1. The document outlines various technological innovations used in neurology, including deep brain stimulation (DBS), vagus nerve stimulation (VNS), radiofrequency ablation, high-intensity focused ultrasound (HIFU), transcranial magnetic stimulation (TMS), and other devices.
2. DBS involves surgically implanting electrodes into the brain which are connected to a pulse generator to electrically stimulate areas of the brain involved in movement disorders. TMS uses magnetic fields to non-invasively stimulate areas of the brain from outside the skull.
3. HIFU is a non-invasive technique that uses focused ultrasound to heat and destroy targeted brain tissue, avoiding the risks of surgery. These technologies are used
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
What’s next: The future of non-invasive neurotechnologySharpBrains
(Session held at the 2014 SharpBrains Virtual Summit; October 28-30th, 2014)
3-4pm. What’s next: The future of non-invasive neurotechnology
- Dr. Bruce Cuthbert, Director of Adult Translational Research and Treatment Development at the NIMH
- Charles Fisher, President of Fisher Wallace Laboratories
- Chair: James Cavuoto, Editor and Publisher at Neurotech Reports
Learn more here:
http://sharpbrains.com/summit-2014/agenda/
Radio Frequency Ablation (RFA Treatment ) -Modern Technology for management l...SafeMedTrip
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This presentation gives an over view: of the depression, its symptoms, prevalence, and patho-physiology. It then reviews various treatment options for depression, first starting with medication, and then moving to neuro-modulation. Focus is then on the similarities and differences of ECT and TMS. And finally information is provided about PineWood TMS.
Marom Bikson speaks at the BrainSTIM2015 - Targeting transcranial Electrical Stimulation (tES) using EEG. Includes how to use EEG to inform transcranial Direct Current Stimulation (tDCS) montages. And critical pitfalls in concurrent recording. Stay tuned for our upcoming paper on reciprocity.
The complete video can be found here: https://www.youtube.com/watch?v=yYmDQB7qSCE
The first publication on the topic can be found here http://neuralengr.com/wp-content/uploads/2016/05/2016-Cancelli-A-simple-method.pdf
Related technology can be found here http://soterixmedical.com/research/monitoring/eeg
Delivery of electrical current to a specific subcortical grey matter target to stimulate a desired group of nerve cells which results in specific modulation the output of the involved neurocirciut.
Significance of Brain imaging in Psychiatry. Most of the major Psychiatric disorders are associated with statistically significant differences on various Neuroimaging measures, when comparing groups of patients and controls.
This a power point presentation (Iecture slides) on regional anaesthesia techniques. It explains in detail the regional anaesthesia techniques involved, the indications as well as the contraindications.
Description (with pictures) of successful (and failed) lunar landings - supplemented with numerous pictures of Lunar Surfaces, with Craters and all.
Disclaimer and Credits
All material (Text, Images, Graphics etc.) in these slides have been procured from publicly available sources of ISRO and other agencies, which includes ISRO partners. There are selected images from NASA and Wikipedia also, where relevant, also procured from freely available public resources, with attribution. Some images and text have been individually acknowledged. Others have been collectively credited through this Disclaimer page. The author makes no copyright claims on any material.
They have been sorted, edited as relevant, collated, compiled and inserted to align them with the sequence of the slides, as deemed fit by the author. They have been posted with academic altruism in mind, for those interested in Astrophysics and Astronomy and related technology, like the author. There is no commercial or promotional motivation involved anywhere.
The author is not an Astrophysicist or an Astronomer. The author does not work for ISRO, NASA or any tech company. The author is a nerd who loves technology, Astrophysics and Astronomy and who dabbles in related developments of ISRO, NASA etc. during his spare time, as an intellectual hobby. Thus, he satiates his academic appetite, learns in the process and wishes to share them with like-minded people.
At the time of publication, all material has been updated and is deemed to be accurate. If any errors are detected by the reader(s) the author will be happy to be corrected. The responsibility for any errors are solely the author’s and not that of the parent organization(s).
Here’s is wishing everyone a happy armchair space exploration on this occasion of New Year 2024!
Updated as on 31 January 2024
JAXA being an ethical Space Agency disclosed the real reason why SLIM Lander could not communicate for 1st week after soft-landing on Moon.
Picture released by JAXA
A. SLIM lost one of its Engines during descent
B. Because of the resultant asymmetric Thrust, SLIM landed on Lunar Surface upside down
C. Resulting in its Solar Panels facing away from Sun (See the direction of shadows to determine relative position of Sun and Solar Panels)
MARS Images ISRO-NASA-Compiled by Sanjoy SanyalSanjoy Sanyal
MCC Imaging Timeline
28 September 2014 – MOM (Mars Orbiter Mission) controllers published the spacecraft's first global view of Mars. The image was captured by the Mars Color Camera (MCC)
4 March 2015 – MCC was returning new images of Martian surface
24 September 2015 – ISRO released ‘Mars Atlas’, a 120-page scientific atlas containing images and data from MOM’s 1st year in orbit
19 May 2017 – MOM reached 1,000 days (973 sols (Martian Days)) in orbit around Mars. In that time, the spacecraft completed 388 orbits of the planet and relayed > 715 images back to Earth
24 September 2018 – MOM completed 4 years in its orbit around Mars, although the designed mission life was only 6 months. Over these years, MOM’s MCC captured > 980 images that were released to the public
24 September 2019 – MOM completed 5 years in orbit around Mars, sending 2 TB of imaging data
1 July 2020 – MOM captured a photo of Mars satellite Phobos from 4,200 km away
18 July 2021 – MCC captured full disc image of Mars from an altitude of 75,000 km with spatial resolution about 3.7 km
October 2022 – MCC produced 1,100+ images before retirement
DISCLAIMER
All material (Text, Images, Graphics etc.) in these slides have been procured from publicly available sources of ISRO and other agencies, which includes ISRO partners. There are selected images from NASA also, where relevant, also procured from freely available public resources. Instead of individually acknowledging each image they have been collectively credited through this Disclaimer page. The author makes no copyright claims on any material.
They have been sorted, edited as relevant, collated and inserted to align them with the sequence of the slides, as deemed fit by the author. They have been posted with academic altruism in mind, for those interested in Astrophysics and Astronomy and related technology, like the author. There is no commercial or promotional motivation involved anywhere.
The author is not an Astrophysicist or an Astronomer. The author does not work for ISRO, NASA or any tech company. The author is a nerd who loves technology, Astrophysics and Astronomy and who dabbles in related developments of ISRO, NASA etc. during his spare time as an intellectual hobby. Thus, he satiates his academic appetite, learns in the process and wishes to share them with like-minded people.
At the time of publication, all material has been updated and is deemed to be accurate. If any errors are detected by the reader(s), I shall be happy to be corrected. The responsibility for any errors are solely mine and not that of the parent organizations.
Here’s is wishing everyone a happy armchair space exploration on this occasion of New Year 2024!
Aditya-L1 Suit Images ISRO - Compiled by Sanjoy Sanyal.pptxSanjoy Sanyal
Solar Ultraviolet Imaging Telescope (SUIT):
Instrument on board Aditya-L1 Spacecraft has successfully captured the first full-disk images of the Sun in 200-400 nm Wavelength range
SUIT captures images of the Sun's Photosphere and Chromosphere in this wavelength range using various Filters
20 November 2023: SUIT payload was powered ON
Successful pre-commissioning phase
6 December 2023: SUIT captured its first light science images
Images: Taken using 11 different Filters (Slide 4), include the first-ever full-disk representations of the Sun in Wavelengths ranging from 200 to 400 nm, excluding Ca II h
Notable Features: Sunspots, Plage (Chromosphere variant of Faculae), Limb Darkening, and Quiet Regions of Sun, as marked in Mg II h image (Slide 7), provide scientists with insights into the intricate details of Sun's Photosphere and Chromosphere
SUIT observations will help scientists study the dynamic coupling of magnetized solar atmosphere and assist them in determining the effects of solar radiation on Earth's climate
DISCLAIMER
All material (Text, Images, Graphics etc.) in these slides have been procured from publicly available sources of ISRO and other agencies, which includes ISRO partners. There are selected images from NASA also, where relevant, also procured from freely available public resources. Instead of individually acknowledging each image they have been collectively credited through this Disclaimer page. The author makes no copyright claims on any material.
They have been sorted, edited as relevant, collated and inserted to align them with the sequence of the slides, as deemed fit by the author. They have been posted with academic altruism in mind, for those interested in Astrophysics and Astronomy and related technology, like the author. There is no commercial or promotional motivation involved anywhere.
The author is not an Astrophysicist or an Astronomer. The author does not work for ISRO, NASA or any tech company. The author is a nerd who loves technology, Astrophysics and Astronomy and who dabbles in related developments of ISRO, NASA etc. during his spare time as an intellectual hobby. Thus, he satiates his academic appetite, learns in the process and wishes to share them with like-minded people.
At the time of publication, all material has been updated and is deemed to be accurate. If any errors are detected by the reader(s), I shall be happy to be corrected. The responsibility for any errors are solely mine and not that of the parent organizations.
Here’s is wishing everyone a happy armchair space exploration on this occasion of New Year 2024!
Charting Neural Pathways in Schizophrenia and BPD-Chicago Conference 2016 - S...Sanjoy Sanyal
This was presented by Dr. Sanjoy Sanyal, Professor, Surgeon, Neuroscientist, Informatician, at 2nd International Conference on Brain Disorders and Therapeutics, Chicago, USA, October 26-28, 2016
Types of Schizophrenia
Types of Bipolar Disorder (BPD)
DTI Findings in Schizophrenia / BPD
Videos of White Matter Affected in Psychosis
Brain Network Concepts
Basal Forebrain Components and VTA
Videos of Meso-limbic / Meso-cortical Tracts
Receptors in Psychotic Disorders
Videos of Pathophysiology in Schizophrenia 1 and 2 – Rx Principles
Future Research Possibilities
Summary and Conclusion
Thank you for watching.
Aorta–IVC–Kidney Dissection and Surgical Correlations - Dr Sanjoy SanyalSanjoy Sanyal
Educational PPTX created by Dr. Sanjoy Sanyal; Professor, Department Chair, Surgeon, Neuroscientist and Medical Informatician
It shows the surgical anatomy of the posterior abdominal contents, with special emphasis on the aorta, IVC and Kidney-Ureters. The specimen was harvested from a cadaver.
With real-time narration and relevant captions, it enhances the learning experience by means of a trimodal learning style approach - Visual, Auditory, Textual.
Thank you for watching. If you have any questions or comments, please put them in the comments section below. Have a nice day!
Educational Video created by Dr Sanjoy Sanyal; Professor, Surgeon, Medical Informatician and Department Chair in the Western Hemisphere.
A section of the anterior chest wall from a cadaver is described - the Bones, Muscles, Vessels, and some Clinical Correlations
Camera person is Ms. Selvie Krishna, an enthusiastic student with her Blackberry.
Errata Corrigendum: There is an inadvertent error in my narration, where I mentioned Sternum instead of Vertebral Column. The same was corrected immediately thereafter in my narration, and the error and correction have also been captioned in the body of the video.
Thank you for watching. If there are questions or comments, put them in the comments section below.
Dissections of the calf and its functional and surgical aspects have been discussed in real time by Dr. Sanjoy Sanyal, Professor, Surgeon, Neuroscientist and Medical Informatician.
Important points discussed are: Triceps surae, Gastrocnemius, Soleus, Plantaris, Tendo calcaneus, Love and Whelan classification, Plantar reflex, calcaneal bursitis, calcaneal tendinitis, calcaneal tendon rupture, Gastrocnemius strain, tennis leg, PAES, accessory soleus
Educational importance lies in the following aspects: Combination of audio, video, graphics and textual description in real time
Surgical Aspects of Popliteal Fossa - Dr. Sanjoy SanyalSanjoy Sanyal
Dissection of the popliteal fossa and its surgical aspects has been discussed in real time by Dr. Sanjoy Sanyal, Professor, Surgeon and Neuroscientist.
Important points discussed are: Popliteal fossa, Palpation, Popliteal artery entrapment, PAES, Popliteal aneurysm, Popliteal AV fistula, Popliteal hemorrhage, Genicular anastomosis, Popliteal cyst, Baker cyst, Morrant baker cyst, Heidelberg classification, Love and Whelan classification
Educational importance lies in the following aspects: Combination of audio, video, graphics and textual description in real time
Surgical Anatomy of Cadaveric Abdominal Viscera - Dr Sanjoy SanyalSanjoy Sanyal
Educational Video created by Dr Sanjoy Sanyal; Professor, Surgeon, Neuroscientist and Medical Informatician
A section of abdominal viscera from a cadaver has been described - Stomach, Spleen, Colon, Greater Omenutm, with some clinical and surgical correlations
Corrigendum: Please disregard the inadvertent error when the Gastrosplenic ligament is being described - GS ligament contains Gastro-epiploic vessels; Spleno-renal ligament contains the Splenic vessels
This was presented by Dr Sanjoy Sanyal at the 2016 International Education Conference in Orlando, FL on 4 January 2016 in Disney's Boardwalk Inn.
It was voted the best paper presentation of the session by the attendees.
Educational Video created by Dr Sanjoy Sanyal; Professor, Surgeon and Medical Informatician
Deals with Blended / Hybrid Learning, Rotation Model, Flipped Classroom, Student responses, Audience Response System Clicker,
Abnormal Right Vertebral Artery MRA Sequence - Sanjoy SanyalSanjoy Sanyal
This is an MR Angiography sequence of a 46-year old male patient who was being investigated for TIA. The image sequence shows 3-D Time of Flight (TOF) Spoiled Gradient Recall (SPGR) Echo Acquisition images. It shows the Vertebrobasilar and Carotid systems of Cerebral circulation. An incidental finding was abnormal Right Vertebral artery - Narrow, Double, Accessory, Communication with Right Internal Carotid. The best way to visualize the image is by slideshow - imagine the head is rotating clockwise. There are plenty of labels in the images to guide the viewer.
Ionizing Radiation in Surgery - Sanjoy SanyalSanjoy Sanyal
Ionizing radiations exert their biological effects by excitation and ionization of molecules within cells. In terms of energy deposited within cells, ionizing radiations are the most potent of all physical and chemical agents
Lasers in Surgery Systemic Applications Part-III - Sanjoy SanyalSanjoy Sanyal
Applications of lasers in organ-systems of the body are at the cross-roads today, with limitless horizon ahead of it. The authors dwell upon the applications in important oragns of the human body.
Illustrated Surgical GI Endoscopy - Sanjoy SanyalSanjoy Sanyal
Therapeutic endoscopy has made considerable inroads in the treatment of surgical disorders of the GI tract. This has been brought about by technological innovations in the hardware and the ingenuity of the clinician in accessing the lesion.
Lasers in Surgery Specific Applications Part-II - Sanjoy SanyalSanjoy Sanyal
Experiments with lasers are going on a hectic pace in order to improve upon the existing applications of lasers in surgery. However it behoves the surgeon to be cognizant of its potential hazards and to take appropriate precautions.
Automatic Physiological Assessment in Surgery Computer Program - Sanjoy SanyalSanjoy Sanyal
Computer programs for automatic interpretation of physiological variables in critically ill surgical patients are quick and efficient decision-making aids to the clinician.
Surgical Aspects of Colorectal Endoscopy Part-IV - Sanjoy SanyalSanjoy Sanyal
Colorectal endoscopy differs significantly from UGI endoscopy. The authors describe some differential aspects, some common and some exotic coloscopic findings.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
How to Give Better Lectures: Some Tips for Doctors
Technological innovations in neurology 1
1. Technological innovations
in Neurology – 1
Dr Sanjoy Sanyal sanyal.sanjoy8@gmail.com
Professor – Neuroscience
An outline of techno-gadgets used in Neurological disorders
Med 3 Neuroscience students from Summer 2009 to Summer 2010 semesters of
Medical University of Americas (MUA), Nevis, St. Kitts-Nevis, W.I., contributed partly to
the material for this presentation
Updated June 2013
3. Deep brain
stimulation (DBS)
Definition: Electrical
stimulation of specific
deep brain (basal
ganglia) structures
with implanted
electrodes, with the
aim of evoking a
therapeutic response
in motor (and other)
dysfunctions.
4. • DBS is an experimental neurosurgical treatment in
which the brain is stimulated with electrical
impulses
• Recently out of clinical trials, Medtronics made an
electronic stimulation device that stimulates the
Globus pallidus (GP) / Subthalamic nucleus (STN)
• DBS uses Activa® Therapy, a brain stimulation
technology developed by Medtronic Neurological
Therapy Development Group, to deliver carefully
controlled electrical pulses to precisely targeted
areas of the brain involved in movement control
• The procedure involves placing electrodes, thin
flexible wires, through the skull into deep portions
of the brain
Deep brain stimulation (DBS)
8. • Invasive 8-10 hour surgery
• Target areas are located by
CT / MRI / Microelectrodes.
Latter are used to record the
electrical activity of brain
cells. When right pattern of
activity is noted, surgeon
decides on the best location
for the electrodes
• Lead is inserted via14mm
burr hole in skull, and
Electrodes are implanted in
Subthalamic nucleus (STN) /
Thalamus / Globus pallidus
DBS procedure
9. • Platinum-iridium Electrode has 4
metal contacts (3 cathodes, 1
anode) that can be used in many
different combinations
• Pulse generator (IPG; Neuro-
stimulator) in its titanium casing
is implanted subcutaneously
under left clavicle
• Insulated Extension from IPG is
tunneled under skin, runs behind
ear, up left side of neck and
connects IPG to Lead-Electrodes
DBS procedure
12. • Experts are still not clear exactly how it works
• DBS works much like a pacemaker for the brain
• Battery-powered IPG (Neuro-stimulator) delivers
high-frequency, continuous electrical stimulation to
brain structures
• Pulses inactivate or modulate the brain’s impulses
which helps reduce motor symptoms (dyskinesias)
• The IPG creates electrical stimulation that stops
spasmodic contractions at the source
• Electrical impulses to the brain interfere with neural
activity of targeted site without destroying the brain
DBS mechanism of action
13. • After the surgery adjustment has to be made to the
frequency and power of the electrical stimulus
being presented to the nerve cells through the
device
• If the right adjustment is made as to the rate and
strength of delivery, remarkable improvement can
be seen
• As patient’s response to stimulation changes over
time, the impulses can be adjusted from outside by
means of an external programming system,
w/out the necessity for repeat operation
• Several RCT’s are still going on to provide more
evidence of the effectiveness of DBS
DBS mechanism of action
14. • Apathy; Hallucination
• Compulsive gambling
• Hyper-sexuality
• Cognitive dysfunction
• Depression; Déjà vu episodes
• Parkinson's patients showed decline in
executive functions, and problems with word
generation, attention and learning
• Because brain can shift slightly during surgery, there
is possibility of electrodes becoming displaced or
dislodged. This may cause complications like
personality changes, but electrode displacement is
relatively easy to identify using CT or MRI
DBS side-effects / complications
15. • Parkinson’s disease (PD): Reduces
tremor, rigidity, stiffness (70% patients);
Improves speed, dexterity of arm; Blocks
involuntary movements, Reduces medication; FDA
approved for Rx of Essential tremor and PD
• Dystonias: Chronic, intractable (drug refractory)
Primary dystonia, including Generalized and/or
Segmental dystonia, Hemi-dystonia and Cervical
dystonia (Spasmodic torticollis) in patients >7
years; received FDA approval via Humanitarian
Device Exemption process in April 2005
• L-dopa-induced dyskinesia in PD
DBS applications
16. DBS applications
• Tourette’s syndrome
• Intractable epilepsy: Stimulation of the anterior
nuclei of thalamus for epilepsy (SANTE);
Modulates impulses in Papez circuit
• Obsessive compulsive disorder (OCD): 40%
decrease in symptoms
• Learning / Memory-associated disorders
• Major depression
• Multiple sclerosis: DBS controls tremor
• Stroke patients: For rehabilitation, neuropathic pain
and seizure control
• Lesch-Nyhan syndrome
• Phantom limb pain
18. T1 weighted MRI shows
position of contacts; 0,1
are w/in STN; 2, 3 are
just above STN, where
GPi is located.
Table summarizes
results; Stimulation of
STN by cathode 0,1
resulted in decrease in
rigidity, tremor and
akinesia of PD, but no
change in L-dopa-
induced dyskinesia;
Stimulation of GPi by
cathode 2, showed same
results, and also a
marked decrease in L-
dopa induced Dyskinesia
DBS in L-dopa-induced
dyskinesia in PD
19. DBS in Tourette’s syndrome
Left: Plain X-ray of skull AP view, showing position of
intracranial lead and electrodes; Right: Axial T1 MRI
of brain showing DBS-induced lesion in both
thalamus (arrows) in Tourette’s syndrome
20. • Definition: DBS in conjunction with medications to
treat chronic symptoms of Obsessive compulsive
disorder (OCD) that are unresponsive to medical
and other therapies alone
• OCD: Ventral striatum is involved in the processing
of emotional and motivational behavior; These are
altered in OCD, due to potential impairment of
ventral striatum in these patients
• DBS sites: IPG (under abdomen skin or
infraclavicular) sends impulses to (in next slide)
– Ventromedial caudate nucleus (bilateral)
– Nucleus accumbens (bilateral)
– Anterior limb of internal capsule
Reclaim DBS in OCD
21. DBStargetOCD
Left: Most ventral axial MRI slice demonstrates Nucleus accumbens (acc)
and ventral portion of Putamen (P), which was used to determine ventral
striatum targets and trajectories. Targets were defined based on position of
the middle of Accumbens. Right: Coronal MRI slice passing through the
targets of Caudate nucleus head (C) and Anterior capsule (AC). Dark
lines represent trajectories passing through both ventromedial Caudate
nucleus head and Accumbens
22. • High frequency micro-stimulation rather than
low frequency result in sustained dopamine
release in the striatum
• Animal trials proved performance was
significantly better with high frequency rather
than low frequency
• Elicits specific autobiographical recollection of
precise episodes, TV advertisements,
Life events etc
• In some individuals semantic memory
is improved as opposed to episodic;
This is controlled by Broadmann Area 20
(object recognition)
DBS for learning – memory
23. DBS in PD
DBS of STN
is accepted
form of
therapy in
intractable
Parkinson’s
disease
(PD); It is
most
commonly
performed
DBS
procedure
24. Vagus nerve stimulation (VNS)
Implanted pulse generator (IPG) is
similar to that in DBS; but electrode
stimulates left vagus nerve in neck;
Uses: Intractable epilepsy, Major
depression; MOA is unclear
26. • Focuses a large number of ultrasound beams
onto a small target of a few millimeters inside
the body
• Uses high intensity ultrasound beams that are
focused into a hotspot where the heating is high
enough to induce thermal tissue destruction
• A focal temperature increase can be produced
which is sufficient to ablate (surgically remove)
the tissue through coagulation
High-intensity focused ultrasound
(HIFU) principle
29. Focuses high intensity US
waves thro a transducer (like
a magnifying glass focusing
sunlight) on a deep lesion;
Raises local temperature
w/out damaging surrounding
tissue
30.
31. • Ultrasound (US) does not go through skull
because bone absorbs US waves;
• Transducers: 1,024 (210) Transducers create a
helmet-like atmosphere; individually set to beam
separately into skull, and calculated to individually
meet the targeted focus
• The HIFU beams produced by transducers are
transferred through the intact skull into the brain
and concentrated on a 3-5 mm focus (‘Hot Spot’)
• This coagulates sharply defined targets deep
inside the brain by heating them up to a focal
temperature of 60 degrees Celsius
• This non-invasive procedure lasts several hours
and is performed without anesthesia; Patients are
awake and fully conscious during the intervention
HIFU in brain
32. • The whole procedure is planned and monitored in
real-time by MRI
• The temperature increase during the sequential
sonifications, each lasting 10-20 seconds, is
continuously displayed and controlled on precise
MR temperature distribution maps
• The combination of HIFU and MR imaging allows
– Exact planning of the target area
– Visualization of the whole procedure
– Precise monitoring of temperature development
throughout the procedure
• Despite its great potential, MRI exhibits limitations
when information with very high spatial and / or
temporal resolution is needed
MR-guided HIFU
34. • ExAblate is the 1st
MR-guided focused
ultrasound technology
that uses MRI to
visualize body
anatomy, plan
treatment and monitor
outcomes in real time;
and deliver HIFU to
brain tissue non-
invasively
ExAblate® 4000
35. • Benefits: Main advantage is non-invasiveness;
Safer than conventional surgery; Avoids risk of
complications – infection, hemorrhage and
collateral damage to normal brain structures
– The whole procedure is performed without
anaesthesia (patient is awake and conscious)
– Procedure can be performed on out-patient
basis
– Extreme precision and accuracy deep in brain
• Side effects: Vertigo, light headedness, and
stinging sensation during procedure
HIFU advantages / side-effects
36. Patients treated
• Neuropathic pain due to functional brain disorders
• Post-amputation phantom limb syndrome, Nerve
injury, Stroke, Trigeminal neuralgia, Post-herpetic
neuralgia from shingles
Future
• Long term effects such as heat-related swelling
and what happens when brain tissue is heated
• Paves the way for further research and other
potential clinical applications of treatment;
Alzheimer's; Parkinson's disease; Essential tremor;
Epilepsy; Brain tumors
HIFU applications present / future
37. HIFU result
• Axial T2 MRI
(with fluid
attenuation) of
brain
• Showing
HIFU-induced
lesions in
pulvinar region
of both
thalamus
40. TMSprinciple
(1) Electric current applied to external coil in anti-clockwise direction; (2)
Magnetic field generated around coil (according to Right-hand rule of
Physics), with high concentration of magnetic field in center of coil; (3)
This induces electric current in brain substance in clockwise direction;
(4) Which stimulates nerve cells in the field of induced current
41. • Electromagnetic coil on the scalp creates very
rapid bursts of magnetic energy on the brain
surface, which penetrates 2-3 cm deep
• Once inside the brain, the dynamic (rapidly
changing) nature of the magnetic pulses
induces electrical charges to flow, which
activates or inhibits neural activity
• The amount of electricity created in the brain is
very small and cannot be felt by the patient
• When in the correct orientation relative to brain
neurons, these very small electric charges can
cause the neurons to fire or become active
TMS principle
42. TMS principle
• Right-hand rule (Physics): When electric current
flows along a conductor in the direction of pointing
thumb of a semi-clenched fist, the resultant
magnetic field is generated in the direction of other
4 semi-clenched fingers of the hand
• If the electrical conductor is in form of a coil placed
over the brain, a high-intensity magnetic field is
generated in the center of the coil in the brain
substance, at right angles to the plane of the coil
• The magnetic field, in turn, induces electric current
in brain, whose direction of flow is opposite to the
original current in the coil
• This induced electric current in the brain stimulates
nerve cells, which is the basis of TMS therapy
43. • rTMS mechanism
– Electrostatic energy in a coil produces fast
oscillating magnetic fields
– High intensity, multiple impulses in high tempo
(trains) within a short interval produces
‘repetitive’ magnetic field (rTMS), which
influence neurons within reach of magnetic field
• >1Hz pulses produce neuronal excitation
• <1Hz pulses produce neuronal inhibition
–Exact mechanism is uncertain
• rTMS uses
– Examine brain behavior relationships
– Used on the Pre-frontal cortex (PFC) to treat
Resistant depression
Repetitive TMS (rTMS)
44. Effects of TMS
can be
recorded by:
EEG: Electro-
encephalogram
PET: Positron
Emission
Tomogram
fMRI:
Functional MRI
NIRS: Near
Infra-red
Spectroscopy
SPECT: Single
Photon
Emission
Computerized
Tomogram
EMG: Electro-
myogram
45. • Advantages
– Non- Invasive; Painless
– Anesthesia is not required
– Economical
– Quite effective
– Requires a significantly shorter amount of time
to implement
– Reduces dependence on medication; Important
for those who do not tolerate medications
• Side effects
– Headaches or scalp discomfort
– Nausea in some patients
TMS advantages / side-effects
49. • Resistant depression: rTMS excites neurons
especially in Prefrontal cortex (PFC) to improve
symptoms of major depression
• Tinnitus: PET scans look for excessive neuronal
activity with increased blood flow in the temporal
lobe; This area is then targeted with TMS to
decrease neuronal activity and tinnitus
• Stroke
• Parkinson’s disease
• Epilepsy
• Migraine
• Obsessive-compulsive disorder (OCD)
• Amyotrophic lateral sclerosis (Lou Gehrig’s)
• Fibromyalgia
TMS applications – present / future
50. • FES: Application of neuromuscular electrical
stimulation concurrently with training for specific
task or functional activity. This application is
termed as neuroprosthetics
• FES tries to benefit patients who had a low initial
volitional motor control, and who were not
expected to recover limb function after stroke
• FES + Exercise is likely to minimize motor loss,
but it may not significantly enhance the ability to
use the limb after ischemic stroke
• More patients may regain some functional ability
after training with FES compared with training
without FES. Patients with severe motor loss may
require prolonged task-specific FES training
Functional electrical stimulation (FES)
51. • Improves active
range of hand
motion and
function
• Improves
voluntary
movement
• Re-educates
muscles
• Prevents or retards
disuse atrophy
• Increases local blood
circulation
• Reduces muscle spasm
• Maintains or increases
range of motion
•Prevents contractures
FES – NESS H200
52. • Pathology: Injured Deep Fibular (Peroneal) nerve,
which supplies the anterior compartment of leg
(especially Tibialis anterior muscle)
• Manifestations: Inability to dorsiflex the foot; Foot
hangs inferiorly; hence the term ‘Foot drop’;
Patients catch their toes on the ground when
walking, making it difficult to walk normally
• Etiology: (Other than Common/Deep Fibular nerve
transection)
–Multiple Sclerosis (MS)
–Traumatic brain injuries
–Incomplete s. cord injury
–Cerebral palsy
–Stroke
Foot drop
53. • Functional Electrical
Stimulation (FES)
system to treat Foot drop
• Sends low-level electrical
impulses to Deep Fibular
nerve in the leg
• Stimulates lifting of foot
• FDA approved NESS
L300 in 2008
• By 2008, 7/10 major
rehabilitation centers in
US had implemented it
FES – NESS L300
54.
55. FES – NESS L300
Gait sensor over ankle
detects attempted movement
during walking; Stimulator in
leg cuff sends impulses to
leg dorsiflexors during heel-
strike phase of gait
56. • While walking, the ankle Gait sensor detects
gait events and transmits wireless signals to
synchronize with electrical impulses emitted by
the Stimulator
• Electrical impulses from the leg cuff Stimulator
work on the common Fibular nerve and Tibialis
anterior at the appropriate time during walking
• The mini Control unit displays real-time
information regarding the system’s current
status, and allows fine-tuning of adjustments
• Monitoring unit for healthcare professionals
logs all information and monitors patient
compliance
FES – NESS L300
57. Benefits
• Normal natural walking gait
• Prevents muscle atrophy
• Increases range of joint motion
• Increases local blood flow
• Clinical research has shown
–17% immediate increase in mean walking speed
–34% increase in mean walking speed after 8 wks
–45% improvement in gait asymmetry index after
8 weeks
–92% decrease in fall frequency
• Note: NESS L300 cannot function if Common /
Deep Fibular nerve itself is cut and / or Tibialis
Anterior muscle is atrophied
FES – NESS L300
58. • The NESS L300 uses wireless communication
which eliminates the need for externally worn
cumbersome wires
• Stimulation of the Common Fibular nerve and
Tibialis Anterior causes dorsiflexion in individuals
with Foot drop
• Ness L300 can dramatically improve the lifestyle of
these patients by helping them to:
–Walk normally
–Enjoy everyday activities, which were previously
difficult or impossible to accomplish
NESS L300 summary
62. • Microphone: Positioned over external ear;
Receives the sound; transmits to Speech
processor
• Speech processor: (a) Behind ear; or (b)
Body-worn; Receives sound from microphone
and decides how the electrodes stimulating
cochlear nerve should be activated
• Transmitter coil: Attached by magnet to side
of skull; Receives info from Speech processor
and transmits radiofrequency (RF) waves to
Receiver-Stimulator inside skull; Lack of direct
connection thro skull reduces infection and pain
Cochlear implant
63. • Receiver-Stimulator: Embedded in skull bone
behind ear; Receives input from Speech
processor via the external Transmitter coil;
Receives its power by magnetic induction;
Transmits processed sound info, and controls
electric current to cochlear electrodes
• Electrode array: Drilled thro mastoid bone into
inner ear and implanted on cochlea; Stimulates
different areas of cochlea (and CN8c), based
on how sound is interpreted by Processor (~to
organ of Corti); Several weeks after insertion,
cochlear implant is fine-tuned
Cochlear implant
65. • In May 2013 a Brainstem implant was performed in the US
for the first time on a 3-year old child. An earlier attempt at
Cochlear implant failed because the Cochlear nerve was
congenitally absent.
• The components of Brainstem implant are similar to
Cochlear implant; but the technique is 4-5 times more
challenging because the cable has to go under the
Temporal lobe and the Electrode has to be positioned on
the Brainstem
• The composite image was created from screenshots of the
news video. The labels are self-explanatory. An
anatomical error has been highlighted.
Copyright Disclaimer Under Section 107 of the Copyright Act 1976, allowance is made for
"fair use" for purposes such as criticism, comment, news reporting, teaching,
scholarship, and research. Fair use is a use permitted by copyright statute that might
otherwise be infringing. Non-profit, educational or personal use tips the balance in favor
of fair use.
Brainstem implant
67. • Tinnitus masker: Tinnitus masking was once
thought to be useful because it blocked the sound
perceived by the patient
• It proved to be counter-productive because for
habituation (one of the effective modes of
treatment) to work, the sound needs to be audible
• Habituation cannot occur if perception of the sound
is not present; viz. one cannot cure acrophobia
simply by avoiding heights
• Tinnitus Retraining Therapy: Goal of this therapy
is to adjust the reaction of patient to the tinnitus
and the perception of the tinnitus sound itself. This
includes counseling and use of Noise generators
Tinnitus masker
68. • Sound generators: Electronic devices in ear that
amplifies hearing and masks tinnitus with ‘white
noise’ or static (different sounds at different
frequencies that block out the tinnitus sounds)
• Disadvantages: Long time period before patient
experiences benefits; High cost related to the
prosthesis, High dependence on counseling, Not
covered by health insurance
• Wearable sound generator (WSG): New WSGs
use many frequencies to stimulate all nerve cells in
the auditory pathway, to make allowances for
greater plasticity of the nerve cells
Sound generator
69. • Sound
generator
produces sound
at many
different
frequencies
(a.k.a. ‘white
noise’)
• This masks the
perception of
tinnitus by
impedance
Wearable sound generator
Editor's Notes
FUKAYA. C, KATAYAMA. Y, KOBAYASHI. K, NISHIKAWA. Y, OGAWA. A, OGASAWARA. K, OSHIMA. H, YAMAMOTO. T. Direct Relief of Levodopa-Induced Dyskinesia by Stimulation in the Area Above the Subthalamic Nucleus in a Patient With Parkinson's Disease.Neurol Med Chir. 50: 257-259
U.S Department of Health & Human Services [homepage on the Internet]. U.S Food and Drug Administration ; c1999-2009 [cited 2009 August 9]. Reclaim™ DBS™ Therapy for OCD - H050003; [about 1 screen]. Available from: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm125520.htm
Aouizerate, Bruno, Cuny, Emmanuel, et al. Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive—compulsive disorder and major depressionCase report. JNS [serial on the Internet]. 2004 October [cited 2009 August 9]; 101 (4):[about 2 screens]. Available from: http://thejns.org/doi/abs/10.3171/jns.2004.101.4.0682