Name: clinical effects of ultrasound-guided acupotomy in knee osteoarthritis treatment
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Description: Read this Scientific Article Protocol about Author Spotlight: Minimally Invasive Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment at JoVE.com

我们感谢上海市进一步加快中医药传承和创新三年行动计划 （ZY（2021-2023）-0201-01）;浦东新区卫生系统浦东名医培训项目（PWRzm2020-15）;中医康复服务提升计划（医疗 032）;龙华医院创新项目：针筐联合膝关节平衡运动治疗膝骨关节炎的临床研究 （CX202045）;针筐切开术联合 Mulligan 动态关节松弛治疗肩周关节炎的临床研究 （PKJ2020-Y76）;浦东新区卫健委浦东名医接班人培训计划（PWRzj2020-21）;中医专病品牌建设倍增计划-小针尖专病（PDZY-2021-0304）。

2022 年 6 月至 2023 年 6 月在上海市浦东新区光明医院中医康复门诊对所有 KOA 患者进行评估，共 60 例。本研究经上海市浦东新区光明中医院伦理审查委员会批准（伦理编号：GMEC-KY-2020034）。医生告知患者及其家属该研究的临床意义、风险和随访要求。患者在获得患者或其家人的知情同意书并签署知情同意书后被纳入研究。外科医生熟悉膝关节的解剖结构和针尖切开术治疗。
1. 患者招募
<ol><li>诊断标准<ol><li>根据中国骨学分会骨关节炎诊断和治疗指南 （GDTO） 16，使用以下诊断标准诊断膝骨关节炎。检查受累膝关节上个月是否有疼痛，如果存在以下 4 项标准中的任何 2 项，则诊断为膝骨关节炎：（1） X 线片（站立或负重）显示关节间隙狭窄、关节边缘骨赘形成、软骨下骨硬化或囊性改变;（2） 年龄≥ 60 岁;（3） 晨僵 ≤ 30 分钟;（4） 活动时磨骨声。</li>
	</ol></li>
	<li>纳入标准<ol><li>使用以下纳入标准将患者纳入本研究：（1） 符合 KOA 的诊断标准;（2） 年龄在 40-75 岁之间;（3） 体重指数 ≤ 25 kg/m2;（4） 无认知功能障碍;（5） 1 个月内没有膝关节手术或针尖切开术;（6） 详细了解研究的相关内容，具有良好的医疗依从性和高度合作性;（7） 同意并签署知情同意书。</li>
	</ol></li>
	<li>排除标准<ol><li>使用以下排除标准不包括本研究中的患者：（1） 孕妇和哺乳期妇女;（2） 治疗部位（膝关节）感染和肌肉坏死或深脓肿的患者;（3） 有针头昏厥史的患者;（4） 严重半月板撕裂、前交叉韧带或后交叉韧带撕裂、内侧或外侧副韧带损伤的患者;（5） 神经系统疾病引起的膝关节疼痛患者;（6） 患有严重心血管、肝脏、肾脏或造血系统疾病的患者;（7） 接受其他治疗方案的患者;（8） 盐酸利多卡因过敏;（9） 不想接受随访的患者。</li>
	</ol></li>
	<li>退出标准<ol><li>使用以下退出标准允许患者退出本研究：（1） 患者自愿退出;（2） 发生其他并发症。</li>
	</ol></li>
</ol>2. 针刺治疗
<ol><li>术前准备<ol><li>材料准备（图1）：一次性医用塑料杯、镊子、吸水棉球、自粘敷料、超声器械（便携式彩色超声系统）、无菌超声耦合器、探头无菌保护罩、40毫米小型一次性无菌针刀、记号笔、一次性医用口罩、卫生帽、II型皮肤消毒剂、一次性无菌毛巾、2%盐酸利多卡因、无菌注射用水、 10 mL 一次性无菌注射器、无菌注射针头和手术橡胶手套。</li>
		<li>操作地点：准备具有空气消毒功能的治疗室。</li>
		<li>检查患者信息：检查所有基本患者信息，如姓名、年龄和治疗部位。解释针刀疗法程序，包括治疗可能的风险和益处。确保患者了解针刀治疗并在手术过程中保持放松。</li>
