We would like to thank the whole Service of Neuroradiology. We would like to thank Lis Prussen for her work in the library.

NOTA: Este protocolo segue as orientações do Centre Hospitalier de Luxembourg no Luxemburgo. 1 Preparação de Diffusion Tensor Imaging para a via visual para Neurocirurgia e Acompanhamento <ol style="margin-left: 40px;"><li> Realizar uma ressonância magnética-scan pelo menos um dia antes da cirurgia estritamente axial usando 32 direções de gradiente e um b0-imagem. Tenha em estreito contato com a unidade de neurorradiologia a qualquer momento. NOTA: Adicione claro para o neurorradiologista que as imagens após a cirurgia são as mesmas que aquelas antes da operação. </li><li> Usando um de 3 Tesla MRI, faça uma 3DT1 ponderadas e DTI-seqüência scans. Realizar uma seqüência 3DT1 ponderada após a cirurgia também. </li></ol> 2 usando a estação de Planejamento <ol><li> Transfira os dados de varredura em T2, 3DT1 ponderada e DTI-seqüência de imagem digital e comunicações em medicina (DICOM). Este procedimento leva até 7 min. NOTA: Don `t parar o procedimento before ter transferido todas as seqüências. É possível parar e continuar mais tarde, dependendo da data da cirurgia. </li><li> Abra o programa de sistema de navegação cirúrgica. Clique em Arquivo e depois em Importar DICOM. Repetir este procedimento três vezes para todas as sequências acima mencionadas. <ol><li> Clique em Adicionar para exibir. Adicionar cada seqüência separadamente. Don `t tentar prosseguir com Vista. </li></ol></li><li> Clique em Ferramentas. Abrir preparação DTI Tensor. Observar uma nova janela no meio do ecrã. </li><li> Conclua as seguintes quatro etapas. <ol><li> Realizar Atribuição Gradiente como o primeiro passo. <ol><li> Altere o valor de b de 1.000 para 800 s / mm ² na parte inferior direita da janela. </li><li> Ajustar o limite no canto superior direito da janela. Fazê-lo manualmente, basta escrever um número ou mover um cursor. 20 pode ser um valor aceitável. É uma experiência pessoal e não é obrigatório. </li></ol></li><li> Realizar o registro de Gradient como a segunda etapa. <ol> &lt;li&gt; Clique no botão All Auto. Este procedimento leva até 5 min. </li><li> Clique em Verificar todos os registros. Sem verificar os registos de que não é possível continuar. </li></ol></li><li> Co-registro executar como o terceiro passo. <ol><li> Coregister MR1 e imagens MR2 B0 manualmente. No final, verificar todas as inscrições. NOTA: É possível executar este passo automaticamente. No entanto, os resultados podem não ser sempre satisfatório no final. </li></ol></li><li> Realize Tensor computação como a quarta e última etapa, <ol><li> Certifique-se de FA / DEC / ADC estão ligados. Se não clicar. </li><li> Clique em Calcular. Este procedimento levará apenas alguns segundos. </li></ol></li></ol></li><li> Salve todos os dados e continuar com fibertracking. Não pare sem salvar tudo. </li></ol> 3. Fibertracking NOTA: Anatomic conhecimento da via visual é muito importante para o sucesso da técnica. <ol stYLE = &quot;margin-left: 40px;&quot;&gt; <li> Prepare-se para encontrar os três pontos importantes onde as fibras têm que passar. </li><li> Determine o quiasma usando conhecimento anatômico. <ol><li> Use um ROI como ponto de partida e deixar que as fibras passam. ROIs são definidos pelo médico. </li><li> Alternativamente, o segmento na região suspeita. Clique Segmentação no canto inferior esquerdo e outra janela aparecerá. Áreas segmentadas são áreas anatomicamente definido. <ol><li> Pinte a região manualmente. Vá para cima e para baixo para incluir todo o quiasma. Salve o procedimento e voltar. </li></ol></li><li> Rastrear as fibras quer a partir da região de interesse ou para a área segmentada ou ambos. </li><li> As fibras de atingir o núcleo geniculado esquerda (LGN), que é o segundo ponto importante da via visual. O ângulo máximo era de 50 O risco de falsos tractos surgirá se o ângulo é demasiado elevada. <ol><li> Existe a possibilidade de segmentar o LGN como mostrado com o quiasmae acompanhar as fibras. Depois de ter segmentado quiasma óptico, fibras pista que correm do LGN e de chegada no quiasma ou vice-versa. </li></ol></li><li> Segmento do córtex visual. Proceder como no caso do quiasma. Isso pode levar algum tempo como imagem 3DT1 ponderada contém 160 fatias. </li><li> Rastrear as fibras do córtex visual do LGN. É possível controlá-los a partir do LGN para o córtex visual bem. </li><li> Se o córtex visual é invadido por tumor ou edema, em seguida, usar uma região de interesse no local de uma zona segmentada e, em seguida, deixar as fibras correm na direcção do LGN. NOTA: Se o edema é segmentado por vezes, pode invadir o córtex visual, em seguida, em seguida, o córtex visual pode não ser capaz de segmentado totalmente porque o computador não posso distinguir entre eles. Isso é porque é necessário colocar um ROI. </li><li> Repita tudo para o outro hemisfério. </li><li> Comece com o hemisfério saudável em primeiro lugar. Nota:É possível começar com o outro também, mas talvez seja mais fácil para acompanhar as fibras do hemisfério saudável primeiro a tornar-se uma primeira ideia sobre a situação. Não é obrigatório, é apenas um conselho. </li></ol></li><li> Segmento da lesão cerebral e do edema. Proceder como mencionado acima, no ponto 3.2.2. <ol><li> Atribua uma cor para cada área segmentada ou lesão, a fim de distinguir melhor. </li></ol></li><li> Salve o procedimento após cada etapa, no caso de acontecimentos imprevistos ou em caso de uma emergência. </li><li> Exportar todos os dados localmente. É possível exportá-la para a sala de operações diretamente, mas ele isn `t recomendado. <ol><li> Pressione Arquivo e depois exportar objetos 3D. Certifique-se de exportar apenas o exame de navegação. </li><li> Don `t exportar o Exame Hybrid. </li></ol></li><li> Digite craniana. Escolha o paciente certo, em seguida, pressione Stealthmerge. Escolha imagens 3DT1 ponderadas como exame de referência. </li><li> Criar um modelo 3D e inserir tudo. </li><li> Importe o i dadosn sala de operação. </li></ol>

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The authors declare that they have no competing financial interests.

DTI é uma técnica que permite o neurocirurgião visualizar tratos de substância branca in vivo 8. O caminho visual é um desses intervalos. Embora este método fornece aos médicos novas possibilidades em relação ao tratamento de pacientes com lesões relativas às regiões eloquentes do cérebro que temos a dizer que algumas limitações desta técnica ainda existem. A primeira e mais óbvia desafio é mudança cérebro, que continua sendo um problema sob investigação 4. Após a ab...

Imagiologia tensor de difusão (DTI) é usado para representar WMT de forma não invasiva no cérebro humano 1. Tem sido usado na última década para reduzir o risco de prejudicar eloquentes áreas do cérebro durante uma cirurgia. DTI foi realizada em cinqüenta pacientes entre Março de 2012 e Janeiro de 2014 e retratam a via visual. DTI pode melhorar a preservação de áreas eloqüentes do cérebro durante a cirurgia, fornecendo informações importantes sobre a localização anatômica de tratos de substância branca. Foi incorporada ao planejamento estratégico para ressecção de lesões cerebrais complexos 1. No entanto, o retrato da via visual continua a ser um desafio, porque não existe um padrão para os parâmetros de DTI, a colocação dos volumes e interpretação dos resultados de 12 sementes. Diferentes algoritmos foram implementados até agora 19-21. Algumas abordagens concentrado em métodos determinísticos 19, 22-25. Outros estavam usando métodos probabilísticos, 26,27,29. Mais recentemente, técnicas usando campos tensores Q-bola, da difusão espectral e alta resolução angular de difusão de imagens (Hardi) estão sendo usados ​​para descrever tratos de substância branca, entre outros a via visual 1,13-15,18. No entanto, o tempo necessário para HARDI é significativamente maior com 45 min, o software não está disponível comercialmente e enfatiza as aplicações científicas 18. O período de ensino para Hardi parece ser maior do que para o DTI 18. O protocolo apresentado é fácil viável e pode ser utilizado para a rotina diária em operações neurocirúrgicas, a fim de evitar a morbidade e melhorar o resultado de pós-operatório. O tempo adicional para este protocolo é inferior a 9 min que é significativamente mais rápido do que outros protocolos 1,9,12,16. Reconhecendo o fato de que muitos algoritmos sofisticados foram desenvolvidos recentemente, os restringe de papelprópria para o uso de um software comercialmente disponível e aprovado pela FDA. No entanto, é obrigatório ter em conta as limitações desta técnica que são mencionados acima.

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</table>

dti of the visual pathway - white matter tracts and cerebral lesions

<html> DTI é uma técnica que identifica tratos de substância branca (WMT) não-invasiva em pacientes saudáveis ​​e não-saudáveis, utilizando medidas de difusão. Semelhante a vias visuais (VP), WMT não são visíveis com MRI clássica ou intra-operatório com microscópio. DIT vai ajudar neurocirurgiões para evitar a destruição da VP ao remover lesões adjacentes a este WMT. Efetuamos DTI em cinqüenta pacientes, antes e após a cirurgia, entre março de 2012 a janeiro de 2014 Para navegar usamos uma seqüência 3DT1 ponderado. Além disso, foi realizado um T2 e DTI-sequências. Os parâmetros utilizados foram, FOV: 200 x 200 mm, espessura de fatia de 2 mm, e matriz de aquisição: 96 x 96 originando voxels quase isotrópica de 2 x 2 x 2 mm. Axial MRI foi realizada utilizando um gradiente de direcção 32 e um b0-imagem. Usamos Echo-Planar-Imaging (EPI) e ASSET imagens paralelas com um fator de aceleração de 2 e b-valor de 800 s / mm ². O tempo de varredura foi inferior a 9 min. ent &quot;&gt; Os DTI-dados obtidos foram processados ​​utilizando um FDA aprovou o programa de sistema de navegação cirúrgica que utiliza uma abordagem de fibra de rastreamento simples conhecido como atribuição fibra de rastreamento contínuo (FACT). Isto é baseado na propagação de linhas entre as regiões de interesse ( ROI), que é definida por um médico. um ângulo máximo de 50, FA valor de 0,10 e valor parada ADC de 0,20 mm ² / s começar foram os parâmetros utilizados para tractography. Existem algumas limitações para esta técnica. A aquisição prazo limitado impõe trade-offs na qualidade da imagem. Outro ponto importante que não deve ser negligenciado é a mudança do cérebro durante a cirurgia. Quanto a esta última ressonância magnética intra-operatória pode ser útil. Além disso, o risco de falsos positivos, ou negativos extensões falsas precisa ser levado em conta o que pode comprometer os resultados finais.

<html> Este protocolo permite que o médico para retratar adequadamente as principais partes do VP. Ele pode ser usado com uma pequena quantidade de tempo, a fim de evitar danos em doentes com lesões cerebrais próximos de zonas eloquentes. Controlos pós-operatórios mostram também bons resultados. VP é retratado na Figura 7 após o paciente foi operado de um glioblastoma. Figura 2 mostra o vice-presidente após o retorno de um glioblastoma. Os autores reconhecem o fato de as dificul...

Watch this Scientific Journal Video about DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions at JoVE.com

DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

Imagem por tensores de difusão (DTI) foi realizada para tentar descrever as principais partes do sistema visual. O objectivo era utilizar um FDA aprovou estação comercial padrão que pode ser usado para a rotina diária, a fim de tentar reduzir os danos de pós-operatório da via visual nos pacientes.

DTI do Caminho Visual - substância branca panfletos e Cerebral Lesões

DTI is a technique that identifies white matter tracts (WMT) non-invasively in healthy and non-healthy patients using diffusion measurements. Similar to ...

dti-of-the-visual-pathway-white-matter-tracts-and-cerebral-lesions

Research

JoVE Journal

Medicine

13.9K visualizações.  Centre Hospitalier de Luxembourg.  Imagem por tensores de difusão (DTI) foi realizada para tentar descrever as principais partes do sistema visual. O objectivo era utilizar um FDA aprovou estação comercial padrão que pode ser usado para a rotina diária, a fim de tentar reduzir os danos de pós-operatório da via visual nos pacientes. 

Vídeo: DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

The Application Of Permanent Middle Cerebral Artery Ligation in the Mouse

Focal cerebral ischemia is among the most common type of stroke seen in patients. Due to the clinical significance there has been a prolonged effort to develop suitable animal models to study the events that unfold during ischemic insult. These techniques include transient or permanent, focal or global ischemia models using many different animal models, with the most common being rodents.
The permanent MCA ligation method which is also referred as pMCAo in the literature is used extensively as a focal ischemia model in rodents 1-6. This method was originally described for rats by Tamura et al. in 1981 7. In this protocol a craniotomy was used to access the MCA and the proximal regions were occluded by electrocoagulation. The infarcts involve mostly cortical and sometimes striatal regions depending on the location of the occlusion. This technique is now well established and used in many laboratories 8-13. Early use of this technique led to the definition and description of &#x201C;infarct core&#x201D; and &#x201C;penumbra&#x201D; 14-16, and it is often used to evaluate potential neuroprotective compounds 10, 12, 13, 17. Although the initial studies were performed in rats, permanent MCA ligation has been used successfully in mice with slight modifications 18-20 .
This model yields reproducible infarcts and increased post-survival rates. Approximately 80% of the ischemic strokes in humans happen in the MCA area 21 and thus this is a very relevant model for stroke studies. Currently, there is a paucity of effective treatments available to stroke patients, and thus there is a need for good models to test potential pharmacological compounds and evaluate physiological outcomes. This method can also be used for studying intracellular hypoxia response mechanisms in vivo. 
Here, we present the MCA ligation surgery in a C57/BL6 mouse. We describe the pre-surgical preparation, MCA ligation surgery and 2,3,5 Triphenyltetrazolium chloride (TTC) staining for quantification of infarct volumes.

Middle cerebral artery (MCA) ligation is a technique to study focal cerebral ischemia in animal models. In this method, the middle cerebral artery is exposed by craniotomy and ligated by cauterization. This method gives highly reproducible infarct volumes and increased post-operative survival rates compared to other methods available.

A aplicação de ligadura da artéria Cerebral Média Permanente no mouse

Focal cerebral ischemia is among the most common type of stroke seen in patients. Due to the clinical significance there has been a prolonged effort to ...

Medicina

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily life, despite similar visual deficits. We assume this could be due to variable development of compensatory strategies such as altered visual scanning behavior. Scanning compensatory therapy (SCT) is studied as part of the visual training after infarction next to vision restoration therapy. SCT consists of learning to make larger eye movements into the blind field enlarging the visual field of search, which has been proven to be the most useful strategy1, not only in natural search tasks but also in mastering daily life activities2. Nevertheless, in clinical routine it is difficult to identify individual levels and training effects of compensatory behavior, since it requires measurement of eye movements in a head unrestrained condition. Studies demonstrated that unrestrained head movements alter the visual exploratory behavior compared to a head-restrained laboratory condition3. Martin et al.4 and Hayhoe et al.5 showed that behavior demonstrated in a laboratory setting cannot be assigned easily to a natural condition. Hence, our goal was to develop a study set-up which uncovers different compensatory oculomotor strategies quickly in a realistic testing situation: Patients are tested in the clinical environment in a driving simulator. SILAB software (Wuerzburg Institute for Traffic Sciences GmbH (WIVW)) was used to program driving scenarios of varying complexity and recording the driver's performance. The software was combined with a head mounted infrared video pupil tracker, recording head- and eye-movements (EyeSeeCam, University of Munich Hospital, Clinical Neurosciences).
The positioning of the patient in the driving simulator and the positioning, adjustment and calibration of the camera is demonstrated. Typical performances of a patient with and without compensatory strategy and a healthy control are illustrated in this pilot study. Different oculomotor behaviors (frequency and amplitude of eye- and head-movements) are evaluated very quickly during the drive itself by dynamic overlay pictures indicating where the subjects gaze is located on the screen, and by analyzing the data. Compensatory gaze behavior in a patient leads to a driving performance comparable to a healthy control, while the performance of a patient without compensatory behavior is significantly worse. The data of eye- and head-movement-behavior as well as driving performance are discussed with respect to different oculomotor strategies and in a broader context with respect to possible training effects throughout the testing session and implications on rehabilitation potential.

Patients with visual deficits after stroke report about different constraints in daily life most likely due to variable compensatory strategies, which are difficult to differentiate in clinical routine. We present a clinical set-up which allows measurement of different compensatory head- and eye-movement-strategies and evaluating their effects on driving performance.

Condução Simulação na Clínica: Teste o comportamento exploratório Visual em Atividades da Vida Diária em pacientes com defeitos Campo Visual

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion

The translational potential of pre-clinical stroke research depends on the accuracy of experimental modeling. Cerebral perfusion monitoring in animal models of acute ischemic stroke allows to confirm successful arterial occlusion and exclude subarachnoid hemorrhage. Cerebral perfusion monitoring can also be used to study intracranial collateral circulation, which is emerging as a powerful determinant of stroke outcome and a possible therapeutic target. Despite a recognized role of Laser Doppler perfusion monitoring as part of the current guidelines for experimental cerebral ischemia, a number of technical difficulties exist that limit its widespread use. One of the major issues is obtaining a secure and prolonged attachment of a deep-penetration Laser Doppler probe to the animal skull. In this video, we show our optimized system for cerebral perfusion monitoring during transient middle cerebral artery occlusion by intraluminal filament in the rat. We developed in-house a simple method to obtain a custom made holder for twin-fibre (deep-penetration) Laser Doppler probes, which allow multi-site monitoring if needed. A continuous and prolonged monitoring of cerebral perfusion could easily be obtained over the intact skull.

Cerebral perfusion monitoring has been demonstrated to improve accuracy in ischemic stroke models. Technical difficulties often limit the use of this essential tool for cerebrovascular research. In this video, an optimized system is shown to obtain a single or multi-site hemodynamic monitoring during intraluminal middle cerebral artery occlusion in rats.

Sistema otimizado para Monitorização de perfusão cerebral no modelo do rato do curso de oclusão da artéria cerebral média intraluminal

The translational potential of pre-clinical stroke research depends on the accuracy of experimental modeling. Cerebral perfusion monitoring in animal ...

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow (ischemia) 1. Middle cerebral artery (MCA) delivers a great majority of blood to the lateral surface of the cortex 2, is the most common site of human stroke 3, and ischemia within its territory can result in extensive dysfunction or death 1,4,5. Survivors of ischemic stroke often suffer loss or disruption of motor capabilities, sensory deficits, and infarct. In an effort to capture these key characteristics of stroke, and thereby develop effective treatment, a great deal of emphasis is placed upon animal models of ischemia in MCA.
Here we present a method of permanently occluding a cortical surface blood vessel. We will present this method using an example of a relevant vessel occlusion that models the most common type, location, and outcome of human stroke, permanent middle cerebral artery occlusion (pMCAO). In this model, we surgically expose MCA in the adult rat and subsequently occlude via double ligature and transection of the vessel. This pMCAO blocks the proximal cortical branch of MCA, causing ischemia in all of MCA cortical territory, a large portion of the cortex. This method of occlusion can also be used to occlude more distal portions of cortical vessels in order to achieve more focal ischemia targeting a smaller region of cortex. The primary disadvantages of pMCAO are that the surgical procedure is somewhat invasive as a small craniotomy is required to access MCA, though this results in minimal tissue damage. The primary advantages of this model, however, are: the site of occlusion is well defined, the degree of blood flow reduction is consistent, functional and neurological impairment occurs rapidly, infarct size is consistent, and the high rate of survival allows for long-term chronic assessment.

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

We describe a highly reproducible method for the permanent occlusion of a rodent major cerebral blood vessel. This technique can be accomplished with very little peripheral damage, minimal blood loss, a high rate of long-term survival, and consistent infarct volume commensurate with the human clinical population.

Permanente oclusão vascular cerebral<em&gt; Via</em&gt; Dupla ligadura e transecção

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow ...

Generation and 3-Dimensional Quantitation of Arterial Lesions in Mice Using Optical Projection Tomography

The generation and analysis of vascular lesions in appropriate animal models is a cornerstone of research into cardiovascular disease, generating important information on the pathogenesis of lesion formation and the action of novel therapies. Use of atherosclerosis-prone mice, surgical methods of lesion induction, and dietary modification has dramatically improved understanding of the mechanisms that contribute to disease development and the potential of new treatments.
Classically, analysis of lesions is performed ex vivo using 2-dimensional histological techniques. This article describes application of optical projection tomography (OPT) to 3-dimensional quantitation of arterial lesions. As this technique is non-destructive, it can be used as an adjunct to standard histological and immunohistochemical analyses.
Neointimal lesions were induced by wire-insertion or ligation of the mouse femoral artery whilst atherosclerotic lesions were generated by administration of an atherogenic diet to apoE-deficient mice.
Lesions were examined using OPT imaging of autofluorescent emission followed by complementary histological and immunohistochemical analysis. OPT clearly distinguished lesions from the underlying vascular wall. Lesion size was calculated in 2-dimensional sections using planimetry, enabling calculation of lesion volume and maximal cross-sectional area. Data generated using OPT were consistent with measurements obtained using histology, confirming the accuracy of the technique and its potential as a complement (rather than alternative) to traditional methods of analysis.
This work demonstrates the potential of OPT for imaging atherosclerotic and neointimal lesions. It provides a rapid, much needed ex vivo technique for the routine 3-dimensional quantification of vascular remodelling.

Ex vivo analysis of arterial lesions from animal models of cardiovascular disease classically relies on histological and immunohistochemical techniques. These provide 2-dimensional measurements in 3-dimensional lesions. This manuscript describes the generation of arterial lesions for quantitative analysis in 3-dimensions using optical projection tomography.

Geração e quantificação 3-Dimensional de Arterial lesões em ratos por meio de tomografia óptica de Projeção

The generation and analysis of vascular lesions in appropriate animal models is a cornerstone of research into cardiovascular disease, generating ...

Quantitative Analysis and Characterization of Atherosclerotic Lesions in the Murine Aortic Sinus

Atherosclerosis is a disease of the large arteries and a major underlying cause of myocardial infarction and stroke. Several different mouse models have been developed to facilitate the study of the molecular and cellular pathophysiology of this disease. In this manuscript we describe specific techniques for the quantification and characterization of atherosclerotic lesions in the murine aortic sinus and ascending aorta. The advantage of this procedure is that it provides an accurate measurement of the cross-sectional area and total volume of the lesion, which can be used to compare atherosclerotic progression across different treatment groups. This is possible through the use of the valve leaflets as an anatomical landmark, together with careful adjustment of the sectioning angle. We also describe basic staining methods that can be used to begin to characterize atherosclerotic progression. These can be further modified to investigate antigens of specific interest to the researcher. The described techniques are generally applicable to a wide variety of existing and newly created dietary and genetically-induced models of atherogenesis.

We describe procedures to quantify and characterize atherosclerotic lesions in mouse models using precision sectioning of the aortic sinus and ascending aorta combined with histochemical and immunohistochemical analysis.

Atherosclerosis is a disease of the large arteries and a major underlying cause of myocardial infarction and stroke. Several different mouse models have ...

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to assess changes in myelination at the central nervous system (CNS). However, standard measurements, including routine visual tests and MRI scans, are not sensitive enough for this purpose. We present two visual tests addressing dynamic monocular and binocular functions which may closely associate with the extent of myelination along visual pathways. These include Object From Motion (OFM) extraction and Time-constrained stereo protocols. In the OFM test, an array of dots compose an object, by moving the dots within the image rightward while moving the dots outside the image leftward or vice versa. The dot pattern generates a camouflaged object that cannot be detected when the dots are stationary or moving as a whole. Importantly, object recognition is critically dependent on motion perception. In the Time-constrained Stereo protocol, spatially disparate images are presented for a limited length of time, challenging binocular 3-dimensional integration in time. Both tests are appropriate for clinical usage and provide a simple, yet powerful, way to identify and quantify processes of demyelination and remyelination along visual pathways. These protocols may be efficient to diagnose and follow optic neuritis and multiple sclerosis patients.
In the diagnostic process, these protocols may reveal visual deficits that cannot be identified via current standard visual measurements. Moreover, these protocols sensitively identify the basis of the currently unexplained continued visual complaints of patients following recovery of visual acuity. In the longitudinal follow up course, the protocols can be used as a sensitive marker of demyelinating and remyelinating processes along time. These protocols may therefore be used to evaluate the efficacy of current and evolving therapeutic strategies, targeting myelination of the CNS.

Object From Motion (OFM) and Time-constrained stereo protocols are sensitive tools to identify monocular and binocular dynamic visual function deficits, which are uniquely affected in optic neuritis patients. Furthermore, these tests may be used as quantitative noninvasive tools to assess the extent of myelination along visual pathways.

Testes dinâmicos visuais para identificar e quantificar danos Visual e Reparação Após desmielinização na neurite óptica Pacientes

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to ...

A Versatile Murine Model of Subcortical White Matter Stroke for the Study of Axonal Degeneration and White Matter Neurobiology

Stroke affecting white matter accounts for up to 25% of clinical stroke presentations, occurs silently at rates that may be 5-10 fold greater, and contributes significantly to the development of vascular dementia. Few models of focal white matter stroke exist and this lack of appropriate models has hampered understanding of the neurobiologic mechanisms involved in injury response and repair after this type of stroke. The main limitation of other subcortical stroke models is that they do not focally restrict the infarct to the white matter or have primarily been validated in non-murine species. This limits the ability to apply the wide variety of murine research tools to study the neurobiology of white matter stroke. Here we present a methodology for the reliable production of a focal stroke in murine white matter using a local injection of an irreversible eNOS inhibitor. We also present several variations on the general protocol including two unique stereotactic variations, retrograde neuronal tracing, as well as fresh tissue labeling and dissection that greatly expand the potential applications of this technique. These variations allow for multiple approaches to analyze the neurobiologic effects of this common and understudied form of stroke.

Here we present methodology for the production of a focal stroke in murine white matter by local injection of an irreversible endothelial nitric oxide synthase (eNOS) inhibitor (L-Nio). Presented are two stereotactic variations, retrograde neuronal tracing, and fresh tissue labeling and dissection that expand the potential applications of this technique.

A Stroke Versátil Modelo murino de Subcortical Branco Matéria para o Estudo da axonal Degeneration e branco Matéria Neurobiology

Stroke affecting white matter accounts for up to 25% of clinical stroke presentations, occurs silently at rates that may be 5-10 fold greater, and ...

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue.
In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion.
Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.

The aim of this study is to report a protocol for the arthroscopic treatment of osteochondral lesions of the talus using microfractured and purified adipose-derived stem cells.

Microfractured autólogo e purificado tecido adiposo para gestão artroscópica das lesões osteocondrais do tálus

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several ...

Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow the examination of all semicircular canals in the clinical setting. Assessment methods of the otolithic system, which is responsible for the perception of linear acceleration and perception of gravity, are far less in clinical use. There are several experimental approaches for measuring the perception of gravity. The most frequently used method is the determination of the subjective visual vertical. This is usually measured with the head in an upright position. We present here an assessment method for testing otolith function in the roll plane. The subjective visual vertical is measured in the head upright position as well as with head inclination of &#177; 15&#176; and &#177; 30&#176; in the roll plane. This extended functional paradigm is an easy-to-perform clinical test of otolith function and ensures increased information content for the detection of impaired graviceptive perception.

The perception of gravity is commonly determined by the subjective visual vertical in the head upright position. The additional assessment at head tilts of &#177; 15&#176; and &#177; 30&#176; in the roll plane ensures increased information content for the detection of impaired graviceptive perception.

Avaliação da Percepção Graviceptiva Estática no Plano de Rolagem usando o Paradigma Vertical Visual Subjetivo

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow ...