Wir möchten allen Kolleginnen und Kollegen in der Neugeborenen-Intensivstation für ihre Arbeit zu würdigen.

dieses Protokoll wurde genehmigt durch das institutionelle Review Board von Renji Krankenhaus, Shanghai Jiaotong University School of Medicine.
 1. Vorbereitung des Patienten Hinweis: ICP Sensor sitzt der Patient durch einen chirurgischen Eingriff ( Abbildung 1). Der Sensor sitzt in den Epiduralraum, Subduralraum, Parenchym oder Ventrikelsystem.
<ol><li>Verbinden die ICP-Überwachung-Maschine mit dem Patientenmonitor über eine spezifische Kommunikationskabel.</li>
	<li>Stellen Sie die Referenz des Patienten &#39; s Bett zu überwachen, so dass die Daten aus dem Patientenmonitor im Einklang mit dem ICP Überwachung Maschine.</li>
	<li>Eine arteriellen Linie Platzierung auf Patienten durchführen &#39; s links oder rechts radialis 20.</li>
	<li>Verbinden die arterielle Linie mit der Barorezeptor.</li>
	<li>Verbinden die Druckaufnehmer mit Patienten &#39; s Patientenmonitor über ein Kommunikationskabel.</li>
	<li>Null dem Patientenmonitor so einstellen, dass der gemessene Blutdruck deckt sich mit dem tatsächlichen Wert.</li>
</ol> 2. Aufnahme von physiologischen Parametern <ol><li>verbinden den Patienten &#39; s Patientenmonitor mit den Daten sammeln und Speichern von Gerät über ein Netzwerkkabel.</li>
	<li>Drücken Sie die Power-Taste schalten Sie die Datenerfassung Gerät.</li>
	<li>Warten Sie einige Sekunden, bis die Multimodalität monitoring-Software automatisch ausgeführt wird.</li>
	<li>Geben Sie die Informationen des Patienten, einschließlich Name, ID, Diagnose und erste Glasgow Coma Scale (GCS).</li>
	<li>Klicken Sie auf die &#34; speichern und starten Sie die Überwachung &#34; Taste, um Daten sammeln und Speichern von.</li>
	<li>Klicken Sie auf den &#34; schalten Sie &#34; Taste auf dem Bildschirm am Ende der Datenerfassung ( Abbildung 2).</li>
	<li>Geben Sie die endgültige GCS.</li>
</ol> 3. Parameter-Analyse <ol><li>Dump der gespeicherten Daten zu einer U-Scheibe durch universellen seriellen Bus (USB)-Schnittstellen auf dem Host.</li>
	<li>Geben Sie einen Benutzernamen und Passwort zum Einloggen auf dem Analysis-Server.</li>
	<li>Klicken Sie auf die &#34; neuen Datensatz erstellen &#34; und wählen Sie die Datendatei in der U-Scheibe zu lade.</li>
	<li>Für rund 10 bis 20 Minuten warten, bevor die Daten (abhängig von der Datengröße) analysiert werden.</li>
	<li>Klicken Sie auf das &#34; Detail &#34; Taste jedes Datensatzes, das Ergebnis zu sehen.</li>
	<li>Klicken Sie auf das &#34; Diagramm anzeigen &#34;, das letzte Diagramm zu sehen.</li>
	<li>Ziehen Sie die Zeitleiste um weitere Details anzuzeigen.</li>
	<li>Klicken Sie auf die &#34; Scattergramm &#34; Taste, um die Verteilung der Parameter sehen.</li>
</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. 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=A+trial+of+intracranial-pressure+monitoring+in+traumatic+brain+injury.">A trial of intracranial-pressure monitoring in traumatic brain injury.</a> N Engl J Med. 367 (26), 2471-2481 (2012).</li></ol>

Keine finanzieller Unterstützung erhielt.

Das Ziel dieses Artikels ist, die neue Multimodalität Überwachung einzuführen und Analyse System für neurochirurgische kritischen Patienten, die verwendet werden können, um physiologische Parameter überwachen, analysieren die aktuellen klinischen Status und hoffentlich die Prognose vorhersagen der neurochirurgischen kritische Patienten. Heute liegt der Schwerpunkt der ICP Überwachung vor allem auf die mittlere ICP Wert und ignorieren andere Parameter, die Gefahr von Ungenauigkeiten oder Verzögerung4,5,21tragen können. Auf der anderen Seite der ICP Parameter abgeleitet, wie z. B. ICP Wellenform, AMP, RAP, PRx und IAAC gemeldet werden, haben großen Bedeutung in der Vorhersage Prognose und leiten entsprechende Behandlung5,16,17, 18,19. All diese Parameter erfordern jedoch Multimodalität Überwachung und große Datenerfassung und -Analyse, die viel Zeit und Mühe in Anspruch nehmen kann. Außerdem gibt es einige spezielle Geräte, die derzeit für Ärzte in ihrer täglichen klinischen Arbeit geeignet sind.
Um dieses Problem zu lösen, haben wir vor kurzem eine Multimodalität monitoring-System entwickelt. Es verwendet eine automatische Datenerfassung und Speicherung Gerät kontinuierlich Patienten physiologische Informationen vor dem Senden der Daten an den Online-Server zur Analyse der Arbeit auf die Bedeutung dieser ICP erwerben Parameter abgeleitet. Wie bereits erwähnt ist, hat die Multimodalität monitoring-System die folgenden Vorteile. Erstens kann es in Echtzeit Daten mit einer hohen Frequenz sammeln. Die Häufigkeit der Datensammlung kann bis zu 120 Hz. Zweitens erreichen, es kann mehrere Parameter, d. h., ICP Wellenform, PRx, RAP und IAAC. Alle von ihnen sind in der Analyse der aktuellen klinischen Status und in der Vorhersage der Prognose von entscheidender Bedeutung. Darüber hinaus kann es langfristig kontinuierliche Überwachung erreichen. Es können alle Details während der gesamten Behandlung der Patienten aufnehmen. Nicht zuletzt ist es tragbar und leicht zu erlernen. Kliniker können problemlos Daten mit einer bestimmten Analysis-Server hochladen, die Berechnung und graphische Konstruktion automatisch durchführen wird. Es gibt nur zwei wichtige Schritte im Protokoll. Eine ist die Platzierung der ICP-Sensor. Die andere ist die arterielle Linie Platzierung und arterielle Blutdruckmessung. Einmal richtig angeschlossen und betrieben werden, kann die Multimodalität monitoring-System Daten erheben und speichern in Echtzeit vor Analyse und grafische Darstellung sie automatisch, die für Ärzte geeignet ist.
Allerdings hat es auch einige Einschränkungen. Dieses System nur umfasst ICP und invasive Blutdruckmessung und andere Parameter wie EKG, EEG oder TCD fehlt. Eine weitere Einschränkung ist, dass die automatische Analysemodus nicht reichlich vorhanden ist, und kann nur bestimmte Berechnungen und graphischen Konstruktionen.
Wir haben wurde dieses System kontinuierlich ändern und haben feste mehrere Probleme, die während der Langzeitgebrauch auftraten. Wir sind zuversichtlich, dass alle Beschränkungen in Zukunft behoben werden werden und es wird mehr anwendbar sein.
Wir hoffen, dass die Multimodalität monitoring-System als eine wesentliche Maßnahme zur physiologischen Parameter, um den aktuellen klinischen Status zu analysieren und die Prognose der neurochirurgischen kritischen Patienten in Zukunft vorherzusagen überwachen akzeptiert werden.

ICP Überwachung ist verbreitet, intrakranielle Status in der Neurochirurgie, vor allem im neurochirurgischen kritischen Patienten1,2,3zu bewerten. Neben der Mittelwert der ICP ICP abgeleitet Parameter wie ICP Wellenform, AMP, RAP, PRx, IAAC und So weiter, können dem Stand Intrazerebrale Zirkulation, Liquor kompensatorische Reserve entsprechen und Compliance4,5, des Gehirns 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13. sie können Anzeichen für bevorstehende neurologische Verschlechterung und sogar Ergebnisse von Patienten14,15,16,17,18sein. Sie können auch als Richtschnur der richtige Behandlung19verwendet werden. Jedoch konzentrieren die meisten von den Ärzten nur auf den Mittelwert der ICP unter Missachtung dieser Parameter. Dies ist zum Teil, weil es gibt nur wenige spezifische Geräte, die für Ärzte in ihrer täglichen klinischen Arbeit geeignet sind.
Um diese Nachteile zu beheben, haben wir vor kurzem eine Multimodalität monitoring-System entwickelt. Wir verwenden eine automatische Datenerfassung und Speicherung von Gerät, um Patientenrechte physiologische Daten wie Blutdruck, ICP und Sauerstoffsättigung kontinuierlich zu erwerben, und diese physiologische Parameter zu analysieren, um den aktuellen klinischen Status zu offenbaren und Ich hoffe, die Prognose der neurochirurgischen kritische Patienten Vorhersagen. Diese Multimodalität monitoring-System hat mehrere Vorteile: (1) Es kann Echtzeit-Datensammlung bei hoher Frequenz, (2) Es kann mehrere Parameter, d. h., ICP Wellenform, PRx, RAP und IAAC, (3) es zu erreichen kann, lange Begriff kontinuierliche Überwachung, aufzeichnen und (4) Es ist portabel und einfach zu erlernen.
Das Ziel dieses Artikels ist daher zeigen eine detaillierte Methode, wie die Multimodalität monitoring-System zu verwenden, um verschiedene physiologische Parameter bei neurochirurgischen kritische Patienten aufnehmen.

<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

Drucküberwachung von intrakraniellen (ICP) ist jetzt bei neurochirurgischen kritische Patienten verbreitet. Neben der mittlere Wert der ICP ICP abgeleitet Parameter wie z. B. ICP Wellenform, Amplitude des Impulses (AMP), die Korrelation der Amplitude der ICP und ICP bedeuten (RAP), Reaktivität Index (PRx), ICP und arteriellen Blutdruck (ABP) Welle Amplitude Korrelation (IAAC) Druck, und so aktiviert ist, können intrakranielle Status zu reflektieren, vorherzusagen Prognose und dient auch als Richtschnur der richtigen Behandlung. Jedoch konzentrieren die meisten von den Ärzten nur auf den Mittelwert der ICP unter Missachtung dieser Parameter aufgrund der Einschränkungen der aktuellen Geräte. Vor kurzem haben wir eine Multimodalität monitoring-System um diese Nachteile zu beheben. Dieses tragbare, benutzerfreundliche System verwendet eine Daten sammeln und Speichern von Gerät kontinuierlich Patienten physiologische Parameter zuerst erwerben, d. h., ABP, ICP und Sauerstoffsättigung, und dann analysieren diese physiologischen Parameter. Wir hoffen, dass die Multimodalität monitoring-System als eine wichtige Maßnahme zur Überwachung der physiologischen Parameter, um den aktuellen klinischen Status zu analysieren und die Prognose der neurochirurgischen kritische Patienten vorherzusagen akzeptiert werden.

Diese neue Multimodalität monitoring-System wurde auf 22 neurochirurgischen kritische Patienten (15 Männer) angewendet. 12 von ihnen (54.55 %) litt von Schädel-Hirn-Trauma (SHT), 9 (40,91 %) hatte intrakraniellen Blutungen und 1 (4,55 %) hatte schweren Hirninfarkt. Die gesamte Überwachungszeit ist mehr als 1.900 h (ca. 88 h pro Patient). Nach einer erfolgreichen Operation, die wir kontinuierlich überwacht und analysiert ihre ICP, BP, CPP, PRx, RAP und IAAC. Abbildung 3 zeigt repräsentative Daten von dieser monitoring-System. Wir passen die Zeitleiste um weitere Detailinformationen zu (Abbildung 4) sehen. Außerdem sind wir in der Lage, analysieren Sie die Beziehung zwischen zwei Parameter, die in Abbildung 5gezeigt.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56388/56388fig1.jpg"> 
Abbildung 1 : ICP Sensor Platzierung. Der Patient unterzieht sich eine Operation für ICP Sensor Platzierung vor der Überwachung. Der Sensor kann in den Epiduralraum, Subduralraum, Parenchym oder Ventrikelsystem platziert werden. Diese Abbildung zeigt ventrikuläre Punktion und Sensor-Platzierung. Der ICP-Sensor befindet sich an der Spitze des Katheters. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig1large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56388/56388fig2.jpg"> 
Abbildung 2 : Bildschirm des Überwachungssystems. Im obere linken Bereich zeigt aktuelle ICP-Wellenform und Blutdruck. Untere linke Bereich zeigt aktuelle RAP, PRx IAAC, CPP und AMP. Rechte Teil des Bildschirms zeigt die Geschichte. Unten sind einige der Funktionstasten wie Ausgang, Screenshot und Hinzufügen von Markern. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig2large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56388/56388fig3.jpg"> 
Abbildung 3 : Repräsentative Daten eines Patienten Hirnblutung. Die Parameter wie ICP, BP, CPP, PRx, RAP und IAAC erfasst und dargestellt. Die x-Achse ist der Zeitplan und die Y-Achsen sind separate Parameter. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig3large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56388/56388fig4.jpg"> 
Abbildung 4 : Detaillierte Informationen von repräsentativen Daten. Wenn wir die Zeitachse anpassen, können wir mehr Details sehen. Die x-Achse ist der Zeitplan und die Y-Achsen sind separate Parameter. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig4large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56388/56388fig5.jpg"> 
Abbildung 5 : Beziehung zwischen ICP und PRx. Wir können ändern Sie die Parameter auf das X und Y Achse zur Analyse der Beziehung zwischen zwei Parameter. In dieser Abbildung die x-Achse ist die ICP und die y-Achse ist die PRx. Jeder rote Punkt steht für eine Echtzeit-Aufnahme. Wir können sehen, dass bei diesem Patienten seine PRx eine Variation von -0.7 bis 1 hat und die niedrigsten PRx erreicht ist, wenn seine ICP 10 MmHg ist. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig5large.jpg" style="font-size: 14px;" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</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

Vor kurzem haben wir einen tragbaren Multimodalität monitoring-System für die Überwachung der verschiedenen physiologischen Parametern bei neurochirurgischen kritische Patienten entwickelt. Ausführliche Protokolle zur Verwendung dieser Multimodalität Überwachungssystem werden hier vorgestellt.

Ein detailliertes Protokoll für physiologische Parameter Erfassung und Analyse bei neurochirurgischen kritische Patienten

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 Aufrufe.  Shanghai Jiaotong University School of Medicine. Vor kurzem haben wir einen tragbaren Multimodalität monitoring-System für die Überwachung der verschiedenen physiologischen Parametern bei neurochirurgischen kritische Patienten entwickelt. Ausführliche Protokolle zur Verwendung dieser Multimodalität Überwachungssystem werden hier vorgestellt.

Serie: 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-Operative Behavioral Aufgaben in Awake Humans Undergoing Deep Brain Stimulation Chirurgie

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

Forschung

Medizin

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.

Manuelle Muskeltests: eine Methode zur Messung Extremität Muscle Strength Applied an kritisch kranke Patienten

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 in Mäuse: Ein detailliertes Protokoll

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.

Klinische Bewertung der Spatiotemporal Gangparameter bei Patienten und ältere Erwachsene

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.

Eine einfache Kritische große Femoral Defect Modell an der Maus

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.

Ein detailliertes Protokoll für Transpiration Überwachung eines neuartigen Verwendung, Klein, Wireless Device

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.

Nozizeptiven objektiven in belüfteten Intensivpatienten: eine Machbarkeitsstudie mit Pupillenreaktion und der nozizeptiven Flexion Reflex

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.

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.

Ein reales hochintensives Intervalltrainingsprotokoll zur Verbesserung der kardiorespiratorischen Fitness

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.

Protokoll zur Entwicklung eines Femurosteotomiemodells bei Wistar Albino-Ratten

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