		<li>患者体位：让患者仰卧，患膝关节完全暴露，并在患膝关节下放一个薄枕头，使关节处于放松状态。稍微外展对侧膝关节，为外科医生提供更多空间。</li>
	</ol></li>
	<li>定位（图 2）<ol><li>压痛点定位：标记因操作者手指压力导致患膝关节出现明显疼痛的点，如腓侧副韧带和髂胫束点、髌外侧支持带点、股四头肌肌腱和髌上滑囊点、髌内侧支持带点、胫骨侧副韧带点、鹅足滑囊点。</li>
		<li>超声定位17：用超声探头（频率8-15 MHz，深度1-4 cm）沿股四头肌腱短长轴、膝胫侧副韧带长轴、膝腓侧副韧带长轴、髌腱长轴和压痛点扫描。在体表的超声中标记局部增厚、回声减弱和板层结构丢失的点。</li>
	</ol></li>
	<li>手术步骤（图 3）<ol><li>遵循无菌程序，佩戴口罩、帽子和无菌手套。</li>
		<li>请手术助理打开 5 mL 2% 利多卡因和 5 mL 无菌水瓶。将 10 mL 注射器、一根 25G 针头和一把 40 mm 一次性小型无菌针刀放入无菌塑料杯中。</li>
		<li>请手术助理使用棉球和 II 型皮肤消毒剂对膝盖标记点周围的 15 厘米区域进行消毒。放置一条无菌毛巾，使标记点位于无菌毛巾的中间。</li>
		<li>用 5 mL 注射器提取 5 mL 2% 利多卡因和 5 mL 无菌水，制备 10 mL 1% 工作 1% 利多卡因溶液。将 22G 针头更换为 25G 针头（使用较细的针头控制疼痛）。</li>
		<li>将无菌保护罩盖在探头上。左手握住超声探头，右手握住注射器。挤出无菌超声凝胶并将其涂抹在探针上。 注意：手术助理协助外科医生完成此操作。</li>
		<li>将探头放在标记的位置。在超声图像中确认目标。将注射器针头从探头侧插入皮肤，使注射器针头和目标在同一视野中。确保抽吸时没有血液回流。用 1-2 mL 的 1% 利多卡因工作溶液注射每个目标。</li>
		<li>用右手握住针刀。将针刀插入利多卡因注射部位。针刀插入方向与肌肉和韧带纤维的方向平行，以避免切割肌肉纤维和韧带纤维。确保针刀和目标在同一视野内。避免触摸血管和神经。</li>
		<li>进行纵向切口、剥离并释放粘连18。患者会感到局部酸痛和疼痛，外科医生会在刀针下感到阻力。当外科医生感到刀下有松动感时，请取下刀针。</li>
	</ol></li>
	<li>术后护理（图 3）<ol><li>用干燥的无菌棉球按压注射部位 1 分钟。用无菌自粘敷料覆盖手术区域。帮助患者穿好衣服并离开手术室。</li>
		<li>让患者在手术室门口安静坐约 15 分钟，以避免术后不适。要求患者在 24 小时后去除敷料，并在 3 天内避免与水接触以避免感染19。</li>
	</ol></li>
	<li>每周进行一次超声引导下针刺术，总共进行 3 次针刺治疗。</li>
</ol>3. 随访评估
<ol><li>评估参数 10,11,12,13,14,15,16,17,18,19,20,21,22<ol><li>使用髌上滑囊的滑膜厚度、视觉模拟量表 （VAS）、特殊外科医院膝关节评分 （HSS） 以及西安大略大学和麦克马斯特大学骨关节炎指数 （WOMAC） 来评估结果。在治疗前和 3 次治疗完成后 1 周进行测量。</li>
	</ol></li>
	<li>基于超声的评估<ol><li>使用超声测量髌上滑囊的滑膜厚度。</li>
		<li>按下 电源 按钮以打开超声机。按 Patient 按钮，单击 New Patient，然后输入患者的姓名。</li>
		<li>让患者仰卧。在受累膝关节的腘窝下放一个薄枕头，使其完全暴露。</li>
		<li>使用探针的前端找到髌骨的上边缘。将尾端放在股四头肌肌腱上。调整探头的方向。确保声束垂直于肌腱并位于髌上滑囊的滑膜上。</li>
		<li>按 Freeze（冻结 ）按钮保存超声图像。按下 卡尺 按钮以测试髌上滑囊的滑膜厚度。记录测量结果。</li>
	</ol></li>
</ol>4. 统计分析
<ol><li>使用统计分析软件。将测量数据表示为平均值±标准差 （SD）。使用 T 检验比较治疗前后的差异。将 p <0.05 视为统计显著性。</li>
</ol>

使用超声引导下针式切开术治疗膝骨关节炎

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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+brief+introduction+to+the+mechanical+anatomical+system+of+human+bowstring.">A brief introduction to the mechanical anatomical system of human bowstring.</a> China Med Rev. 14 (3), 164-168 (2017).</li><li>Zhao, Y., Fang, W., Qin, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanism+of+small+acupotomy+in+closed+treatment+of+myofascitis.">Mechanism of small acupotomy in closed treatment of myofascitis.</a> Chinese J Acupuncture Moxibustion. 34 (9), 907-909 (2014).</li><li>Shi, X., Liu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Short-term+effect+of+acupotomy+on+improving+symptoms+of+knee+osteoarthritis.">Short-term effect of acupotomy on improving symptoms of knee osteoarthritis.</a> J Guangzhou Uni Chinese Med. 36 (1), 74-78 (2019).</li><li>Zhou, S., 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=Effect+of+acupotomy+on+surface+electromyography+and+biomechanical+behavior+of+tendons+of+tibial+anterior+muscle+in+rabbits+with+knee+osteoarthritis.">Effect of acupotomy on surface electromyography and biomechanical behavior of tendons of tibial anterior muscle in rabbits with knee osteoarthritis.</a> J Beijing Uni Chinese Med. 41 (8), 675-680 (2018).</li><li>Geng, 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=Meta-analysis+of+musculoskeletal+ultrasound+in+the+diagnosis+of+soft+tissue+injury.">Meta-analysis of musculoskeletal ultrasound in the diagnosis of soft tissue injury.</a> J Naval Med. 43 (1), 78-83 (2022).</li><li>Liu, Q., 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=Visualization+development+of+acupotomy+with+ultrasonic-assisted+means.">Visualization development of acupotomy with ultrasonic-assisted means.</a> J Hubei Uni Tradl Chinese Med. 18 (4), 117-120 (2016).</li><li>Xu, D. H., 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=Tiaohe+Yinyang+acupotomy+for+knee+osteoarthritis:+a+randomized+controlled+trial.">Tiaohe Yinyang acupotomy for knee osteoarthritis: a randomized controlled trial.</a> Zhongguo Zhen Jiu. 42 (12), 1351-1356 (2022).</li><li>Zhao, L., 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=Zhuifeng+Tougu+capsules+in+the+treatment+of+knee+osteoarthritis+(cold+dampness+obstruction+syndrome):+a+randomized,+double+blind,+multicenter+clinical+study.">Zhuifeng Tougu capsules in the treatment of knee osteoarthritis (cold dampness obstruction syndrome): a randomized, double blind, multicenter clinical study.</a> Chin Med. 19 (1), 18 (2024).</li></ol>

作者报告没有利益冲突。

治疗程序有三个方面需要特别注意。首先是压痛点定位。应按压全膝关节表面，通过患者的抱怨和医生的触诊来标记患者疼痛反应的位置。腓侧副韧带和髂胫束点、髌外侧支持带点、股四头肌肌腱和髌上滑囊点、髌骨内侧支持带点、胫侧副韧带点、鹅足滑囊点是常见的疼痛部位，可以集中治疗。
第二种是超声定位。使用肌肉骨骼超声观察膝盖时，主要通过以下方法观察固定?...

