This study was supported by grants from the American Medical Society for Sports Medicine. The authors would like to acknowledge and show our appreciation for our undergraduate research students including David Lawton, Drew Gardner, Mark Sundman, Kelsey Evans, Graham Cochrane, Jordan Cottle and Jack Halligan for their assistance in data collection over the past four years.

以下に説明するすべての手順は、エロンの治験審査委員会によって承認されています。 1.コンピュータ化された神経認知テスト<ol><li>コンピュータの前に座っても、参加者に依頼する。システムに参加者をログインし、人口統計や背景の情報セクション、自己報告症状のチェックリスト、および6モジュール（ワード差別、設計メモリ、XのおよびOの、シンボルマッチング、カラーマッチを構成されてコンピュータ化された神経心理学的テストを完了するように指示し、 3文字）。 </li><li>要約レポートをダウンロードして、言葉の記憶、視覚的記憶、反応時間とモータ処理速度のための4つの複合スコアを入力してください。 </li></ol> 2.事象関連電位<ol><li>使用するEEGネットのサイズを決定するために巻き尺を使用して、頭囲を測定する。解剖学的ランドマークを測定することにより、脳波ネットの配置を決定します。 </li><li>そこらで脳波ネットソーク塩化ナトリウムおよび5分間ベビーシャンプーのリュー。 </li><li>参加者の頭部に脳波ネットを置きます。我々が使用するシステムは、32チャネルを含む。 </li><li>コンピュータ上のサイトのインピーダンス·レベルを確認してください。私たちのシステムでは、100キロオーム以下のインピーダンスが許容可能であると考えられる。 </li><li>認知課題を説明し、参加者がそれぞれのタスクを練習しましょう​​。 <ol><li>聴覚オドボール課題：ヘッドフォンを装着し、テーブルで快適に座って参加者に指示します。彼らは低域と高一連のトーンが聞こえますし、高周波聴覚トーンにボタンをクリックすることで限り迅速かつ正確に可能な限り対応することことを通知。 </li><li>フランカータスク：彼らはスクリーンに投影一連の矢印が与えられますどこにコンピュータの画面の前に座って、参加者に指示します。それが左を指していた場合、マウスの左ボタンをクリックするか、リグを指していた場合は、マウスの右ボタンをクリックすることにより、中央の矢印の方向に対応するため、参加者に指示HTとして迅速かつ正確に可能な限り。 </li></ol></li><li>聴覚オドボール課題とフランカータスクの両方の2つの試験を完了するために、参加者に指示します。 </li><li>参加者からのEEGネットを外し、10分間殺菌消毒剤に浸漬することにより、EEGネットを清掃してください。 </li></ol> 3.体性感覚知覚応答<ol><li>刺激プローブと接触させて配置桁2と3のパッド入りの先端を有するデバイスの輪郭に沿って配置感覚刺激装置およびその指に載って腹臥位での左手で快適に参加者を座席23 </li><li>コンピュータのモニタにタスク関連の命令や合図を表示し、2つのボタンコンピュータのマウスを使用して応答を入力するよう参加者に依頼。