作者要感谢的整骨手法医学骨科医学系技术学院整个纽约理工学院。这个项目是由整骨手法医学系在骨科医学技术学院纽约研究所资助。

五OMT的这里描述的，可以在显示被用于肺炎病人的骨科程序的小图示。这些技术着重改善胸廓顺应性，改善淋巴和血液循环流动，平衡自主神经张力。这些技术类似于在3 OMT研究在治疗肺炎患者表现出功效利用的技术。 1，肌肉能量肋骨1 -呼功能障碍24,25 <ol><li>通过将第一个数字对患者的第一肋，所述第一肋的锁骨上部分的第二位，并且在所述第一肋的锁骨部第三位数字的后方面评估肋1运动。触诊有限制的运动，或组织充血。 </li><li>病人仰卧于桌子。站上的肋功能障碍（例如，在相反侧，如果它是一个左侧肋骨1呼功能障碍，站立在patient的右侧，反之亦然）。 </li><li>到达尾侧手患者下，把握失调肋1的肋部角度。在一个下外侧方向应用的牵引力。 </li><li>将病人的额头上左手腕的背部。然后，将一只手在病人的手腕上。 </li><li>让患者深呼吸，同时移动肋骨inferiorly从事的限制性屏障。 </li><li>让患者保持他或她的呼吸3-5秒钟，当试图解除他们的头靠在由手提供等距阻力。 </li><li>重复步骤1.5-1.6三至五倍，而重新接合每次重复后，一个新的限制性屏障。 </li><li>继上次的重复，最后，被动牵拉进一步进行到限制性障碍。 </li><li>重新评估肋骨1运动并为您的好转迹象。 </li></ol> 2，肌肉能量肋骨1 -吸入功能障碍24,25 <ol><li>坐在头当患者仰卧表。 </li><li>评估使用肋1的数字触诊功能障碍。放置拇指放在肋，在锁骨上部分的第二位，并且在锁骨区域第三位数字的后方面。感到受限制运动或局部组织充血。 </li><li>监视功能失调肋骨头在锁骨上窝了大拇指。 </li><li> Flex的病人的头部向前的另一只手，直到运动感到肋骨1，以缓解前斜角肌肌的张力。 </li><li>指导病人吸气和呼气深刻。由于患者呼气时，肋骨移动1 inferiorly进入限制性障碍。指导病人保持他/她的呼吸呼气3-5秒。 </li><li>而病人认为他/她的呼吸中呼出，嘱病人他/她的头向后推挤等距阻力。这应该持续3-5秒，而病人抱着他/她的呼吸。 </li><li>当病人吸入，抵制肋骨的自然倾向与吸入优移动。 </li><li>重复步骤2.5-2.7三至五倍，而再接合与每个重复的新的限制性屏障。最后的重复之后，被动伸展进一步进行到限制性屏障。 </li><li>重新驴肋骨运动来评估任何改善。 </li></ol> 3，林乐培的胸隔膜24,25 <ol><li>通过触诊左肋评估双侧胸廓运动，而病人吸气和呼气。 </li><li>患者仰卧在桌子上。站立在患者的任一侧。拇指尖端应放在下侧壁沿外侧肋缘下面肋7，其对应于呼吸的隔膜肌的附件剑突和其余部分。其余的数字应该休息沿肋骨8-10的下侧壁边界。 </li><li>指导患者“深呼吸和日带呼吸所有的出路。“由于病人呼气，按照隔膜按拇指朝后路表。 </li><li>保持这个点上的膜片为患者进行下一次深深吸入。在接下来的呼气时，隔膜的另一头侧运动的建议（在合理的手段，而不是提供任何过度的病人的不适）。继续监测隔膜的优异的运动。 </li><li>重复步骤3.3-3.4三到五呼吸周期，或直到隔膜圆顶容易在呼气结束。 </li><li>通过监测隔膜改善游览重新驴。 </li></ol> 4，坐式罗纹提高24,25 <ol><li>通过触诊左肋评估呼吸运动。特别是，评估阻碍了整个胸廓的运动个体限制的具体肋骨。 </li><li>通过让病人坐下开始。站在面向患者用一只脚是后市其他。 </li><li>嘱病人越过他或她的胳膊和休息，他们的胳膊肘放在你的肩上。患者尽可他/她的头在他/她的手臂。 </li><li>到达病人的胳膊下面。靠近costotransverse关节运动位置的手指垫，在肋2-6的水平。手指垫被用作一个支点延长患者的脊柱。 </li><li>瘦体重到后脚和借鉴患者提出，设置肋角的前外侧牵引。此外，通过移动重心向后，由此拉伸肋间并接合的限制性屏障延长患者的脊柱。 </li><li>保持这个姿势一秒钟，然后让你的体重向前转移到更前足和患者弹回更直立的位置释放。 </li><li>移动手指垫向下肋水平，并重复步骤4.5-4.6。继续这一步一步下来的肋骨水平，直到肋骨水平是遥不可及（通常大约肋6-8）。 </li><li>通过工作备份肋骨直至达到肋骨2逆转的过程。 </li><li>通过重新评估以前受到限制的肋骨水平的肋骨运动确定治疗的成功。 </li></ol> 5，胸泵与呼吸辅助24,25 <ol><li>通过触诊左肋评估双侧胸廓运动，而病人吸气和呼气。 </li><li>病人是仰卧上表，而医生站在表头。表格高度应调整到一个舒适的高度，其中手可以完全伸展到病人的胸部区域。 </li><li>将手在患者的胸部区域，用双手刚刚远端锁骨和拇指在约45度至胸骨高跟鞋。 </li><li>嘱病人吸气和呼气深刻。提供压缩力下降到胸部笼。然后，摆动压缩程度以产生泵运动。孔蒂NUE约一分钟或直到有足够的时间通过适当的淋巴流动。 </li><li>呼吸系统协助被指导病人深吸气，然后呼气深深启动。在呼气阶段，遵循胸壁，直到呼气完成。在呼气结束时，保持胸壁到位，并提供阻力，而患者开始吸入。吸入/到期的几个周期（2-6个周期）按照此步骤（步骤2d）。 </li><li>在最后的吸气阶段，对前病人已经完成了一个完整深深吸入，迅速从病人的胸部取出双手，让空气突然涌入的病人的胸部。 </li><li>重新驴改善通过触诊胸部运动。 </li></ol>