膝骨关节炎 （KOA） 是膝关节最常见的退行性疾病，可引起膝关节疼痛、骨质增大、晨僵、膝关节活动受限和其他症状。膝关节疼痛和功能受限是影响 KOA 患者日常生活和工作的主要因素。大多数 KOA 患者会部分或完全丧失工作和自我护理能力，这是慢性残疾的主要原因1。流行病学数据 2,3 显示 KOA 的患病率与年龄呈正相关。随着中国人口老龄化，KOA 的发病率每年都在增加。在全球范围内，大约有 250 x 106 名患者患有骨关节炎，并且其发病率每年都在增加。到 2030 年，骨关节炎将成为导致残疾的主要原因之一4，约占膝关节骨关节炎病例的85% 5,6，严重影响患者的生活质量，并给他们的生活和工作带来痛苦，给国家和个人带来沉重的经济负担 7,8。因此，为 KOA 患者寻找安全和微创的治疗方法是骨科深入研究的一个领域。
KOA 的主要治疗方法包括保守疗法，如患者教育、生活方式调整、物理治疗、骨科辅助和矫形器以及药物治疗和手术。绝大多数膝关节内手术是通过关节镜手术进行的，创伤小，感染率低。然而，关节镜手术仍然有一些创伤性影响。KOA 患者通常在保守治疗失败后接受手术9。
针刺术是一种比关节镜检查侵入性更小的手术。针切开术可以与保守治疗联合进行。针刀一般长约 10-15 厘米，直径 0.4-1.2 毫米。针刀由手柄、针体和刀片三部分组成。刀片又薄又锋利。它的宽度等于针体的直径。传统针砥术是指在无法直接观察人体内部组织结构的情况下，由外科医生对肌腱痛点进行治疗;介入治疗是根据他/她自己的经验和对局部解剖组织的了解，结合患者的症状和压痛点进行的。由于手术风险高，包括对周围软组织、神经和血管的损伤、感染、影响不确定以及多次手术的可能性，传统针刺术的使用非常有限。随着成像技术的发展，可视化的使用已成为针瘟病学10 的发展趋势，拓宽了针筐切开术的临床应用。超声可用于实时可视化肌肉和筋膜病变，从而可以完整识别相对解剖结构和病变11,12，从而提高针尖切开术的准确性和安全性13。目前，它主要用于治疗颈部、肩部、腰部和腿部14,15 的关节痛。超声引导下针刺术具有精准靶向治疗、风险低、并发症少、安全性高等优点。因此，本研究评估了超声引导下针刺术作为 KOA 的新治疗方法。

<table><tbody><tr><td>Disposable sterile injection needle</td><td>Shanghai Mishava Medical Industry Co., Ltd</td><td>601900973</td><td>Type specification:0.5 x 38 RWLB</td></tr><tr><td>Disposable medical mask</td><td>Shanghai Honglong Medical Supplies Equipment Co., LTD</td><td>20162140493</td><td>Type specification: 17.5 x 9.5cm</td></tr><tr><td>Disposable sterile small needle-knife</td><td>Wujiang Yunlong Medical equipment Co., Ltd</td><td>PR-4040</td><td>Type specification:40 mm x 40 mm&amp;nbsp;</td></tr><tr><td>Disposable sterile syringe</td><td>Shandong Weigo Group Medical polymer Products Co., Ltd</td><td>601909174</td><td>Type specification:10 mL</td></tr><tr><td>Disposable sterile towel</td><td>Xinxiang Huakang Medical Material Co., LT</td><td>20182140517</td><td>Type specification: 80x100cm</td></tr><tr><td>Hygiene hat</td><td>Shanghai Honglong Medical Supplies Equipment Co., LTD</td><td>20150071</td><td>Type specification: 21x14cm</td></tr><tr><td>Lidocaine hydrochloride</td><td>Shanghai Hefeng Pharmaceutical Co., Ltd</td><td>6904996104121</td><td>Type specification:5 mL</td></tr><tr><td>Marker pen</td><td>Zebra Trading (Shenzhen) Co., Ltd</td><td>4901681518111</td><td>Type specification:1.0 mm/0.5 mm</td></tr><tr><td>Sterile absorbent cotton ball</td><td>Shanghai Honglong Medical Supplies Equipment Co., Ltd</td><td>601905637</td><td>Type specification:0.3&amp;nbsp; 25 g</td></tr><tr><td>Sterile disposable medical plastic cup</td><td>Shanghai Honglong Medical Supplies Equipment Co., Ltd</td><td>709008633</td><td>Type specification:Waist-shaped disc</td></tr><tr><td>Sterile dressing block</td><td>Ningbo Haishu Shenyuan Medical Materials Co.,&amp;nbsp; Ltd</td><td>601909470</td><td>Type specification:7.5 cm x 7.5 cm x 8 floors</td></tr><tr><td>Sterile medical tweezers</td><td>Shanghai Honglong Medical Supplies Equipment Co.,Ltd</td><td>603917444</td><td>Type specification:Small size</td></tr><tr><td>Sterile protective cover for probe</td><td>Yangzhou Puen Medical Technology Co., LTD</td><td>20200046</td><td>Type specifications: 20x150cm</td></tr><tr><td>Sterile rubber surgical gloves</td><td>Guilin Hengbao health protection Co.,&amp;nbsp; Ltd</td><td>6971787071320</td><td>Type specification:6.5</td></tr><tr><td>Sterile self-adhesive dressing</td><td>Shanghai ISO Medical Products Co., Ltd</td><td>601909414</td><td>Type specification:10 cm x 15 cm</td></tr><tr><td>Sterile ultrasonic coupler</td><td>Jiangsu Huadong Medical Equipment Industrial Co., LTD</td><td>6972830280430</td><td>Type Specifications: 20g</td></tr><tr><td>Sterile water for injection</td><td>Shanghai Xinyi Jinzhu Pharmaceutical Co., Ltd</td><td>6938493300953</td><td>Type specification:5 mL</td></tr><tr><td>Type II skin disinfectant</td><td>Shanghai Likang Disinfection high-tech Co., Ltd</td><td>6909157000359</td><td>Type specification:500 mL/ bottle</td></tr><tr><td>Ultrasound</td><td>Suzhou Daer Medical Equipment Co., Ltd</td><td>100018857</td><td>uSmart3300 portable color ultrasound system</td></tr></tbody></table>

