Name: cmap scan mune (mscan) - a novel motor unit number estimation (mune) method
Uploaded: 2018-06-07T12:30:00
Description: Watch this Scientific Journal Video about CMAP Scan MUNE MScan - A Novel Motor Unit Number Estimation MUNE Method at JoVE.com

本研究主要由 Lundbeck 基金会资助。
此外, Knud Eriksens Mindefond, Søster 弗纳 Lipperts 喜欢, Fonden Lægevidenskabens, Fremme Aage 路易喬安妮喜欢支持这项研究。

所有受试者必须在考试前给予书面同意, 录音协议必须由适当的地方道德审查委员会批准。这里描述的所有方法都得到了区域科学伦理委员会和丹麦数据保护局的批准。
注: 录音是用"TRONDNF"记录协议, 这是软件的一部分 (见材料表)。使用的其他设备是双极刺激器, 一个 50 Hz 的消噪装置, 一个功放, 和一个模拟到数字 (a/d) 板 (也建议是一个音频放大器的反...

<ol>
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P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Statistical+motor+unit+number+estimation:+from+theory+to+practice.">Statistical motor unit number estimation: from theory to practice.</a> Muscle Nerve. 28, 263-272 (2003).</li><li>Unlusoy Acar, Z., 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=Decline+of+compound+muscle+action+potentials+and+statistical+MUNEs+during+Wallerian+degeneration.">Decline of compound muscle action potentials and statistical MUNEs during Wallerian degeneration.</a> Neurophysiol. Clin. 44, 257-265 (2014).</li><li>Henderson, R. D., Ridall, P. G., Hutchinson, N. M., Pettitt, A. N., McCombe, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bayesian+statistical+MUNE+method.">Bayesian statistical MUNE method.</a> Muscle Nerve. 36, 206-213 (2007).</li><li>Ridall, P. G., Pettitt, A. N., Henderson, R. D., McCombe, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor+unit+number+estimation--a+Bayesian+approach.">Motor unit number estimation--a Bayesian approach.</a> Biometrics. 62, 1235-1250 (2006).</li><li>Nandedkar, S. D., Nandedkar, D. S., Barkhaus, P. E., Stalberg, E. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor+unit+number+index+(MUNIX).">Motor unit number index (MUNIX).</a> IEEE Trans. Biomed. Eng. 51, 2209-2211 (2004).</li><li>Neuwirth, 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=Motor+Unit+Number+Index+(MUNIX):+a+novel+neurophysiological+marker+for+neuromuscular+disorders;+test-retest+reliability+in+healthy+volunteers.">Motor Unit Number Index (MUNIX): a novel neurophysiological marker for neuromuscular disorders; test-retest reliability in healthy volunteers.</a> Clin. Neurophysiol. 122, 1867-1872 (2011).</li><li>Jacobsen, A. B., 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=Reproducibility,+and+sensitivity+to+motor+unit+loss+in+amyotrophic+lateral+sclerosis,+of+a+novel+MUNE+method:+MScanFit+MUNE.">Reproducibility, and sensitivity to motor unit loss in amyotrophic lateral sclerosis, of a novel MUNE method: MScanFit MUNE.</a> Clin neurophysiol. 128, 1380-1388 (2017).</li><li>Maathuis, E. M., Drenthen, J., Visser, G. H., Blok, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reproducibility+of+the+CMAP+scan.">Reproducibility of the CMAP scan.</a> J. Electromyogr. Kinesiol. 21, 433-437 (2011).</li><li>Sleutjes, B. T. H. 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=CMAP+scan+discontinuities:+automated+detection+and+relation+to+motor+unit+loss.">CMAP scan discontinuities: automated detection and relation to motor unit loss.</a> Clin Neurophysiol. 125, 388-395 (2014).</li><li>Bostock, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimating+motor+unit+numbers+from+a+CMAP+scan.">Estimating motor unit numbers from a CMAP scan.</a> Muscle Nerve. 53, 889-896 (2016).</li><li>DeLong, E. R., DeLong, D. M., Clarke-Pearson, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparing+the+areas+under+two+or+more+correlated+receiver+operating+characteristic+curves:+a+nonparametric+approach.">Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.</a> Biometrics. 44, 837-845 (1988).</li><li>Hanley, J. A., McNeil, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+method+of+comparing+the+areas+under+receiver+operating+characteristic+curves+derived+from+the+same+cases.">A method of comparing the areas under receiver operating characteristic curves derived from the same cases.</a> Radiology. 148, 839-843 (1983).</li><li>Farschtschi, S., 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=Muscle+action+potential+scans+and+ultrasound+imaging+in+neurofibromatosis+type+2+:+CMAP+Scans+and+Nerve+Imaging+in+NF2.">Muscle action potential scans and ultrasound imaging in neurofibromatosis type 2 : CMAP Scans and Nerve Imaging in NF2.</a> Muscle Nerve. 55, 350-358 (2017).</li></ol>