プロジェクト5の異なるテスト：2単純な単一サイトの反応時間の作業、デュアルサイト振幅差別、24刺激を適応させる単一のサイトとのデュアルサイト振幅タスク、24と時間的順序判断タスク。25 </li><li>前に各テスト実行の先頭に、コンピュータ上の手がかりは、タスクに慣れるために練習試行を完了するために、参加者に指示します。コンピュータが（;正しくない例えば正しい）各試験後の参加者のパフォーマンスフィードバックが得られます。 </li></ol> 4.バランスプロトコル<ol><li>滑りにくい靴下を置くために、参加者に指示して、楽器と知り合いになるためにバランス·システム上に立つ。 </li><li>画面の中央にドットで圧力ドットの中心に一致する、快適な位置に立って、参加者に指示します。研究者は、デバイスの上に立っている間、すべてのテストが同じ足の位置で行われるように、この快適な開始位置を記録する。 </li><li> 4つの条件のそれぞれについて、30秒間放置する参加者へ質問（目オープン/固い表面、目はフォーム表面/目を閉じて、/しっかり表面を閉じた目をオープン/フォーム表面）。参加者それぞれの条件と各記録の開始前に3秒のカウントダウンの間に10秒の休息を提供します。 </li><li>二次タスクを完了しながら、各条件を繰り返します。彼らに与えられたランダム3桁の数字（ 例えば 、843）から始まる7によって後方にカウントするように指示。 </li><li>スウェイインデックススコア、さらなる分析のために、後で使用するために、各条件と圧力データの中心のための動揺量の標準偏差の測定値を記録します。 </li></ol> 5.歩行評価<ol><li>参加者の足音を検出することがカーペットの長さ全体に存在する圧力センサとの長いカーペット計装歩行分析システム「ポータブル15使って歩行」を参加者を評価する。 </li><li>マットを離れた後「マットの開始前および3 &#39;3の距離から始まる快適な速度で裸足マット全体で5回を歩くよう参加者に依頼。 </li><li> participaに指示同時認知デュアルタスクとしてランダム3桁の数字から7によって後方にカウントしながら国税庁は5つの追加の歩行試験を完了します。 </li><li>歩行分析からの出力として得られた従属変数は、速度、ケイデンスと歩幅のようないくつかの時空間パラメータの絶対及び変動対策を含む。 </li></ol> 6.遺伝学<ol><li> （のみ綿棒スティックのスティック最後に触れないように注意して）、慎重にその無菌容器から綿棒スティックを削除するには、参加者に依頼彼らの口の中に綿棒を動かし、激しく20秒の合計で両頬の内側に綿棒をこする。 </li><li>ラテックスまたはニトリル手袋を着用している技術者にハンド綿棒スティックを。唯一のスティックの端を保持し、その後直ちに氷上に置かれ、（識別番号のみで標識）を滅菌1.7ミリリットルチューブに綿棒先端を置く。 </li><li> 24時間の転送内のサンプルは、-20℃の冷凍庫にある。 </li><li>用いてDNAを抽出製造業者のプロトコールに従って、標準DNA精製キット。より濃縮されたサンプルを得るために、抽出後、イソプロパノール沈殿工程を実行し、EDTA緩衝液（pH8.0）20μlにDNAを再水和する。 </li><li>蛍光タグで標準ポリメラーゼ連鎖反応（PCR）アッセイを用いて遺伝子型決定分析を行うまで-80℃で抽出したDNAを保存する。 </li><li> PCRソフトウェアにより遺伝子型を「呼び出し」、その後のPCR増幅プロットを表示して、手動で確認してください。 </li></ol>