<ol>
	<li>Xu, J., Kochanek, K., Murphy, S., Tejada-Vera, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deaths:+Final+Data+for+2007.">Deaths: Final Data for 2007.</a> National Vital Statistics Reports. 58, (2007).</li><li>Hall, M. J., DeFrances, C., Williams, S., Golosinskiy, A., Schwartzman, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=National+Hospital+Discharge+Survey:+2007+Summary.">National Hospital Discharge Survey: 2007 Summary.</a> National Health Statistic Reports. 29, (2010).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevention+and+Control+of+Influenza+Recommendations+of+the+Advisory+Committee+on+Immunization+Practices+(ACIP).">Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP).</a> Morbidity and Mortality Weekly Report. 56, (2007).</li><li>Haessler, S., Schimmel, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Managing+Community-Acquired+Pneumonia+During+Flu+Season).">Managing Community-Acquired Pneumonia During Flu Season).</a> Cleveland Clinical J. of Medicine. 79, 67-78 (2012).</li><li>Noll, D. R., Degenhardt, B. F., Fossum, C., Hensel, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+and+research+protocol+for+osteopathic+manipulative+treatment+of+elderly+patients+with+pneumonia.">Clinical and research protocol for osteopathic manipulative treatment of elderly patients with pneumonia.</a> J Am Osteopath Assoc. 108 (9), 508-516 (2008).</li><li>Smith, R. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One+hundred+thousand+cases+of+influenza+with+a+death+rate+of+one-fortieth+of+that+officially+reported+under+conventional+medical+treatment.">One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment.</a> J. Am. Osteopath. Assoc. 20, 172-175 (1920).</li><li>Saggio, G., Docimo, S., Pilc, J., Norton, J., Gilliar, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+osteopathic+manipulative+treatment+on+secretory+immunoglobulin+a+levels+in+a+stressed+population.">Impact of osteopathic manipulative treatment on secretory immunoglobulin a levels in a stressed population.</a> J. Am. Osteopath. Assoc. 111, 143-147 (2011).</li><li>Measel, J. W., Kafity, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+the+lymphatic+pump+on+the+B+and+T+cells+in+peripheral+blood.">The effect of the lymphatic pump on the B and T cells in peripheral blood.</a> J. Am. Osteopath. Assoc. 86, 608 (1986).</li><li>Allen, T. W., Pence, T. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+the+thoracic+pump+in+treatment+of+lower+respiratory+tract+disease.">The use of the thoracic pump in treatment of lower respiratory tract disease.</a> J. Am. Osteopath. Assoc. 67, 408-411 (1967).</li><li>Hodge, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteopathic+Lymphatic+pump+techniques+to+enhance+immunity+and+treat+pneumonia.">Osteopathic Lymphatic pump techniques to enhance immunity and treat pneumonia.</a> Int. J. Osteopath. Med. 15, 13-21 (2011).</li><li>Hruby, R. J., Hoffman, K. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Avian+influenza:+an+osteopathic+component+to+treatment.">Avian influenza: an osteopathic component to treatment.</a> Osteopath. Med. Prim. Care. 9, (2007).</li><li>Moeckel, E., Mitha, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Textbook of Pediatric Osteopathy. , 301-304 (2008).</li><li>Eversteen, J., Baumgardner, D. J., Regnery, A., Banerjee, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+management+of+pneumonia+and+bronchitis+in+outpatient+primary+care+practices.">Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices.</a> Primary Care Respiratory Journal. 19 (3), 237-241 (2010).</li><li>Lim, W., van der Eerden, M., Laing, R., Boersma, W., Karalus, N., Town, G., Lewis, S., Macfarlane, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Defining+community+acquired+pneumonia+severity+on+presentation+to+hospital:+an+international+derivation+and+validation+study.">Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.</a> Thorax. 58 (5), 377-283 (2003).</li><li>Fine, M., Auble, T., Yearly, D., Hanusa, B., Weissfeld, L., Singer, D., Coley, C., Marrie, T., Kapoor, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prediction+rule+to+identify+low-risk+patients+community-acquired+pneumonia.">A prediction rule to identify low-risk patients community-acquired pneumonia.</a> The New England Journal of Medicine. 336, 243-250 (1997).</li><li>Mitra, P. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Handbook of Practical Chest Physiotherapy. , (2007).</li><li>Gomella, L. G., Haist, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinician's Pocket Reference: The Scut Monkey. , (2007).</li><li>Noll, D. R., Degenhardt, B. F., Morley, T. F., Blais, F. X., Hortos, K. A., Hensel, K., Johnson, J. C., Pasta, D. J., Stoll, S. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+osteopathic+manipulation+as+an+adjunctive+treatment+for+hospitalized+patients+with+pneumonia:+a+randomized+controlled+trial.">Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial.</a> Osteopath. Med. Prim. Care. 19, (2010).</li><li>Noll, D. R., Shores, J. H., Gamber, R. G., Herron, K. M., Swift Jr, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Benefits+of+osteopathic+manipulative+treatment+for+hospitalized+elderly+patients+with+pneumonia.">Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia.</a> J Am Osteopath Assoc. 100 (12), 776-782 (2000).</li><li>Noll, D. R., Shores, J., Bryman, P. N., Masterson, E. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adjunctive+osteopathic+manipulative+treatment+in+the+elderly+hospitalized+with+pneumonia:+a+pilot+study.">Adjunctive osteopathic manipulative treatment in the elderly hospitalized with pneumonia: a pilot study.</a> J Am Osteopath Assoc. 99 (3), 143-152 (1999).</li><li>Bjorkqvist, M., Wiberg, B., Bodin, L., Barany, M., Holmberg, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bottle-blowing+in+hospital-treated+patients+with+community-acquired+pneumonia.">Bottle-blowing in hospital-treated patients with community-acquired pneumonia.</a> Scand J Infect Dis. 29 (1), 77-82 (1997).</li><li>Britton, S., Bejstedt, M., Vedin, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chest+Physiotherapy+in+Primary+Pneumonia.">Chest Physiotherapy in Primary Pneumonia.</a> Br Med J (Clin Res Ed. 290 (6483), 1703-1704 (1985).</li><li>Graham, W. G., Bradley, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+chest+physiotherapy+and+intermittent+positive-pressure+breathing+in+the+resolution+of+pneumonia.">Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia.</a> N Eng J Med. 299 (12), 624-627 (1978).</li><li>DiGiovanna, E., Schiowitz, S., Dowling, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> An Osteopathic Approach to Diagnosis and Treatment. , (2004).</li><li>Chila, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foundations+of+Osteopathic+Medicine.">Foundations of Osteopathic Medicine.</a> Lippincott Williams &amp; Wilkins. , 797-803 (2011).</li><li>Ward, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foundations+for+Osteopathic+Medicine.">Foundations for Osteopathic Medicine.</a> Lippincott Williams &amp; Wilkins. , 393-1077 (2003).</li><li>Pelosi, P., Quintel, M., Malbrain, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+intra-abdominal+pressure+on+respiratory+mechanics.">Effect of intra-abdominal pressure on respiratory mechanics.</a> Acta Clin Belg Suppl. 1, 78-88 (2007).</li><li>Degenhardt, B. F., Kuchera, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Update+on+osteopathic+medical+concepts+and+the+lymphatic+system.">Update on osteopathic medical concepts and the lymphatic system.</a> J. Am. Osteopath. Assoc. 96, 97-100 (1996).</li><li>Henderson, A. T., Fisher, J. F., Blair, J., Shea, C., Li, T. S., Bridges, K. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+rib+raising+on+the+autonomic+nervous+system:+a+pilot+study+using+noninvasive+biomarkers.">Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers.</a> J. Am. Osteopath Assoc. 6, 324-330 (2010).</li><li>Downey, H. F., Durgam, P., Williams Jr, A. G., Rajmane, A., King, H. H., Stoll, S. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymph+flow+in+the+thoracic+duct+of+conscious+dogs+during+lymphatic+pump+treatment,+exercise,+and+expansion+of+extracellular+fluid+volume.">Lymph flow in the thoracic duct of conscious dogs during lymphatic pump treatment, exercise, and expansion of extracellular fluid volume.</a> Lymphat. Res. Biol. 6, 3-13 (2008).</li><li>Beicastro, M. R., Backes, C. R., Chila, A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bronchiolitis:+A+pilot+study+of+osteopathic+manipulative+treatment,+bronchodilators,+and+other+therapy.">Bronchiolitis: A pilot study of osteopathic manipulative treatment, bronchodilators, and other therapy.</a> J. Am. Osteopath. Assoc. 83, 672-676 (1984).</li><li>Sleszynski, S. L., Kelso, A. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+thoracic+manipulation+with+incentive+spirometry+in+preventing+postoperative+atelectasis.">Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis.</a> J. Am. Osteopath. Assoc. 93, 834-845 (1993).</li><li>Jackson, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+lymphatic+and+splenic+pump+techniques+on+the+antibody+response+to+hepatitis+B+vaccine:+a+pilot+study.">Effect of lymphatic and splenic pump techniques on the antibody response to hepatitis B vaccine: a pilot study.</a> J. Am. Osteopath. Assoc. 98, 155-160 (1998).</li><li>H&#228;r&#233;n, K., Backman, C., Wiberg, M., Scand, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+manual+lymph+drainage+as+described+by+Vodder+on+oedema+of+the+hand+after+fracture+of+the+distal+radius:+a+prospective+clinical.">Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: a prospective clinical.</a> Plast. Reconstr. Surg. Hand Surg. 34, 367-372 (2000).</li><li>Schander, A., Downey, H. F., Hodge, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+pump+manipulation+mobilizes+inflammatory+mediators+into+lymphatic+circulation.">Lymphatic pump manipulation mobilizes inflammatory mediators into lymphatic circulation.</a> J. Exp. Biol. Med. 237, 58-63 (2012).</li><li>Dery, M., Winterson, B., Yonuschot, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+lymphatic+pump+manipulation+on+healthy+and+injured+rat.">The effect of lymphatic pump manipulation on healthy and injured rat.</a> Lymphology. 33, 58-61 (2000).</li><li>Knott, E. M., Tune, J. D., Stoll, S. T., Downey, H. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+lymphatic+flow+in+the+thoracic+duct+during+manipulative+intervention.">Increased lymphatic flow in the thoracic duct during manipulative intervention.</a> J. Am. Osteopath. Assoc. 105, 447-456 (2005).</li><li>Hodge, L. M., King, H. H., Williams Jr, A. G., Reder, S. J., Belavadi, T. J., Simecka, J. W., 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=Abdominal+lymphatic+pump+treatment+increases+leukocyte+count+and+flux+in+thoracic+duct+lymph.">Abdominal lymphatic pump treatment increases leukocyte count and flux in thoracic duct lymph.</a> Lymphat. Res. Biol. 5, 127-133 (2007).</li><li>Hodge, L. M., Bearden, M. K., Schander, A., Huff, J. B., Williams Jr, A., King, H. H., Downey, H. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+pump+treatment+mobilizes+leukocytes+from+the+gut+associated+lymphoid+tissue+into+lymph.">Lymphatic pump treatment mobilizes leukocytes from the gut associated lymphoid tissue into lymph.</a> Lymphat. Res. Biol. 8, 103-110 (2010).</li><li>Prajapati, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+pump+treatment+increases+thoracic+duct+lymph+flow+in+conscious+dogs+with+edema+due+to+constriction+of+the+inferior+vena+cava.">Lymphatic pump treatment increases thoracic duct lymph flow in conscious dogs with edema due to constriction of the inferior vena cava.</a> Lymphat. Res. Biol. 8, 149-154 (2010).</li><li>Huff, J. B., Schander, A., Downey, H. F., Hodge, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+pump+treatment+augments+lymphatic+flux+of+lymphocytes+in+rats.">Lymphatic pump treatment augments lymphatic flux of lymphocytes in rats.</a> Lymphat. Res. Biol. 8, 183-187 (2010).</li></ol>

