩部（BA 47、 図2）。 stimulatioをランダムに患者間のnサイトの順番。 </li><li>患者は各TMSセッションの前と直後に40アイテム画像命名タスクを実行している。映像刺激はSnodgrassとVanderwart 16項目セット、ピーボディ画像語彙テスト21、国際映像命名プロジェクト（IPNP）データベース22から取得されます。 40項目のリストは、ワード長、周波数、意味カテゴリに関して一致しなければなりません。私達の項目に20項目を示し20は練習の効果を評価するためのテストセッションを通じて繰り返されながら、小説だった。彼らは音素8 1を超えないことにより、ターゲットと異なる場合は発話が正しいとしてカウントされるべきである。単語リストの順番は、被験者全体で無作為であるべきであり、各被験者は、すべての訪問で異なる単語リストを受信する必要があります。 </li><li>命名performanの平均変化を各サイトでピクチャ命名パフォーマンスの変化を比較した1標本t検定を行うことにより、刺激の最適な部位を決定他のすべてのサイトのためのセリウム。次に、すべての6つのプリrTMSのセッションにわたって性能の変動に最適な部位での性能の変化を比較する。rTMSの後の性能変化が平均プレTMS性能の2倍の標準偏差よりも大きい場合、そのありそうです。パフォーマンスを命名で利点は再テストの変動9に起因するものである。 </li><li>偽サイトの発見のために、パルスのオトガイ三角にわたってSTMSを管理します。プロトコルセクション4で説明されているようにこの場所は、処理段階の偽アームのための &quot;最適なサイト&quot;として機能します。 </li></ol> 4。処理段階<ol><li> 12日間の期間中に10日間（オフ週末と平日で刺激）に最適な刺激部位にrTMSのかSTMSを管理します。 </li><li>刺激の最初の日に、イベントの順序は次のとおりです。患者がfMRIのを（同時絵の命名と、ベースラインのように）受けた、40項目の命名タスクを管理し、最適なSを刺激ITEは、90％RMTまたはSTMSで1 HzのrTMSのいずれかの20分を使用して再度命名タスクを管理し、そして最終的に患者を持っている絵の命名同時で第二のfMRIを受ける。 </li><li> 〜9日2で、プロトコルは90％RMTまたはSTMSで1 HzのrTMSのを使用して、20分のrTMSのセッション（1,200パルス）で構成されています。 </li><li>日10で、絵に描いたような命名タスクが先行し、続いて1 HzのrTMSの、と20分間に最適なサイトを刺激する。注目すべきは、日1〜10に示すピクチャアイテムの一覧は、上記のように異なるが、周波数、ワード長、と意味カテゴリのために一致する必要があります。 </li></ol> 5。二と6ヶ月のフォローアップ訪問<ol><li> rTMSのかSTMSいずれかの日10以下の二ヶ月は、絵に描いた命名同時にベースラインテスト（ステップ2.1）と同様に、fMRIのを繰り返します。 </li><li>偽状態の患者は、最適なサイト発見相（図1）で始まる、本物のTMSの状態に渡る必要があります。 </li><li>半年FOL、本当のrTMSの刺激の日10をlowing繰り返しベースライン·テスト（ステップ2.1のように）、また、患者を持っている同時ピクチャ命名タスクに別のfMRIのを受ける。 </li></ol>

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著者は、彼らが競合する経済的利益を持っていないことを宣言します。

この記事の目的は、細部への慢性的な非流暢性失語患者における右半球における応答の標的部位を特定するための手順です。そうすることによって、我々は、治療的にその対象領域を刺激言語能力に刺激の効果を評価し、ネーミングおよび慢性非流暢失語症患者における流暢の長期的な改善を引き出すために低周波のrTMSのに使用することができる。我々のアプローチは前の調査官、最も顕著...