议定书内的关键步骤:MScan 是一个高度自动化的程序, 但与所有的肌电信号的方法, 应注意取得一致的结果。在准备阶段, 重要的是要达到松弛, 因为自发活动或运动文物在 CMAP 扫描引入杂散方差在 CMAP 和混淆的世代的初步模型。
修改和疑难解答:我们发现, 手指的录音, 并使用听觉肌电反馈, 以帮助找到最佳肢体位置, 有助于避免一些差异。
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马达系统运动依赖于马达单元, 它指的是单个的运动神经纤维和它激活的肌肉纤维, 而马达单位数是前角细胞或轴突支配单个肌肉1的数量。在神经支配和神经过程中, 健康的轴突接管了由侧枝发芽而失去的轴突的作用。因此, 复合肌肉动作电位 (CMAP) 振幅不提供有关电机单位损耗程度的必要信息。当超过50% 的马达单位丢失时, CMAP 振幅可能会开始下降。同样, 异常自发活动或运动单位电位 (内务部) 变化的幅度与神经支配程度无关。
总的来说, 没有电生理技术允许简单直接测量电机的单位数。相反, 对马达单位数 (免疫性) 的估计被用来评估较低的运动神经元损失2。自 1971年 McComas3引进的第一种方法, 即增量刺激免疫性的实施以来, 已开发出几种免疫性方法。大多数方法都是基于测量几种表面记录的电机单元电位 (sMUP), 并将最大 CMAP 除以平均 sMUP 振幅。这些方法包括增量刺激4, 多点刺激 (MPS)5和穗触发平均6。其他免疫性方法利用统计技术, 根据对刺激7,8,9,10的动力单元的发射概率性质。这种可变性意味着, 发射不同的马达单位组合会导致 CMAP 反应的大小变化。电机单元数指数 (Munix) 是一种较新近采用的方法, 它使用在自愿收缩期间记录的表面干扰模式来估计 sMUP11、12的平均大小。
这些免疫性方法都受到了一个或多个限制, 如主观性的存在, 对绝对 CMAP 振幅的依赖性, 单位选择中的偏倚, 取样足够长的时间, 或分析结果所需的长时间。最近开发了一种新的免疫性方法, 即 "CMAP 扫描免疫性" (MScan), 以克服这些限制13。这种方法避免了单位选择中固有的问题, 考虑到所有单位对 CMAP 的贡献, 在详细的刺激-反应曲线, 或 CMAP 扫描14,15测量。它还避免了类似的模型拟合方法9,10的扩展分析时间, 使用新的算法16。在最近的一项研究中, MScan 在估计运动单位数量方面的重现性优于两种传统方法, MPS 免疫性和 Munix13。此外, MScan 可能显示肌萎缩侧索硬化 (ALS) 早期阶段的运动单位损失比 MPS 免疫性和 Munix。MScan 比 MPS 免疫性快, Munix13。
本文详细介绍了 MScan 的方法。它还总结了以前报告的 MScan 在 ALS 和健康控制科目13患者内和评分员之间的重现性, 这可能使读者判断该方法是否适合于计划的研究。

<table>
	<tbody>
		<tr>
			<td>QtracW software</td>
			<td>Digitimer Ltd (copyright Institute of Neurology, University College, London)&#160;&#160;</td>
			<td>QtracW</td>
			<td></td>
		</tr>
		<tr>
			<td>MScanFit</td>
			<td>Digitimer Ltd (copyright Institute of Neurology, University College, London)&#160;&#160;</td>
			<td>QtracW</td>
			<td></td>
		</tr>
		<tr>
			<td>DS5 bipolar stimulator</td>
			<td>Digitimer Ltd&#160;</td>
			<td>DS5</td>
			<td></td>
		</tr>
		<tr>
			<td>D440 amplifier&#160;</td>
			<td>Digitimer Ltd&#160;</td>
			<td>D440-2 (2 channel) or D440-4 (4 channel)</td>
			<td></td>
		</tr>
		<tr>
			<td>HumBug Noise Eliminator</td>
			<td>Digitimer Ltd&#160;</td>
			<td>Humbug</td>
			<td></td>
		</tr>
		<tr>
			<td>Analogue-to-digital (A/D) board&#160;&#160;</td>
			<td>National Instruments</td>
			<td>NI-6221&#160;</td>
			<td></td>
		</tr>
	</tbody>
</table>

