Nós gostaríamos de reconhecer todos os colegas na Utin para seu trabalho.

este protocolo foi aprovado pelo institucional Review Board de Renji Hospital, Shanghai Jiaotong University School of Medicine.
 1. preparação do paciente Nota: sensor de pressão Intracraniana é colocado no paciente por uma operação cirúrgica ( Figura 1). O sensor é colocado no espaço epidural, espaço subdural, parênquima ou no sistema ventricular.
<ol><li>Ligue a máquina de monitoramento do ICP com o cabeceira monitor através de um cabo de comunicação específica.</li>
	<li>Ajustar a referência do paciente &#39; monitor de cabeceira de s, para que os dados do monitor cabeceira estão em conformidade com a ICP monitoramento máquina.</li>
	<li>Realizar uma colocação de linha arterial no paciente &#39; s esquerda ou da artéria radial direita 20.</li>
	<li>Conectar a linha arterial com a baroreceptor.</li>
	<li>Conectar o transdutor de pressão com o paciente &#39; monitor de cabeceira s através de um cabo de comunicação.</li>
	<li>Zero ajustar o monitor de cabeceira, para que a pressão de sangue medida coincide com o valor real.</li>
</ol> 2. Gravação dos parâmetros fisiológicos <ol><li>conectar o paciente &#39; monitor de cabeceira s com os dados a recolher e armazenar dispositivo através de um cabo de rede.</li>
	<li>Pressione o botão power para ligar os dispositivo de coleta de dados.</li>
	<li>Aguarde alguns segundos até que a multimodalidade, software de monitoramento é executado automaticamente.</li>
	<li>Digite as informações do paciente, incluindo o nome, identificação, diagnóstico e escala de Coma de Glasgow inicial (GCS).</li>
	<li>Clique a &#34; salvar e iniciar o monitoramento &#34; o botão para iniciar dados coletando e armazenando.</li>
	<li>Clique o &#34; desligar &#34; botão na tela no final da aquisição de dados ( Figura 2).</li>
	<li>Digite o GCS final.</li>
</ol> 3. Análise do parâmetro <ol><li>despejar os dados armazenados em um U-disco através de interfaces de barramento serial universal (USB) no host.</li>
	<li>Digite um nome de usuário e senha para fazer logon servidor de análise.</li>
	<li>Clique o &#34; criar novo registro &#34; botão e selecione o arquivo de dados no U-disco para começar a enviar.</li>
	<li>Esperar em torno de 10 a 20 min antes que os dados são analisados (dependendo do tamanho de dados).</li>
	<li>Clique o &#34; detalhe &#34; botão de cada registro para ver o resultado.</li>
	<li>Clique o &#34; visualização de gráfico &#34; para ver o diagrama final.</li>
	<li>Arrastar a linha do tempo para ver mais detalhes.</li>
	<li>Clique no &#34; scattergram &#34; botão para ver a distribuição dos parâmetros.</li>
</ol>

<ol>
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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. 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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. 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Sem apoio financeiro foi recebido.

Este objectivo deste artigo é apresentar o novo monitoramento de multimodalidade e analisando sistema para pacientes críticos neurocirúrgicos, que pode ser usado para monitorar os parâmetros fisiológicos, analisar o status clínico atual e, com sorte, prever o prognóstico dos pacientes críticos neurocirúrgicos. Hoje em dia, o foco de monitoramento do ICP é principalmente sobre o ICP valor médio enquanto ignora outros parâmetros, que podem conter riscos de imprecisão ou atraso4,5,21. Por outro lado, o ICP derivado parâmetros tais como a forma de onda ICP, AMP, RAP, PRx e IAAC são relatados para ter grande importância na previsão de prognóstico e orientar o tratamento adequado de16,de5,17, 18,19. No entanto, todos estes parâmetros exigem monitoramento de multimodalidade e aquisição de grande volume de dados e análise, que pode tomar muito tempo e esforço. Além disso, existem alguns dispositivos específicos que são adequados para os médicos em seu trabalho clínico diário atualmente.
Para resolver este problema, desenvolvemos recentemente uma sistema de monitoramento de multimodalidade. Ele usa uma coleta automática de dados e armazenar dispositivo para continuamente adquirir informações fisiológicas de pacientes antes de enviar os dados para o servidor online para o trabalho de análise para investigar o significado destes ICP derivada parâmetros. Como é mencionado anteriormente, a multimodalidade, sistema de monitoramento tem as seguintes vantagens. Em primeiro lugar, ele pode coletar dados em tempo real em alta-frequência. A frequência de coleta de dados pode chegar até 120 Hz. em segundo lugar, pode gravar vários parâmetros, ou seja, ICP forma de onda, PRx, RAP e IAAC. Todos eles são essenciais na análise do status clínico atual e na predição do prognóstico. Além disso, pode atingir monitoramento contínuo de longo prazo. Pode gravar todos os detalhes durante todo o tratamento dos pacientes. Por último mas não menos importante, é portátil e fácil de aprender. Os clínicos podem facilmente transferir os dados para um servidor de análise específica, que executará o cálculo e construção de gráficos automaticamente. Existem apenas dois passos críticos no protocolo. Uma é a colocação do sensor de pressão Intracraniana. A outra é a colocação de linha arterial e monitorização da pressão arterial. Uma vez corretamente conectado e operado, a multimodalidade, sistema de monitoramento pode coletar e armazenar dados em tempo real antes de análise e representação gráfica-los automaticamente, que é apropriados para os médicos.
No entanto, também tem algumas limitações. Este sistema só inclui ICP e pressão arterial invasiva e não possui outros parâmetros como EKG, EEG ou TCD. Outra limitação é que o modo automático de análise não é abundante e só pode fazer certos cálculos e construções de gráficos.
Nós têm sido continuamente modificar este sistema e ter corrigido vários problemas que ocorreram durante o uso a longo prazo. Estamos confiantes de que todas as limitações serão abordadas no futuro e vai ser mais aplicável.
Esperamos que a multimodalidade, sistema de monitoramento será aceita como uma medida-chave para monitorar os parâmetros fisiológicos, para analisar o status clínico atual e para predizer o prognóstico de pacientes neurocirúrgicos críticos no futuro.

Monitorização da pressão Intracraniana é amplamente utilizado para avaliar o status intracraniana no departamento de neurocirurgia, especialmente em pacientes críticos neurocirúrgicos1,2,3. Além do valor médio de ICP, ICP derivado parâmetros tais como forma de onda ICP, AMP, RAP, PRx, IAAC e assim por diante, podem refletir o status da circulação intracerebral, cerebrospinal reserva compensatória e cérebro conformidade4,5, 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13. podem ser indicativos de iminente deterioração neurológica e até mesmo resultado de pacientes14,15,16,17,18. Eles também podem ser usados como orientação de tratamento adequado19. No entanto, a maioria dos clínicos focar apenas o valor médio do ICP ignorando esses parâmetros. Isto é em parte porque existem alguns dispositivos específicos que são adequados para os médicos em seu trabalho clínico diário.
Para resolver esses inconvenientes, recentemente desenvolvemos uma sistema de monitoramento de multimodalidade. Nós usamos uma coleta de dados automáticos e dispositivo de armazenamento para adquirir continuamente informações fisiológicas dos pacientes, como pressão arterial, pressão Intracraniana e saturação de oxigênio e analisar estes parâmetros fisiológicos a fim de revelar o status clínico atual e, com sorte, prever o prognóstico dos pacientes críticos neurocirúrgicos. Este sistema de monitoramento de multimodalidade tem várias vantagens: (1) ele pode coletar dados em tempo real em alta frequência, (2) pode gravar vários parâmetros, ou seja, ICP forma de onda, PRx, RAP e IAAC, (3) pode conseguir a longo prazo monitoramento contínuo e (4) é portátil e fácil de aprender.
O objetivo do presente artigo, portanto, é mostrar um método detalhado de como usar a multimodalidade, sistema de monitoramento para registrar vários parâmetros fisiológicos em pacientes críticos neurocirúrgicos.

<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

Monitorização da pressão intracraniana (ICP) agora é amplamente utilizado em pacientes críticos neurocirúrgicos. Além de médio valor ICP, ICP derivado parâmetros tais como a forma de onda do ICP, amplitude de pulso (AMP), a correlação da amplitude do ICP e ICP significam (RAP), pressão índice de reatividade (PRx), ICP e correlação de amplitude de onda de pressão arterial (ABP) (IAAC) e então lá, pode refletir status intracraniana, predizer prognóstico e também pode ser usada como orientação de tratamento adequado. No entanto, a maioria dos clínicos focar apenas o valor médio do ICP ignorando esses parâmetros devido às limitações dos dispositivos atuais. Recentemente desenvolvemos uma sistema para resolver esses inconvenientes de monitoramento de multimodalidade. Este portátil, fácil de usar sistema usará uma coleta de dados e armazenar dispositivo continuamente adquirir parâmetros fisiológicos dos pacientes primeiro, ou seja, ABP, ICP e saturação de oxigênio e então analisar estes parâmetros fisiológicos. Esperamos que a multimodalidade, sistema de monitoramento será aceita como uma medida-chave para monitorar os parâmetros fisiológicos, para analisar o status clínico atual e para predizer o prognóstico dos pacientes críticos neurocirúrgicos.