失語症言語の取得赤字能力-であるストローク2の一般的な、しばしば衰弱帰結。急性脳卒中後の失語症からの回復の程度が一般的であるが、多くの患者は、永続的な障害の少なくともある程度が発生すると、既存の言語療法は、一般的に回復までの時間を容易にするだけで適度に有効であると考えられている。近年は、このような失語症を含む脳卒中後の障害の様々のための有望な潜在的な治療アプローチ、などの経頭蓋磁気刺激（TMS）などの非侵襲的な刺激技術の出現を見てきました。 TMSは、電磁誘導の原理を採用し、ワイヤのコイルで急速に融磁界の発生を伴う。コイルが被験者の頭部に隣接して配置されると、磁界が膜及び神経遺伝子を脱分極するのに十分な皮質ニューロンの根底に電流を誘導し、頭皮と頭蓋骨を貫通する速度活動電位3。例えば、周波数、強度、およびパルス数としてTMSパラメータが4,5異なる神経生理学的、行動的および知覚効果を引き出すために変えることができる。反復的なTMS（rTMSの）は、所定の周波数でパルスの系列の投与を伴う刺激の適用をより長くすることができ効果が得られる。現在の実験では、低周波数（0.5ヘルツ）で供給rTMSのは、高周波刺激皮質励起3に関連付けられている間に局所的に、皮質興奮性を低下させる傾向があるという証拠を示していると密接。 rTMSのは、様々な神経や精神疾患、特にうつ病6の治療薬として検討されている。 証拠が増えている低周波rTMSのは慢性脳卒中誘発性失語症者の言語回復を強化するために使用されることを示唆している。 Naeserら7,8は、1 Hzのinhibitoを適用した最初のRYは、慢性の非流暢性失語を持つ4つの右利きの患者では2週間、週20分5日間右の下前頭回にRTMS。命名の大幅な改善が刺激8の完了後少なくとも8ヶ月間持続し、これが認められた。私たちは、その後、複製し、これらの結果を拡張して、1 Hzの刺激がネーミングと自発的の両方で永続的な改善をもたらしたことを明らかにした慢性的な非流暢失語症患者9-11にスピーチを誘発した。心強いことに、このような小規模な研究の結果は、同様に亜急性脳卒中や失語症13の患者のように、慢性的な脳卒中12患者でさらなる調査で複製されている。 非流暢性失語患者における前TMS研究の一つの重要な、ほぼユビキタス機能は、刺激の有益な効果は、サイト固有のように見えるということです。当初Naeserで採用アプローチを採用らは、rTMSのは、言語の回復を容易にするために使用されたほとんどの調査は1（ブロードマンエリア45）オトガイ三角右のパルスを標的にしている。実際に、最近の証拠は、右下前頭回の他の領域の刺激は効果的でないかもしれないことを示唆している、あるいは言語パフォーマンス14に有害な影響を有することができ、最適な刺激部位の慎重な個体識別の必要性を強調する。 Naeserら8によって確立されたアプローチによって構築、当社の継続的な調査は、言語能力に下前頭回に抑制rTMSの効果を探り、また、右の前頭葉におけるrTMSの効果の地形特異性を調べます。本稿では、刺激のために最適なサイトは慢性非流暢性失語患者で識別することができる方法の詳細な説明を提供します。私たちは、その後の治療rTMSの投与することを説明し、OUを説明この集団での言語の回復を高める上で刺激の有効性を評価するためのrはテクニック。

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 <td>Magstim</td>
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utilizing repetitive transcranial magnetic stimulation to improve language function in stroke patients with chronic non-fluent aphasia