cmap scan mune (mscan) - a novel motor unit number estimation (mune) method

与其他电机单位数估计方法 (免疫性) 一样, 复合肌肉动作电位 (CMAP) 扫描免疫性 (MScan) 是一种非侵入性电生理学方法来估计肌肉中运转的运动单位数。免疫性是评价神经病和 neuronopathies 的重要工具。不同于使用的大多数免疫性方法, MScan 评估肌肉中的所有马达单位, 通过拟合模型到详细的刺激反应曲线, 或 CMAP 扫描。它从而避免了所有免疫性方法的固有偏差, 其基础是从一个小样本单位推断出来的。像 ' 贝叶斯免疫性, ' MScan 分析工作的模型, 由不同的振幅, 阈值和阈值多变性的电机单位, 但拟合方法是相当不同的, 并完成五分钟内, 而不是几个小时。MScan 离线分析工作分为两个阶段: 一是基于扫描点的斜率和方差产生的初始模型, 其次, 通过调整所有参数来改进该模型, 以提高原始扫描与由模型生成的扫描。
这一新的方法已被测试的重现性和记录时间22肌萎缩侧索硬化症 (ALS) 患者和20健康的控制, 每一次测试重复两次双盲医生。MScan 显示优异的内部和评分的重复性与 ICC 的价值 > 0.98 和变化系数平均 12.3 1.6%。两名观察员的评分员内重现性没有差异。平均记录时间为 6.27 0.27 分钟。
本协议描述如何记录 CMAP 扫描以及如何使用 MScan 软件来得出对运行的马达单元的数量和大小的估计。MScan 是一种快速、方便、重现性好的方法, 有助于诊断和监测神经肌肉疾病的进展。

在最近的一项研究中获得了以下结果: MScan 法与两种已建立的技术进行了比较, 即多点刺激免疫性 (MPS) 和电机单位数指数 (Munix)13。结果表明, 本协议所描述的技术具有良好的重现性, 可实现一致的结果。该方法能使 ALS 患者比 CMAP 早期的健康控制更加容易, 使用速度快,13。这表明该方法可能适合临床使用。
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Watch this Scientific Journal Video about CMAP Scan MUNE MScan - A Novel Motor Unit Number Estimation MUNE Method at JoVE.com

CMAP Scan MUNE MScan - A Novel Motor Unit Number Estimation MUNE Method

该协议描述了一种新的方法来估计肌肉中运转的运动单位的数量, 通过拟合一个模型到一个详细的刺激反应曲线的复合肌肉动作电位。它快速, 易于执行和分析, 具有优良的重现性。

CMAP 扫描免疫性 (MScan)-一种新的电机单元数估计 (免疫性) 方法

Like other methods for motor unit number estimation (MUNE), compound muscle action potential (CMAP) scan MUNE (MScan) is a non-invasive electrophysiologic ...

The overall goal of this procedure is to describe MScan, a new method used to estimate the number of functioning motor units in a muscle. MScan is a non-invasive method used to estimate the number of functioning motor units in a muscle. MScan works by fitting a model to a detailed stimulus-response curve, or CMAP scan.This method has several advantages. It can be completed quickly, it's easy to perform and analyze, and it has excellent reproducibility. To begin, request written consent from the subject.All subjects must give their written consent prior to the examination. Then, explain that the subject will experience a tickling sensation in their hand and wrist and that the examination can be halted at any time should they experience too much discomfort. First, use skin prep gel and alcohol to clean the subject's hand and forearm.Position the active recording electrode over the abductor pollicis brevis muscle, and then place the reference electrode on the metacarpophalangeal joint of the thumb. Place a ground electrode on the dorsum of the subject's hand, and connect the electrodes to the pre-amplifier. After positioning and connecting the electrodes to the pre-amplifier, tape the subject's fingers together to reduce noise and artifacts caused by voluntary movement.To start the semi-automated computerized system, use the standard protocol for motor nerve excitability tests. From the main menu, select MSCAN-R recording protocol and accept default settings for the pre-amplifier and the stimulator. In the Select recording parameters form, enter a two-to three-letter operator prefix in the Output file box.Then, click OK to continue. When the screen displays the raw EMG input, accept the default parameters and click OK.To find the site of lowest threshold at the median nerve of the wrist, position a repositionable stimulating electrode. Continue to adjust the position of the electrode until the largest EMG response has been achieved.Once the site of lowest threshold has been located, click OK to continue. Next, the modified response will be displayed with the window where the response is measured. The magenta line indicates the response measured in the window, while the short green line immediately before the window indicates the baseline.Replace the repositionable electrode with a non-polarizable adhesive stimulating cathode electrode, and place an anode two centimeters proximally along the median nerve. Encourage the subject to find the most relaxed position for their hand to minimize spontaneous activity. Click the OK button to continue.Manually increase stimulus intensity by steps of 3%by pressing the Insert key. Click the OK button to continue. Make fine 1%stimulus adjustments until the stimulus current is above the level for the maximal amplitude of the CMAP.After the responses to 20 supramaximal pre-scans are recorded, the stimulus intensity will automatically decrease with the frequency and percent steps selected previously. Once there is no longer a response from the subject, click the OK button to finish the recording with the series of 20 CMAP post-scans. Finally, click the OK button in the lower right corner to finish the recording and save the data.To do analyses offline, start the analysis program and select the MScan recording to be analyzed. Select Fit MScan on a QZD file from the menu. Then, the program will automatically generate a preliminary model and optimize the fit.The program will continue to run without user intervention until the multicolored progress bar in the Optimization box is complete and the Stop button is gray. The original scan, in black, can be plotted next to the scan generated by the model, in magenta. Make serial adjustments to minimize the difference between the recorded and simulated scans and optimize the model.In the Plot type box, different plotting options may be used to track the optimization process. A multicolored progress bar will also be displayed in the Optimization panel. Use a contour plot to assess the accuracy of the model by selecting the Diff and Contour map displays.These displays show the differences between the recorded and modeled CMAP scans as a contour plot. As the optimization process runs, these differences will be minimized. When the optimization process is complete, view the analysis results in the MScanFit text display.Finally, click on the OK button to save the model in a MEM file. In this study, MScan MUNE is used to derive an estimation of the number and sizes of functional motor units by fitting a model to CMAP scan. This technique is tested for sensitivity and specificity in both healthy controls and ALS patients.As expected, the median number of motor units in patients with ALS is significantly lower than in healthy controls. As shown by the ROC curve, the ability of MScan MUNE to distinguish the healthy controls from ALS patients is compared to that of CMAP. Area under the curve, or AUC, is used to measure the ability of both techniques to distinguish between ALS patients and healthy controls.The AUC of MScan MUNE is significantly higher than that of CMAP. Once mastered, this technique can be completed in six minutes if it's performed properly. The analysis process is also fast and should take less than five minutes.When attempting this procedure, it's important to remember to achieve adequate relaxation of the subject. MScan is a method that may have the potential to be implemented in a clinical setting for diagnosis and monitoring of neuromuscular disorders such as ALS. Further studies with other neuromuscular disorders and larger study groups are warranted.Studies on the application of MScan in different muscle groups should also be conducted. After watching this video, you should have a good understanding of how to perform and analyze MScan examinations.

Research

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Neuroscience

CMAP Scan MUNE (MScan) - A Novel Motor Unit Number Estimation (MUNE) Method

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Anxiety testing in zebrafish is often studied in combination with the application of pharmacological substances. In these studies, fish are routinely ...

Recording EEG in Freely Moving Neonatal Rats Using a Novel Method

使用新颖的方法在自由移动的新生大鼠中记录脑电图

EEG is a useful method to detect electrical activity in the brain. Moreover, it is a widely used diagnostic tool for various neurological conditions, such ...

A Novel Method to Model Chronic Traumatic Encephalopathy in Drosophila

A Novel Method to Model Chronic Traumatic Encephalopathy in Drosophila

慢性创伤性脑病模型的一种新方法<em&gt;果蝇</em

Chronic Traumatic Encephalopathy (CTE) is an established neurodegenerative disease that is closely associated with exposure to repetitive mild Traumatic ...

Stereological Estimation of Dopaminergic Neuron Number in the Mouse Substantia Nigra Using the Optical Fractionator and Standard Microscopy Equipment

用光学分馏塔和标准显微镜设备对小鼠黑质多巴胺能神经元数的视学估计

In pre-clinical Parkinson&#39;s disease research, analysis of the nigrostriatal tract, including quantification of dopaminergic neuron loss within the ...