clinical effects of ultrasound-guided acupotomy in knee osteoarthritis treatment

这里介绍的方案展示了超声引导下针刺术治疗膝骨关节炎 （KOA） 的手术方法，包括患者招募、术前准备、手法手术和术后护理。该方案的目的是缓解 KOA 患者的疼痛并改善膝关节功能。2022 年 6 月至 2023 年 6 月期间收治的 60 例 KOA 患者接受了超声引导下针切开术治疗。比较治疗前后的病理变化和膝关节功能评分。治疗 1 周后，髌上滑囊滑膜厚度显著小于治疗前 （p < 0.05），特殊外科医院膝关节评分 （HSS） 显著高于治疗前 （p < 0.05），视觉模拟量表 （VAS） 显著低于对照组 （p < 0.05），西安大略大学和麦克马斯特大学骨关节炎指数 （WOMAC） 显著低于对照组 （p <因此，超声引导下针刺治疗 KOA 可减轻滑膜厚度，缓解疼痛，改善膝关节功能，疗效显著。

在研究期间，由于疼痛增加，一名患者接受了额外的其他治疗 （关节内类固醇注射）。在 1 例患者中，超声检查无法检测到髌上滑囊的滑膜厚度。1 例患者治疗后伤口周围出现肿胀和皮下淤滞，冰敷后改善，不影响正常治疗和随访。2 例患者终止实验，其余 58 例患者纳入最终统计分析。
基线功能 参与者包括 27 名男性和 31 名女性。患者年龄从 40 岁到 75 岁不等?...

Read this Scientific Article Protocol about Author Spotlight: Minimally Invasive Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment at JoVE.com

作者聚焦： 膝骨关节炎治疗中的微创超声引导下针刺术

本文介绍了超声引导下针刺术治疗膝骨关节炎的手术方法，可减轻滑膜厚度，改善膝关节功能。具有靶点精确、治疗风险低、并发症少、安全性高等优点。

超声引导下针式切开术治疗膝骨关节炎的临床效果

The protocol presented here demonstrates the operation method of ultrasound-guided acupotomy for knee osteoarthritis (KOA), including patient recruitment, ...

膝骨关节炎的发病率随着人口老龄化而增加。因此，我们有兴趣为 KOA 患者探索安全和微创的治疗方法。KOA 的主要治疗方法包括保守疗法，如患者教育、生活方式调整、物理治疗、骨科辅助和矫形器、药物治疗和膝内手术。KOA 患者通常在保守治疗失败后接受手术。针切开术可以与保守治疗联合进行。针刺术是一种比关节镜检查侵入性更小的手术。超声引导下针刺术可用于实时可视化肌肉和裂隙病变，从而可以完整识别相对解剖结构和病变，从而提高针刺术的准确性和安全性。

clinical-effects-ultrasound-guided-acupotomy-knee-osteoarthritis

Research

JoVE Journal

Medicine

Clinical Effects of Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment

426 次观看.  Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine. 膝骨关节炎的发病率随着人口老龄化而增加。因此，我们有兴趣为 KOA 患者探索安全和微创的治疗方法。KOA 的主要治疗方法包括保守疗法，如患者教育、生活方式调整、物理治疗、骨科辅助和矫形器、药物治疗和膝内手术。KOA 患者通常在保守治疗失败后接受手术。针切开术可以与保守治疗联合进行。针刺术是一种比关节镜检查侵入性更小的手术。超声引导下针刺?...

视频: 作者聚焦： 膝骨关节炎治疗中的微创超声引导下针刺术

Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia

Receptor tyrosine kinases have been implicated in the development and progression of many cancers, including both leukemia and solid tumors, and are attractive druggable therapeutic targets. Here we describe an efficient four-step strategy for pre-clinical evaluation of tyrosine kinase inhibitors (TKIs) in the treatment of acute leukemia. Initially, western blot analysis is used to confirm target inhibition in cultured leukemia cells. Functional activity is then evaluated using clonogenic assays in methylcellulose or soft agar cultures. Experimental compounds that demonstrate activity in cell culture assays are evaluated in vivo using NOD-SCID-gamma (NSG) mice transplanted orthotopically with human leukemia cell lines. Initial in vivo pharmacodynamic studies evaluate target inhibition in leukemic blasts isolated from the bone marrow. This approach is used to determine the dose and schedule of administration required for effective target inhibition. Subsequent studies evaluate the efficacy of the TKIs in vivo using luciferase expressing leukemia cells, thereby allowing for non-invasive bioluminescent monitoring of leukemia burden and assessment of therapeutic response using an in vivo bioluminescence imaging system. This strategy has been effective for evaluation of TKIs in vitro and in vivo and can be applied for identification of molecularly-targeted agents with therapeutic potential or for direct comparison and prioritization of multiple compounds.

Receptor tyrosine kinases are ectopically expressed in many cancers and have been identified as therapeutic targets in acute leukemia. This manuscript describes an efficient strategy for pre-clinical evaluation of tyrosine kinase inhibitors for the treatment of acute leukemia.

酪氨酸激酶抑制剂的临床前评价急性白血病的治疗

Receptor tyrosine kinases have been implicated in the development and progression of many cancers, including both leukemia and solid tumors, and are ...

科研

医学

Ultrasound-guided Transthoracic Intramyocardial Injection in Mice

Murine models of cardiovascular disease are important for investigating pathophysiological mechanisms and exploring potential regenerative therapies. Experiments involving myocardial injection are currently performed by direct surgical access through a thoracotomy. While convenient when performed at the time of another experimental manipulation such as coronary artery ligation, the need for an invasive procedure for intramyocardial delivery limits potential experimental designs. With ever improving ultrasound resolution and advanced noninvasive imaging modalities, it is now feasible to routinely perform ultrasound-guided, percutaneous intramyocardial injection. This modality efficiently and reliably delivers agents to a targeted region of myocardium. Advantages of this technique include the avoidance of surgical morbidity, the facility to target regions of myocardium selectively under ultrasound guidance, and the opportunity to deliver injectate to the myocardium at multiple, predetermined time intervals. With practiced technique, complications from intramyocardial injection are rare, and mice quickly return to normal activity on recovery from anesthetic. Following the steps outlined in this protocol, the operator with basic echocardiography experience can quickly become competent in this versatile, minimally invasive technique.

Echocardiography-guided percutaneous intramyocardial injection represents an efficient, reliable, and targetable modality for the delivery of gene transfer agents or cells into the murine heart. Following the steps outlined in this protocol, the operator can quickly become competent in this versatile, minimally invasive technique.

超声引导下经皮内注射小鼠

Murine models of cardiovascular disease are important for investigating pathophysiological mechanisms and exploring potential regenerative therapies. ...