頭蓋磁気刺激（TMS）は有意に非流暢失語1患者における言語機能を改善することが示されている。この実験では、慢性の非流暢性失語患者における右半球における最適な刺激部位に低周波反復TMS（rTMSの）の管理を実証する。標準化された言語対策の電池は基本性能を評価するために投与される。患者はいずれかの実rTMSのまたは最初偽刺激を受けることが、その後、ランダム化されます。実際の刺激の患者は、サイトを見つける段階を経る、5日間にわたって投与6 rTMSのセッションのシリーズから成る;刺激はこれらの各セッションの間に右前頭葉内の別のサイトに配信されます。各サイトの発見セッションが絵命名タスクが先行と続く1 HzのrTMSの、600パルスで構成されています。能力が命名に過渡変化の度合いを比較することにより、端末に対してのみの刺激によって誘発されるサイトをidateを、我々は個々の患者に対する最適応答の領域を見つけることができます。私たちは、その後の治療段階の間、このサイトへのrTMSの管理を行います。治療中、患者は二週間のスパンで刺激の10日間の合計を受け、各セッションは90％安静運動閾値で配信1 HzのrTMSのの20分で構成されています。刺激は治療の最初と最後の日にfMRIの命名タスクと対になっている。処理段階が完了した後、ベースラインで得られた言語電池は性能のrTMSの誘起変化を識別するために、刺激後2〜6ヶ月繰り返される。 fMRIの命名タスクはまた、治療後2〜6ヶ月が繰り返される。研究の偽アームにランダム化された患者は、偽サイトの発見、偽治療、fMRIの-命名研究、二ヶ月偽治療を完了した後にテストを繰り返し言葉を受ける。偽患者はその後本当のサイト発見、本当のtreatmを完了し、実際の刺激腕にクロスオーバーENT、fMRIの、2と6ヵ月後の刺激言語テスト。

この調査のサイトを見つける段階では、ほとんどすべてではない患者が14オトガイ三角右パルスの刺激に画像の命名タスクに最適に応える。我々の経験では、絵の命名上の患者のパフォーマンスは、最も一貫してパルスのオトガイ三角（図3）の腹側後面の刺激によって促進される。 標準言語評価に関する性能の長期的な改善が図4</...

Watch this Scientific Journal Video about Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia at JoVE.com

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

我々は慢性的脳卒中、非流暢性失語患者で言語能力を向上させるための反復経頭蓋磁気刺激の使用（rTMSの）を探る。刺激に最適に反応する患者ごとに右前頭回でサイトを識別した後、我々はrTMSの治療の10日間に、このサイトをターゲットにしています。

慢性非流暢失語症脳卒中患者における言語機能を改善するために反復経頭蓋磁気刺激の活用

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

utilizing-repetitive-transcranial-magnetic-stimulation-to-improve

Research

JoVE Journal

Medicine

17.6K ビュー.  University of Pennsylvania. 我々は慢性的脳卒中、非流暢性失語患者で言語能力を向上させるための反復経頭蓋磁気刺激の使用（rTMSの）を探る。刺激に最適に反応する患者ごとに右前頭回でサイトを識別した後、我々はrTMSの治療の10日間に、このサイトをターゲットにしています。

ビデオ: Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

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.

人間の神経筋システムを研究するために経頭蓋磁気刺激の活用

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 ...

医学

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.

慢性腎臓病患者における血管機能の評価

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

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.

マルチモーダルImaging-とてんかんの患者で接続関連の脳の興奮性を評価するの刺激に基づく方法

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

Home-Based Transcranial Direct Current Stimulation Device Development: An Updated Protocol Used at Home in Healthy Subjects and Fibromyalgia Patients

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the cerebral cortex by a low-intensity direct current. tDCS is a low-cost technique with minimal adverse effects and easy application. This neurostimulation method has a promising future to improve pain therapy, treatment of neuropsychiatric disorders, and physical rehabilitation.
Current studies demonstrate the benefits of using tDCS over consecutive multiple sessions. However, the daily displacement to the specialized centers, travel costs, and disruptions to daily activities are some of the difficulties faced by patients. Thus, to be more comfortable, easy-to-use, and not disrupt daily commitments, a home-based tDCS was designed. Therefore, the objective of this study was to evaluate the feasibility of a portable tDCS device for home use in healthy subjects and fibromyalgia patients.
Despite increased tDCS use and a reasonably large body of research on the effects across a range of clinical conditions, there is a limited amount of research on developing secure devices that guarantee the dose and contain a block system to avoid excessive use. Therefore, we used a tDCS device with a security system to permit daily use for 20 minutes with a minimal interval of 12 hours between sessions. A programmer preconfigures the equipment, which has a neoprene cap that allows the electrode positions in any assembly, according to individualized protocols for treatments or research. After, researchers can assess the effectiveness of treatment, and its adherence using information kept in the device software.
Results suggest that the device is feasible for home use, with proper monitoring of adherence and contact impedance. There were reports of a few adverse effects, which do not differ from those reported in the literature in studies with the treatment under direct supervision.

