This project was supported by Grant Numbers HL96593 from NIH and D56HP20783 from HRSA/ HHS. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or HRSA / HHS.

注意:获取处理用于获得毛细管图像先前已公布的和使用静止数字照相机与对应图像采集和分析的计算机程序来完成11 21本实验利用静止图像进行分析，而不是视频，简化用于分析图像采集。以下描述了一种用于从图像中定量的毛细血管的新技术。 1.图像增强处理<ol><li>获得的数字图像与单色的数码相机。通过取已知长度的对象的图片，例如用相机尺子校准图像以已知尺寸的目的。此过程允许计算机程序，测量和加工后准确地计算毛细管。理想情况下最高的精度，应使用一个手提袋（科学制造的一块玻璃，用蚀刻成它的统治者）。测量在一个1平方毫米的像素数框使用的计算机程序。 注意:关键此协议的重复性和标准化很大程度上取决于1mm 2中框被计数的正确放置。 </li><li>使用对比度增强工具变暗毛细血管，减轻的背景下，这将最大限度地提高毛细血管的可视化。毛细管从背景的初始分化为在后续步骤中的图像的适当的裁切重要。通过调整使用的图像做这个要做到这一点，点击"最适合的直方图。":捕捉，亮度，图像的直方图，最适合的。 </li><li>作物感兴趣区域（ROI）的毛细管计数为新图像的区域（选择，感兴趣区域）。使用1毫米2中，这是通过校准图像530的像素等于1毫米来确定。检查该裁剪出的图像放置毛细血管袢的顶点在图像的最顶端。 </li><li>拼合因此未来所有的图像调整将均匀地涂在图像图片。要做到这一点点击:进程选项卡，2D过滤器，压平，"光明"，对象宽度BG强度为"75"，适用。 </li><li>提高图像的对比度，因此毛细管最大限度可视化。要做到这一点点击:调整选项卡，显示屏，对比度提升到75。 </li><li>去斑的图片，点击进程选项卡，2D过滤器，去斑，内核尺寸7×7平滑毛细血管的边缘，适用。 </li><li>最终确定的图像对比度使毛细血管是黑色的，背景是白色的。执行此步骤通过调整直方图的"最适合"的模式。 注: 请参考图2代表结果的处理图像应该是什么样子以下步骤的一个例子。 </li></ol> 2.执行毛细管计数/定性测定毛细血管密度<ol><li>每个图像，手动选择使用"目标对象"featur一个明确定义的毛细管中的一个部分E要被识别为对象的程序计算。然后，选择的背景的一小部分，采用了"背景"的功能，作为参考，以需要由所述计数算法被忽略的区域。 注意:这些亮点的组合导致而忽视了背景噪音所有毛细管加以强调。定量（计数）协议使用的计算机的功能来区分基于颜色和形态图像的某些部分。 </li><li>使用计数功能能够即时计算所有毛细管与成像设备的形象。为了避免计算的背景噪声如毛细血管设置计算的对象到5个像素的最小直径。 </li><li>对于每个单独的，计数为3的平均 - 4个图像，以获得一个更可靠的评估。 注: 请参考图3。代表结果的形象应该是什么样子的计算过程中的一个例子。 </li></ol&gt; 3.创建和使用宏来自动图像处理注:为了节省时间，宏可以以一个或多个图像自动执行的过程特定顺序创建。这些序列可以定制，以使该图像修改更快。从本质上说，这些宏记住如何图像进行处理，并迅速和没有用户输入执行所有的步骤。 12毛细管图像执行计数需要20至30分钟之间的这种实验室用宏（2至3每个画面分钟），相对于每个图象约8分钟而不宏。因此，使用宏是比手动处理每个单独的图像3至5倍更有效的。 <ol><li>为了创建宏，选择"记录宏"，并在一个图像执行的步骤和过程所需的，如在步骤1和2如上所述。在此基础上的图像处理步骤进行以供将来参考进行命名宏。当USI纳克未来图片宏，只需单击"运行宏"，程序将自动应用所记录的增强功能需要的图像（S）。 注:本实验使用宏来执行的在几秒钟的方法第1节所有，但其中一个步骤。需要用户输入唯一的步骤是选择在哪里裁剪图像，步骤1.2。 </li></ol>

