自分の仕事のため NICU におけるすべての同僚を確認したいと思います。

このプロトコルは制度的レビュー ボードの恋次病院、上海交通大学医学部によって承認された。
 1 です。 患者の準備 注: 外科手術 ( 図 1) によって患者に ICP センサーを配置。センサーは、硬膜外腔、硬膜下、実質、または心室システムに配置されます。
<ol><li>特定の通信ケーブルを介してベッドサイド モニター誘導監視マシンに接続します</li>。
	<li>患者の参照を調整する &#39; s ベッドサイド モニター、ベッドサイド モニターからデータがマシンを監視誘導に従ってされるようにします</li>。
	<li>の患者に静脈ライン配置を実行 &#39; s 左または右橈骨動脈 20</li>。
	<li>、圧受容体と動脈の線を接続します</li>。
	<li>患者の圧力トランスデューサーを接続 &#39; 通信ケーブルを介して s ベッドサイド モニターします</li>。
	<li>測定された血圧が実際の値と一致するようにゼロ調整ベッドサイド モニターします</li>。
</ol> 2。生理学的パラメーターの記録 <ol><li>患者に接続 &#39; s ベッドサイド モニター データを収集し、ネットワーク ケーブルを介してデバイスを格納するとします</li>。
	<li>データ収集装置をオンにする電源ボタンを押します</li>。
	<li>集学的監視ソフトウェアが自動的に実行されるまで、数秒間待ちます</li>。
	<li>患者の名前、ID、診断、初期グラスゴーの昏睡状態のスケール (GCS) などの情報を入力します</li>。
	<li>をクリックして、&#34; を保存し、監視を開始 &#34;] ボタンをクリックすると、データの収集と格納を開始</li>。
	<li>をクリックして、&#34; をオフに &#34; データ集録 ( 図 2) の終わりに画面上のボタン</li>。
	<li>最後の GC を入力します</li>。
</ol> 3。パラメーター解析 <ol><li>ホスト上のユニバーサル シリアル バス (USB) インターフェイスを介して U ディスクに格納されたデータをダンプします</li>。
	<li>ユーザー名と分析サーバーへのログインにパスワードを入力します</li>。
	<li>をクリックして、&#34; 新しいレコードを作成する &#34; ボタンをクリックし、アップロードを開始する U ディスクのデータ ファイルを選択します</li>。
	<li>(データのサイズ) によって、データが分析される前に約 10 〜 20 分待ちます</li>。
	<li>をクリックして、&#34; 詳細 &#34; の結果を表示する各レコード ボタン</li>。
	<li>をクリックして、&#34; グラフ表示 &#34; に最終的な図を参照してください</li>。
	<li>詳細を表示するタイムラインをドラッグします</li>。
	<li>をクリックして、&#34; スキャッタ グラム &#34;] ボタンをクリックすると、パラメーターの分布を参照してください</li>。
</ol>

<ol>
	<li>Hawthorne, C., Piper, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+of+intracranial+pressure+in+patients+with+traumatic+brain+injury.">Monitoring of intracranial pressure in patients with traumatic brain injury.</a> Front Neurol. 5, 121 (2014).</li><li>Cooper, D. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decompressive+craniectomy+in+diffuse+traumatic+brain+injury.">Decompressive craniectomy in diffuse traumatic brain injury.</a> N Engl J Med. 364 (16), 1493-1502 (2011).</li><li>Jiang, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Head+trauma+in+China.">Head trauma in China.</a> Injury. 44 (11), 1453-1457 (2013).</li><li>Hu, X., Xu, P., Asgari, S., Vespa, P., Bergsneider, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Forecasting+ICP+elevation+based+on+prescient+changes+of+intracranial+pressure+waveform+morphology.">Forecasting ICP elevation based on prescient changes of intracranial pressure waveform morphology.</a> IEEE Trans Biomed Eng. 57 (5), 1070-1078 (2010).</li><li>Di Ieva, A., Schmitz, E. M., Cusimano, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+intracranial+pressure:+past,+present,+and+future.">Analysis of intracranial pressure: past, present, and future.</a> Neuroscientist. 19 (6), 592-603 (2013).</li><li>Czosnyka, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracranial+pressure:+more+than+a+number.">Intracranial pressure: more than a number.</a> Neurosurg Focus. 22 (5), 10 (2007).</li><li>Lu, C. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complexity+of+intracranial+pressure+correlates+with+outcome+after+traumatic+brain+injury.">Complexity of intracranial pressure correlates with outcome after traumatic brain injury.</a> Brain. 135 (8), 2399-2408 (2012).</li><li>Nucci, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracranial+pressure+wave+morphological+classification:+automated+analysis+and+clinical+validation.">Intracranial pressure wave morphological classification: automated analysis and clinical validation.</a> Acta Neurochir (Wien). 158 (3), 581-588 (2016).</li><li>Eide, P. K., Sorteberg, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+among+intracranial+compliance,+intracranial+pulse+pressure+amplitude+and+intracranial+pressure+in+patients+with+intracranial+bleeds.">Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds.</a> Neurol Res. 29 (8), 798-802 (2007).</li><li>Czosnyka, M., Czosnyka, Z. H., Whitfield, P. C., Donovan, T., Pickard, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age+dependence+of+cerebrospinal+pressure-volume+compensation+in+patients+with+hydrocephalus.">Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus.</a> J Neurosurg. 94 (3), 482-486 (2001).</li><li>Howells, T., Lewen, A., Skold, M. K., Ronne-Engstrom, E., Enblad, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+evaluation+of+three+measures+of+intracranial+compliance+in+traumatic+brain+injury+patients.">An evaluation of three measures of intracranial compliance in traumatic brain injury patients.</a> Intensive Care Med. 38 (6), 1061-1068 (2012).</li><li>Schuhmann, M. U., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Value+of+overnight+monitoring+of+intracranial+pressure+in+hydrocephalic+children.">Value of overnight monitoring of intracranial pressure in hydrocephalic children.</a> Pediatr Neurosurg. 44 (4), 269-279 (2008).</li><li>Czosnyka, M., Pickard, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+and+interpretation+of+intracranial+pressure.">Monitoring and interpretation of intracranial pressure.</a> J Neurol Neurosurg Psychiatry. 75 (6), 813-821 (2004).</li><li>Sorrentino, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Critical+thresholds+for+cerebrovascular+reactivity+after+traumatic+brain+injury.">Critical thresholds for cerebrovascular reactivity after traumatic brain injury.</a> Neurocrit Care. 16 (2), 258-266 (2012).</li><li>Carrera, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+shapes+pulse+amplitude+of+intracranial+pressure.">What shapes pulse amplitude of intracranial pressure.</a> J Neurotrauma. 27 (2), 317-324 (2010).</li><li>Eide, P. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pressure-derived+versus+pressure+wave+amplitude-derived+indices+of+cerebrovascular+pressure+reactivity+in+relation+to+early+clinical+state+and+12-month+outcome+following+aneurysmal+subarachnoid+hemorrhage.">Pressure-derived versus pressure wave amplitude-derived indices of cerebrovascular pressure reactivity in relation to early clinical state and 12-month outcome following aneurysmal subarachnoid hemorrhage.</a> J Neurosurg. 116 (5), 961-971 (2012).</li><li>Lazaridis, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-specific+thresholds+of+intracranial+pressure+in+severe+traumatic+brain+injury.">Patient-specific thresholds of intracranial pressure in severe traumatic brain injury.</a> J Neurosurg. 120 (4), 893-900 (2014).</li><li>Czosnyka, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+and+interpretation+of+intracranial+pressure+after+head+injury.">Monitoring and interpretation of intracranial pressure after head injury.</a> Acta Neurochir Suppl. 96, 114-118 (2006).</li><li>Steiner, L. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+monitoring+of+cerebrovascular+pressure+reactivity+allows+determination+of+optimal+cerebral+perfusion+pressure+in+patients+with+traumatic+brain+injury.">Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury.</a> Crit Care Med. 30 (4), 733-738 (2002).</li><li>Tegtmeyer, K., Brady, G., Lai, S., Hodo, R., Braner, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Videos+in+Clinical+Medicine.+Placement+of+an+arterial+line.">Videos in Clinical Medicine. Placement of an arterial line.</a> N Engl J Med. 354 (15), 13 (2006).</li><li>Chesnut, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+trial+of+intracranial-pressure+monitoring+in+traumatic+brain+injury.">A trial of intracranial-pressure monitoring in traumatic brain injury.</a> N Engl J Med. 367 (26), 2471-2481 (2012).</li></ol>

財政支援は受信されませんでした。

新しい集学的監視を紹介するこの記事の目的は、生理学的パラメーターを監視する使用ことができます、脳神経外科の重要な患者のための解析システムは臨床の現状を分析し、うまくいけば、予後を予測します。脳神経外科の重要な患者。今日では、ICP モニタリングの焦点は、不正確または遅延4,5,21のリスクを運ぶことができる他のパラメーターは無視しながら ICP 値平均値を中心にです。ICP にパラメーターが派生したような誘導波形、アンプ、ラップ、PRx と IAAC 予後を予測し、適切な治療5,16,17,の指導の意義を偉大いるが報告されます一方、18,19。ただし、集学的監視し大きなデータ集録および解析は、時間と労力の多くを取ることができますこれらのすべてのパラメーターが必要です。その上、現在の日常の臨床業務における臨床医のために適しているほとんどの特定のデバイスがありません。
この問題を解決するために我々 は最近、集学的モニタリング システムを開発しました。自動データ収集を使用し、継続的にこれらの ICP の意味を調査するための分析作業用のオンライン サーバーにデータを送信する前に患者の生体情報を取得するデバイスを格納するパラメーターを派生しました。以前に記載されているように、次の利点があります集学的モニタリング システム。まず第一に、それは高周波でリアルタイムのデータを収集できます。データ コレクションの頻度は最大 120 hz 第二に達することができる、複数のパラメーター、すなわち、誘導波形、PRx、ラップ、IAAC 記録することができます。それらのすべては現在の臨床状態の解析と予後の予測に重要です。さらに、それは長期的継続的な監視を実現できます。それは、患者の治療を通してすべての詳細を記録できます。最後になりましたが、それはポータブルと簡単に学ぶことです。臨床医は、自動的に計算・ グラフィック施工を実行する特定の分析サーバーにデータを簡単にアップロードできます。プロトコルの 2 つの重要なステップがあります。ICP センサーの配置であります。他、動脈ライン配置と動脈血圧の監視です。正しく接続され、運営、一度集学的モニタリング システムは収集し、臨床医のために適しているを分析し、自動的にグラフ化する前にリアルタイム データを格納できます。
しかし、それはいくつかの制限があります。このシステムはのみ ICP と観血的血圧、心電図、脳波、TCD など他のパラメーターが欠けています。別の制限は、自動解析モード、豊富ではない特定の計算およびグラフィックの構造にのみ行うことができます。
我々 は、このシステムを継続的に変更しているし、長期使用中に発生したいくつかの問題を修正しました。すべての制限は、将来的に対処するより適切であろうと確信しております。
集学的モニタリング システムは、現在の臨床状態を分析し、将来的に脳神経外科の重要な患者の予後を予測する生理学的パラメーターを監視する重要な尺度として受け付けられると思います。

ICP モニタリングが広く脳神経外科重症患者1,2,3で特に脳神経科で脳状態を評価する使用されます。誘導波形、アンプ、ラップ、PRx、IAAC、脳内循環、脳脊髄の代償的な予備の状態を反映でき、脳の対応4,5,のように ICP が派生したパラメーター平均 ICP 値ほか6,7,8,9,10,11,12,13。 彼らは切迫した神経学的な悪化および患者14,15,16,17,18も結果の可能性があります。彼らは、適切な治療19のガイダンスとして使用できます。ただし、臨床医のほとんどは、これらのパラメーターを無視して平均 ICP 値だけに集中します。いくつかの特定のデバイスの日常の臨床業務における臨床医のために適しているがあるために部分的です。
これらの欠点に対処する集学的モニタリング システムを最近開発しました。連続血圧計、ICP、酸素飽和度など患者の生体情報を集録するデータの自動収集と貯蔵装置を使用し、現在の臨床状態を明らかにするためにこれらの生理学的パラメーターを分析し、うまくいけば、脳神経外科の重要な患者の予後を予測します。この集学的モニタリング システムいくつかの利点があります: (1) 高周波、(2) 複数のパラメーター、すなわち、誘導波形、PRx、ラップ、IAAC、(3) それを長期間連続モニタリング、達成することができますそれを記録することができます、(4) でリアルタイムのデータを収集できます。ポータブルおよび簡単に学ぶことです。
この資料の目的は、したがって、重要な脳神経外科の患者の様々 な生理学的パラメーターを記録する集学的監視システムを使用する方法の詳細な方法を紹介しますです。

<table style="border-collapse:collapse;width:639pt" width="852">
	<colgroup>
		<col style="width:136pt" width="181" />
		<col style="width:171pt" width="228" />
		<col style="width:134pt" width="179" />
		<col style="width:198pt" width="264" />
	</colgroup>
	<tbody>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="width:136pt;height:15.75pt" width="181">Bedside monitor</td>
			<td style="width:171pt" width="228">Philips</td>
			<td style="width:134pt" width="179">IntelliVue MP40 M8003A</td>
			<td style="width:198pt" width="264">With interfacing module</td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">ICP monitoring machine</td>
			<td>&#160;Johnson &#38; Johnson or Sophysa</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Arterial cannula</td>
			<td>BD</td>
			<td>REF682245</td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Pressure transducer</td>
			<td>Haisheng Medical</td>
			<td>DBPT-0103</td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Data collection device</td>
			<td>Shanghai Haoju</td>
			<td>Neumatic</td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Computer</td>
			<td></td>
			<td></td>
			<td>Requires Windows operating system</td>
		</tr>
	</tbody>
</table>

a detailed protocol for physiological parameters acquisition and analysis in neurosurgical critical patients

頭蓋内の圧力 (ICP) 監視は今広く脳神経外科重症患者。誘導波形、パルス (AMP) の振幅, ICP 振幅と ICP 平均 (RAP) の相関圧力反応性指数 (PRx)、ICP と動脈血圧 (ABP) 波振幅相関 (IAAC) ようなパラメーターを派生 ICP ICP 値の平均、ほかできます、頭蓋内圧亢進状態を反映、予後、および適切な治療の指針としても使用できます。ただし、臨床医のほとんどは、現在のデバイスの制限のためにこれらのパラメーターを無視している間平均 ICP 値だけに集中します。最近、監視システムはこれらの欠点に対処する集学的治療を開発しました。このポータブル、ユーザーフレンドリーなシステムはデータを収集し、及び貯蔵装置最初患者の生理学的パラメーターを連続集録する、すなわちABP、ICP、酸素飽和度を使用し、これらの生理学的パラメーターを分析します。集学的モニタリング システムは、現在の臨床状態を分析し、脳神経外科重症患者の予後を予測する生理学的パラメーターを監視する重要な尺度として受け付けられると思います。

この新しい集学的モニタリング システムは、22 脳神経外科重症患者 (男性 15 名) に適用されました。(54.55%) の 12 に外傷性脳損傷 (TBI) 苦しんでいた、9 (40.91%) いた頭蓋内出血と (4.55%) 1 重症脳梗塞。監視時間 1,900 時間 (患者 1 人あたり約 88 h) 以上です。成功の手術後我々 は継続的に監視され、分析、ICP、BP、CPP、PRx、ラップ、IAAC。図 3は、この監視システムから代表的なデータを示します。我々 より詳細な情報 (図 4) を表示するタイムラインを調整できます。加えて、我々 が、図 5に示す任意の 2 つのパラメーターの関係を解析することができます。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56388/56388fig1.jpg"> 
図 1: ICP センサー配置します。患者監視前に ICP センサー配置のための操作が行われます。センサーは、硬膜外腔、硬膜下、実質、または心室システムに配置できます。この図は、心室の穿刺とセンサーの配置を示しています。カテーテルの先端には、ICP センサーがあります。<a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig1large.jpg" target="_blank">この図の拡大版を表示するのにはここをクリックしてください</a>。
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56388/56388fig2.jpg"> 
図 2: 画面のシステムを監視します。左上の領域では、電流の誘導波形と血圧を示しています。左下の領域には、現在のラップ、PRx、IAAC、CPP、アンプが示しています。画面の右側の部分には、歴史が示しています。出力、スクリーン ショット マーカーを追加するなどの機能のボタンの一部は、下部に表示。<a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig2large.jpg" target="_blank">この図の拡大版を表示するのにはここをクリックしてください</a>。
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56388/56388fig3.jpg"> 
図 3: 脳出血患者の代表的なデータです。ICP、BP、CPP、PRx、ラップ、IAAC などパラメーターは記録およびプロットします。タイムラインは、X 軸と Y 軸が別のパラメーター。<a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig3large.jpg" target="_blank">この図の拡大版を表示するのにはここをクリックしてください</a>。
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56388/56388fig4.jpg"> 
図 4: 代表的なデータの詳細情報。我々 は、タイムラインを調整する、詳細については我々 が表示されます。タイムラインは、X 軸と Y 軸が別のパラメーター。<a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig4large.jpg" target="_blank">この図の拡大版を表示するのにはここをクリックしてください</a>。
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56388/56388fig5.jpg"> 
図 5: ICP と PRx 関係。X パラメーターを変更できる軸と Y 軸の 2 つのパラメーター間の関係を分析します。この図は、ICP は、X 軸と Y 軸を PRx。それぞれの赤いドットは、リアルタイムのレコードを表します。我々 はこの患者で、彼の PRx は-0.7 から 1 への変化と最低の PRx に達する彼の誘導が 10 mmHg の場合を見ることができます。<a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig5large.jpg" style="font-size: 14px;" target="_blank">この図の拡大版を表示するのにはここをクリックしてください</a>。

Watch this Scientific Journal Video about A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients at JoVE.com

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

最近、ポータブルの集学的脳神経外科重症患者の様々 な生理学的パラメーターの監視の監視システムを開発しました。この集学的監視システムを使用する方法の詳細なプロトコルをご紹介します。

生理学的パラメーターの詳細なプロトコル獲得と脳神経外科の重要な患者の分析

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ...

a-detailed-protocol-for-physiological-parameters-acquisition-analysis

Nanyang Technological University

Research

JoVE Journal

Medicine

6.8K ビュー.  Shanghai Jiaotong University School of Medicine. 最近、ポータブルの集学的脳神経外科重症患者の様々 な生理学的パラメーターの監視の監視システムを開発しました。この集学的監視システムを使用する方法の詳細なプロトコルをご紹介します。

ビデオ: A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

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

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

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

脳深部刺激術を受けた覚醒ヒトにおける術中行動作業

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

医学

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

徒手筋力テスト：四肢筋力の測定方法は、危篤状態の患者に適用

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

Parabiosis in Mice: A Detailed Protocol

Parabiosis is a surgical union of two organisms allowing sharing of the blood circulation. Attaching the skin of two animals promotes formation of microvasculature at the site of inflammation. Parabiotic partners share their circulating antigens and thus are free of adverse immune reaction. First described by Paul Bert in 18641, the parabiosis surgery was refined by Bunster and Meyer in 1933 to improve animal survival2. In the current protocol, two mice are surgically joined following a modification of the Bunster and Meyer technique. Animals are connected through the elbow and knee joints followed by attachment of the skin allowing firm support that prevents strain on the sutured skin. Herein, we describe in detail the parabiotic joining of a ubiquitous GFP expressing mouse to a wild type (WT) mouse. Two weeks after the procedure, the pair is separated and GFP positive cells can be detected by flow cytometric analysis in the blood circulation of the WT mouse. The blood chimerism allows one to examine the contribution of the circulating cells from one animal in the other.

Parabiotic joining of two organisms leads to the development of a shared circulatory system. In this protocol, we describe the surgical steps to form a parabiotic connection between a wild-type mouse and a constitutive GFP-expressing mouse.

マウスの並体結合：詳細なプロトコル

Parabiosis is a surgical union of two organisms allowing sharing of the blood circulation. Attaching the skin of two animals promotes formation of ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

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

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

患者と高齢者における時空間歩行パラメータの臨床的評価

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

A Simple Critical-sized Femoral Defect Model in Mice

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all limb bone fractures fail to heal completely due to the extent of the trauma, disease, or age of the patient. Our ability to improve bone regenerative strategies is critically dependent on the ability to mimic serious bone trauma in test animals, but the generation and stabilization of large bone lesions is technically challenging. In most cases, serious long bone trauma is mimicked experimentally by establishing a defect that will not naturally heal. This is achieved by complete removal of a bone segment that is larger than 1.5 times the diameter of the bone cross-section. The bone is then stabilized with a metal implant to maintain proper orientation of the fracture edges and allow for mobility. 
Due to their small size and the fragility of their long bones, establishment of such lesions in mice are beyond the capabilities of most research groups. As such, long bone defect models are confined to rats and larger animals. Nevertheless, mice afford significant research advantages in that they can be genetically modified and bred as immune-compromised strains that do not reject human cells and tissue.
Herein, we demonstrate a technique that facilitates the generation of a segmental defect in mouse femora using standard laboratory and veterinary equipment. With practice, fabrication of the fixation device and surgical implantation is feasible for the majority of trained veterinarians and animal research personnel. Using example data, we also provide methodologies for the quantitative analysis of bone healing for the model.

Animal models are frequently employed to mimic serious bone injury in biomedical research. Due to their small size, establishment of stabilized bone lesions in mice are beyond the capabilities of most research groups. Herein, we describe a simple method for establishing and analyzing experimental femoral defects in mice.

マウスの簡単な重要なサイズの大腿欠陥モデル

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all ...

A Detailed Protocol for Perspiration Monitoring Using a Novel, Small, Wireless Device

Perspiration monitoring can be utilized for the detection of certain diseases, such as thermoregulation and mental disorders, particularly when the patients are unaware of such disorders or are having difficulty expressing their symptoms. Until now, several devices for perspiration monitoring have been developed; however, such devices tend to have a relatively large exterior, considerable power consumption, and/or less sensitivity.
Recently, we developed a small, wireless device for perspiration monitoring. The device consists of a temperature/relative humidity (T/RH) sensor, battery-driven small data logger, and silica gel as a desiccant in a small cylindrical exterior. The T/RH sensor is placed between the detection windows (through which the water vapor from the skin enters) and the silica gel. The underlying principle of the perspiration monitoring device is based on Fick&#39;s law of diffusion, which means that water vapor flux from the skin to the silica gel (i.e.&#160;transepidermal water loss and perspiration) can be captured by change in humidity at the T/RH sensor. In addition, a baseline subtraction method was adopted to distinguish perspiration and transepidermal water loss.
As shown in the previous report, the developed device can monitor the perspiration at any sites of the body in an easy, wireless manner. However, detailed methods of how to use the device have not been disclosed yet. In this article, therefore, we would like to show the point-by-point tutorials of how to use the device for perspiration monitoring, by showing the sympathetic activity test with the sympathetic skin response monitoring as an example.

Recently, we developed a small wireless device for perspiration monitoring. In this article, we present detailed protocols on how to use the device for perspiration monitoring with an example of the sympathetic activity test.

汗は小説、小型、ワイヤレスデバイスを使用した監視するための詳細なプロトコル

Perspiration monitoring can be utilized for the detection of certain diseases, such as thermoregulation and mental disorders, particularly when the ...

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and long-term consequences of unresolved pain or excessive analgosedation, adequate nociceptive monitoring remains challenging in non-communicative, critically ill adults. In the intensive care unit (ICU), routine nociceptive evaluation is carried out by the attending nurse using the Behavior Pain Scale (BPS) in mechanically ventilated patients. This assessment is limited by medication use (e.g., neuromuscular blocking agents) and the inherent subjective character of nociceptive evaluation by third parties.
Here, we describe the use of two nociceptive reflex testing devices as tools for objective pain evaluation: the pupillary dilation reflex (PDR) and nociception flexion reflex (NFR). These measurement tools are non-invasive and well tolerated, providing clinicians and researchers with objective information regarding two different nociceptive processing pathways: (1)&#160;the pain-related autonomic reactivity&#160;and (2) the ascending component of the somatosensory system. The use of PDR and NFR measurements are currently limited to specialized pain clinics and research institutions because of impressions that these are technically demanding or time-consuming procedures, or even because of a lack of knowledge regarding their existence.
By focusing on the two abovementioned nociceptive reflex assessments, this study evaluated their feasibility as a physiological pain measurement method in daily practice. Pursuing novel technologies for evaluating the analgesia level in unconscious patients may further improve individual pharmacological treatment and patient related outcome measures. Therefore, future research must include large well-designed clinical trials in a real-life environment.

Pain assessment in anesthetized patients who cannot communicate with the outside world in any way remains challenging despite the development of innovative objective pain evaluation tools. In this project, the pupillary dilation reflex and the nociception flexion reflex are assessed in critically ill, mechanically ventilated adult patients.

換気の ICU 患者の客観的な受容評価: Pupillometry と侵害受容性屈曲反射を用いた可能性の検討

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and ...

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Lipopolysaccharide, also known as endotoxin, is a fundamental component of gram-negative bacteria and plays a crucial role in the development of sepsis and septic shock. The early identification of an infectious process that is rapidly evolving to a critical illness might prompt a quicker and more intensive treatment, thereby potentially leading to better patient outcomes. The Endotoxin Activity (EA) assay can be used at the bedside as a reliable biomarker of systemic endotoxemia. The detection of elevated endotoxin activity levels has been repeatedly shown to be associated with an increased disease severity in patients with sepsis and septic shock. The assay is quick and easy to perform. Briefly, after sampling, an aliquot of whole blood is mixed with an anti-endotoxin antibody and with added LPS. Endotoxin activity is measured as the relative oxidative burst of primed neutrophils as detected by chemioluminescence. The assay&#39;s output is expressed on a scale from 0 (absent) to 1 (maximal) and categorized as &#8220;low&#8221; (&#60;0.4 units), &#8220;intermediate&#8221; (0.4&#8211;0.59 units), or &#8220;high&#8221; (&#8805;0.6 units). The detailed methodology and rationale for the implementation of the EA assay are reported in this manuscript.

We hereby present a protocol to measure at the bedside the endotoxin activity of human whole blood samples. The Endotoxin Activity assay is a simple test to perform and may be a useful biomarker in critically ill patients with sepsis.

重症患者における全血エンドトキシア血症の検出に関するエンドトキシン活性アッセイ

Lipopolysaccharide, also known as endotoxin, is a fundamental component of gram-negative bacteria and plays a crucial role in the development of sepsis ...

A Real-World High-Intensity Interval Training Protocol for Cardiorespiratory Fitness Improvement

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, few studies have tested the efficiency of HIIT protocols in a &#34;real world&#34; setting, e.g., HIIT protocols designed for outdoor spaces without specialized equipment. This study presents a &#34;real world&#34; training protocol, named &#34;beep training&#34;, and compares the efficiency of a HIIT regiment versus a traditional long-duration Moderate-Intensity Continuous Training (MICT) regiment using this beep training protocol on VO2 max of overweight untrained men. Twenty-two subjects performed outdoor running with MICT (n = 11) or HIIT (n = 11). Cardiorespiratory fitness was assessed before and after training protocols using a metabolic analyzer. Both training protocols were performed 3 days a week for 8 weeks using the Beep Test results. The MICT group performed the exercise program at 60%-75% of the maximum speed of the 20 m shuttle test (Vmax) and with a progression of the distance of 3,500-5,000 m. The HIIT group performed the interval exercise with 7-10 bouts of 200 m at 85%-100% of the maximum speed of the 20 m shuttle test (Vmax), interspersed with 1 min of passive recovery. Although the HIIT group presented a significantly lower training volume than the MICT group (p &#60; 0.05) after 8 weeks of beep training, HIIT was superior to MICT in improving VO2 max (MICT: ~4.1%; HIIT: ~7.3%; p &#60; 0.05). The &#34;real world&#34; HIIT regiment based on beep training protocol is a time-efficient, low-cost, and easy-to-implement protocol for overweight untrained men.

This study presents a low-cost and easy-to-implement "real world" high-intensity interval training (HIIT) protocol for scientific research and discusses its efficiency for cardiorespiratory fitness.

心肺機能改善のための現実世界の高強度インターバルトレーニングプロトコル

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, ...

Protocol for Developing a Femur Osteotomy Model in Wistar Albino Rats

Fracture healing is a physiological process resulting in the regeneration of bone defects by the coordinated action of osteoblasts and osteoclasts. Osteoanabolic drugs have the potential to augment the repair of fractures but have constraints like high costs or undesirable side effects. The bone healing potential of a drug can initially be determined by in vitro studies, but in vivo studies are needed for the final proof of concept. Our objective was to develop a femur osteotomy rodent model that could help researchers understand the development of callus formation following fracture of the shaft of the femur and that could help establish whether a potential drug has bone healing properties. Adult male Wistar albino rats were used after Institutional Animal Ethics Committee clearance. The rodents were anesthetized, and under aseptic conditions, complete transverse fractures at the middle one-third of the shafts of the femurs were created using open osteotomy. The fractures were reduced and internally fixed using intramedullary K-wires, and secondary fracture healing was allowed to take place. After surgery, intraperitoneal analgesics and antibiotics were given for 5 days. Sequential weekly x-rays assessed callus formation. The rats were sacrificed based on radiologically pre-determined time points, and the development of the fracture callus was analyzed radiologically and using immunohistochemistry.

Here, we present a protocol to iatrogenically fracture the shaft of the femur of Wistar albino rats and follow up on the development of the callus. This femur osteotomy model can help researchers evaluate the process of fracture healing and to study how a drug could influence fracture healing.

Wistarアルビノラットにおける大腿骨骨切り術モデルを開発するためのプロトコル

Fracture healing is a physiological process resulting in the regeneration of bone defects by the coordinated action of osteoblasts and osteoclasts. ...