This study provides an updated home-based tDCS protocol that enables subjects to receive the beneficial effects of tDCS at home with an easy to use device with settings to control the use and dosage, enhancing the feasibility for long-term use at home.

経頭蓋直通のホームベースの現在刺激デバイスの開発: 更新されたプロトコルで使用される自宅健康者と線維筋痛患者

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the ...

Updated Technique for Reliable, Easy, and Tolerated Transcranial Electrical Stimulation Including Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) is a noninvasive method of neuromodulation using low-intensity direct electrical currents. This method of brain stimulation presents several potential advantages compared to other techniques, as it is noninvasive, cost-effective, broadly deployable, and well-tolerated provided proper equipment and protocols are administered. Even though tDCS is apparently simple to perform, correct administration of the tDCS session, especially the electrode positioning and preparation, is vital for ensuring reproducibility and tolerability. The electrode positioning and preparation steps are traditionally also the most time consuming and error-prone. To address these challenges, modern tDCS techniques, using fixed-position headgear and pre-assembled sponge electrodes, reduce complexity and setup time while also ensuring that the electrodes are consistently placed as intended. These modern tDCS methods present advantages for research, clinic, and remote-supervised (at home) settings. This article provides a comprehensive step-by-step guide for administering a tDCS session using fixed-position headgear and pre-assembled sponge electrodes. This guide demonstrates tDCS using commonly applied montages intended for motor cortex and dorsolateral prefrontal cortex (DLPFC) stimulation. As described, selection of the head size and montage-specific headgear automates electrode positioning. Fully assembled pre-saturated snap-electrodes are simply affixed to the set position snap-connectors on the headgear. The modern tDCS method is shown to reduce setup time and reduce errors for both novice and expert operators. The methods outlined in this article can be adapted to different applications of tDCS as well as other forms of transcranial electrical stimulation (tES) such as transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS). However, since tES is application specific, as appropriate, any methods recipe is customized to accommodate subject, indication, environment, and outcome specific features.

When administering transcranial direct current stimulation (tDCS), reproducible electrode preparation and placement are vital for a tolerated and effective session. The purpose of this article is to demonstrate updated modern setup procedures for the administration of tDCS and related transcranial electrical stimulation techniques, such as transcranial alternating current stimulation (tACS).

経頭蓋直流刺激を含む信頼性、容易、および許容経頭蓋電気刺激のための更新された技術

Transcranial direct current stimulation (tDCS) is a noninvasive method of neuromodulation using low-intensity direct electrical currents. This method of ...

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF) is the most common form of arrhythmia. Atrial remodeling is considered the most critical mechanism for the presence and development of atrial fibrillation. Also, atrial remodeling can lead to the enlargement and dysfunction of the left atrium (LA), resulting in thrombosis and heart failure. Functional changes in left atrial strain and strain rate occur before structural alterations and are closely associated with structural remodeling and left atrial fibrosis. These parameters are sensitive biomarkers for atrial function. Cardiac magnetic resonance feature tracking (CMR-FT) is a novel, non-invasive, post-processing technique that can evaluate left atrial strain and strain rate. The CMR-FT was utilized in this investigation to assess the bilateral atrium strain rate in individuals with paroxysmal AF. Modifications in each segmental strain were evaluated using segmental analysis. The CMR-FT is recommended for non-invasive evaluations in the clinical assessment of atrial strain among existing strain imaging techniques. Further, it is a flexible parameter measurement with good reproducibility, high soft-tissue resolution, and post-processing based on standard cine balanced steady-state free precision (bSSFP) long-axis images without requiring a new sequence acquisition.