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The authors declare that they have no competing financial interests.

ベースライン脳震盪のテストにこの多次元アプローチの目的は2つあります。1）優れた神経筋システム上の脳震盪（急性および長期）の影響を理解する。 2）（マクロイによって示唆されているように、彼らは主に神経認知テストを使用）決定をプレイするスポーツ医学スタッフメイク復帰を支援する。26評価を脳震盪するために、この多面的なアプローチは、病因、機能変化、及び?...

脳震盪は、米国の憂慮すべき速度で発生していると公衆衛生上の懸念として注目のかなり多くを集めている。疾病管理予防1-3米国センター（CDC）は、1.6から3800000脳震盪がスポーツやレクリエーション活動で発生すると推定している毎年。2013脳震盪合意声明2で定義されている4,5脳震盪」はどちらか頭に伝え「衝動」の力で頭、顔、首、または身体の他の場所での直接の打撃によって引き起こされることがあります。 &quot;脳震盪月機能障害を生じ得る神経病理学的および/ ​​または下部構造の変化をもたらす。2これらの赤字が数週間持続し得る。選手は最初の損傷後の姿勢制御における増加した自己報告された症状、デクリメントを経験し、さらには14日神経認知機能の低下することは珍しいことではありません。6症状の長期の性質を、で一貫性の脳震盪の同定、およびpreinjury能力の変動は、多くの場合、医師、不確実な回復時間、そしておそらく長期的な後遺症により、複雑で非標準化されたリターン·ツー·プレイの決定につながる。7-9 脳震盪後、個々の短期および長期の両方の効果を経験し得る。スポーツ関連の脳震盪の短期的効果は能力、錯乱、記憶障害、意識消失、反応時間の遅延、協調運動障害、頭痛、めまい、嘔吐、睡眠パターンと気分の変化の推移を再生における変化を含むことができる。これらの症状は通常、数日で解決する。2,10たが、損傷後の数週間または数ヶ月続くことができるいくつかの個体ではなく、すぐにシングル脳震盪から回復しつつ、多くの経験長引く効果。10,11、12これらの症候性外乱毎日の機能は、認知と性能が関係用いて定量化することができるDテスト。誰も単一のテストは脳震盪、一連のテストの診断を決定するべきではないとテストの間の既知の関係は、診断を行う際に医療スタッフを支援教室に戻り、決定を場に戻すことができますが。2 脳震盪のための個々のリスクとそれに対応する回復に大きなばらつきがある。感受性と回復時間経過を脳震盪に関連する11の要因は、よく知られているか理解されていない。いくつかの要因が個々の脳震盪感受性と回復に影響を与える可能性があることが示唆されている。これらの要因は、個人の脳震盪の歴史、初期傷害の重症度、片頭痛の歴史、学習障害の歴史、精神科併存疾患の歴史、そしておそらく遺伝的要因が含まれています。7、9、13、14 多くの研究は、個々の短期および長期の両方の効果のための特定の要因を検討した脳震盪の要因として脳震盪、回復時間コース、遺伝学。4,8,15-17明確に確立されていない、何が効果的な多面的病因、機能的な変更に関連する貴重な情報が得られるだろうな評価を脳震盪するアプローチ、および回復で脳震盪から。起因するさまざまな症状と回復の不確実な時間経過に、脳震盪評価への多面的アプローチが正当化されると、これは事前の練習と競技への参加へのすべてのアスリートのベースライン検査だけでなく、タイムリーな評価ポスト傷害を含める必要があります。最近のレビューは、神経認知評価は、症状のみを監視するより脳震盪からの回復に対してより感受性であり得ることを示唆する。18これは脳震盪からの回復の良い指標であり得る他の客観的測定が存在することであってもよい。 このプロトコルのために、我々は彼らがBに影響を与えているかを確認するために、システムのさまざまなコンポーネントを評価するためにいくつかのタスクを使用するYA脳震盪。コンピュータ化された神経認知試験は、メモリ、処理速度、問題解決能力、認知効率および衝動制御を評価することができる。6 EEGを聴覚および視覚処理タスク、イベント関連電位の検討を通してneuroefficiencyを評価するために用いることができる。19性感覚弁別課題があることができる末梢および中枢感覚処理能力を評価するために使用される。20バランスと歩行対策機能性能能力を評価するために使用することができる。さらに、6,21、我々は歴史、脳震盪回復および認知機能を脳震盪する関係を有していてもよいさまざまな遺伝子型を評価する。22今後ベースラインは、テストのこのバッテリーで私たちの代表チームの学生選手をテストし、彼らは無症候時脳震盪を被る場合、テストを繰り返します。 このプロジェクトの目的は、遺伝的、neurocを用い脳震盪の結果として性能の潜在的な短期および長期の減分を評価することであるognitive、電気生理学的、行動的、体性感覚、バランス、歩行措置。脳震盪で発生するさまざまな症状や障害に関連している可能性が潜在的なメカニズムを理解することは、脳震盪についての我々の知識を促進する際に重要である。それがプレーや学者に戻るに戻るに関連するこれらの変更の大knowledgleは将来の脳震盪の診断の補助としてだけでなく、脳震盪管理で発生することがあります。 以下に説明されているすべての措置は、ベースラインで撮影されている（スポーツの学生運動選手の参加の前に）。私たちの現在のプロトコルは、我々はこれらが回復し、可能リターン·ツー·プレイに関する有用な情報を提供し、リターン·ツー·学者と考えているため、バランスのプロトコルと一緒に48時間でコンピュータ化された神経認知テストを完了することです。学生運動選手が無症候報告すると彼らは再びすべてのベースライン措置が再び遺伝子検査を除き、行われている研究室に戻る。完全なプロトコル、BASELINEと無症候性、1テスト期間中に完了するのに約90分かかります。