Esta multimodalidade nova sistema de monitoramento foi aplicada em 22 pacientes críticos neurocirúrgicos (15 machos). 12 deles (54.55%) tinha sofrido de traumatismo crânio-encefálico (TCE), 9 deles (40.91%) teve hemorragia intracraniana e 1 deles (4,55%) teve infarto cerebral grave. O total de tempo de monitoramento é mais de 1.900 h (cerca de 88 h por paciente). Após a bem sucedida cirurgia, nós continuamente monitorados e analisados sua ICP, BP, CPP, PRx, RAP e IAAC. A Figura 3 mostra dados representativos deste sistema de vigilância. Podemos ajustar o cronograma para ver informações mais detalhadas (Figura 4). Além disso, somos capazes de analisar a relação entre quaisquer dois parâmetros, o que é demonstrado na Figura 5.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56388/56388fig1.jpg"> 
Figura 1 : Colocação de sensor ICP. O paciente passa por uma operação para a colocação do sensor de pressão Intracraniana antes de monitoramento. O sensor pode ser colocado no espaço epidural, espaço subdural, parênquima ou no sistema ventricular. Esta figura mostra a punção ventricular e a localização do sensor. O sensor de pressão Intracraniana está localizado na ponta do cateter. <a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig1large.jpg" target="_blank">Clique aqui para ver uma versão maior desta figura.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56388/56388fig2.jpg"> 
Figura 2 : Tela de sistema de monitoramento. A área superior esquerda mostra a atual onda de pressão Intracraniana e pressão arterial. A área inferior esquerda mostra atual RAP, PRx, IAAC, CPP e AMP. A parte direita da tela mostra a história. Mostrado na parte inferior são alguns dos botões funcionais como saída, captura de tela e adicionar marcadores. <a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig2large.jpg" target="_blank">Clique aqui para ver uma versão maior desta figura.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56388/56388fig3.jpg"> 
Figura 3 : Dados representativos de uma paciente de hemorragia cerebral. Os parâmetros como o ICP, BP, CPP, PRx, RAP e IAAC são registrados e plotados. O eixo X é o cronograma e os eixos Y são os parâmetros separados. <a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig3large.jpg" target="_blank">Clique aqui para ver uma versão maior desta figura.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56388/56388fig4.jpg"> 
Figura 4 : Informações detalhadas de dados representativos. Como ajustar a linha do tempo, podemos ver mais detalhadamente. O eixo X é o cronograma e os eixos Y são os parâmetros separados. <a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig4large.jpg" target="_blank">Clique aqui para ver uma versão maior desta figura.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56388/56388fig5.jpg"> 
Figura 5 : Relação entre o ICP e PRx. Nós podemos mudar os parâmetros no X eixo e o eixo Y para analisar a relação entre quaisquer dois parâmetros. Nesta figura, o eixo X é o ICP e o eixo Y é o PRx. Cada ponto vermelho representa um registro em tempo real. Podemos ver que, neste paciente, seu PRx tem uma variação de-0.7 para 1 e o PRx mais baixo é atingido quando o ICP é de 10 mmHg. <a href="//ecsource.jove.com/files/ftp_upload/56388/56388fig5large.jpg" style="font-size: 14px;" target="_blank">Clique aqui para ver uma versão maior desta figura.</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

Recentemente, temos desenvolvido uma multimodalidade portátil sistema de monitoramento para a monitorização de diversos parâmetros fisiológicos em pacientes críticos neurocirúrgicos. Protocolos detalhados sobre como usar este sistema de monitoramento de multimodalidade são apresentados aqui.

Um protocolo detalhado para parâmetros fisiológicos aquisição e análise em pacientes críticos neurocirúrgicos

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

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6.8K visualizações.  Shanghai Jiaotong University School of Medicine. Recentemente, temos desenvolvido uma multimodalidade portátil sistema de monitoramento para a monitorização de diversos parâmetros fisiológicos em pacientes críticos neurocirúrgicos. Protocolos detalhados sobre como usar este sistema de monitoramento de multimodalidade são apresentados aqui.

Vídeo: 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.

Intra-operatórias tarefas comportamentais em humanos Awake Submetidas à Cirurgia de Estimulação Profunda do Cérebro

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

Medicina

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.

Teste muscular manual: um método de medir a força muscular Extremidade Aplicada à pacientes criticamente enfermos

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.

Parabiose em Ratos: Um protocolo detalhado

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.

Avaliação Clínica de espaço-temporal parâmetros da marcha em pacientes mais velhas e adultos

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.

Um Defeito modelo simples Critical porte Femoral em Ratos

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.

Um protocolo detalhado para Monitoramento transpiração Usando um Novel, Pequeno, dispositivo sem fios

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.

Avaliação nociceptiva objectiva em pacientes de UTI ventilado: um estudo de viabilidade usando o Pupillometry e o reflexo de flexão nociceptiva

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.

Ensaio da atividade da endotoxina para a deteção do endotoxemia do sangue inteiro em pacientes criticamente doentes

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.

Um protocolo de treinamento intervalado de alta intensidade do mundo real para melhoria do condicionamento cardiorrespiratório

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.

Protocolo para o Desenvolvimento de um Modelo de Osteotomia do Fêmur em Ratos Albinos Wistar

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