这项研究由成都中医药大学附属妇科资助。

本研究所有程序均通过临床试验注册进行，并经成都中医药大学附属医院伦理机构批准（备案号：2022SL-015）。本研究中的所有患者都获得了充分的知情同意，并同意研究人员在试验期间使用数据、图像和相关视频拍摄。2023年1月至2023年4月，在成都中医药大学医院住院部通过传单、文字交流、医生推荐等方式招募符合条件的患者。
1. 患者选择
<ol><li>纳入标准<ol><li>确认宫内妊娠。参考美国内科医师学会 2018年 10 月发布的《NVP 诊断和管理指南》，确定早孕呕吐为主要主诉，并确保参与者符合临床 NVP 的诊断标准。</li>
		<li>确认参与者目前没有参加其他临床试验。</li>
	</ol></li>
	<li>排除标准<ol><li>排除患有引起 NVP 的其他病理状况的个体，例如妊娠剧吐、妊娠相关性病毒性肝炎或妊娠相关性急性胃肠炎。</li>
		<li>排除拒绝接受耳膏治疗的参与者。</li>
		<li>排除患有严重 NVP 或对药物或其赋形剂过敏的个体以及耳廓损伤的参与者。</li>
		<li>排除在过去 2 周内接受过 NVP 治疗的患者。</li>
	</ol></li>
	<li>辍学个案的处理<ol><li>如果参与者无法维持对治疗的依从性，则退出试验。如果参与者选择退出研究，允许他们自愿退出研究。</li>
	</ol></li>
	<li>终止试验的标准<ol><li>终止在研究期间出现严重并发症或出现疾病进展的参与者。如果参与者出现严重的不良反应，则停止试验。</li>
	</ol></li>
</ol>2. 患者分组和治疗方案
<ol><li>招募20名患者，并将他们随机分配到实验组或对照组。</li>
	<li>为对照组提供控制饮食并进行常规治疗，包括补液和补充维生素（详见结果部分）。</li>
	<li>对于实验组，除常规治疗外，还进行耳膏治疗。</li>
	<li>确保两组的休息管理保持不变，直到患者出院。</li>
</ol>3. 耳膏治疗程序的准备
<ol><li>收集必要的物品（图1）：剪刀，无菌棉签，镊子，医用胶带，75%酒精和牛草种子（见 材料表）。</li>
	<li>耳膏的准备<ol><li>将胶带切成 0.6 厘米 x 0.6 厘米的正方形。</li>
		<li>取 1 或 2 颗光滑的牛草种子（B. Wang 的种子，从制药公司获得，见 材料表），并将它们放在每个胶带正方形的中心，如图 2 所示。</li>
	</ol></li>
	<li>患者准备<ol><li>指导患者以舒适的姿势坐下。</li>
		<li>检查耳朵皮肤的状况。 注意： 在进行治疗之前，请确保耳朵皮肤完好无损且没有任何异常（例如炎症、溃疡、冻伤等）。不应在耳廓创伤或炎症区域进行耳膏治疗。只有在这些异常消退且创伤愈合后才能进行。如果患者对胶带过敏，请使用替代材料。</li>
	</ol></li>
	<li>穴位的选择<ol><li>定位耳朵上的穴位/敏感区域。用一只手的拇指和食指向上捏住和抬起耳螺旋，使该区域完全暴露，从而稳定耳廓。</li>
		<li>另一只手拿着无菌拭子，轻轻探查患者的耳朵，以确定胃（CO4）、贲门（CO3）、腹部（AH8）、神门（TF4）、皮层下（AT4）和肝脏（CO12）六个耳廓点附近的敏感压力点（图3）。 注意： 敏感点是指在施加压力时与其他区域相比有明显酸痛、麻木、肿胀或疼痛的区域。与其他常见的耳穴相比，这些敏感穴位显示出更好的治疗效果7。根据先前的临床研究，六个耳穴点（CO4、CO3、AH8、TF4、AT4 和 CO12）通常用于治疗 NVP，并具有突出的止吐和镇静作用11,12,13。如果未检测到耳朵上的敏感点，则可以选择上述六个点进行后续治疗。</li>
	</ol></li>
	<li>消毒<ol><li>使用浸有酒精的棉球对操作员的手进行消毒。</li>
		<li>使用蘸有 75% 酒精的无菌棉签对患者的耳廓进行消毒。 注意： 消毒区域应覆盖目标点周围约 1-2 平方厘米的耳廓皮肤。酒精有助于去除皮肤表面的油脂，确保胶带具有更好的粘合性能。如果患者对酒精过敏，可以使用碘伏作为替代药物。</li>
	</ol></li>
</ol>4. 耳膏治疗
<ol><li>一旦该区域干燥，用一只手的拇指和食指捏住耳螺旋，将其向后和向上抬起，以稳定耳廓。</li>
	<li>使用镊子，取出准备好的耳膏（步骤3.2），将牛草的中心种子放在选定的点上， 如图4所示。与患者确认种子放置对应于敏感点或疼痛区域。</li>
	<li>将拇指和食指放在耳廓的前后，以有节奏的按压和放松运动施加适度且可忍受的压力，以刺激耳廓部位的牛草种子。在每个部位按下并松开3-5分钟，保持均匀的节奏。 注意： 根据与患者的沟通调整压力强度，确保在不过度用力的情况下感觉到酸痛、麻木、肿胀和疼痛。</li>
	<li>治疗后监测患者的整体状况 15 分钟。 注意： 如果出现恐慌、胸部不适、头晕或大量出汗，请立即撕下胶带。</li>
	<li>指导患者或其家属每天揉搓种子三次：早上、中午和晚上。 注意：强调当患者感到恶心时需要对种子进行额外刺激。</li>
	<li>三天后取下耳膏，在对侧耳朵上重复上述步骤，在两只耳朵之间交替治疗。 注意：继续治疗，直到患者符合出院标准：PUQE 评分 ≤4 且尿酮体变为阴性。如果耳膏脱落，请重新涂抹。</li>
</ol>5. 患者诊断
<ol><li>从住院第一天开始，每 2 天收集一次新鲜尿液，以测量和记录尿酮水平。注意从治疗开始到尿酮水平转为阴性的持续时间。 注：尿酮水平是评估NVP患者的重要指标。尿酮水平阳性表明持续饥饿和脱水14,15。确保及时检测尿液样本，防止酮体蒸发引起的低值。</li>
	<li>指导患者每天完成妊娠特有的呕吐和恶心量化 （PUQE） 量表（见 表 1）。每天根据他们的实际症状记录分数，直到出院当天。 注意：PUQE 量表广泛用于全球各种实践指南中，以测量患者 NVP 症状的严重程度16.PUQE 分数越高表示病情越严重。</li>
</ol>6. 术后护理
<ol><li>建议患者保持耳朵清洁和干燥。 注意： 种子贴片的放置不会干扰日常活动，例如洗涤和沐浴。</li>
	<li>提供安慰和支持，以减轻患者的紧张和恐惧。</li>
	<li>指导患者在出现恶心和呕吐时进行吞咽动作或深呼吸。</li>
	<li>如果患者在治疗过程中出现局部过敏反应，例如皮肤瘙痒、发红或渗出，请立即撕下胶带并局部涂抹抗过敏软膏以缓解这些症状。</li>
	<li>如果发生感染，应将其作为普通感染进行管理。使用外用抗生素（适用于孕妇）或消炎镇痛软膏进行治疗。</li>
	<li>监测呕吐的频率和量，评估脱水体征，并定期测量尿酮水平。 注意：如果存在影响胎儿发育和母体安全且无法有效解决的情况，请考虑终止妊娠。</li>
</ol>

用耳石膏治疗妊娠呕吐

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作者声明他们没有利益冲突。

妊娠期恶心和呕吐 （NVP） 是一种常见的疾病，可能对孕妇的健康构成风险，甚至会导致终止妊娠的并发症。通常用于止吐/抗恶心作用的临床药物，如昂丹司琼和异丙嗪，对孕妇有潜在风险，包括肌张力障碍、镇静和降低癫痫发作阈值22.因此，药物治疗有其自身的一系列危险。另一方面，今天通常采用的以症状为中心的治疗方法缺乏特异性，有时无效23.因此，?...

妊娠期恶心和呕吐 （NVP） 很常见，不同程度地影响约 50%-80% 的孕妇1。当NVP进展到中度或重度水平时，它会增加母亲和胎儿不良妊娠结局的风险。因此，NVP 的早期干预可能有助于预防妊娠剧吐2 的发生。NVP 的确切原因在现代生物医学中尚不清楚，但据信它与怀孕期间人绒毛膜促性腺激素血清水平的变化和某些维生素3 的缺乏等因素有关。目前 NVP 的治疗方法包括禁食、输液和纠正电解质失衡，但这些方法都不被认为是可靠的4。因此，找到一种不影响胚胎或胎儿发育的有效治疗方法是一项重大的临床挑战。
耳膏疗法是一种传统的中医治疗方法，涉及使用小而圆的物体，通常是牛草的种子，刺激耳朵上的特定穴位，以预防和治疗疾病5.牛痘的干燥和成熟种子，也称为牛草，用于这种疗法，因为它们被认为可以调节血液和通道，增强血液循环，促进泌乳。耳廓（耳朵的外侧）富含神经，包含许多针灸和敏感穴位6。通过刺激这些穴位，耳朵的软组织可能产生局部无菌炎症，进而可能调节神经内分泌系统，包括垂体-肾上腺皮质和交感神经-肾上腺皮质腺。此外，这种疗法可以潜在地激活人体的非特异性免疫反应，从而产生治疗效果7.耳膏疗法通过靶向耳朵上主要调节自主神经功能障碍、减少胃肠道反应和减轻呕吐感的特定穴位来有效治疗 NVP。它还可以增加Motilin的水平，Motilin是一种促进肠道蠕动的激素8，并恢复孕妇的食欲。此外，以前的一些研究表明，耳膏疗法可能对 NVP 相关的情绪障碍产生有利影响9，因为它在缓解焦虑方面表现出与镇静剂相似的作用。
耳膏疗法是一种简单且易于管理的治疗方法。它可以与常规治疗结合使用，以缓解NVP的症状，同时将母亲和胎儿与药物使用相关的潜在风险降至最低。该协议提供了有关如何进行这种治疗以及在此过程中要考虑的事项的详细说明。我们希望耳膏治疗能够得到更多的关注，并在临床实践中得到推广和利用。

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ear plaster therapy as a safe and effective treatment for gestational vomiting

妊娠期恶心和呕吐 （NVP） 是常见症状，通常使许多女性的妊娠早期复杂化。虽然禁食、输液和营养支持等临床治疗通常用于管理 NVP，但其有效性各不相同。然而，传统的耳膏疗法提供了一种很有前途的替代方案，可以有效缓解症状，并且对胚胎或胎儿的发育没有已知的风险。这种疗法以其易于应用、成本效益和良好的结果而闻名。先前的研究表明，将耳膏疗法与常规治疗相结合在缓解孕妇恶心和呕吐症状方面的有效性超过了单独使用常规治疗所取得的结果。本文介绍的方案描述了一种使用应用于特定耳点的圆形、光滑和坚硬的牛草种子来缓解NVP的方法。利用穴位按摩的原理，将这些种子轻轻擦到耳朵表面。通过刺激指定的耳穴，该程序旨在调节身体的能量流动并恢复平衡，从而降低NVP的严重程度和频率。将牛草种子涂抹在特定的耳穴上是一种简单的技术，医疗保健专业人员可以在适当的指导下轻松实施或由孕妇自行管理。总体而言，耳膏疗法提供了一种安全、有效和经济的方法来控制妊娠呕吐，为女性提供了一种潜在的解决方案，以减轻怀孕期间的不适。

这项临床研究的所有 20 名参与者都成功完成了试验。4例患者符合出院标准，第5天出院，其余16例患者符合出院标准，住院后2周内出院。
试验期间，对照组接受控制饮食和静脉滴注，包括以下成分：维生素C 2g+0.9%氯化钠注射液500 mL、维生素B6 0.2 g+0.9%氯化钠注射液500 mL、甲萘醌钾镁20 mL+5%葡萄糖注射液500 mL、氯化钾15 mL+葡萄糖注射液500 mL、0.9%氯化钠注射液500 mL、 和维生素 B1 20...

Watch this Scientific Journal Video about Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture at JoVE.com

作者聚焦：通过安全有效的耳针缓解怀孕期间的恶心和呕吐 

所提出的方案描述了一种传统的中医治疗程序，以其在管理妊娠呕吐方面的安全性和有效性而闻名。

耳膏疗法是一种安全有效的妊娠呕吐治疗方法

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as ...

我们的研究重点是开发治疗怀孕期间恶心和呕吐的有效方法。我们的目标是探索在不影响胎儿发育的情况下最好地缓解此类患者症状的方法。治疗妊娠呕吐的最新进展包括许多药物，如维生素 B6、多西拉明和某种抗胆碱能药。此外，一些心理支持已被证明对康复很重要。耳膏治疗简单、经济、安全，在临床实践中被患者高度接受。这种疗法与传统的对症治疗相辅相成，在缓解孕妇呕吐和恶心症状方面更有效。我们的研究证明了我们的眼针治疗妊娠呕吐的有效性和安全性。现在需要更多的随机对照研究和临床试验来评估其疗效和副作用风险。

ear-plaster-therapy-as-safe-effective-treatment-for-gestational

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JoVE Journal

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Pharmacology

Medicine

Ear Plaster Therapy as a Safe and Effective Treatment for Gestational Vomiting

Unit 1

Drugs for Nausea and Vomiting

SCIENTISTS IN ACTION

1.2K 次观看.  Hospital of Chengdu University of Traditional Chinese Medicine. 我们的研究重点是开发治疗怀孕期间恶心和呕吐的有效方法。我们的目标是探索在不影响胎儿发育的情况下最好地缓解此类患者症状的方法。治疗妊娠呕吐的最新进展包括许多药物，如维生素 B6、多西拉明和某种抗胆碱能药。此外，一些心理支持已被证明对康复很重要。耳膏治疗简单、经济、安全，在临床实践中被患者高度接受。这种疗法与传统的对症治疗相辅相成，?...

视频: 作者聚焦：通过安全有效的耳针缓解怀孕期间的恶心和呕吐 

Human Neuroendocrine Tumor Cell Lines as a Three-Dimensional Model for the Study of Human Neuroendocrine Tumor Therapy

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human malignancies.1 Other than surgery for the minority of patients who present with localized disease, there is little or no survival benefit of systemic therapy. Therefore, there is a great need to better understand the biology of NETs, and in particular define new therapeutic targets for patients with nonresectable or metastatic neuroendocrine tumors. 3D cell culture is becoming a popular method for drug screening due to its relevance in modeling the in vivo tumor tissue organization and microenvironment.2,3 The 3D multicellular spheroids could provide valuable information in a more timely and less expensive manner than directly proceeding from 2D cell culture experiments to animal (murine) models.
To facilitate the discovery of new therapeutics for NET patients, we have developed an in vitro 3D multicellular spheroids model using the human NET cell lines. The NET cells are plated in a non-adhesive agarose-coated 24-well plate and incubated under physiological conditions (5% CO2, 37 &deg;C) with a very slow agitation for 16-24 hr after plating. The cells form multicellular spheroids starting on the 3rd or 4th day. The spheroids become more spherical by the 6th day, at which point the drug treatments are initiated. The efficacy of the drug treatments on the NET spheroids is monitored based on the morphology, shape and size of the spheroids with a phase-contrast light microscope. The size of the spheroids is estimated automatically using a custom-developed MATLAB program based on an active contour algorithm. Further, we demonstrate a simple method to process the HistoGel embedding on these 3D spheroids, allowing the use of standard histological and immunohistochemical techniques. 
This is the first report on generating 3D spheroids using NET cell lines to examine the effect of therapeutic drugs. We have also performed histology on these 3D spheroids, and displayed an example of a single drug's effect on growth and proliferation of the NET spheroids. Our results support that the NET spheroids are valuable for further studies of NET biology and drug development.

We present a simple agarose overlay platform to grow 3D multicellular spheroids using neuroendocrine cancer cell lines. This method provides a very convenient way to examine the effect of therapeutic drugs on the neuroendocrine tumor cells. It could also help us establish human neuroendocrine tumor spheroids for cancer therapy.

人类神经内分泌肿瘤细胞株为研究人类神经内分泌肿瘤治疗的三维模型

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human ...

科研

医学

Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

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 the hospitalization of 1.1 million patients2. With an average length of in-patient hospital stay of five days2, pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 20053. Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence4. (Figure 1)

Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients&#8217; length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone5. The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians6. When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems7,8, 9, 10.

The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and lymphatic systems. Specifically, we will discuss and demonstrate four routine techniques that address autonomics, lymph drainage, and rib cage mobility: 1) Rib Raising, 2) Thoracic Pump, 3) Doming of the Thoracic Diaphragm, and 4) Muscle Energy for Rib 1.5,11

Pneumonia is one of the top ten leading causes of death in the U.S. Osteopathic manipulative techniques (OMT) may be utilized as an adjunctive therapy in the treatment of pneumonia to enhance biomechanical and immune function; and ultimately, to reduce hospital stay, duration of antibiotics, incidence of respiratory failure, and mortality. In this video-article, we will review randomized controlled studies on the use of OMT in pneumonia patients, as well as demonstrate specific hands-on techniques that are routinely practiced by osteopathic physicians when treating pulmonary infections.

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 ...

Tumor Treating Field Therapy in Combination with Bevacizumab for the Treatment of Recurrent Glioblastoma

A novel device that employs TTF therapy has recently been developed and is currently in use for the treatment of recurrent glioblastoma (rGBM). It was FDA approved in April 2011 for the treatment of patients 22 years or older with rGBM. The device delivers alternating electric fields and is programmed to ensure maximal tumor cell kill1.
Glioblastoma is the most common type of glioma and has an estimated incidence of approximately 10,000 new cases per year in the United States alone2. This tumor is particularly resistant to treatment and is uniformly fatal especially in the recurrent setting3-5. Prior to the approval of the TTF System, the only FDA approved treatment for rGBM was bevacizumab6. Bevacizumab is a humanized monoclonal antibody targeted against the vascular endothelial growth factor (VEGF) protein that drives tumor angiogenesis7. By blocking the VEGF pathway, bevacizumab can result in a significant radiographic response (pseudoresponse), improve progression free survival and reduce corticosteroid requirements in rGBM patients8,9. Bevacizumab however failed to prolong overall survival in a recent phase III trial26. A pivotal phase III trial (EF-11) demonstrated comparable overall survival between physicians&#8217; choice chemotherapy and TTF Therapy but better quality of life were observed in the TTF arm10.
There is currently an unmet need to develop novel approaches designed to prolong overall survival and/or improve quality of life in this unfortunate patient population. One appealing approach would be to combine the two currently approved treatment modalities namely bevacizumab and TTF Therapy. These two treatments are currently approved as monotherapy11,12, but their combination has never been evaluated in a clinical trial. We have developed an approach for combining those two treatment modalities and treated 2 rGBM patients. Here we describe a detailed methodology outlining this novel treatment protocol and present representative data from one of the treated patients.

A novel methodology that is employed for the treatment of recurrent glioblastomas is described. This treatment approach employs the application of alternating electric tumor treating fields (TTFields), known as TTF Therapy in combination with bevacizumab, a targeted agent that is currently FDA approved as monotherapy.

肿瘤治疗领域的治疗与联合贝伐单抗治疗复发性胶质母细胞瘤的治疗

A novel device that employs TTF therapy has recently been developed and is currently in use for the treatment of recurrent glioblastoma (rGBM). It was FDA ...

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 ...

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 ...

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes.
The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.

The aim of this article is to describe the methodology of exclusively endoscopic cadaveric middle ear dissection. Moreover, we aim to provide a comprehensive guide to endoscopic middle ear anatomy.

Transcanal 内窥镜下耳部手术发现中耳解剖: 解剖手册

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal ...

External Cephalic Version: Is it an Effective and Safe Procedure?

External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the methodology of this procedure. The main objective is to show how to perform ECV with a specific protocol with tocolysis before the procedure and analgesia. Moreover, we describe and analyze the factors associated with successful ECV, and also compare to deliveries in the general pregnant population.
A retrospective and descriptive analysis of ECV carried out at the Hospital Clinico Universitario Virgen de la Arrixaca in Murcia (Spain) between 1/1/2014 and 12/31/2018 was assessed. The latest data available of labor deliveries in the local center, which is the biggest maternity department in Spain, were from 2018.
320 patients were recruited and 3 pregnant women were lost during the study. ECV was carried out at 37&#177;3 weeks gestation. ECV was successful in 82.5% (N=264). 19 complications were reported (5.9%): 8 vaginal bleeding (2.5%), 9 fetal bradycardia (2.8%), 1 preterm rupture of membranes (0.3%) and 1 cord prolapse (0.3%). A previous vaginal delivery increases the success rate of ECV ORadjusted=3.03 (1.62-5.68). Maternal Body Mass Index (BMI) affects the success of ECV ORadjusted=0.94 (0.89-0.99). Patients with BMI&#62;40 kg/m2 have an ORadjusted=0.09 (0.009-0.89) compared with those with BMI &#60;25 kg/m2. If ECV was successful, the cesarean delivery index is 22.2% (17.5-27.6%), the eutocic delivery index is 52.1% (46.1-58.1%) and the instrumented vaginal delivery index is 25.7% (20.7-31.2%). There are no differences in cesarean and eutocic delivery indexes after successful ECV. However, a successful ECV is associated with a 6.29% increase in the instrumented delivery rate (OR=1.63).
ECV is an effective procedure to reduce the number of cesarean sections for breech presentations. Maternal BMI and previous vaginal delivery are associated with ECV success. Successful ECV does not modify the usual delivery pattern.

This article shows how to perform the external cephalic version (ECV) by two experienced obstetricians in the obstetric operating room in the presence of an anesthesiologist and a midwife. The ECV is carried out with analgesia and tocolysis. Two attempts are made under ultrasonography control.

外部脑积水版本:它是一个有效和安全的程序吗？

External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the ...

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

辅助二极管激光治疗和益生菌 乳酸杆菌 治疗牙周炎和种植体周围疾病

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode ...

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway or high ventilation pressures. Endotracheal intubation is a challenging skill,&#160;requiring a minimum number of successful endotracheal intubations to achieve a high success rate under optimal conditions, which is often unachievable for non-anaesthesiology researchers. Due to the specific porcine airway anatomy, a difficult airway can usually be assumed. The impossibility of establishing a secure airway can result in injury, adverse events, or death of the laboratory animal. Using a prospective, randomized, controlled evaluation approach, it has been shown that fiberoptic-assisted endotracheal intubation takes longer but has a higher first-pass success rate than conventional intubation without causing clinically relevant drops in oxygen saturation. This model presents a standardized regimen for endoscopically guided endotracheal intubation, providing a secured airway, especially for researchers who are inexperienced in the technique of endotracheal intubation via direct laryngoscopy. This procedure is expected to minimize animal suffering and unnecessary animal losses.

The use of pigs in research has increased in recent years. Nevertheless, pigs are characterized by difficult airway anatomy. By demonstrating how to perform endoscopically guided endotracheal intubation, the present protocol aims to further increase laboratory animals' safety to avoid animal suffering and unnecessary death.

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

内淋巴管阻塞作为梅尼埃病的手术治疗选择

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...