Nos gustaría reconocer a todos los colegas en la UCIN para su trabajo.

este protocolo fue aprobado por el institucional de Junta de Renji Hospital, Shanghai Jiaotong University School of Medicine.
 1. preparación del paciente Nota: ICP sensor es colocado en el paciente por una intervención quirúrgica ( figura 1). El sensor se coloca en el espacio epidural, el espacio subdural, el parénquima o el sistema ventricular.
<ol><li>Conectar la máquina de monitoreo ICP con el monitor de la cabecera mediante un cable de comunicación.</li>
	<li>Ajustar la referencia de paciente &#39; monitor de cabecera s, para que los datos desde el monitor de la cabecera son según el ICP monitoreo máquina.</li>
	<li>Realizar una colocación de línea arterial en paciente &#39; s izquierda o arteria radial derecha 20.</li>
	<li>Conectar la línea arterial con el barorreceptor.</li>
	<li>Conectar el transductor de presión con el paciente &#39; monitor de cabecera s mediante un cable de comunicación.</li>
	<li>Cero ajuste el monitor de la cabecera de modo que la presión de sangre medida coincide con el valor real.</li>
</ol> 2. Registro de parámetros fisiológicos <ol><li>Conecte el paciente &#39; monitor de s la cabecera con los datos que recoge y almacena el dispositivo a través de un cable de red.</li>
	<li>Presione el botón power para encender el dispositivo de recogida de datos.</li>
	<li>Espere unos segundos hasta que se ejecuta automáticamente el software de monitoreo de la multimodalidad.</li>
	<li>Introduzca la información del paciente, incluyendo el nombre, identificación, diagnóstico y escala de Coma de Glasgow inicial (GCS).</li>
	<li>Haga clic en el &#34; guardar y comience a controlar &#34; botón para iniciar la reunión de datos y almacenamiento de.</li>
	<li>Haga clic en el &#34; apagar &#34; botón en la pantalla al final de la adquisición de datos ( figura 2).</li>
	<li>Entrar en la GCS final.</li>
</ol> 3. Análisis del parámetro <ol><li>los datos almacenados en un disco U a través de interfaces de bus serie universal (USB) en el host de descarga.</li>
	<li>Ingresar un nombre de usuario y contraseña para iniciar sesión el servidor de análisis.</li>
	<li>Haga clic en el &#34; crear nuevo registro &#34; botón y seleccione el archivo de datos en el disco de U para empezar a subir.</li>
	<li>Espere alrededor de 10 a 20 minutos antes de que los datos son analizados (dependiendo del tamaño de los datos).</li>
	<li>Haga clic en la &#34; detalle &#34; botón de cada registro para ver el resultado.</li>
	<li>Haga clic en el &#34; ver tabla &#34; para ver el diagrama final.</li>
	<li>Arrastre la línea de tiempo para ver más detalles.</li>
	<li>Haga clic en el &#34; scattergram &#34; botón para ver la distribución de los parámetros de.</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. 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No se recibió ningún apoyo financiero.

Este objetivo de este artículo es introducir el nuevo seguimiento de multimodalidad y analizar sistema para neurocirugía pacientes críticos, que se puede utilizar para vigilar los parámetros fisiológicos, analizar el estado clínico actual y, ojalá, predecir el pronóstico de los pacientes neuroquirúrgicos críticos. Hoy en día, el foco de la monitorización de la PIC es principalmente en el valor ICP del medio mientras se ignoran otros parámetros, que pueden llevar a riesgos de imprecisión o demora4,5,21. Por otro lado, el ICP deriva parámetros tales como la forma de onda ICP, AMP, RAP, PRx y CAAI divulgan tener gran importancia en predecir el pronóstico y orientar el tratamiento adecuado5,16,17, 18,19. Sin embargo, todos estos parámetros requieren monitoreo de multimodalidad y adquisición de datos grandes y análisis, que puede tomar mucho tiempo y esfuerzo. Además, existen unos dispositivos específicos que son adecuados para los médicos en su trabajo clínico diario actualmente.
Para resolver este problema, hemos desarrollado recientemente un sistema de monitoreo del multimodality. Utiliza una recolección automática de datos y almacenamiento de dispositivo para adquirir continuamente información fisiológica de pacientes antes de enviar los datos al servidor en línea para el trabajo de análisis para investigar el significado de estos ICP deriva parámetros. Como se menciona anteriormente, la multimodalidad, sistema de vigilancia tiene las siguientes ventajas. En primer lugar, puede recopilar datos en tiempo real a una frecuencia alta. La frecuencia de recolección de datos puede alcanzar hasta 120 Hz. en segundo lugar, puede registrar múltiples parámetros, es decir, ICP forma de onda, PRx, RAP y CAAI. Todos ellos son críticos en el análisis de la situación clínica actual y en la predicción del pronóstico. Además, se puede lograr a largo plazo de monitoreo continuo. Pueden grabar todos los detalles durante el tratamiento de los pacientes. Por último pero no menos importante, es portátil y fácil de aprender. Los médicos pueden subir fácilmente los datos a un servidor de análisis específico, que se pueden realizar el cálculo y la construcción gráfica automáticamente. Hay solamente dos pasos críticos en el protocolo. Uno es la colocación de sensor de PIC. La otra es la colocación de línea arterial y monitorización de la presión arterial. Una vez correctamente conectado y operado, el sistema de monitoreo de la multimodalidad puede recopilar y almacenar datos en tiempo real antes de analizar y graficarlos automáticamente, que es convenientes para los médicos.
Sin embargo, también tiene algunas limitaciones. Este sistema solo incluye PIC y presión arterial invasiva y carece de otros parámetros tales como EKG, EEG o TCD. Otra limitación es que el modo de análisis automático no es abundante y sólo puede hacer ciertos cálculos y construcciones gráficas.
Han estado modificando constantemente este sistema y han corregido varios problemas que ocurrieron durante el uso a largo plazo. Estamos seguros de que todas las limitaciones se abordarán en el futuro y será más aplicable.
Esperamos que el sistema de monitoreo de la multimodalidad se aceptará como una medida clave para vigilar los parámetros fisiológicos, para analizar el estado clínico actual y predecir el pronóstico de pacientes críticos neuroquirúrgicos en el futuro.

Monitorización de la PIC es ampliamente utilizado para evaluar el estado intracraneal en el Departamento de Neurocirugía, especialmente en pacientes críticos neuroquirúrgicos1,2,3. Además de valor medio de ICP, ICP deriva parámetros tales como ICP forma de onda, AMP, RAP, PRx, IAAC y así sucesivamente, pueden reflejar el estado de la circulación intracerebral, cerebroespinal reserva compensatoria y cerebro cumplimiento4,5, 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13. pueden ser indicativos de deterioro neurológico inminente y hasta resultado de pacientes14,15,16,17,18. También puede utilizarse como guía de tratamiento adecuado19. Sin embargo, la mayoría de los clínicos centrarse sólo en el valor medio de ICP ignorando estos parámetros al mismo tiempo. Esto es en parte porque hay pocos dispositivos específicos que son adecuados para los médicos en su trabajo clínico diario.
Para solucionar estos inconvenientes, hemos desarrollado recientemente un sistema de monitoreo del multimodality. Utilizamos una recogida de datos automáticos y dispositivo de almacenamiento continuamente adquirir información fisiológica de pacientes tales como presión arterial, ICP y saturación de oxígeno y analizar estos parámetros fisiológicos para revelar el estado clínico actual y, que predicen el pronóstico de los pacientes neuroquirúrgicos críticos. Este sistema de monitoreo de la multimodalidad tiene varias ventajas: (1) se puede recopilar datos en tiempo real en alta frecuencia, (2) puede grabar múltiples parámetros, es decir, ICP forma de onda, PRx, RAP y CAAI, (3) puede alcanzar el largo término monitoreo continuo y (4) es portátil y fácil de aprender.
Por lo tanto, el objetivo de este artículo, es mostrar un método detallado de cómo utilizar el sistema de monitoreo de la multimodalidad para registrar distintos parámetros fisiológicos en pacientes neuroquirúrgicos críticos.

<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

Monitoreo de la presión intracraneal (ICP) ahora es ampliamente utilizado en pacientes neuroquirúrgicos críticos. Además de medio valor ICP, ICP deriva parámetros tales como presión de forma de onda de ICP, amplitud de pulso (AMP), la correlación de la amplitud ICP y de ICP media (RAP), índice de reactividad (PRx), ICP y correlación de amplitud de onda de la presión arterial (ABP) (IAAC) y así puede reflejar estado intracraneal, predecir el pronóstico y también puede ser utilizado como guía de tratamiento adecuado. Sin embargo, la mayoría de los clínicos centrarse sólo en el valor medio de ICP mientras se ignoran estos parámetros debido a las limitaciones de los dispositivos actuales. Recientemente hemos desarrollado una sistema para hacer frente a estos inconvenientes la multimodalidad. Este sistema portátil, fácil de usar utiliza una recolección de datos y almacenar el dispositivo a adquirir continuamente parámetros fisiológicos del paciente en primer lugar, es decir, ABP, ICP y saturación de oxígeno y luego analizar estos parámetros fisiológicos. Esperamos que el sistema de monitoreo de la multimodalidad se aceptará como una medida clave para vigilar los parámetros fisiológicos, para analizar el estado clínico actual y predecir el pronóstico de los pacientes neuroquirúrgicos críticos.

Este nuevo sistema de vigilancia la multimodalidad se aplicó en 22 pacientes críticos neuroquirúrgicos (15 hombres). 12 de ellos (54.55%) habían sufrido lesión cerebral traumática (TBI), 9 de ellos (40.91%) tenían hemorragia intracraneal y 1 (4.55%) tenía grave infarto cerebral. El total control de tiempo es más de 1.900 h (88 h aproximadamente por paciente). Después de la cirugía exitosa, continuamente monitoreado y había analizado su ICP, BP, CPP, PRx, RAP y CAAI. La figura 3 muestra datos representativos de este sistema de vigilancia. Podemos ajustar la línea de tiempo para ver información más detallada (figura 4). Además, somos capaces de analizar la relación entre dos parámetros, que se demuestra en la figura 5.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56388/56388fig1.jpg"> 
Figura 1 : Colocación de sensor ICP. El paciente somete a una operación para la colocación de sensor ICP antes de monitoreo. El sensor puede colocarse en el espacio epidural, el espacio subdural, el parénquima o el sistema ventricular. Esta figura muestra punción ventricular y colocación de la sensor. El sensor ICP está situado en la punta del catéter. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig1large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56388/56388fig2.jpg"> 
Figura 2 : Pantalla del sistema de vigilancia. El área izquierda superior muestra la forma de onda corriente del ICP y la presión arterial. La zona inferior izquierda muestra actual RAP, PRx, IAAC, CPP y AMP. La parte derecha de la pantalla muestra la historia. En la parte inferior se muestran algunos de los botones funcionales como producción, captura de pantalla y agregar marcadores. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig2large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56388/56388fig3.jpg"> 
Figura 3 : Datos representativos de un paciente de hemorragia cerebral. Los parámetros tales como ICP, BP, CPP, PRx, RAP y CAAI se registran y se trazan. El eje X es la línea de tiempo y los ejes Y son los parámetros independientes. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig3large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56388/56388fig4.jpg"> 
Figura 4 : Información detallada de datos representativos. Como se ajusta la línea de tiempo, podemos ver más detalles. El eje X es la línea de tiempo y los ejes Y son los parámetros independientes. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig4large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56388/56388fig5.jpg"> 
Figura 5 : Relación entre ICP y PRx. Podemos cambiar los parámetros de la X eje y eje para analizar la relación entre dos parámetros. En esta figura, el eje X es el ICP y el eje Y es el PRx. Cada punto rojo representa un registro en tiempo real. Podemos ver que, en este paciente, su PRx tiene una variación de -0,7 a 1 y la PRx más bajo se alcanza cuando su ICP es 10 mmHg. <a href="//ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56388/56388fig5large.jpg" style="font-size: 14px;" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a>

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A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Recientemente, hemos desarrollado un sistema de monitoreo para el seguimiento de diferentes parámetros fisiológicos en pacientes críticos neuroquirúrgicos del multimodality portátil. Aquí se presentan protocolos detallados sobre cómo utilizar este sistema de monitoreo del multimodality.

Un protocolo detallado de parámetros fisiológicos de adquisición y análisis en pacientes críticos neuroquirúrgicos

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 vistas.  Shanghai Jiaotong University School of Medicine. Recientemente, hemos desarrollado un sistema de monitoreo para el seguimiento de diferentes parámetros fisiológicos en pacientes críticos neuroquirúrgicos del multimodality portátil. Aquí se presentan protocolos detallados sobre cómo utilizar este sistema de monitoreo del multimodality.

Video: 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-operatoria tareas comportamiento en seres humanos sometidos a cirugía Awake Estimulación Cerebral Profunda

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

Investigación

Medicina

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

Pruebas musculares manuales: un método para medir fuerza de las extremidades muscular aplicada a los pacientes críticos

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.

Parabiosis en ratones: un protocolo detallado

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.

Evaluación clínica de los parámetros de la marcha en pacientes Spatiotemporal y Adultos Mayores

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.

A-crítico tamaño femoral Defecto sencillo modelo en ratones

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.

Un protocolo detallado para la Vigilancia transpiración utilizando un nuevo, pequeño, dispositivo inalámbrico

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.

Evaluación objetiva nociceptiva en pacientes de la UCI ventilados: un estudio de viabilidad usando pupilometría y el reflejo de flexión nociceptiva

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and ...

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Lipopolysaccharide, also known as endotoxin, is a fundamental component of gram-negative bacteria and plays a crucial role in the development of sepsis and septic shock. The early identification of an infectious process that is rapidly evolving to a critical illness might prompt a quicker and more intensive treatment, thereby potentially leading to better patient outcomes. The Endotoxin Activity (EA) assay can be used at the bedside as a reliable biomarker of systemic endotoxemia. The detection of elevated endotoxin activity levels has been repeatedly shown to be associated with an increased disease severity in patients with sepsis and septic shock. The assay is quick and easy to perform. Briefly, after sampling, an aliquot of whole blood is mixed with an anti-endotoxin antibody and with added LPS. Endotoxin activity is measured as the relative oxidative burst of primed neutrophils as detected by chemioluminescence. The assay&#39;s output is expressed on a scale from 0 (absent) to 1 (maximal) and categorized as &#8220;low&#8221; (&#60;0.4 units), &#8220;intermediate&#8221; (0.4&#8211;0.59 units), or &#8220;high&#8221; (&#8805;0.6 units). The detailed methodology and rationale for the implementation of the EA assay are reported in this manuscript.

We hereby present a protocol to measure at the bedside the endotoxin activity of human whole blood samples. The Endotoxin Activity assay is a simple test to perform and may be a useful biomarker in critically ill patients with sepsis.

Ensayo de actividad de endotoxinas para la detección de endotoxemia de sangre completa en pacientes con enfermedades críticas

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.

Un protocolo de entrenamiento en intervalos de alta intensidad en el mundo real para la mejora de la aptitud cardiorrespiratoria

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, ...

Protocol for Developing a Femur Osteotomy Model in Wistar Albino Rats

Fracture healing is a physiological process resulting in the regeneration of bone defects by the coordinated action of osteoblasts and osteoclasts. Osteoanabolic drugs have the potential to augment the repair of fractures but have constraints like high costs or undesirable side effects. The bone healing potential of a drug can initially be determined by in vitro studies, but in vivo studies are needed for the final proof of concept. Our objective was to develop a femur osteotomy rodent model that could help researchers understand the development of callus formation following fracture of the shaft of the femur and that could help establish whether a potential drug has bone healing properties. Adult male Wistar albino rats were used after Institutional Animal Ethics Committee clearance. The rodents were anesthetized, and under aseptic conditions, complete transverse fractures at the middle one-third of the shafts of the femurs were created using open osteotomy. The fractures were reduced and internally fixed using intramedullary K-wires, and secondary fracture healing was allowed to take place. After surgery, intraperitoneal analgesics and antibiotics were given for 5 days. Sequential weekly x-rays assessed callus formation. The rats were sacrificed based on radiologically pre-determined time points, and the development of the fracture callus was analyzed radiologically and using immunohistochemistry.

Here, we present a protocol to iatrogenically fracture the shaft of the femur of Wistar albino rats and follow up on the development of the callus. This femur osteotomy model can help researchers evaluate the process of fracture healing and to study how a drug could influence fracture healing.

Protocolo para el desarrollo de un modelo de osteotomía de fémur en ratas albinas Wistar

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