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			<td height="42" style="height:42px;width:216px;">Name of Material/ Equipment</td>
			<td style="width:356px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:167px;">Comments/Description</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:216px;">ImPACT</td>
			<td style="width:356px;">ImPACT, Pittsburgh, PA</td>
			<td style="width:119px;"></td>
			<td>Neurocognitive concussion testing</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">EEG</td>
			<td style="width:356px;">EGI, Eugene, OR</td>
			<td style="width:119px;"></td>
			<td>EEG 32-channel system</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Stim2</td>
			<td style="width:356px;">Compumedics Neuroscan, Charlotte, NC</td>
			<td style="width:119px;"></td>
			<td>Software for task presentation for flanker task and auditory oddball</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">NetStation</td>
			<td style="width:356px;">EGI, Eugene, OR</td>
			<td style="width:119px;"></td>
			<td>Software for data collection and analysis of EEG</td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:216px;">Sensory Device</td>
			<td style="width:356px;">Cortical Metrics</td>
			<td style="width:119px;"></td>
			<td>Sensory testing</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Balance System SD</td>
			<td>Biodex Medical Systems, Inc., Shirley, NY</td>
			<td style="width:119px;"></td>
			<td>balance testing</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Force Plate</td>
			<td>AMTI Corp., Watertown, MA, USA</td>
			<td style="width:119px;"></td>
			<td>Gait Initiation</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Movement Analysis</td>
			<td>Qualisys AB, Gothenburg, Sweden</td>
			<td style="width:119px;"></td>
			<td>Gait Analysis</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">GAITRite&#160;</td>
			<td style="width:356px;">CIR systems, Inc., Sparta, NJ, USA</td>
			<td style="width:119px;"></td>
			<td>Gait analysis</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;width:216px;">PCR</td>
			<td style="width:356px;">Applied Biosystems, Foster City, CA</td>
			<td style="width:119px;"></td>
			<td>Genetic Analysis</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;">Matlab</td>
			<td style="width:356px;">Mathworks, Natick, MA, USA</td>
			<td style="width:119px;"></td>
			<td>Gait and balance analysis</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Visual 3D</td>
			<td style="width:356px;">C Motion, Inc, Germantown, MD, USA</td>
			<td style="width:119px;"></td>
			<td>3D analysis&#160;</td>
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</table>

a neuroscientific approach to the examination of concussions in student-athletes

脳震盪は、米国の憂慮すべき速度で発生していると、深刻な公衆衛生上の懸念となっている。 CDCは1.6から3800000脳震盪は年間スポーツやレクリエーション活動で発生すると推定している。 2013脳震盪合意声明で定義されて脳震盪は「どちらか頭に伝え「衝動」の力で体の他の部分に頭、顔、首、またはへの直接打撃によって引き起こされることがあります。「脳震盪は短期両方で個人を残すそして長期的な影響。スポーツ関連の脳震盪の短期的効果は能力、錯乱、記憶障害、意識消失、反応時間の遅延、協調運動障害、頭痛、めまい、嘔吐、睡眠パターンと気分の変化の推移を再生における変化を含むことができる。これらの症状は通常、数日で解決する。そのことができますしかし、いくつかの個人はむしろすぐにシングル脳震盪から回復しつつ、多くの経験長引く効果数週間または数ヶ月続く。要因は、感受性を脳震盪に関連するとその後の回復時間は、このときにも知られているか、または理解されていない。いくつかの要因が示唆されていると、彼らは個人の脳震盪の歴史、初期傷害の重症度、片頭痛の歴史、学習障害の歴史、精神科併存疾患の病歴、および場合によっては、遺伝的要因が含まれる。多くの研究は、個別に特定の因子の両方脳震盪、回復の時間経過、感受性および回復の短期および長期の効果を調べた。どのような明確に確立されていないことは病因、機能変化、およびリカバリに関連の貴重な情報をもたらすでしょう脳震盪評価への効果的な多面的なアプローチである。この原稿の目的は、そのようなコンピュータ化された神経認知検査、イベント関連電位、体性感覚知覚応答を使用して脳震盪を調べている近づいて、バランスを多面ロバを表示することですsment、歩行評価および遺伝子検査。

コンピュータ化された神経認知テスト コンピュータ化された神経認知試験の結果の一例を図1に見ることができる。コンピュータプログラムは、多くの場合、復帰再生を行い、復帰するために使用される動詞メモリ上の複合スコア、視覚記憶、視覚モーター速度と反応時間を誘発-learn脳震盪管理プロトコル。口頭および視覚的記憶複合材料は、?...