<ol>
	<li>Gronenschild, E. H., 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=Semi-automatic+assessment+of+skin+capillary+density:+proof+of+principle+and+validation.">Semi-automatic assessment of skin capillary density: proof of principle and validation.</a> Microvasc Res. 90, 192-198 (2013).</li><li>Allen, J., Howell, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microvascular+imaging:+techniques+and+opportunities+for+clinical+physiological+measurements.">Microvascular imaging: techniques and opportunities for clinical physiological measurements.</a> Physiol Meas. 35, R91-R141 (2014).</li><li>Boettcher, M., Gloe, T., de Wit, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Semiautomatic+quantification+of+angiogenesis.">Semiautomatic quantification of angiogenesis.</a> J Surg Res. 162, 132-139 (2010).</li><li>Wild, R., Ramakrishnan, S., Sedgewick, J., Griffioen, A. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+assessment+of+angiogenesis+and+tumor+vessel+architecture+by+computer-assisted+digital+image+analysis:+effects+of+VEGF-toxin+conjugate+on+tumor+microvessel+density.">Quantitative assessment of angiogenesis and tumor vessel architecture by computer-assisted digital image analysis: effects of VEGF-toxin conjugate on tumor microvessel density.</a> Microvasc Res. 59, 368-376 (2000).</li><li>Tresadern, P. 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=Simulating+nailfold+capillaroscopy+sequences+to+evaluate+algorithms+for+blood+flow+estimation.">Simulating nailfold capillaroscopy sequences to evaluate algorithms for blood flow estimation.</a> Conf Proc IEEE Eng Med Biol Soc. , 2636-2639 (2013).</li><li>Anderson, M. 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=Computerized+nailfold+video+capillaroscopy--a+new+tool+for+assessment+of+Raynaud's+phenomenon.">Computerized nailfold video capillaroscopy--a new tool for assessment of Raynaud's phenomenon.</a> J Rheumatol. 32, 841-848 (2005).</li><li>Neubauer-Geryk, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decreased+reactivity+of+skin+microcirculation+in+response+to+L-arginine+in+later-onset+type+1+diabetes.">Decreased reactivity of skin microcirculation in response to L-arginine in later-onset type 1 diabetes.</a> Diabetes Care. 36, 950-956 (2013).</li><li>Pazos-Moura, C. C., Moura, E. G., Bouskela, E., Torres-Filho, I. P., Breitenbach, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nailfold+capillaroscopy+in+diabetes+mellitus:+morphological+abnormalities+and+relationship+with+microangiopathy.">Nailfold capillaroscopy in diabetes mellitus: morphological abnormalities and relationship with microangiopathy.</a> Braz J Med Biol Res. 20, 777-780 (1987).</li><li>Antonios, T. F., Singer, D. R., Markandu, N. D., Mortimer, P. S., MacGregor, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Structural+skin+capillary+rarefaction+in+essential+hypertension.">Structural skin capillary rarefaction in essential hypertension.</a> Hypertension. 33, 998-1001 (1999).</li><li>Kaiser, S. E., Sanjuliani, A. F., Estato, V., Gomes, M. B., Tibirica, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Antihypertensive+treatment+improves+microvascular+rarefaction+and+reactivity+in+low-risk+hypertensive+individuals.">Antihypertensive treatment improves microvascular rarefaction and reactivity in low-risk hypertensive individuals.</a> Microcirculation. 20, 703-716 (2013).</li><li>Cheng, C., Diamond, J. J., Falkner, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+capillary+rarefaction+in+mild+blood+pressure+elevation.">Functional capillary rarefaction in mild blood pressure elevation.</a> Clinical and Translational Science. 1, 75-79 (2008).</li><li>Debbabi, H., Bonnin, P., Levy, B. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+blood+pressure+control+with+perindopril/indapamide+on+the+microcirculation+in+hypertensive+patients.">Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients.</a> Am J Hypertens. 23, 1136-1143 (2010).</li><li>He, F. J., Marciniak, M., Markandu, N. D., Antonios, T. F., MacGregor, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+modest+salt+reduction+on+skin+capillary+rarefaction+in+white,+black,+and+Asian+individuals+with+mild+hypertension.">Effect of modest salt reduction on skin capillary rarefaction in white, black, and Asian individuals with mild hypertension.</a> Hypertension. 56, 253-259 (2010).</li><li>Murray, A. 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=The+influence+of+measurement+location+on+reliability+of+quantitative+nailfold+videocapillaroscopy+in+patients+with+SSc.">The influence of measurement location on reliability of quantitative nailfold videocapillaroscopy in patients with SSc.</a> Rheumatology (Oxford). 51, 1323-1330 (2012).</li><li>Ingegnoli, F., 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=Feasibility+of+different+capillaroscopic+measures+for+identifying+nailfold+microvascular+alterations.">Feasibility of different capillaroscopic measures for identifying nailfold microvascular alterations.</a> Semin Arthritis Rheum. 38, 289-295 (2009).</li><li>Debbabi, H., 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=Increased+skin+capillary+density+in+treated+essential+hypertensive+patients.">Increased skin capillary density in treated essential hypertensive patients.</a> Am J Hypertens. 19, 477-483 (2006).</li><li>Serne, E. H., 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=Impaired+skin+capillary+recruitment+in+essential+hypertension+is+caused+by+both+functional+and+structural+capillary+rarefaction.">Impaired skin capillary recruitment in essential hypertension is caused by both functional and structural capillary rarefaction.</a> Hypertension. 38, 238-242 (2001).</li><li>Shore, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillaroscopy+and+the+measurement+of+capillary+pressure.">Capillaroscopy and the measurement of capillary pressure.</a> Br J Clin Pharmacol. 50, 501-513 (2000).</li><li>Rieder, M. J., O'Drobinak, D. M., Greene, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+computerized+method+for+determination+of+microvascular+density.">A computerized method for determination of microvascular density.</a> Microvasc Res. 49, 180-189 (1995).</li><li>Vermeulen, P. 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=Quantification+of+angiogenesis+in+solid+human+tumours:+an+international+consensus+on+the+methodology+and+criteria+of+evaluation.">Quantification of angiogenesis in solid human tumours: an international consensus on the methodology and criteria of evaluation.</a> Eur J Cancer. 32A, 2474-2484 (1996).</li><li>Cheng, C., Daskalakis, C., Falkner, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+Assessment+of+Microvascular+and+Endothelial+Function.">Non-invasive Assessment of Microvascular and Endothelial Function.</a> Journal of Visualized Experiments. , (2012).</li><li>Antonios, T. F., 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=Maximization+of+skin+capillaries+during+intravital+video-microscopy+in+essential+hypertension:+comparison+between+venous+congestion,+reactive+hyperaemia+and+core+heat+load+tests.">Maximization of skin capillaries during intravital video-microscopy in essential hypertension: comparison between venous congestion, reactive hyperaemia and core heat load tests.</a> Clin Sci (Lond). 97, 523-528 (1999).</li></ol>

The authors have no conflicts of interest.

甲襞capillaroscopy表明承诺作为一个在未来各种肿瘤，心血管疾病，风湿病和疾病临床上的应用程序非常有用的工具。图像采集过程是研究人员之间相当一致的，但目前有多种方法用于图像处理和分析。方法目前包括计算机及人工毛细血管计数。手动计数是有问题的，因为它们是费时，并受到用户的主观性和疲劳。当前的计算机为基础的方法需要用户输入的一个高层次，无论在图像增强处理和量化处理。这里描述的新方法需要相对较少的用户培训或参与，所述图像增强步骤是完全自动化的。用户输入仅需要计数过程最初从背景区别毛细管中的处理的图像。使用自动宏所以此处所述的三到五倍比马努更有效盟友处理每幅图像。 可靠的标准化计算机算法来定量capillaroscopy数据缺乏。 为了减少主观性，提高效率的需要毛细管定量可靠的标准化计算机为基础的方法。这里所描述的技术展示与这两个区域内和跨观察员重复性为0.93至0.98内相关的好成绩出色的可靠性。之前我们已经报道通过电脑毛细血管密度评估得到的结果的相关性，相对于人工计数的黄金标准。基线，缺血后，并用软件来完成静脉充血数量和相应的人工计数之间21皮尔逊相关性在10个受试者0.78，0.78，0.71（均P &lt;0.05），说明两种方法之间合理的协议。 该实验室的形象操作步骤利用了若干计算机处理工具。步骤1.3，图像"压扁"，除去各种"层"中存在的每个图像。这首先必须这样做将来所有的图像处理程序将被均匀地应用到图像的所有部分。对比度调节双方加深毛细血管和相形见绌出的背景下，因此使毛细血管更加明显。的"去散斑"过程平滑毛细管的边缘，同时保持其尺寸和形状。虽然似乎是在一个除斑的图像肉眼无差异，这是为了确保多毛细血管不会在计票过程融合在一起的一个重要过程。最终确定使用"最适合直方图"的形象排除所有像素在两个极端的直方图。这有助于限定毛细管的边界，同时进一步提高毛细血管和背景之间的对比度。总体有3对比度增强步骤，并且所有三个需要最大程度的毛细管数量最终图像的清晰度。 偶尔，该计划将依靠过多或过少的毛细血管。解决这个问题的第一步是要撤消高亮，只是再次尝试高亮处理。如果毛细管是被强调的不当，调整最低毛细管直径可能是必要的。作者建议的5个像素，默认最小直径。如果该程序计数太多毛细管或计数一个毛细管作为多个毛细管用户应该由一个或两个像素增加的最小直径。另一方面，如果程序不计算暗像素团的毛细管时，用户可以通过一个像素减少的最小直径。 还有一个需要统一的甲床内的这些计数的位置上。看到的表中，对在该同一个体是高度位置相关的，不同而异大大根据的甲床的一部分正在计数。 关键步骤协议包括毛细血管的正常和最佳的可视化。允许毛细管在这个协议中的最佳可视化的步骤是完全自动化，从而允许快速，准确的图像处理。虽然这些方法代表了可靠性的一个重大进步，缓解处理和计数capillaroscopic图像的，该技术的主要限制是半自动化的计数处理。理想的是，一个完全自动化的过程将在不久的将来被创建。研究人员应该感到鼓舞，以建立在本文中，以建立一个完全自动化的临床上有用的技术，可以让患者的甲襞毛细血管密度的快速定量描述的方法。

微血管成像是一个快速增长的领域有许多潜在的临床应用价值。2例如 ，肿瘤学家使用微血管成像，以确定肿瘤血管生成的程度，产生关于肿瘤和洞察力的状态变成可能的治疗选择有价值的信息。3 4然而，甲襞capillaroscopy也许是微血管成像的最具成本效益和广泛适用的形式。研究人员正在利用视频甲襞capillaroscopy研究血流量和调查毛细血管形态。5 6视频和静态图像甲襞capillaroscopy的附属品照顾诊断和治疗雷诺氏现象和各种结缔组织病如系统性硬化症。2 甲襞capillaroscopy具有多种潜在的心血管应用程序。目前的研究使用甲襞capillaroscopy建议该糖尿病类型1和类型2的患者表现出异常毛细管形态的高患病率，但有不变的毛细管密度相比，非糖尿病个体7-8 Capillaroscopy也进行了研究实验中高血压。结构毛细管稀疏导致降低的毛细血管密度已被证明在高血压个体相比，非高血压的个体。9-10相对于这些老年高血压患者（平均年龄40以上）谁展示稀疏结构，最近的研究已经证明，年轻的高血压患者（平均年龄40岁）有没有结构疏松功能稀疏。11这表明，功能性稀薄之前发生，并且随着时间的推移可能会发展为结构疏松。 有趣的是，高血压患者与特定的降压药如培哚普利治疗/吲达帕胺显示规范人毛细血管密度及治疗后血管内皮功能，而与ACE（血管紧张素转化酶）抑制剂或利尿剂治疗维持，尽管可比控制血压低的毛细血管密度。12这表明，一些抗高血压药物可能会恢复正常毛细血管密度扭转毛细管稀疏由高血压引起的。此外，其他研究人员已经表明，在食盐摄入量的减少导致逆转高血压个体功能和结构的毛细管稀薄。13 尽管这种技术的各种潜在的临床应用中，很少有标准化技术定量毛细血管密度的图像。2迄今为止，研究人员已经发现，毛细血管密度的结果是从两帧内观察者和观察者间的角度仅当精确重现的同一地区被每次计数。1,14 15 </sup&gt;值得注意的是，以往的研究人员已经基本上完成毛细血管计数手动使用肉眼，9 16 17 18这是一个缓慢而主观的过程。 标准化，基于计算机算法毛细血管图像的定量理论提供更加高效和可重复的数据分析，用更少的主体性，促进capillaroscopy的临床应用。一些研究人员已经确实使用基于计算机的程序，以从甲襞capillaroscopic图片定量的数据。1,6 19 20然而，只有一个出版迄今为止描述了一种复杂的软件程序的可用的可靠性定量capillaroscopy数据，1，并将该软件是复杂的作为先前在上文所指出的要求来算完全相同的视野。在这里，我们提出了一个简单的，可靠的协议，使用一个标准化的算法允许定量毛细管使用多个视场。使用多个视野，不仅简化了程序，而且还允许正常生物变化的毛细管计数的评估。 这项研究的目的是描述一个基于可重复和高效的计算机算法，它规范了毛细管定量的过程。虽然这些方法都没有完全自动化它们需要非常少的用户输入，并且提供图片的快速，可靠的定量。

<table>
	<tbody>
		<tr>
			<td class="xl65">Image-Pro Premier</td>
			<td class="xl65">Media Cybernetics, Inc</td>
			<td align="right" class="xl63">9.1</td>
			<td class="xl63">Image processing software</td>
		</tr>
	</tbody>
</table>

a reproducible computerized method for quantitation of capillary density using nailfold capillaroscopy

Capillaroscopy为直接可视化的微循环的非侵入性的，高效的，相对便宜和容易学习方法学。的capillaroscopy技术可以提供深入了解患者的微血管健康，导致各种潜在的有价值的皮肤病，眼科，风湿病和心血管临床应用。此外，肿瘤生长可能是依赖于血管生成，这可以通过测量肿瘤内微血管密度进行定量。然而，目前还几乎没有标准化的技术，只有一个出版迄今为止报告的当前可用的，复杂的基于计算机的算法的可靠性为定量capillaroscopy数据。1本文介绍了一种新的，更简单的，可靠的，标准化的毛细管计数算法对于定量甲襞capillaroscopy数据。一个简单的，可重复的电脑capillaroscopy算法，因为这将有利于更多广泛使用，研究人员和临床医生的技术。许多研究者目前正在分析capillaroscopy图像手工，促进成果的使用者的疲劳和主观性。本文介绍了一种新的，易于使用的自动除可重复的，半自动化计数算法的图像处理算法。这个算法使图像的分析中，同时降低主观性分钟;的训练时间仅有极少量（在我们的经验，不到1小时），需要学习的技术。

该图像处理程序的目标是从背景图像区分的毛细血管，这样他们可以被精确定量。这两个不完整的图像处理和过度的图像处理，损害程序的量化毛细血管能力。 正如图3中，不完整的图像处理使得毛细管难以从背景区别开来。该用户能够容易地辨别一个毛细管的边界，因为上述的计数方法取决于用户的准确强调几个毛细管能力是至关重要的。另一方面， 如在图3看到的，不必要的图像处理步骤，应用程序可以导致模糊的毛细血管，因此也可能是有害的量化过程。 一个最佳处理后的图像可在30秒进行计数，并且清楚地从背景中区分毛细血管作为以及从彼此作为单个毛细管。处理后的图像的一个例子可见图2的D部分中， 与图3所示的计数图像。 毛细血管密度不同，取决于甲床的位置被计算。 表1表明，毛细血管密度与来自毛细管在甲床顶行距离的增加。投资回报率安置标准化是关键计数的重现性。 图1显示了图像可以与不同的投资回报安置被改变。 <table><tbody><tr><td> ID </td><td> T1 </td><td> T2 </td><td> T3 </td><td> T4 </td><td>平均顶部</td><td> M1 </td><td> M2 </td><td> M3 </td><td> M4 </td><td>平均中东</td><td> L1 </td><td> L2 </td><td> L3 </td><td> L4 </td><td>最低</td></tr><tr><td>患者A </td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>底线</td><td> 46 </td><td> 45 </td><td> 44 </td><td> 46 </td><td> 45.25 </td><td> 64 </td><td> 62 </td><td> 62 </td><td> 62 </td><td> 62.5 </td><td> 66 </td><td> 67 </td><td> 66 </td><td> 66 </td><td> 66.25 </td></tr><tr><td>静脉闭塞</td><td> 51 </td><td> 53 </td><td> 49 </td><td> 59 </td><td> 53 </td><td> 59 </td><td> 61 </td><td> 64 </td><td> 69 </td><td> 63.25 </td><td> 70 </td><td> 70 </td><td> 75 </td><td> 72 </td><td> 71.75 </td></tr><tr><td>患者乙</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>底线</td><td> 47 </td><td> 51 </td><td> 48 </td><td> 51 </td><td> 49.25 </td><td>73 </td><td> 74 </td><td> 75 </td><td> 81 </td><td> 75.75 </td><td> 76 </td><td> 85 </td><td> 81 </td><td> 80 </td><td> 80.5 </td></tr><tr><td>静脉闭塞</td><td> 68 </td><td> 57 </td><td> 65 </td><td> 64 </td><td> 63.5 </td><td> 75 </td><td> 78 </td><td> 76 </td><td> 72 </td><td> 75.25 </td><td> 91 </td><td> 89 </td><td> 93 </td><td> 83 </td><td> 89 </td></tr><tr><td>病人Ç </td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>底线</td><td> 51 </td><td> 54 </td><td> 51 </td><td> 56 </td><td> 53 </td><td> 66 </td><td> 59 </td><td> 58 </td><td> 60 </td><td> 60.75 </td><td> 60 </td><td> 61 </td><td> 62 </td><td> 69 </td><td> 63 </td></tr><tr><td>静脉闭塞</td><td> 62 </td><td> 66 </td><td>五7 </td><td> 59 </td><td> 61 </td><td> 63 </td><td> 63 </td><td> 73 </td><td> 65 </td><td> 66 </td><td> 83 </td><td> 74 </td><td> 81 </td><td> 77 </td><td> 78.75 </td></tr></tbody></table> 表1:变异毛细管计数与差分定位在指甲床此表显示了三种不同的患者（A，B，C），当ROI框可变位于顶部（计数T1 - T4）获得的计数，中间（M1 - M4）和下部区域（L1 - L4）的指甲床。的平均计数从顶部增加，降低区域，表明需要的ROI框放置标准化比较来自不同实验室获得的计数。 在步骤1.2中描述的区域进行计数，基线计数的范围应该是30至60的毛细管/毫米2，而静脉闭塞计数范围可在任何地方从50到100 如表1，这些ðensities从其他文献中有所不同。在作者实验室得到毛细血管密度计数是最有可能更低，因为此实验开始计数在毛细管的第一行，这里的密度是最低的。 如表1所示，在甲床的下部区域进行计数增加由安东尼奥斯等人 9和Debbabi先前获得的朝向值的计数等人的 16这一差异说明通过计数所述第一需要标准化在甲床capillaroscopy定量（最近）排毛细血管。计数在毛细管的第一行也是最优的，因为毛细管是最清楚，完整地显现在第一行中，并逐渐成为与随后的行不太显眼。 使用N = 10受试者和两个独立的观察员蒙蔽重复性研究进行。可靠性是指结果的平均A，B和C计数，通过AV获得<html> eraging跨4图像每个结果。在A，B和C的计数表示用于评估微血管健康，简要总结同一个体中的不同生理状态。详情已先前公布的21。毛细血管密度被定义为每毛细血管的手指甲襞皮肤平方毫米（mm 2）的数量。 A阶段是一个休息的基线阶段，毛细血管被连续灌注16。 B阶段期间postocclusive反应性充血发生。这些计数代表连续灌注和间歇性灌注（功能储备）的毛细血管的总和。这个阶段被用作毛细管功能 16的量度。 C阶段发生静脉闭塞期间，因此表示最大毛细血管密度包括灌注（有效的红血细胞（RBC）的运动）和nonperfused（填充有停滞，非移动红细胞）毛细血管。22 内容】"&gt;对于内部信度，组内相关（ICC）为0.93的平均值的统计，0.93的平均乙计数和0.94的均值C计数。对于间信度的相关系数均0.94的平均值的数量， 0.98平均乙计数和0.94的均值C重要的。因此，这里所描述的技术展示与这两个区域内和跨观察员重复性好成绩出色的可靠性。 <img alt="图1" src="/files/ftp_upload/53088/53088fig1.jpg" /> 图1.规范的裁剪位置。这个数字说明了ROI框的位置变化明显改变裁剪后的图像。在左边，方块被放置过低，切断毛细管的第一行。中间框置于过高，引起毛细管的第一行上方的空白空间中。右边的框中最佳放置。它的裁剪图像显示C的第一行apillaries在图像的最顶端。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53088/53088fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/53088/53088fig2.jpg" /> 图2.阶段图像处理的（A）的 A阶段显示从被检者的甲床使用单色相机拍摄初始图像;（B）的阶段B表示第一对比增强后的原始图像。绿色框显示一个530 x 530像素的盒子，相当于1×1毫米框的摄像头;（三）C阶段表示从图像B 1mm的框裁剪;（四）D阶段显示了应用后，提高了图像上面讨论的增强。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53088/53088fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> </p&gt; <img alt="图3" src="/files/ftp_upload/53088/53088fig3.jpg" /> 图3.最终计数形象的提升，计算图像。确定这个图片总数为54毛细血管/毫米2。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53088/53088fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图4" src="/files/ftp_upload/53088/53088fig4.jpg" /> 图4.不正确的图像处理。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53088/53088fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> 左侧的照片显示了未加工的足够的照片。毛细血管是很难从背景区分和定量过程将是负affec特德。右边的照片显示不正确的图像处理后，相同的图像。单个毛细管难以从他们的邻居区分开，从而定量过程中会受到负面影响。

Watch this Scientific Journal Video about A Reproducible Computerized Method for Quantitation of Capillary Density using Nailfold Capillaroscopy at JoVE.com

A Reproducible Computerized Method for Quantitation of Capillary Density using Nailfold Capillaroscopy

Capillaroscopy is a non-invasive, efficient, relatively inexpensive and easy-to-learn methodology for directly visualizing capillaries in the microcirculation. However, only one publication to date describes the reliability of a complex software program available for quantitating capillaroscopy data. Here, we present a simple, reliable protocol for quantitating capillaries using a standardized algorithm.

对于毛细血管密度的定量使用甲襞Capillaroscopy可再生的计算机化方法

Capillaroscopy is a non-invasive, efficient, relatively inexpensive and easy to learn methodology for directly visualizing the microcirculation. The ...

a-reproducible-computerized-method-for-quantitation-capillary-density

Nanyang Technological University

Research

JoVE Journal

Medicine

8.9K 次观看.  Thomas Jefferson University. Capillaroscopy is a non-invasive, efficient, relatively inexpensive and easy-to-learn methodology for directly visualizing capillaries in the microcirculation. However, only one publication to date describes the reliability of a complex software program available for quantitating capillaroscopy data. Here, we present a simple, reliable protocol for quantitating capillaries using a standardized algorithm. 

视频: A Reproducible Computerized Method for Quantitation of Capillary Density using Nailfold Capillaroscopy

Photothrombotic Ischemia: A Minimally Invasive and Reproducible Photochemical Cortical Lesion Model for Mouse Stroke Studies

The photothrombotic stroke model aims to induce an ischemic damage within a given cortical area by means of photo-activation of a previously injected light-sensitive dye. Following illumination, the dye is activated and produces singlet oxygen that damages components of endothelial cell membranes, with subsequent platelet aggregation and thrombi formation, which eventually determines the interruption of local blood flow. This approach, initially proposed by Rosenblum and El-Sabban in 1977, was later improved by Watson in 1985 in rat brain and set the basis of the current model. Also, the increased availability of transgenic mouse lines further contributed to raise the interest on the photothrombosis model. Briefly, a photosensitive dye (Rose Bengal) is injected intraperitoneally and enters the blood stream. When illuminated by a cold light source, the dye becomes activated and induces endothelial damage with platelet activation and thrombosis, resulting in local blood flow interruption. The light source can be applied on the intact skull with no need of craniotomy, which allows targeting of any cortical area of interest in a reproducible and non-invasive way. The mouse is then sutured and allowed to wake up. The evaluation of ischemic damage can be quickly accomplished by triphenyl-tetrazolium chloride or cresyl violet staining. This technique produces infarction of small size and well-delimited boundaries, which is highly advantageous for precise cell characterization or functional studies. Furthermore, it is particularly suitable for studying cellular and molecular responses underlying brain plasticity in transgenic mice.

Photothrombosis is a quick, minimally-invasive technique for inducing small and well-delimited infarction in areas of interest in highly reproducible manner. It is particularly suitable for studying cellular and molecular responses underlying brain plasticity in transgenic mice.

光化学缺血:一种微创和可重复性的光化学皮质病变模型小鼠中风研究

The photothrombotic stroke model aims to induce an ischemic damage within a given cortical area by means of photo-activation of a previously injected ...

科研

医学

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.

生成和动脉病变的小鼠的三维定量使用光学投影层析成像

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

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic conditions. As part of a diagnostic assessment, the early detection of postural deficits is important so that appropriate and targeted interventions can be prescribed. The Sensory Organization Test (SOT) on the EquiTest determines an individual&#39;s use of the sensory systems (somatosensory, visual, and vestibular) that are responsible for postural control. Somatosensory and visual input are altered by the calibrated sway-referenced support surface and visual surround, which move in the anterior-posterior direction in response to the individual&#39;s postural sway. This creates a conflicting sensory experience. The Motor Control Test (MCT) challenges postural control by creating unexpected postural disturbances in the form of backwards and forwards translations. The translations are graded in magnitude and the time to recover from the perturbation is computed.
Intermittent claudication, the most common symptom of peripheral arterial disease, is characterized by a cramping pain in the lower limbs and caused by muscle ischemia secondary to reduced blood flow to working muscles during physical exertion. Claudicants often display poor balance, making them susceptible to falls and activity avoidance. The Ankle Brachial Pressure Index (ABPI) is a noninvasive method for indicating the presence of peripheral arterial disease and intermittent claudication, a common symptom in the lower extremities. ABPI is measured as the highest systolic pressure from either the dorsalis pedis or posterior tibial artery divided by the highest brachial artery systolic pressure from either arm. This paper will focus on the use of computerized dynamic posturography in the assessment of balance in claudicants.

Individuals with intermittent claudication exhibit poor balance compared to healthy controls. Computerized dynamic posturography is an objective method for measuring an individual's postural responses to balance disturbances. This provides an objective reflection of the person&#x2019;s ability to respond to situations under which sensory stimuli are altered and unexpected perturbations occur.

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Quantitation of Intra-peritoneal Ovarian Cancer Metastasis

Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancy in the United States. Mortality is due to diagnosis of 75% of women with late stage disease, when metastasis is already present. EOC is characterized by diffuse and widely disseminated intra-peritoneal metastasis. Cells shed from the primary tumor anchor in the mesothelium that lines the peritoneal cavity as well as in the omentum, resulting in multi-focal metastasis, often in the presence of peritoneal ascites. Efforts in our laboratory are directed at a more detailed understanding of factors that regulate EOC metastatic success. However, quantifying metastatic tumor burden represents a significant technical challenge due to the large number, small size and broad distribution of lesions throughout the peritoneum. Herein we describe a method for analysis of EOC metastasis using cells labeled with red fluorescent protein (RFP) coupled with in vivo multispectral imaging. Following intra-peritoneal injection of RFP-labelled tumor cells, mice are imaged weekly until time of sacrifice. At this time, the peritoneal cavity is surgically exposed and organs are imaged in situ. Dissected organs are then placed on a labeled transparent template and imaged ex vivo. Removal of tissue auto-fluorescence during image processing using multispectral unmixing enables accurate quantitation of relative tumor burden. This method has utility in a variety of applications including therapeutic studies to evaluate compounds that may inhibit metastasis and thereby improve overall survival.

Ovarian cancer metastasis is characterized by numerous diffuse intra-peritoneal lesions, such that accurate visual quantitation of tumor burden is challenging. Herein we describe a method for in situ and ex vivo quantitation of metastatic tumor burden using red fluorescent protein (RFP)-labeled tumor cells and optical imaging.

腹膜内卵巢癌转移的定量

Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancy in the United States.  Mortality is due to diagnosis of 75% of ...

Method of Direct Segmental Intra-hepatic Delivery Using a Rat Liver Hilar Clamp Model

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ischemia/reperfusion (I/R) injury with myriad negative consequences. Potential I/R injury in marginal organs destined for liver transplantation contributes to the current donor shortage secondary to a decreased organ utilization rate. A significant need exists to explore hepatic I/R injury in order to mediate its impact on graft function in transplantation. Rat liver hilar clamp models are used to investigate the impact of different molecules on hepatic I/R injury. Depending on the model, these molecules have been delivered using inhalation, epidural infusion, intraperitoneal injection, intravenous administration or injection into the peripheral superior mesenteric vein. A rat liver hilar clamp model has been developed for use in studying the impact of pharmacologic molecules in ameliorating I/R injury. The described model for rat liver hilar clamp includes direct cannulation of the portal supply to the ischemic hepatic segment via a side branch of the portal vein, allowing for direct segmental hepatic delivery. Our approach is to induce ischemia in the left lateral and median lobes for 60 min, during which time the substance under study is infused. In this case, pegylated-superoxide dismutase (PEG-SOD), a free radical scavenger, is infused directly into the ischemic segment. This series of experiments demonstrates that infusion of PEG-SOD is protective against hepatic I/R injury. Advantages of this approach include direct injection of the molecule into the ischemic segment with consequent decrease in volume of distribution and reduction in systemic side effects.

A unique rat liver hilar clamp model was developed for studying the impact of pharmacologic molecules in ameliorating ischemia-reperfusion injury. This model includes direct cannulation of the portal supply to the ischemic liver segment via a branch of the portal vein, allowing for direct hepatic delivery.

直接节段性肝内交付使用大鼠肝门部夹具模型方法

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ...

Reproducible Arterial Denudation Injury by Infrarenal Abdominal Aortic Clamping in a Murine Model

Percutaneous vascular interventions uniformly result in arterial denudation injuries that subsequently lead to thrombosis and restenosis. These complications can be attributed to impairments in re-endothelialization within the wound margins. Yet, the cellular and molecular mechanisms of re-endothelialization remain to be defined. While several animal models to study re-endothelialization after arterial denudation are available, few are performed in the mouse because of surgical limitations. This undermines the opportunity to exploit transgenic mouse lines and investigate the contribution of specific genes to the process of re-endothelialization. Here, we present a step-by-step protocol for creating a highly reproducible murine model of arterial denudation injury in the infrarenal abdominal aorta using external vascular clamping. Immunocytochemical staining of injured aortas for fibrinogen and &#946;-catenin demonstrate the exposure of a pro-thrombotic surface and the border of intact endothelium, respectively. The method presented here has the advantages of speed, excellent overall survival rate, and relative technical ease, creating a uniquely practical tool for imposing arterial denudation injury in transgenic mouse models. Using this method, investigators may elucidate the mechanisms of re-endothelialization under normal or pathological conditions.

Understanding the cellular and molecular mechanisms of re-endothelialization following arterial denudation injury is of paramount importance in preventing thrombosis and restenosis of arteries. Here we describe a protocol for reproducible arterial denudation injury of the infrarenal abdominal aorta. The procedure was developed to investigate the underlying mechanisms that regulate endothelial regeneration using mouse models.

重复性的动脉剥脱损伤腹主动脉阻断在小鼠模型

Percutaneous vascular interventions uniformly result in arterial denudation injuries that subsequently lead to thrombosis and restenosis. These ...

A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. It has become important to measure a person's activities in daily life, and not just measure their capacity for activity in the structured environment of a clinic or laboratory. A wearable sensor that is now enabling measurement of daily movement is the accelerometer. Accelerometers are commercially-available devices resembling large wrist watches that can be worn throughout the day. Data from accelerometers can quantify how the limbs are engaged to perform activities in peoples' homes and communities. This report describes a methodology to collect accelerometry data and turn it into clinically-relevant information. First, data are collected by having the participant wear two accelerometers (one on each wrist) for 24 h or longer. The accelerometry data are then downloaded and processed to produce four different variables that describe key aspects of upper limb activity in daily life: hours of use, use ratio, magnitude ratio, and the bilateral magnitude. Density plots can be constructed that visually represent the data from the 24 h wearing period. The variables and their resultant density plots are highly consistent in neurologically-intact, community-dwelling adults. This striking consistency makes them a useful tool for determining if upper limb daily performance is different from normal. This methodology is appropriate for research studies investigating upper limb dysfunction and interventions designed to improve upper limb performance in daily life in people with stroke and other patient populations. Because of its relative simplicity, it may not be long before it is also incorporated in clinical neurorehabilitation practice.

This protocol describes a method to quantify upper limb performance in daily life using wrist-worn accelerometers.

一种使用加速度计量化上肢表现在日常生活的方法

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. ...

Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts

The purpose of this paper is to introduce a promising, novel method to aid in the assessment of bone quality in forensically relevant skeletal remains. BMD is an important component of bone&#39;s nutritional status and in skeletal remains of both juveniles and adults, and it can provide information about bone quality. For adults remains, it can provide information on pathological conditions or when bone insufficiency may have occurred. In juveniles, it provides a useful metric to elucidate cases of fatal starvation or neglect, which are generally difficult to identify. This paper provides a protocol for the anatomical orientation and analysis of skeletal remains for scanning via dual-energy X-ray absorptiometry (DXA). Three case studies are presented to illustrate when DXA scans can be informative to the forensic practitioner. The first case study presents an individual with observed longitudinal fractures in the weight bearing bones and DXA is used to assess bone insufficiency. BMD is found to be normal suggesting another etiology for the fracture pattern present. The second case study employed DXA to investigate suspected chronic malnutrition. The BMD results are consistent with results from long bone lengths and suggest the juvenile had suffered from chronic malnutrition. The final case study provides an example where fatal starvation in a fourteen-month infant is suspected, which supports autopsy findings of fatal starvation. DXA scans showed low bone mineral density for chronological age and is substantiated by traditional assessments of infant health. However, when dealing with skeletal remains taphonomic alterations should be considered before applying this method.

Bone mineral density (BMD) is an important factor in understanding nutritional intake. For human skeletal remains, it is a useful metric to assess quality of life in both juveniles and adults, particularly in fatal starvation and neglect cases. This paper provides guidelines for scanning human skeletal remains for forensic purposes.

扫描骨骼遗骸的骨骼矿物密度在法医学背景下

The purpose of this paper is to introduce a promising, novel method to aid in the assessment of bone quality in forensically relevant skeletal remains. ...

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

Ventricular tachycardia (VT) in patients with ischemic cardiomyopathy mainly results from endocardial scars after myocardial infarction; those scars represent zones of slow conduction that allow the occurrence and maintenance of reentrant circuits. Catheter ablation enables substrate modification of those low voltage areas and thus can help to alter the scar tissue in such a way that arrhythmias cannot appear anymore. Hospitalizations of concerned patients decrease, quality of life and outcome rise. Consequently, VT ablation represents a growing field in electrophysiology, especially for patients with endocardial scars in ischemic heart disease after myocardial infarction. However, ablation of ventricular tachycardia remains one of the most challenging procedures in the electrophysiology lab. Precise scar definition and localization of abnormal potentials are critical for ablation success. The following manuscript describes the use of a multipolar mapping catheter and 3-dimensional (3D) mapping system to create a high density electro-anatomical map of the left ventricle including a precise scar representation as well as mapping of fractionated and late potentials in order to allow a highly accurate substrate modification.

With the following protocol, we provide an approach to Ventricular Tachycardia (VT) ablation using high density mapping with a multipolar catheter and 3D mapping system enhancing the success of the procedure.

采用多极导管三维测图系统进行缺血性室性心动过速的高密度电解剖重建

Ventricular tachycardia (VT) in patients with ischemic cardiomyopathy mainly results from endocardial scars after myocardial infarction; those scars ...

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program.
Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation.
51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p&#60;0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t&#60;1.66, all p&#62;0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t&#60;1.64, all p&#62;0.11).
Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.

This training protocol uses computerized training to teach technology-related everyday functional skills. These skills include financial skills, travel and transit, as well as medication management.