The atrial function is associated with the strain and strain rate. The cardiac magnetic resonance feature tracking (CMR-FT) technique was used in this study to quantify left and right atrial global and segmental longitudinal strain and strain rate in individuals with paroxysmal atrial fibrillation.

発作性心房細動患者における心血管磁気共鳴特徴追跡による両側心房機能の推定

Atrial fibrillation (AF) is the most common form of arrhythmia. Atrial remodeling is considered the most critical mechanism for the presence and ...

Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional mapping of language areas for surgical decision-making is usually done invasively by electrical direct cortical stimulation (DCS), which is used to identify the organization of the crucial cortical and subcortical structures within each patient. Accurate preoperative non-invasive mapping aids surgical planning, reduces time, costs, and risks in the operating room, and provides an alternative for patients not suitable for awake craniotomy. Non-invasive imaging methods like MRI, fMRI, MEG, and PET are currently applied in presurgical design and planning. Although anatomical and functional imaging can identify the brain regions involved in speech, they cannot determine whether these regions are critical for speech. Transcranial magnetic stimulation (TMS) non-invasively excites the cortical neuronal populations by means of electric field induction in the brain. When applied in its repetitive mode (rTMS) to stimulate a speech-related cortical site, it can produce speech-related errors analogous to those induced by intraoperative DCS. rTMS combined with neuronavigation (nrTMS) enables neurosurgeons to preoperatively assess where these errors occur and to plan the DCS and the operation to preserve the language function. A detailed protocol is provided here for non-invasive speech cortical mapping (SCM) using nrTMS. The proposed protocol can be modified to best fit the patient- and site-specific demands. It can also be applied to language cortical network studies in healthy subjects or in patients with diseases that are not amenable to surgery.

Navigated repetitive transcranial magnetic stimulation is a highly efficient non-invasive tool for mapping speech-related cortical areas. It helps in designing brain surgery and speeds up the direct cortical stimulation conducted during the surgery. This report describes how to perform speech cortical mapping reliably for preoperative evaluation and research.

音声皮質マッピングのためのナビゲート反復経頭蓋磁気刺激の研究デザイン

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional ...

COPD患者の睡眠障害を緩和するための耳の鍼治療刺激

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic respiratory symptoms. It has a wide spectrum of complications, and sleep disorders, as part of it, are common in severe cases, especially in elderly patients. Long-term lack of sleep may lead to the aggravation of the original disease, reducing patients' quality of life. Benzodiazepines are mainly used for symptomatic treatment of COPD combined with sleep disorders. However, such drugs have the side effect of respiratory central inhibition and could probably aggravate hypoxia symptoms. Auricular acupuncture is a special method of treating physical and psychosomatic dysfunctions by stimulating specific points in the ear. This article explains the specific methods of clinical operation of auricular acupuncture in detail, including assessment of patient eligibility, medical devices used, acupuncture points, course of treatment, post-treatment care, responses to emergencies, etc. The Pittsburgh sleep quality index (PSQI) and chronic obstructive pulmonary disease assessment scale (CAT) were used as the observational index of this method. So far, clinical reports have proved that auricular acupuncture has a definite curative effect in the treatment of COPD combined with sleep disorders, and its advantages of simple operation, few adverse reactions are worthy of further study and promotion, which provide a reference for the clinical treatment of such diseases.

著者スポットライト:睡眠障害を改善するために伝統的な中国の耳の鍼治療を利用する 

This protocol introduces an effective method to improve the sleep condition of patients with chronic obstructive pulmonary disease and alleviate cough symptoms by using auricular acupuncture techniques to percutaneously stimulate specific acupoints in the patients' ears.