Watch this Scientific Journal Video about A Neuroscientific Approach to the Examination of Concussions in Student-Athletes at JoVE.com

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

脳震盪とそれに対応する回復のための個々のリスクに大きなばらつきがあります。脳震盪の評価に多面的アプローチが正当化される。スポーツとタイムリーな評価損傷後の参加の前にアスリートのベースラインテストを含む。このプロトコルの目的は、脳震盪を検討するための適切な多面的なアプローチを提供することにある。

学生·アスリートで脳震盪の検討に神経科学のアプローチ

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

a-neuroscientific-approach-to-examination-concussions-student

Research

JoVE Journal

Medicine

12.6K ビュー.  Elon University. 脳震盪とそれに対応する回復のための個々のリスクに大きなばらつきがあります。脳震盪の評価に多面的アプローチが正当化される。スポーツとタイムリーな評価損傷後の参加の前にアスリートのベースラインテストを含む。このプロトコルの目的は、脳震盪を検討するための適切な多面的なアプローチを提供することにある。 

ビデオ: A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

気管支熱形成術：重篤な喘息の新しい治療アプローチ

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

医学

A Strategy to Identify de Novo Mutations in Common Disorders such as Autism and Schizophrenia

There are several lines of evidence supporting the role of de novo mutations as a mechanism for common disorders, such as autism and schizophrenia. First, the de novo mutation rate in humans is relatively high, so new mutations are generated at a high frequency in the population. However, de novo mutations have not been reported in most common diseases. Mutations in genes leading to severe diseases where there is a strong negative selection against the phenotype, such as lethality in embryonic stages or reduced reproductive fitness, will not be transmitted to multiple family members, and therefore will not be detected by linkage gene mapping or association studies. The observation of very high concordance in monozygotic twins and very low concordance in dizygotic twins also strongly supports the hypothesis that a significant fraction of cases may result from new mutations. Such is the case for diseases such as autism and schizophrenia. Second, despite reduced reproductive fitness1 and extremely variable environmental factors, the incidence of some diseases is maintained worldwide at a relatively high and constant rate. This is the case for autism and schizophrenia, with an incidence of approximately 1% worldwide. Mutational load can be thought of as a balance between selection for or against a deleterious mutation and its production by de novo mutation. Lower rates of reproduction constitute a negative selection factor that should reduce the number of mutant alleles in the population, ultimately leading to decreased disease prevalence. These selective pressures tend to be of different intensity in different environments. Nonetheless, these severe mental disorders have been maintained at a constant relatively high prevalence in the worldwide population across a wide range of cultures and countries despite a strong negative selection against them2. This is not what one would predict in diseases with reduced reproductive fitness, unless there was a high new mutation rate. Finally, the effects of paternal age: there is a significantly increased risk of the disease with increasing paternal age, which could result from the age related increase in paternal de novo mutations. This is the case for autism and schizophrenia3. The male-to-female ratio of mutation rate is estimated at about 4&#x2013;6:1, presumably due to a higher number of germ-cell divisions with age in males. Therefore, one would predict that de novo mutations would more frequently come from males, particularly older males4. A high rate of new mutations may in part explain why genetic studies have so far failed to identify many genes predisposing to complexes diseases genes, such as autism and schizophrenia, and why diseases have been identified for a mere 3% of genes in the human genome. Identification for de novo mutations as a cause of a disease requires a targeted molecular approach, which includes studying parents and affected subjects. The process for determining if the genetic basis of a disease may result in part from de novo mutations and the molecular approach to establish this link will be illustrated, using autism and schizophrenia as examples.

Molecular genetic strategy for finding de novo mutations causing common disorders such as autism and schizophrenia.

そのような自閉症や統合失調症のような一般的な疾患でのde novo変異を同定するための戦略

There are several lines of evidence supporting the role of de novo mutations as a mechanism for common disorders, such as autism and schizophrenia. First, ...

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

弱視における抑制の測定と治療

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated prion protein by post mortem tests. Unless a random sample of the sheep or goat population is actively monitored for scrapie, identification of scrapie cases relies on the reporting of clinical suspects, which is dependent on the individual&#39;s familiarization with the disease and ability to recognize clinical signs associated with scrapie. Scrapie may not be considered in the differential diagnosis of neurological diseases in small ruminants, particularly in countries with low scrapie prevalence, or not recognized&#160;if it presents as nonpruritic form like atypical scrapie. To aid in the identification of clinical suspects, a short examination protocol is presented to assess the display of specific clinical signs associated with pruritic and nonpruritic forms of TSEs in sheep, which could also be applied to goats. This includes assessment of behavior, vision (by testing of the menace response), pruritus (by testing the response to scratching), and movement (with and without blindfolding). This may lead to a more detailed neurologic examination&#160;of reporting animals as scrapie suspects. It&#160;could also be used in experimental TSE studies of sheep or goats to evaluate disease progression or to identify clinical end-point.

A short clinical examination protocol is presented to aid in the detection of classical and atypical scrapie in sheep and goats.

羊の非定型および古典スククレープを検出する臨床検査プロトコル

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated ...

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20&#176; of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20&#176; flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Isolated Musculus gastrocnemius tightness is a common cause for foot and ankle pathologies. Currently no standardized examination procedure exists. This manuscript demonstrates that 20 degree of knee flexion eliminates the restraining effect of the M. gastrocnemius on ankle dorsiflexion and presents a video description of a standardized examination protocol.

の診断<em&gt;腓腹筋</em&gt;気密性 - 臨床検査のための主要因

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described ...

Echocardiographic and Histological Examination of Cardiac Morphology in the Mouse

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed in mice is high. Phenotypic characterization of these mouse models also requires the examination of cardiac function and morphology. Echocardiography and magnetic resonance imaging (MRI) are commonly used approaches to characterize cardiac function and morphology in mice. Echocardiographic and MRI equipment specialized for use in small rodents is&#160;expensive and requires a dedicated space. This protocol describes cardiac measurements in mice using a clinical echocardiographic system with a 15 MHz human vascular probe. Measurements are performed on anesthetized adult mice. At least three image sequences are recorded and analyzed for each animal in M-mode in the parasternal short-axis view. Afterwards, cardiac histological examination is performed, and cardiomyocyte diameters are determined on hematoxylin-eosin- or wheat germ agglutinin (WGA)-stained paraffin sections. Vessel density is determined morphometrically after Pecam-1 immunostaining. The protocol has been applied successfully to pharmacological studies and different genetic animal models under baseline conditions, as well as after experimental myocardial infarction by the permanent ligation of the left anterior descending coronary artery (LAD). In our experience, echocardiographic investigation is limited to anesthetized animals and is feasible in adult mice weighing at least 25 g.

Echocardiographic examination is frequently used in mice. Expensive high-resolution ultrasound devices have been developed for this purpose. This protocol describes an affordable echocardiographic procedure combined with histological morphometric analyses to determine cardiac morphology.

マウスの心臓形態の心エコー検査・組織学的検討

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed ...

The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

The human placenta is highly inaccessible for research while still in utero. The current understanding of human placental physiology in vivo is therefore largely based on animal studies, despite the high diversity among species in placental anatomy, hemodynamics and duration of the pregnancy. The vast majority of human placenta studies are ex vivo perfusion studies or in vitro trophoblast studies. Although in vitro studies and animal models are essential, extrapolation of the results from such studies to the human placenta in vivo is uncertain. We aimed to study human placenta physiology in vivo at term, and present a detailed protocol of the method. Exploiting the intraabdominal access to the uterine vein just before the uterine incision during planned cesarean section, we collect blood samples from the incoming and outgoing vessels on the maternal and fetal sides of the placenta. When combining concentration measurements from blood samples with volume blood flow measurements, we are able to quantify placental and fetal uptake and release of any compound. Furthermore, placental tissue samples from the same mother-fetus pairs can provide measurements of transporter density and activity and other aspects of placental functions in vivo. Through this integrative use of the 4-vessel sampling method we are able to test some of the current concepts of placental nutrient transfer and metabolism in vivo, both in normal and pathological pregnancies. Furthermore, this method enables the identification of substances secreted by the placenta to the maternal circulation, which could be an important contribution to the search for biomarkers of placenta dysfunction.

The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

We present a detailed method to study human placental physiology in vivo at term. The method combines blood sampling from the incoming and outgoing vessels on the maternal and fetal sides of the placenta with ultrasound measurements of volume blood flow and placental tissue sampling.

ヒト胎盤生理学の統合研究への4容器サンプリングアプローチ<em&gt;インビボ</em

The human placenta is highly inaccessible for research while still in utero. The current understanding of human placental physiology in vivo is therefore ...

An In Vitro Approach to Photodynamic Therapy

Photodynamic therapy (PDT) is a medical procedure that involves incubation of an exogenously applied photosensitizer (PS) followed by visible light photoactivation to induce cell apoptosis. The Federal Drug Administration has approved PDT for the treatment of actinic keratosis, and clinical guidelines recommend PDT as a treatment for certain non-melanoma skin cancers and acne vulgaris. PDT is an advantageous therapeutic modality as it is low cost, non-invasive, and associated with minimal adverse events and scaring. In the first step of PDT, a PS is applied and allowed to accumulate intracellularly. Subsequent light irradiation induces reactive oxygen species formation, which may ultimately lead to cell apoptosis, membrane disruption, mitochondrial damage, immune modulation, keratinocyte proliferation, and collagen turnover. Herein, we present an in vitro method to study PDT in an adherent cell line. This treatment protocol is designed to simulate PDT and may be adjusted to studying the use of PDT with various cell lines, photosensitizers, incubation temperatures, or photoactivation wavelengths. Squamous cell carcinoma cells were incubated with 0, 0.5, 1.0, and 2 mM 5-aminolevulinic acid (5-ALA) for 30 min and photoactivated with 417 nm blue light for 1,000 s. The primary outcome measure was apoptosis and necrosis, as measured by annexin-V and 7-aminoactinomycin D flow cytometry. There was a dose-dependent increase in cell apoptosis following thirty-minute incubation of 5-ALA. To achieve high inter-test validity, it is important to maintain consistent incubation and light parameters when performing in vitro PDT experiments. PDT is a useful clinical procedure and in vitro research may allow for the development of novel PSs, optimization of protocols, and new indications for PDT.

An In Vitro Approach to Photodynamic Therapy

Photodynamic therapy (PDT) is a medical procedure that involves incubation of an exogenously applied photosensitizer (PS) followed by visible light photoactivation to induce apoptosis. We present an in vitro PDT protocol designed to simulate PDT that may be used to study differences in PS incubation and light treatment parameters.

体外光線力学的治療へのアプローチ

Photodynamic therapy (PDT) is a medical procedure that involves incubation of an exogenously applied photosensitizer (PS) followed by visible light ...

A Metadata Extraction Approach for Clinical Case Reports to Enable Advanced Understanding of Biomedical Concepts

Clinical case reports (CCRs) are a valuable means of sharing observations and insights in medicine. The form of these documents varies, and their content includes descriptions of numerous, novel disease presentations and treatments. Thus far, the text data within CCRs is largely unstructured, requiring significant human and computational effort to render these data useful for in-depth analysis. In this protocol, we describe methods for identifying metadata corresponding to specific biomedical concepts frequently observed within CCRs. We provide a metadata template as a guide for document annotation, recognizing that imposing structure on CCRs may be pursued by combinations of manual and automated effort. The approach presented here is appropriate for organization of concept-related text from a large literature corpus (e.g., thousands of CCRs) but may be easily adapted to facilitate more focused tasks or small sets of reports. The resulting structured text data includes sufficient semantic context to support a variety of subsequent text analysis workflows: meta-analyses to determine how to maximize CCR detail, epidemiological studies of rare diseases, and the development of models of medical language may all be made more realizable and manageable through the use of structured text data.

We present a protocol and associated metadata template for the extraction of text describing biomedical concepts in clinical case reports. The structured text values produced through this protocol can support deep analysis of thousands of clinical narratives.

臨床症例を有効にするためのメタデータ抽出アプローチ先端医学の概念の理解

Clinical case reports (CCRs) are a valuable means of sharing observations and insights in medicine. The form of these documents varies, and their content ...

A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids direct contact with the measured area, it is suitable for monitoring blood flow changes during wound healing in human patients. Vestibuloplasty is periodontal surgery to the oral vestibule, aiming to restore vestibular depth with simultaneous enlargement of the keratinized gingiva. In this special clinical case, a split thickness flap was elevated at the first upper premolar and a xenogenic collagen matrix was adapted to the resulting recipient bed. LSCI was used to monitor the re- and neovascularization of the graft and the surrounding mucosa for one year. A protocol is introduced for the correct adjustment of microcirculation measurement in the oral mucosa, highlighting difficulties and possible failures.
The clinical case study presented demonstrated that &#8212; following the appropriate protocol &#8212; LSCI is a suitable and reliable method for following up microcirculation in a healing wound in the human oral mucosa and gives useful information on graft integration.

This study introduces a protocol for measuring microcirculation in human oral mucosa by laser speckle contrast imaging. The monitoring of wound healing after vestibuloplasty combined with a xenogenic collagen graft is presented on a clinical case.

ひと歯肉移植血管新生を監視への新しいアプローチ

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids ...