Financiamento apoio do Instituto Motor Neuron Disease Research da Austrália (MNDRIA), Sylvia e Charles Viertel Charitable Foundation Clínica concessão Investigator, Fundação Ramaciotti e Nacional de Saúde e Pesquisa Médica do Conselho da Austrália (número de concessão do projeto APP1024915) é reconhecido agradecimento.

1. Preparação do paciente <ol><li> Recrutar pacientes prospectiva e consecutivamente. Nota: O protocolo seguinte é aprovado pelos Comitês de Ética em Sydney West Área de Serviço de Saúde Humanos Pesquisa. O consentimento informado foi fornecida por todos os pacientes. Os pacientes foram recrutados prospectiva e consecutivamente a partir da clínica ALS / neuromuscular em Westmead Hospital. </li><li> Determinar a adequação de pacientes com ELA para o teste. Excluir os pacientes que não são diagnosticados com ELA ou uma doença neuromuscular. </li><li> Excluir pacientes com neuropatia focal coexistente, neuropatia mediano no punho ou neuropatia ulnar no cotovelo. </li><li> Exclui pacientes com uma neuropatia generalizada, tal como polineuropatia diabética. </li><li> Amplamente investigar e clinicamente pacientes de acompanhamento para confirmar o diagnóstico de esclerose lateral amiotrófica ou doenças neuromusculares imitar. </li><li> Certifique-se de que o consentimento informado é fornecida por todos os pacientes, incluindo ALS e pacientes com transtorno de imitar neuromusculares, para all os procedimentos neurofisiológicos. </li></ol> 2. Avaliação Clínica <ol><li> Determine o estadiamento clínico de todos os pacientes com ELA usando a Esclerose Lateral Amiotrófica Avaliação Funcional Revisado-Scale (ALSFRS-R) marcar 18. </li><li> Determinar a taxa de progressão da doença em todos os pacientes de ELA de acordo com a fórmula anteriormente relatada; (48-ALSFRS-R) / duração dos sintomas) 19. </li><li> Determine a força muscular em todos os pacientes que utilizam a classificação do Medical Research Council (MRC) escala de 20. Desenvolver uma pontuação total MRC compreendendo membro superior (ombro rapto; flexão do cotovelo; extensão do cotovelo; pulso dorsiflexão; dedo rapto; abdução do polegar, a pontuação total de 60) e membros inferiores (flexão do quadril; dorsiflexão do tornozelo, a pontuação total de 30; extensão do joelho) grupos musculares . A pontuação total de MRC deve ser de 90, se a força muscular é normal. </li><li> Determine o local de início da doença, definido como bulbar ou membro, em todas as ALSpacientes. </li></ol> 3. Avaliação neurofisiológica <ol><li> Realizar estudos de condução nervosa motora na mediana e os nervos ulnar com potencial de ação muscular composto (CMAP) respostas gravado a partir do abdutor curto do polegar (APB), primeiro interósseo dorsal (IDE) e abdutor minimi dígitos (ADM) músculos. </li><li> Preparar os sítios de estimulação no punho, através da limpeza da superfície da pele com um gel de abrasivo para reduzir a resistência da pele, seguida pela aplicação de um algodão embebido em álcool. Defina o estímulo atual para 20% acima da intensidade necessária para produzir uma resposta máxima CMAP (atual supramaximal). </li><li> Verifique se o local de estimulação selecionado exibe o menor limiar para a estimulação de tal forma que a condução de volume é evitado. </li><li> Prepare o local de gravação por cima de cada músculo, limpando a superfície da pele com um gel abrasivo para reduzir a resistência da pele, seguido pela aplicação de uma compressa com álcool. </li><li> Registre o tamanho do motor de acti compostoem potencial (CMAP) dos APB, a ADM, e IDE músculos. As respostas a serem registrados em 10 mm eletrodos de disco de ouro posicionados em um arranjo barriga tendão sobre cada músculo. Especificamente, posicionar o eletrodo ativo sobre o ponto médio do respectivo músculo garantindo uma decolagem negativa da resposta CMAP, enquanto eletrodo de referência deve ser posicionado sobre a base do polegar (APB e gravações IED CMAP) e base de dígito 5 (para ADM gravações CMAP). </li><li> Defina a distância entre o cátodo estimulante e eletrodo ativo para APB e ADM ação motora composto potenciais respostas a 5 cm e a distância para o IED em 8 cm. </li><li> Posicione a placa de terra neutra electrosurgical no aspecto dorsal da mão, entre o estímulo e G1 eletrodo, com gel condutor para reduzir o artefato. Antes da aplicação da terra neutro preparar o local de limpar a superfície da pele com um gel de abrasivo para reduzir a resistência da pele, seguida pela aplicação de um algodão embebido em álcool. </li><li>Garantir que as configurações de filtro estão entre 3 Hz (filtro de baixa freqüência) e 10 KHz (filtro de alta frequência). </li><li> Certifique-se que a velocidade de varredura é definido para 20 ms ou 2 ms / divisão. </li><li> Certifique-se que a sensibilidade para as respostas gravação CMAP é definido como 5 mV. </li><li> Monitorar a temperatura no local de estimulação durante todo o estudo e assegurar que a temperatura do membro é mantida a 32 ° C. </li></ol> 4. Análise e Interpretação <ol><li> Medida de referência a pico amplitudes CMAP (mV) sobre os músculos APB, IDE e ADM em pacientes com ELA e os controles de doenças neuromusculares imitar. </li><li> Cálculo do índice de divisão de mão (Figura 1) através da multiplicação da amplitude de CMAP registado nos músculos APB e de IDE, e dividindo o produto pela amplitude de CMAP gravada sobre o músculo ADM, tal como se segue: SI = APB CMAP * IED CMAP _________________________ &amp; #160; ADM CMAP </li><li> Determine o utilitário de diagnóstico do índice de mão dividida pela comparação dos valores do IE entre pacientes com ELA e controles patológicos transtorno imitar neuromusculares de acordo com as normas para apresentação de acurácia diagnóstica critérios (STARD). </li><li> Determine os valores de corte diagnóstico ideais para o índice de divisão mão, usando o receiver operating characteristic (ROC). Deriva curva ROC traçando a sensibilidade (eixo y) e 1-especificidade para (eixo x) para valores de SI derivadas de ALS e pacientes com transtorno neuromuscular. </li></ol>

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O presente estudo relata o utilitário de diagnóstico do índice de divisão de mãos ALS, um biomarcador diagnóstico neurofisiológico romance. O SI distinguido confiável ALS de doenças neuromusculares, com um valor de corte de diagnóstico ideal de 5,2. A redução no SI foi mais proeminente em pacientes com ALS membro de início. É importante ressaltar que uma proporção substancial de pacientes com ELA, que foram classificados na categoria &quot;possível&quot; diagnóstica de acordo com os critérios diagnós...

A mão dividida, refere-se a atrofia preferencial do grupo tenar complexo de músculos intrínsecos da mão [abdutor curto do polegar (APB) e primeiro interósseo dorsal (IED)], com relativa preservação dos músculos hipotenar, e é uma característica clínica específica e precoce de amiotrófica esclerose lateral (ALS) 1-4. A constatação de que o sinal de divisão mão é específico para ALS, sugere um papel potencial para o sinal de divisão de mão como um biomarcador de diagnóstico em ALS 3. Quantificação do sinal de divisão lado, através do desenvolvimento de um biomarcador neurofisiológica romance, pode ajudar ainda mais no diagnóstico ALS. Especificamente, o índice de divisão mão (SI), que quantifica o fenômeno de divisão lado, calcula-se multiplicando o composto potencial de ação muscular (CMAP) amplitude registrada nos músculos complexos tenar (APB e IDE), e dividindo o produto pela amplitude CMAP registrado sobre o hypmúsculos othenar (ou seja, a minimi digiti sequestrador, a ADM) 5. O diagnóstico de ELA depende em grande parte de critérios baseados clinicamente abrangendo uma combinação de neurônio motor superior e inferior assina 6. Estes critérios, no entanto, foram consideradas insensíveis especialmente para estabelecer um diagnóstico de esclerose lateral amiotrófica nos estágios iniciais do processo de doença 7-10. Uma modificação recente dos critérios de diagnóstico foram desenvolvidas 11, e embora estes critérios parecem aumentar a sensibilidade diagnóstica 12-16, a sensibilidade aumento parece restrita a bulbar-início 15 pacientes com ELA. Na ausência de um teste patognomónico, o diagnóstico de ELA pode ser significativamente retardada 8. Em última análise, a instituição de terapias neuroprotetoras e recrutamento para ensaios clínicos pode ser adiada, talvez para além do período de janela terapêutica crítica 9, 17. Por conseguinte, outilitário de diagnóstico do SI foi prospectivamente avaliada em pacientes com ELA esporádica.

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

utility of dissociated intrinsic hand muscle atrophy in the diagnosis of amyotrophic lateral sclerosis

O fenômeno de divisão lado refere-se a perda de massa predominante de tenar os músculos e é uma característica precoce e específico de esclerose lateral amiotrófica (ELA). Um índice de romance mão dividida (SI) foi desenvolvido para quantificar o fenômeno de divisão lado, eo seu utilitário de diagnóstico foi avaliada em pacientes com ELA. O índice de separação mão foi obtido dividindo-se o produto do potencial de ação muscular composto (CMAP) amplitude registrada sobre o abdutor curto do polegar e primeiro interósseo dorsal músculos pela amplitude CMAP registradas sobre o músculo minimi digiti raptor. A fim de avaliar a utilidade diagnóstica do índice de divisão lado, pacientes com ELA foram prospectivamente avaliadas e seus resultados foram comparados com pacientes com transtorno neuromuscular. O índice de separação mão foi significativamente reduzida em ALS quando comparados com pacientes com transtorno neuromuscular (p &lt;0,0001). Pacientes com ELA Membro de início apresentou a maior redução no índice de divisão lado, e um valor dede 5,2 ou menos diferenciados de forma confiável ALS de outras doenças neuromusculares. Consequentemente, o índice de divisão mão parece ser um biomarcador diagnóstico romance para ALS, talvez facilitando um diagnóstico mais precoce.

Fenótipo clínico No total, 44 doentes de ALS foram estudados, dos quais 76% (N = 33) foram classificadas como definida ou provável e 24% (N = 11) como possíveis ALS de acordo com os critérios Awaji 11. O diagnóstico de ELA foi confirmado no &quot;possível&quot; coorte após extensas investigações e acompanhamento clínico de até 3 anos e 53% morreram durante este período. Doença Bulbar de início foi evidente em 41%, enquanto membro de início em 59% dos pacient...

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

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

Atrofia dos músculos Dissociated intrínsecos da mão, chamado de mão dividida, parece ser uma característica específica da esclerose lateral amiotrófica (ELA). Consequentemente, um teste neurodiagnostic romance, denominado o índice de divisão lado, foi desenvolvido para quantificar o fenômeno clínico da mão dividida, o que diferencia ALS de distúrbios imitar.

Utilitário de Dissociated Intrínseca Mão atrofia muscular no Diagnóstico de Esclerose Lateral Amiotrófica

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

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

Research

JoVE Journal

Medicine

31.2K visualizações.  Westmead Hospital.  Atrofia dos músculos Dissociated intrínsecos da mão, chamado de mão dividida, parece ser uma característica específica da esclerose lateral amiotrófica (ELA). Consequentemente, um teste neurodiagnostic romance, denominado o índice de divisão lado, foi desenvolvido para quantificar o fenômeno clínico da mão dividida, o que diferencia ALS de distúrbios imitar. 

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

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

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

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

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

Um Protocolo de Avaliação Abrangente de Disfunção Bulbar em Esclerose Lateral Amiotrófica (ALS)

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

Medicina

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

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

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

Intra Transplante de Células de Segmentação Chifre Cervical Ventral em Esclerose Lateral Amiotrófica e lesão medular traumática

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

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

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

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

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

Testes clínicos e Remoção da Medula Espinhal em um modelo do rato para a Esclerose Lateral Amiotrófica (ELA)

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

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

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

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

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

Real-time Digital Imaging de leucócito-endotélio Interação em isquemia-reperfusão (IRI) do músculo cremaster de rato

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

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

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

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

Secção do nervo tibial - um modelo padronizado para denervação induzida por atrofia muscular em ratos

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

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

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

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

High-throughput Citometria de Fluxo Ensaio Celular para detectar anticorpos em N-metil-D-aspartato ou dopamina-2 Receptor em Soro Humano

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

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

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

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

Lesão tecido isquêmico na Skinfold Câmara do mouse Dorsal: Um Modelo retalho de pele para investigar aguda isquemia persistente

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

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

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

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

Simples estágio dinâmico Reanimação do Sorriso em Irreversível Paralisia Facial pela Free Funcional transferência muscular

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

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

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

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

Um Método de Trigonometria Modelagem da Variação Sazonal demonstrado com esclerose múltipla Relapse Dados

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

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

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

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

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

Projeto, fabricação e Administração da Mão do Active Sensation Test (pressa)

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