马丁·加涅是一个副主编的杂志可视化实验（朱庇特）2009至2011年余下的作者有没有其他披露事项。

整骨疗法医学，当应用于肺炎患者，有助于通过鼓励正常的血液循环和免疫功能的恢复健康。这是在三个连续的步骤来实现：去除功能障碍，通过淋巴组织26妨碍引流，呼吸功能的最大化，和流量增大的。淋巴系统的角色包括：平衡间质液，多余的物质运输，配送免疫细胞从淋巴组织到全身循环，并过滤并除去异物从间质液的组成。 文献表明，靶向淋巴回流技术是有利的肺炎的治疗通过改变压差在胸隔膜26，改善呼吸功能31,32，增强抗体反应7,33，减轻水肿34路，激活自主神经介导的内在淋巴收缩28，增加外周血8白血细胞的丰度。淋巴管泵技术已被证明能增加细胞因子和趋化因子在胸椎和肠淋巴管35，而机械压力，以一定的身体部位从淋巴的形成位置的遥远提高流入淋巴系统36。另外，它已经表明，淋巴OMT增强白细胞的动员和流量在狗和大鼠中，主要从肠道相关淋巴组织37,38,39,40,41。 禁忌在执行OMT包括骨骨折，血栓事件，癌的某些阶段，和细菌感染与当前温度超过102华氏度。骨科人工操作只能由受过培训的骨科医生进行。如果医生有困难的performing所描述的技术，建议重新定位和/或患者对附加结构异常的进一步检查。 在实践中，临床医师可利用的所描述的技术进行各种修改。例如，当患者是仰卧，可以执行类似的版本的肋饲养技术。在这种结构中，医师应该使用手指垫双手接触病人的肋角度。利用掌指关节和处理表作为一个支点，医生应该靠在椅背上横向拉。这个位置应该被保留，直到释放感觉到，然后重复在肋骨的其他区域的步骤。的修改，胸泵技术涉及提供振动压缩到肋骨期间患者的呼气阶段。 总之，我们认为，OMT是一种宝贵的在肺炎的治疗辅助工具。我们来讨论这些治疗相关的步骤，机制和生理机能检讨既定协议。有了更好的理解这些技术，我们希望更多的医生会选择把整骨原则纳入传染病的协议。

儿童，老年人和免疫功能低下的患者特别容易受到肺炎。患者可伴有发热呈现，咳嗽，呼吸困难，呼吸急促，心动过速，咳痰，胸痛，恶心，呕吐，腹泻，乏力4。胸部临床检查可发现浊音界叩诊及湿啰音听诊时对肺的影响12。实验室结果可能会显示与左移，以及增加血沉和C-反应蛋白4白细胞增多。试验阐明具体的致病微生物包括尿抗原检查，聚合酶链反应，痰分析和血培养4。最后，X线成像，这作为诊断的金标准，可能会显示合并或炎性改变对肺12的各种叶。虽然没有具体的算法或症状的星座一直被证明EStablish临床诊断肺炎，温度&gt; 100ºF和异常呼吸音（罗音或干啰音）普遍被接受为订购一个胸部X光或痰液标本13项标准。此外，肺炎严重程度指数（PSI）和CURB-65的标准已被证明准确地预测死亡率肺炎患者14，15 一旦肺炎的诊断已被证实，标准的护理传统的管理应进行管理。对于患者病情稳定，骨科评估和辅助治疗可能是有益的，应予以考虑。 除了是完全授权练传统医学，骨科医生利用一个多步骤的全面的方法来诊断和治疗，可以改善结构，功能，医治身体的内在能力。管理始于服用标准的历史和进行体检。如果有必要，实验室和影像学检查进行。然后，进行整骨结构的考试，其中包括以下参数，这些参数超出了本文的范围，评估和考核：运动，胸廓不动，肌肉痉挛，tenderpoints，内脏躯体反射，查普曼的分节段和区域限制的存在，淋巴阻塞，植物神经异常和结构的不规则性。患者随后接受动手操作旨在解决任何具体的功能障碍，除了标准的保健治疗方案。最后，重新评估，以评估干预措施的有效性进行。 文献综述 我们最初的纳入标准，随机对照试验（RCT）的考研学习索引OMT对成年人（&gt; 18岁）的疗效确诊为社区获得性肺炎。检索PubMed为“整骨*肺炎随机对照试验”，取得了一回的六篇文章。这些结果中，三名符合纳入标准范围。 因为OMT的肺炎患者的疗效随机对照试验的数量有限，我们扩大了我们的纳入标准，包括对其他手册中，非药物，在治疗肺炎，即胸部理疗用于辅助治疗的疗效研究。胸部理疗被定义为一组旨在通过促 ​​进扩张肺部，加强呼吸肌，并从肺16消除分泌物提高呼吸效率的技术。胸部物理治疗包括例如打击乐和体位引流以及咳嗽和深呼吸练习，这是显示技术d是肺炎17的管理。很明显，胸部理疗的理想目标是类似OMT中，这两个手动的方式协助减少呼吸功，促进肺扩张。这，这是合乎逻辑的我们扩大搜寻范围至包括胸部理疗。 然后，我们检索PubMed为“物理治疗肺炎的随机对照试验”，取得了一回59篇。这些结果的，另外三个研究适合的纳入标准范围。 当两者结合搜索，共六个随机对照试验符合我们的纳入标准。这些随机对照试验如下所述，总结和图3-4显示： <ul><li> 2010年，诺尔公布整骨手法的疗效为住院患者辅助治疗肺炎：一项随机对照试验这是一个多中心随机对照试验，涉及406科，在老年患者专注于辅助治疗肺炎。治疗组给予OMT从骨科专家，灵活运用，如肋骨养殖技术，隆起膈肌，胸泵和淋巴泵。安慰剂组接受光的触摸，而对照组仅接受常规护理。诺尔发现，相较于由每个协议分析常规治疗，OMT与降低住院时间（LOS）和第IV抗生素的持续时间，以及呼吸衰竭和死亡的发生率较低有关。18 </li><li>在2000年和1999年，诺尔公布骨科手法治疗住院老年肺炎患者和辅助整骨手法治疗中老年人肺炎住院的好处：一项试验性研究 。这些试验报道，辅助OMT，相对于轻碰，是伴有降低LOS和硬脑膜静脉注射抗生素化19，20 </li><li> 1997年，Bjorkqvist的吹瓶在医院治疗的患者与肺炎患者社区获得性肺炎比较，观察指标分层，收到一个辅助协议，用于早期活动，深呼吸，或泡沫吹。泡泡吹是与降低LOS相对于早期活动组相关联。21 </li><li> 1985年，布里顿出版胸部物理治疗在原发性肺炎 。本研究发现，没有好处肺炎患者接受的协议体位引流，敲击，振动和外部帮助呼吸。22 </li><li> 1978年， 胸部理疗和肺炎的分辨率间歇正压呼吸格雷厄姆的功效没有发现益处肺炎患者参加了一个协议体位引流，敲击，振动和鼓励深呼吸和咳嗽。23 </l我&gt; </ul>

osteopathic manipulative treatment as a useful adjunctive tool for pneumonia

肺炎，肺组织主要是由于微生物感染的炎症状态，声称52,306生活在美国于2007年1并导致110万例2的住院治疗。随着住院病人住院五天2逗留的平均长度，肺炎和流感包括显著的经济负担成本核算美国$ 40.2十亿在2005年3。在美国/美国胸科学会指南当前传染病学会，标准的，保健建议包括适当的抗生素团，补液和通风（如果需要的话）的快速管理。非标准疗法包括使用糖皮质激素和他汀类药物;然而，这些疗法缺乏确凿的证据4。 （图1） 整骨手法治疗（OMT）是一种经济有效的辅助治疗肺炎的NIA已被证明可以减少住院时间，静脉抗生素治疗持续时间，呼吸衰竭或死亡的发生率患者的长度相比，谁接受单纯常规护理5门科目。首次录得肺​​炎采用手工操作技术，早在1918年，当与标准的医疗护理治疗的患者估计死亡率为33％的西班牙流感大流行相比，死亡率10％的患者由骨科医生治疗6。当施加到肺炎的管理，手动操纵技术 ​​通过靶向参与了这些系统7,8，9，10的解剖结构加强淋巴流动，呼吸功能，和免疫防御。 此评论视频文章的目的有三方面：一）总结上OMT的成年患者直径的疗效的随机对照研究的结果gnosed肺炎，B）证明由骨科医生治疗肺炎利用既定协议，三）阐明背后手动操作的呼吸系统和淋巴系统的生理机制。具体来说，我们将讨论和演示，解决自主计算，淋巴引流，肋骨移动4常规技术：1）募集罗纹，2）胸泵，胸隔膜3）林乐培，以及4）肌肉能量的肋骨1 5 ，11