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

胸骨后甲状腺活检使用支气管内超声引导下经支气管针吸

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an impaired quality of life, often worsened by correlated complications such as aspiration pneumonia, oral infections, dental caries, and maceration of the skin. Diverse therapeutic approaches have been proposed for the treatment of sialorrhea, including surgery and the use of anticholinergic agents, with limited results and the possible occurrence of serious adverse events. Recently, botulinum toxin (BoNT) injection within the major salivary glands has been proposed in patients refractory to anticholinergic therapy, with the aim of inhibiting local acetylcholine release and gland activity. 
In order to obtain a better outcome in terms of reduction of saliva production, efficacy, duration, and avoidance of major adverse events, we developed an ultrasound-guided BoNT-type A injection technique accurately described in the text. Here we present a method of treating sialorrhea with bilateral parotid and submandibular gland BoNT-type A injections under ultrasound guidance. Four quadrants of the parotid gland and two quadrants of the submandibular gland are visualized and injected using two accesses and one access, respectively. 
The ultrasound-guided procedure provides a simple, non-invasive, real-time visualization of the muscular and glandular tissues and their surrounding structures, optimizing treatment efficacy and safety.

Botulinum toxin is injected into the salivary glands for the treatment of sialorrhea. The ultrasound-guided botulinum toxin injection in both the parotid and submandibular glands demonstrates a sustained efficacy and the absence of serious side effects.

超声引导下肉毒毒素-A注射液:治疗流涎的一种方法

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Preparation, Procedures and Evaluation of Platelet-Rich Plasma Injection in the Treatment of Knee Osteoarthritis

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department. Existing non-surgical treatments have a limited effect on the repair of cartilage and on bone regeneration. Platelet-rich plasma (PRP) is an autologous bioactive substance that can repair cartilage injury and accelerate bone regeneration effectively. However, reporting of PRP preparation protocols in clinical studies is highly inconsistent, with the majority of studies providing insufficient information to allow the protocol to be reproduced. We describe a repeatable method of preparing PRP visually, the treatment of KOA using PRP intra-articular injection, and methods of evaluating the outcome. PRP was prepared using manual double centrifugation. The PRP layer was extracted from peripheral blood and used for knee joint cavity injection. Evaluations included assessments of blood platelet concentrations and clinical outcomes. Preparation of PRP by manual centrifugation requires less apparatus and is less costly than plasma filtration or centrifugation using equipment. The centrifugation time of our double centrifugation method was 6 and 5 minutes for the respective centrifugations at forces of 800 and 1400 x g, respectively, to allow for the consistent preparation of standardized PRP. However, a manual method is susceptible to operator error, and PRP batch preparation is not available. Intra-articular injection of PRP proved to be an effective treatment for knee osteoarthritis. The entire treatment procedure took less than 30 minutes, the blood platelet concentration of PRP could be standardized, and treatment was proven to be effective when evaluated by follow-up.

Knee osteoarthritis is frequently seen in the orthopedic department. We introduce in detail the entire knee osteoarthritis treatment process with platelet-rich plasma injection, including preparation, procedures, and evaluation.

富血小板血浆注射液治疗膝关节骨关节炎的制备、程序及评价

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department. Existing non-surgical treatments have a limited ...

The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation

Here, based on a clinician&rsquo;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in addition to a clinical, functional assessment methodology, including details for further encouragement of the development of non-drug surgical intervention strategies in knee osteoarthritis patients. However, we only present the effect of LBPP training in improvement of pain and knee function in one patient through three-dimensional gait analysis. The exact, long-term effects of this approach should be explored in future studies.

Here, based on a clinician&#8217;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in addition to a clinical, functional assessment methodology, including details for further encouragement of the development of non-drug surgical intervention strategies in knee osteoarthritis patients. However, we only present the effect of LBPP training in improvement of pain and knee function in one patient through three-dimensional gait analysis. The exact, long-term effects of this approach should be explored in future studies.

下体正压跑步机用于膝关节骨关节炎康复

Here, based on a clinician&rsquo;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in ...

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary biliary drainage method whenever possible. Percutaneous Transhepatic Biliary Drainage (PTBD) is used as a salvage method if ERCP fails. Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) provides a feasible alternative biliary drainage method where one of the methods is EUS guided Hepaticogastrostomy (EUS-HGS). Here we describe the EUS-HGS technique in a case of unresectable malignant hilar biliary obstruction to achieve biliary drainage.
Presented here is the case of a 71-year-old female with painless jaundice and weight loss for 2 weeks. Computed Tomography (CT) imaging showed a 4 x 5 cm hilar tumor with lymphadenopathy and liver metastasis. EUS fine needle biopsy (FNB) of the lesion was consistent with cholangiocarcinoma. Her bilirubin levels were 212 &#181;mol/L (&lt;15) during presentation.
A linear echoendoscope was used to locate the left dilated intrahepatic ducts (IHD) of the liver. The segment 3 dilated IHD was identified and punctured using a 19 G needle. Contrast was used to opacify the IHDs under fluoroscopic guidance. The IHD was cannulated using a 0.025-inch guidewire. This was followed by the dilation of the fistula tract using a 6 Fr electrocautery dilator along with a 4 mm biliary balloon dilator. A partially covered metallic stent of 10 cm in length was deployed under fluoroscopic guidance. The distal part opens in the IHD and the proximal part was deployed within the working channel of the echoendoscope that subsequently released into the stomach. The patient was discharged three days after the procedure. Follow up performed in the second and fourth weeks showed that the bilirubin levels were 30 &#181;mol/L and 14 &#181;mol/L, respectively. This indicates that EUS-HGS is a safe method for biliary drainage in unresectable malignant biliary obstruction.

Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) is an alternative method of biliary decompression in malignant biliary obstruction. Here we describe the technique of EUS guided-Hepaticogastrostomy (EUS-HGS) in a case of unresectable malignant hilar biliary obstruction.

内镜超声引导下胆道引流:内镜超声引导下肝胃造瘘术治疗恶性胆道梗阻

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

Ultrasound-Guided Induced Pluripotent Stem Cell-Derived Cardiomyocyte Implantation in Myocardial Infarcted Mice

The key objective of cell therapy after myocardial infarction (MI) is to effectively enhance the cell grafted rate, and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are a promising cell source for cardiac repair after ischemic damage. However, a low grafted rate is a significant obstacle for effective cardiac tissue regeneration after transplantation. This protocol shows that multiple hiPSC-CM ultrasound-guided percutaneous injections into an MI area effectively increase cell transplantation rates. The study also describes the entire hiPSC-CM culture process, pretreatment, and ultrasound-guided percutaneous delivery methods. In addition, the use of human mitochondrial DNA help detect the absence of hiPSC-CMs in other mouse organs. Lastly, this paper describes the changes in cardiac function, angiogenesis, cell size, and apoptosis at the infarcted border zone in mice 4 weeks after cell delivery. It can be concluded that echocardiography-guided percutaneous injection of the left ventricular myocardium is a feasible, relatively invasive, satisfactory, repeatable, and effective cellular therapy.

Ultrasound-guided cell delivery around the site of myocardial infarction in mice is a safe, effective, and convenient way of cell transplantation.

超声引导诱导多能干细胞来源心肌细胞植入心肌梗死小鼠

The key objective of cell therapy after myocardial infarction (MI) is to effectively enhance the cell grafted rate, and human induced pluripotent stem ...

使用改进的 Videman 方法在兔子中建立 KOA 模型

Application of Acupotomy in a Knee Osteoarthritis Model in Rabbit

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department, which seriously reduces the quality of life of people with KOA. Among several pathogenic factors, the biomechanical imbalance of the knee joint is one of the main causes of KOA. Acupotomology believes that restoring the mechanical balance of the knee joint is the key to treating KOA. Clinical studies have shown that acupotomy can effectively reduce pain and improve knee mobility by reducing adhesion, contracture of soft tissues, and stress concentration points in muscles and tendons around the knee joint. 
In this protocol, we used the modified Videman method to establish a KOA model by immobilizing the left hindlimb in a straight position. We have outlined the method of operation and the precautions related to acupotomy in detail and evaluated the efficacy of acupotomy in conjunction with the theory of "Modulating Muscles and Tendons to Treat Bone Disorders" through the detection of the mechanical properties of quadriceps femoris and tendon, as well as cartilage mechanics and morphology. The results show that acupotomy has a protective effect on cartilage by adjusting the mechanical properties of the soft tissues around the knee joint, improving the cartilage stress environment, and delaying cartilage degeneration.

作者聚焦:研究针尖切开术治疗膝骨关节炎的作用机制

In this protocol, a knee osteoarthritis model was prepared using the modified Videman method, and the operation procedures and precautions of acupotomy are detailed. The effectiveness of acupotomy has been demonstrated by testing the mechanical properties of quadriceps femoris and tendon and the mechanical and morphological properties of cartilage.

针灸术在兔膝骨关节炎模型中的应用

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department, which seriously reduces the quality of life of ...