首先，肌肉能源技术主攻高尔基腱器官，这是位于骨骼肌牵张感受器。后收缩，高尔基腱器官被拉伸，从而激活传入感觉Ib型神经传递到脊髓。在中枢神经系统，Ib型神经突触后抑制运动神经元，然后提供抑制性冲动的α运动神经元定位的同名肌肉群。最终的结果是松弛的初始和协同的肌肉，以及拮抗肌的收缩。这种效应被称为高尔基腱反射或反向Myostatic反射。在肌肉能源技术在胸廓的应用，参与呼吸的肌肉所从事的等距阻力。在肋1的情况下，肋的运动可以由病理相关的斜角肌受到限制。通过INSPIRA在改善这一呼吸肌组，罗纹1移动体功能障碍，后顾无忧化和到期。治疗，协助胸廓运动的呼吸道结构，分别位于胸廓入口/出口地区减少淋巴回流的阻抗。在锁骨区肌筋膜限制，如斜角肌肥厚或痉挛，会阻碍淋巴管的末端排水途中锁骨下静脉。此外，增加胸廓游览改善压力梯度，从而进一步促进淋巴流动。 二，胸隔膜技术林乐培涉及操纵胸隔膜，这是参与呼吸，血液循环，淋巴回流，以及其他关键要素22主要的肌肉。这项技术涉及“隆起”的肌肉，以减轻有一平整的或不正常的状态相关联高渗性。隆起是指施加压力和拉伸，以便将其返回到更正常的圆形形状的肌肉的方法;因此，减少它的张力过高。这种技术间接接合所述弹性膜片的下表面和过期26中增加它的偏移。此外，通过膜片上施加流体容器中的泵样的推进作用协助淋巴回流。因此，在隔膜的物理抽吸力的障碍会限制淋巴回流至循环。例如，高渗性​​隔膜可以阻碍从所述池辣椒，这是位于膈附件后面一个主要的血管淋巴流动。胸隔膜技术的隆起增加了偏移，因此将有两个最佳的淋巴液流量及回报压力梯度正常。 三，罗纹饲养技术通过改善呼吸游览和减少交感神经增强淋巴回流。过多的自主神经支配由产生肋骨肌肉的张力过高，增加腹内按减少胸壁的流动性URE 27。由于淋巴回流是依赖于充分的呼吸漂移产生的压力梯度，过度的交感神经张力可以是一个妨碍淋巴引流28。因此，该技术解决了这一病理专注于相邻交感神经链节，以肋骨2-6 26。此外，在肋饲养效果比较轻触摸对照组的研究中，有α-淀粉酶，交感神经活性29的既定生理生物标志物的水平显著下降。 第四，胸泵技术通过淋巴管的壁上有节奏的，阶段性压缩和区域淋巴结组织30，尤其是胸导管增加淋巴和其他免疫细胞的流动。这种技术提供的机械力来补充淋巴引流到静脉循环，这是在extracellul的阻塞或排水有限的国家主要是有用的AR舱。振荡压缩作用产生交变压力梯度，这使淋巴液流经它的天然河道中的优势方向。 <img alt="图1" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig1highres.jpg" src="/files/ftp_upload/50687/50687fig1.jpg" /> 图1：此图说明肺炎的治疗和疗效的各个组成部分，由目前的文献4所支持的。 <img alt="图2" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig2highres.jpg" src="/files/ftp_upload/50687/50687fig2.jpg" /> 图2，这个数字说明了一步一步的朝着方法病人护理由骨科医生利用。 <img aLT =“图3”FO：内容宽度=“6英寸”FO：SRC =“/ files/ftp_upload/50687/50687fig3highres.jpg”SRC =“/ files/ftp_upload/50687/50687fig3.jpg”/&gt; 图3，这个数字表明在逗留比较长的随机对照试验显著成果。 <img alt="图4" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig4highres.jpg" src="/files/ftp_upload/50687/50687fig4.jpg" /> 图4，这个数字表明在比较抗生素持续时间的随机对照试验显著成果。 <img alt="图5" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig5highres.jpg" src="/files/ftp_upload/50687/50687fig5.jpg" /> 图5，这个数字说明了高尔基腱反射消失。当拉伸时，高尔基腱器官被激活，并提供反馈到中枢神经系统，结果在INHI<html> bitory脉冲被发送到同名肌肉。 <img alt="图6" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig6highres.jpg" src="/files/ftp_upload/50687/50687fig6.jpg" /> 图6，这个数字显示的位置设置为肌肉能源技术应用到肋骨1的呼出功能障碍。 <img alt="图7" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig7highres.jpg" src="/files/ftp_upload/50687/50687fig7.jpg" /> 图7，该图说明了大拇指对林乐培的隔膜技术，它规格化膜片以缓解异常呼吸运动的形状的位置。 / files/ftp_upload/50687/50687fig8.jpg“/&gt; 图8，这个数字显示的位置设置为林乐培隔膜技术。 <img alt="图9" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig9highres.jpg" src="/files/ftp_upload/50687/50687fig9.jpg" /> 图9，该图说明了肋饲养技术，提高呼吸膨胀和减轻由来自交感神经链神经节神经支配过度高渗。 <img alt="图10" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig10highres.jpg" src="/files/ftp_upload/50687/50687fig10.jpg" /> 图10，这个数字显示的位置设置为肋骨饲养技术。 <img alt="图11" fo:con帐篷宽度=“6英寸”FO：SRC =“/ files/ftp_upload/50687/50687fig11highres.jpg”SRC =“/ files/ftp_upload/50687/50687fig11.jpg”/&gt; 图11，这个数字说明了手的定位，相对于淋巴系统，在胸泵技术提供向下摆动压缩之前。 <img alt="图12" fo:content-width="6in" fo:src="/files/ftp_upload/50687/50687fig12highres.jpg" src="/files/ftp_upload/50687/50687fig12.jpg" /> 图12，这个数字显示的位置设置了胸泵技术。

Watch this Scientific Journal Video about Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia at JoVE.com

Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

肺炎是导致死亡的，在美国整骨手法技术（OMT）的十大主要原因之一可用作辅助治疗肺炎，提升生物力学和免疫功能的治疗;最终，以减少住院天数，抗生素的持续时间，呼吸衰竭的发病率和死亡率。在这个视频文章中，我们将回顾对肺炎患者使用OMT的随机对照研究，以及具体的演示动手的那些定期由骨科医生治疗肺部感染时，练技术。

整骨手法治疗为肺炎是非常好的辅助工具

Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071 and resulted in ...

osteopathic-manipulative-treatment-as-useful-adjunctive-tool-for

Research

Education

JoVE Core

JoVE Journal

Pharmacology

Medicine

Unit 1

Lower Respiratory Disorders

SCIENTISTS IN ACTION

47.5K 次观看.  New York Institute of Technology College of Osteopathic Medicine. 肺炎是导致死亡的，在美国整骨手法技术（OMT）的十大主要原因之一可用作辅助治疗肺炎，提升生物力学和免疫功能的治疗;最终，以减少住院天数，抗生素的持续时间，呼吸衰竭的发病率和死亡率。在这个视频文章中，我们将回顾对肺炎患者使用OMT的随机对照研究，以及具体的演示动手的那些定期由骨科医生治疗肺部感染时，练技术。 

视频: Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The Goeckerman regimen, formulated for the treatment of psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). The following protocol is for the administration of Goeckerman therapy for the treatment of moderate-to-severe psoriasis.

Goeckerman方案用于治疗中度至重度牛皮癣

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

科研

医学

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research. Because the testing is computer-based, test performance can be analyzed in traditional or novel ways and data can be directly entered into research or clinical databases. The MSPT could be widely disseminated to clinicians in practice settings who are not connected to clinical trial performance sites or who are practicing in rural settings, drastically improving access to clinical trials for clinicians and patients. The MSPT could be adapted to out of clinic settings, like the patient&#8217;s home, thereby providing more meaningful real world data. The MSPT represents a new paradigm for neuroperformance testing. This method could have the same transformative effect on clinical care and research in MS as standardized computer-adapted testing has had in the education field, with clear potential to accelerate progress in clinical care and research.

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report methodologic details on a new test, the Multiple Sclerosis Performance Test (MSPT). This new approach to the objective of quantification of MS related disability provides a computer-based platform for precise, valid measurement of MS severity.

多发性硬化症性能测试（MSPT）：一个iPad为基础的残疾评估工具

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the ...

Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies

The microcirculation consists of blood vessels with diameters less than 150 &#181;m. It makes up a large part of the circulatory system and plays an important role in maintaining cardiovascular health. The retina is a tissue that lines the interior of the eye and it is the only tissue that allows for a non-invasive analysis of the microvasculature. Nowadays, high-quality fundus images can be acquired using digital cameras. Retinal images can be collected in 5 min or less, even without dilatation of the pupils. This unobtrusive and fast procedure for visualizing the microcirculation is attractive to apply in epidemiological studies and to monitor cardiovascular health from early age up to old age.
Systemic diseases that affect the circulation can result in progressive morphological changes in the retinal vasculature. For example, changes in the vessel calibers of retinal arteries and veins have been associated with hypertension, atherosclerosis, and increased risk of stroke and myocardial infarction. The vessel widths are derived using image analysis software and the width of the six largest arteries and veins are summarized in the Central Retinal Arteriolar Equivalent (CRAE) and the Central Retinal Venular Equivalent (CRVE). The latter features have been shown useful to study the impact of modifiable lifestyle and environmental cardiovascular disease risk factors.
The procedures to acquire fundus images and the analysis steps to obtain CRAE and CRVE are described. Coefficients of variation of repeated measures of CRAE and CRVE are less than 2% and within-rater reliability is very high. Using a panel study, the rapid response of the retinal vessel calibers to short-term changes in particulate air pollution, a known risk factor for cardiovascular mortality and morbidity, is reported. In conclusion, retinal imaging is proposed as a convenient and instrumental tool for epidemiological studies to study microvascular responses to cardiovascular disease risk factors.

Retinal image analysis is an unobtrusive procedure for visualizing the microcirculation. The impact of cardiovascular disease risk factors can result in changes of retinal vessel calibers. The procedures to acquire fundus images and the steps for calculating the vessel calibers are described.

眼底摄影作为一种方便的工具，研究微血管回应流行病学研究心血管疾病的风险因素

The microcirculation consists of blood vessels with diameters less than 150 &#181;m. It makes up a large part of the circulatory system and plays an ...

Using Adeno-associated Virus as a Tool to Study Retinal Barriers in Disease

M&#252;ller cells are the principal glial cells of the retina. Their end-feet form the limits of the retina at the outer and inner limiting membranes (ILM), and in conjunction with astrocytes, pericytes and endothelial cells they establish the blood-retinal barrier (BRB). BRB limits material transport between the bloodstream and the retina while the ILM acts as a basement membrane that defines histologically the border between the retina and the vitreous cavity. Labeling M&#252;ller cells is particularly relevant to study the physical state of the retinal barriers, as these cells are an integral part of the BRB and ILM. Both BRB and ILM are frequently altered in retinal disease and are responsible for disease symptoms.
There are several well-established methods to study the integrity of the BRB, such as the Evans blue assay or fluorescein angiography. However these methods do not provide information on the extent of BRB permeability to larger molecules, in nanometer range. Furthermore, they do not provide information on the state of other retinal barriers such as the ILM. To study BRB permeability alongside retinal ILM, we used an AAV based method that provides information on permeability of BRB to larger molecules while indicating the state of the ILM and extracellular matrix proteins in disease states. Two AAV variants are useful for such study: AAV5 and ShH10. AAV5&#160;has a natural tropism for photoreceptors but it cannot get across to the outer retina when administered into the vitreous when the ILM is intact (i.e., in wild-type retinas). ShH10 has a strong tropism towards glial cells and will selectively label M&#252;ller glia in both healthy and diseased retinas. ShH10 provides more efficient gene delivery in retinas where ILM is compromised. These viral tools coupled with immunohistochemistry and blood-DNA analysis shed light onto the state of retinal barriers in disease.

To investigate the blood-retinal barrier permeability and the inner limiting membrane integrity in animal models of retinal disease, we used several adeno-associated virus (AAV) variants as tools to label retinal neurons and glia. Virus mediated reporter gene expression is then used as an indicator of retinal barrier permeability.

使用腺相关病毒作为一种工具来研究疾病中的视网膜障碍

M&#252;ller cells are the principal glial cells of the retina. Their end-feet form the limits of the retina at the outer and inner limiting membranes ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Evaluation of the Efficacy of the H. pylori Protein HP-NAP as a Therapeutic Tool for Treatment of Bladder Cancer in an Orthotopic Murine Model

Bladder cancer is one of the most common malignancies of the urogenital tract. Intravesical injection of Bacillus Calmette-Gu&#233;rin (BCG) is the gold standard treatment for the high-grade non-muscle invasive bladder cancer (NMIBC). However, since the treatment-related side effects are relevant, newer biological response modifiers with a better benefit/side effects ratio are needed.
The tumour microenvironment can influence both tumour development and therapy efficacy. In order to obtain a good model, it is desirable to implant tumour cells in the organ from which the cancer originates.
In this protocol, we describe a method for establishing a tumour in the bladder cavity of female mice and subsequent delivery of therapeutic agents; the latter are exemplified by our use of Helicobacter pylori neutrophil activating protein (HP-NAP). A preliminary chemical burn of the mucosa, followed by the injection of mouse urothelial carcinoma cell line MB49 via urethral catheterization, enables the cells to attach to the bladder mucosa. After a period, required to allow an initial proliferation of the cells, mice are treated with HP-NAP, administrated again via catheterization. The anti-tumour activity of HP-NAP is evaluated comparing the tumour volume, the extent of necrosis and the degree of vascularization between vehicle- and HP-NAP-treated animals.

Evaluation of the Efficacy of the H. pylori Protein HP-NAP as a Therapeutic Tool for Treatment of Bladder Cancer in an Orthotopic Murine Model

Here the method to establish a syngeneic mouse model of orthotopic bladder tumour to evaluate the anti-tumour efficacy of the bacterial protein HP-NAP is described.

评价疗效<em&gt;小时。幽门螺杆菌</em&gt;蛋白HP-NAP为膀胱癌的治疗在原位小鼠模型的治疗工具

Bladder cancer is one of the most common malignancies of the urogenital tract. Intravesical injection of Bacillus Calmette-Gu&#233;rin (BCG) is the gold ...

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-rTMS work should include sham-controlled studies to confirm its clinical efficacy in MDD.

Here we outline the procedure for MRI-guided repetitive transcranial magnetic stimulation to the dorsomedial prefrontal cortex as an experimental treatment for major depressive disorder.

MRI引导dmPFC-rTMS治疗作为治疗难治性抑郁症

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial ...

An Acute Retinal Model for Evaluating Blood Retinal Barrier Breach and Potential Drugs for Treatment

A low-cost, easy-to-use and powerful model system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach. An inflammatory factor, histamine, is demonstrated to compromise vessel integrity in the cultured retina through positive staining of IgG outside of the blood vessels. The effects of histamine itself and those of candidate drugs for potential treatments, such as lipoxin A4, are assessed using three parameters: blood vessel leakage via IgG immunostaining, activation of M&#252;ller cells via GFAP staining and change in neuronal dendrites through staining for MAP2. Furthermore, the layered organization of the retina allows a detailed analysis of the processes of M&#252;ller and ganglion cells, such as changes in width and continuity. While the data presented is with swine retinal culture, the system is applicable to multiple species. Thus, the model provides a reliable tool to investigate the early effects of compromised retinal vessel integrity on different cell types and also to evaluate potential drug candidates for treatment.

A low-cost, easy-to-use and powerful system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach induced by histamine. Blood vessel leakage, M&#252;ller cell activation and the continuity of neuronal processes are utilized to assess the damage response and its reversal with a potential drug, lipoxin A4.

急性视网膜模型评估血视网膜屏障违约和潜在的药物治疗

A low-cost, easy-to-use and powerful model system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach. An ...

Tubal Cytology of the Fallopian Tube as a Promising Tool for Ovarian Cancer Early Detection

Currently, it is widely accepted that the vast majority of ovarian high-grade serous carcinoma (HGSC) originate from the fallopian tube. However, due to the lack of markers or tools for the ovarian cancer identification, the early detection of HGSC remains challenging. Direct sampling of the fallopian tube can enhance sensitivity for detection of neoplastic cells when the tumor is not grossly visible. We developed a procedure to collect fallopian tube cells directly from freshly received surgical specimens, which has shown excellent correlation with histological findings. This approach lays a foundation for the future utility of minimally invasive laparoscopic screening in high-risk patient populations.

We explored a tubal cytologic method by sampling the fallopian tube directly post-surgical excision as a tool of ovarian cancer early detection. Here, we present a protocol to collect fallopian tube cells from freshly received surgical specimens.

输卵管的管状细胞学作为卵巢癌早期检测的有前景的工具

Currently, it is widely accepted that the vast majority of ovarian high-grade serous carcinoma (HGSC) originate from the fallopian tube. However, due to ...

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression (TRD). VNS exhibits antidepressive and stabilizing effects. This method is particularly useful as a long-term treatment, in which up to two-thirds of patients respond. The vagus nerve stimulator is positioned on the left vagus nerve during a surgical procedure and is activated telemetrically by a wand connected to a handheld computerized device. The treating physician can perform various adjustments of the vagus nerve stimulator during in-office visits (e.g., by modifying stimulation intensity or stimulation frequency) to achieve maximum therapeutic effects with low side effects. Set-up of the device usually takes several months. Typical side effects include wound infection, temporary salivation, coughing, paralysis of the vocal cords, bradycardia, or even asystole. The patient can stop the VNS by placing a magnet over the generator. The current protocol describes delivery of the specific stimulation tool and methods for adjusting the tuning parameters to achieve the best remission rates in patients with TRD.

Vagus nerve stimulation (VNS) has been shown to be effective as an adjunct treatment for treatment-resistant depression (TRD). VNS leads to antidepressive and antisuicidal effects and quality of life improvements. This protocol offers a step-by-step guide to managing and adjusting a vagus nerve stimulator for efficient treatment of TRD.

迷走神经刺激作为抗抑郁抑郁症的辅助神经刺激工具

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression ...