저자는 웬 이(Wen Yi) 박사와 청두 중국 전통 의학 대학(Chengdu University of Traditional Chinese Medicine) 병원 산부인과 의료진에게 도움을 준 것에 대해 감사를 표한다.

이 연구의 모든 절차는 임상시험 등록에 따라 수행되었으며 청두 중의과대학 부속병원 윤리위원회의 승인을 받았습니다(출원 번호 2021KL-004). 이 연구에 참여한 모든 환자는 임상시험 기간 동안 연구자의 데이터, 이미지 및 관련 비디오 촬영 사용에 대해 정보에 입각한 동의를 제공했습니다.
1. 수술 전 준비 사항
<ol><li>포함 기준을 다음과 같이 설정합니다: 서양 의학에서 골반 염증성 질환 8,9 및 중국 전통 의학에서 축축한 열 정체 증후군 유형에 대한 진단 기준을 충족하는 환자10, 20-25세 환자를 포함합니다.</li>
	<li>다음 제외 기준을 설정하십시오 : 골반 통증 또는 하복부 통증의 다른 원인; 임신, 수유 또는 지난 6개월 이내에 임신을 준비하고 있는 경우; 치료를 견딜 수 없게 만드는 심장, 간, 신장 및 조혈계에 영향을 미치는 심각한 상태; 협력할 능력이 없거나 협력할 의사가 없음; 알레르기 또는 켈로이드 형성이 발생하기 쉬운 개인; 지난 달에 유사한 약물 또는 물리적 치료의 병력.</li>
	<li>멸균 장갑, 일회용 캣거트 매립 바늘, 일회용 실 매매 키트(치료 트레이, 멸균 거즈, 멸균 면봉, 요오드포 면봉, 핀셋, "0" 캣거트, 의료용 패치; 그림 1).</li>
	<li>환자에게 등을 대고 누워서 긴장을 풀고 복부와 하지를 완전히 노출시키도록 요청합니다.</li>
	<li>대상 경혈 위치의 피부 상태를 확인하고 이상이 없으면 시술을 진행합니다. 알림: 경혈 피부에 감염, 궤양 또는 흉터가 있는 환자는 매삽입을 받아서는 안 됩니다. 환자가 극도로 배고프거나 피곤하거나 상당한 정신적 스트레스를 받고 있는 경우 즉시 시술을 받아서는 안 됩니다. 월경 중인 환자에게 시술을 하지 마십시오.</li>
	<li>의사가 정기적인 손 소독을 수행하고 멸균 장갑을 착용하도록 하십시오.</li>
	<li>일회용 실 매립 바늘의 코어와 바늘 튜브가 매끄럽게 일치하는지 확인하십시오(그림 2A).</li>
	<li>오른손에 핀셋을 잡고 캣거트를 바늘 튜브에 넣습니다(그림 2B). 알림: 캣거트는 니들 튜브에 완전히 삽입되어야 합니다.</li>
</ol>2. 운영 단계
<ol><li>다음 경혈(국제 코드)을 선택하십시오: Zhongji(RN3), Guanyuan(RN4), Qihai(RN6), Guilai(ST29), Zigong(EX-CA1), Xueha(SP10), Zusanl(ST36), Yinlingquan(SP9) 및 Sanyinjiao(SP6; 그림 3).</li>
	<li>바늘 삽입<ol><li>왼손으로 바늘 삽입 부위의 피부를 조이고 오른손의 엄지, 검지, 중지로 바늘 튜브를 끼웁니다.</li>
		<li>바늘을 피부에 대해 90° 각도로 아래쪽으로 빠르게 삽입합니다(그림 2C,D).</li>
		<li>환자가 통증, 무감각, 복부 팽만감과 같은 기(바늘 감각)를 경험하면 바늘 삽입을 중지하고 바늘 코어를 밀어 바늘 튜브를 빼내어 고양이 창자가 기를 받는 영역에 남겨 둡니다.</li>
	</ol></li>
	<li>바늘 추출 : 왼손으로 경혈의 피부를 누르고 오른손으로 바늘 코어와 배럴을 빼냅니다. 알림: 캣거트 실은 완전히 피내 상태여야 하며 피하 상태로 두거나 피하 주사 외부로 노출되어서는 안 됩니다.</li>
	<li>멸균된 마른 면봉으로 바늘 구멍을 30초 동안 압박하고 바늘 구멍에 2일 동안 의료용 도포를 합니다.</li>
</ol>3. 캣거트 삽입 후 주의사항
<ol><li>임베디드 사이트가 처음 48시간 이내에 물과 접촉하지 않도록 하십시오.</li>
	<li>시술 후 7일 동안 환자에게 격렬한 신체 활동, 특히 실이 박힌 부위 주변을 피하도록 조언하십시오.</li>
</ol>4. 부작용 및 관리
<ol><li>환자의 불편함<ol><li>통증이 있습니다<ol><li>통증은 흔한 부작용이며11 통증은 5-7일 후에 대부분 사라진다고 환자에게 조언한다.</li>
			<li>시술 중에는 가는 실이 박힌 바늘과 캣거트 본체를 사용하십시오.</li>
			<li>통증에 민감하고 알려진 금기 사항이 없는 환자를 위해 수술 전 경구용 진통제를 고려한다11; 필요한 경우 캣굿을 삽입하기 전에 리도카인으로 국소 마취를 투여합니다12.</li>
		</ol></li>
		<li>바늘 관련 실신 알림: 이것은 경혈 캣굿 삽입 치료 중 현기증, 시야 흐림, 심계항진, 메스꺼움, 심지어 실신이 갑자기 발생하는 것을 말합니다.<ol><li>환자가 기절하면 즉시 캣거트 매립을 중단하고 환자의 활력 징후를 관찰하십시오. 경미한 경우에는 환자에게 잠시 누워 있으면서 따뜻한 물이나 설탕이 든 음료를 마시게 한다. 증상이 완화되지 않는 경우에는 현대적인 응급 처치 방법을 사용하십시오.</li>
		</ol></li>
		<li>출혈 또는 국소 혈종<ol><li>매복 부위에 수술 후 출혈이 발생한 경우에는 국소 부위에 마른 면봉으로 부드러운 압력을 가하여 출혈을 멈춥니다.</li>
			<li>혈종이 형성되면 24시간 이내에 냉찜질을 하고 24시간 후에 온찜질을 하여 혈종 흡수를 촉진합니다. 참고: 출혈이 지속되거나 상당한 경우 혈관 손상을 나타낼 수 있으므로 외과적 개입이 필요합니다.</li>
		</ol></li>
	</ol></li>
	<li>Catgut 신체 거부 반응<ol><li>발열 참고: 모든 열은 일반적으로 1주일 이내에 사라집니다.<ol><li>환자에게 물을 많이 마시도록 지시하십시오. 지속적인 열은 신체 냉각 또는 경구용 해열제로 치료하십시오.</li>
			<li>장기간 고열이 발생하면 외과 전문의가 즉시 냉각하고 내장된 고양이 창자를 제거하도록 하십시오.</li>
		</ol></li>
		<li>알레르기 반응<ol><li>국소 발적, 발진 및 가려움증과 같은 알레르기 증상을 찾으십시오. 알레르기 관리를 위해 항히스타민제(예: 클로르페니라민 말레산염, 세티리진, 로라타딘) 또는 코르티코스테로이드(예: 덱사메타손)를 제공하고 필요한 경우 몸에 박힌 고양이 창자를 제거합니다.</li>
		</ol></li>
		<li>결절 또는 종괴<ol><li>작은 결절은 일반적으로 저절로 해결됩니다. 국소적으로 단단한 덩어리의 경우, 뜸과 경혈 주사와 같은 방법을 사용한다13.</li>
		</ol></li>
		<li>스레드 오버플로<ol><li>돌출된 catgut를 자르거나 추출한 다음 다시 포함하여 스레드 오버플로를 관리합니다.</li>
		</ol></li>
		<li>감염<ol><li>캣굿 삽입 후 처음 5일 동안은 국소 부위에 다양한 정도의 염증이 있을 수 있습니다. 매립 부위에 과도한 분비물이 나오거나 화농성 변화의 징후가 있는 경우에는 감염 관리를 위해 항생제로 치료합니다. 필요한 경우 외과적 개입을 받으십시오.</li>
		</ol></li>
	</ol></li>
</ol>5. 관찰 지표
<ol><li>임상적 유효성 평가14<ol><li>회복을 골반 통증과 같은 모든 관련 증상 및 징후의 개선으로 정의하며 점수는 ≥95% 감소합니다.</li>
		<li>유의한 효과를 70% ≤ 점수 감소 < 95%로 정의합니다.</li>
		<li>점수 감소< 30%≤ 70%인 경우 치료가 효과적이라고 생각합니다.</li>
		<li>점수 감소가 <30%인 경우 처리가 유효하지 않은 것으로 간주합니다.</li>
	</ol></li>
	<li>단순화된 McGill Pain Scale(SF-MPQ)15 을 사용하여 치료 전후의 통증 감정과 중증도를 평가하며, 점수가 높을수록 통증이 더 심함을 나타냅니다.</li>
	<li>Traditional Chinese Medicine Damp Heat Stasis Syndrome Scale을 사용하여 Traditional Chinese Medicine Syndrome16을 점수화합니다. 점수가 높을수록 증상이 더 심각합니다.</li>
	<li>골반 신체 징후 척도17을 사용하여 치료 전후에 복부 압통 또는 반동 통증, 자궁 압통, 목 상승 및 스윙 통증, 부속 압통을 평가합니다. 점수가 높을수록 골반 통증이 더 심합니다.</li>
	<li>세계보건기구(WHOQOL) - BREF 척도18 을 사용하여 환자의 생존의 질을 평가하고 도메인 점수를 긍정적으로 계산하여 점수가 높을수록 삶의 질이 좋다는 것을 의미합니다.</li>
</ol>6. 통계 분석
<ol><li>정규 분포를 따르는 측정 데이터를 평균 ± 표준 편차(SD)로 표현합니다.</li>
	<li>그룹 비교에는 독립 표본 t-검정을 사용하고 처리 전과 후의 비교에는 쌍체 표본 t-검정을 사용합니다.</li>
	<li>정규 분포를 따르지 않는 데이터를 M(25%,75%)으로 표현합니다.</li>
	<li>rank-sum test를 사용하여 그룹 비교를 수행하고 쌍체 rank-sum test를 사용하여 치료 전과 후를 비교합니다.</li>
	<li>개수 또는 순서 데이터를 구성 요소 비율로 표현합니다.</li>
	<li>Fisher의 정확 확률 방법 또는 카이제곱 검정을 사용하여 그룹 비교를 수행합니다.</li>
	<li>사전 및 사후 관리를 위해 대응 설계 t-검정을 사용합니다. α= 0.05로 양측 가설 검정을 수행합니다. P < 0.05가 통계적으로 유의하다고 가정합니다.</li>
</ol>

만성 골반 통증 관리를 위한 Acupoint Catgut 임베딩

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Y., 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=Analgesic+efficacy+of+acupuncture+on+chronic+pelvic+pain:+a+systemic+review+and+meta-analysis+study.">Analgesic efficacy of acupuncture on chronic pelvic pain: a systemic review and meta-analysis study.</a> Healthcare (Basel). 11 (6), 830 (2023).</li><li>Wang, X., 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=Evidence+for+the+role+of+mast+cells+in+cystitis-associated+lower+urinary+tract+dysfunction:+a+multidisciplinary+approach+to+the+study+of+chronic+pelvic+pain+research+network+animal+model+study+[J]).">Evidence for the role of mast cells in cystitis-associated lower urinary tract dysfunction: a multidisciplinary approach to the study of chronic pelvic pain research network animal model study [J]).</a> PLoS One. 11 (12), e0168772 (2016).</li><li>Supajatura, V., 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=Differential+responses+of+mast+cell+Toll-like+receptors+2+and+4+in+allergy+and+innate+immunity+[J].">Differential responses of mast cell Toll-like receptors 2 and 4 in allergy and innate immunity [J].</a> J Clin Invest. 109 (10), 1351-1359 (2002).</li><li>Zhang, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-cell+multi-omics+analysis+presents+the+landscape+of+peripheral+blood+T-cell+subsets+in+human+chronic+prostatitis/chronic+pelvic+pain+syndrome+[J].">Single-cell multi-omics analysis presents the landscape of peripheral blood T-cell subsets in human chronic prostatitis/chronic pelvic pain syndrome [J].</a> J Cell Mol Med. 24 (23), 14099-14109 (2020).</li><li>Vickers, A. 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Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+and+peripheral+mechanism+of+acupuncture+analgesia+on+visceral+pain:+a+systematic+review.">Central and peripheral mechanism of acupuncture analgesia on visceral pain: a systematic review.</a> Evid Based Complement Alternat Med. 2019, 1304152 (2019).</li><li>Du, K., Wang, X., Chi, L., Li, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+sigma-1+receptor/p38+MAPK+inhibition+in+acupoint+catgut+embedding-mediated+analgesic+effects+in+complete+Freund's+adjuvant-induced+inflammatory+pain.">Role of sigma-1 receptor/p38 MAPK inhibition in acupoint catgut embedding-mediated analgesic effects in complete Freund's adjuvant-induced inflammatory pain.</a> Anesth Analg. 125 (2), 662-669 (2017).</li><li>Yang, F. 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저자는 이해 상충이 없다고 선언합니다.

고대 한의학서에는 만성 골반통에 대한 기록이 없으며, 증상 특성에 따라 '복통', '여성의 복통', '생리 복통'과 같은 질병과 상호 언급 할 수 있습니다. 한의학 이론에 따르면 혈관이 열려 있을 때 부적절한 관리는 습기와 악열과 같은 병원성 요인의 침입으로 이어질 수 있으며, 이는 자궁과 자궁 통로에 정체될 수 있으며, 이로 인해 병원성 요인과 건강한 에너지 사이의 투쟁으로 이어질 수 있으며 ...

만성 골반통(CPP)은 6개월 이상 지속되고 비주기적이며 비마약성 진통제에 반응하지 않는 골반통을 말합니다. 최신 연구에 따르면 CPP의 전 세계 발병률은 ~5%-26%1입니다. 순차성 골반 염증성 질환(SPID)은 CPP를 유발하는 주요 질환 중 하나로, 여성의 모든 만성 골반 통증 사례의 23%-30%를 차지합니다2. 이러한 통증을 완화하는 데 기존 진통제의 효능이 제한적으로 작용하기 때문에 CPP 환자의 50% 이상이 비약물적 치료를 받을 수 있다3. 현재 주요 비약물적 치료법으로는 골반저근물리치료, 심리치료, 신경조절치료, 당뇨병치료가 있습니다. 그러나 차선의 통증 완화 및 장기적인 통제의 어려움과 같은 한계도 있습니다. CPP를 앓고 있는 대부분의 SPID 여성은 불안, 우울증 및 반복적인 통증으로 인한 삶의 질 저하를 경험한다4. 따라서 환자의 통증 증상을 완화할 수 있는 효과적인 치료 방법을 찾는 것이 임상적으로 시급한 관심사가 되었습니다.
침술과 뜸은 중국 전통 의학의 주요 외부 치료 방법 중 두 가지로, 통증 관련 질환을 치료하는 데 우수한 효능을 보였으며 임상 실습, 특히 만성 통증 완화에 널리 사용되어 CPP에 대한 다른 비약물적 치료를 능가하는 효과를 보였습니다 5,6. 한의학을 이용한 양압기 치료에 대한 단면 연구에서 만성 통증 환자의 7.63%가 침 및 뜸 치료를 받도록 선택되었으며, 그 결과 우수한 치료 결과가 나타났다7. 이 글에서 소개하는 경혈 캣굿 임베딩은 침술과 뜸의 확장이자 발전이다. 그것은 특별히 고안된 일회용 의료 기기를 사용하여 흡수성 고양이 창자를 해당 경혈에 이식하고 장기적이고 지속적인 경혈 자극을 제공하여 진통 효과를 얻는 중국 전통 의학 외부 치료 기술을 말합니다. 저자의 팀은 이 기술을 사용하여 SPID로 인한 여성의 재발성 및 불치성 골반 통증을 치료하여 긍정적인 결과를 얻었습니다. 이는 단독 치료법으로 활용될 수도 있고, 종합적인 한의학 치료 계획의 중요한 구성 요소로 활용될 수도 있으며, 중국 전통 의학과 서양 의학의 조합으로 활용될 수도 있습니다. 이 기사에서는 SPID가 있는 가장 흔한 한의학 증후군(습윤, 열 정체 유형) 환자를 예로 들어 경혈 캣거트 삽입 절차에 대한 자세한 시연을 제공합니다.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>disposable catgut embedding needles</td>
			<td>Yangzhou Junbang Technology Development Co., Ltd</td>
			<td>20212200112</td>
			<td></td>
		</tr>
		<tr>
			<td>disposable thread embedding kit</td>
			<td>Shangdong Weigao Ruixin Medical Technology Co.,Ltd.</td>
			<td>20182140148</td>
			<td></td>
		</tr>
		<tr>
			<td>SPSS26.0&#160;</td>
			<td></td>
			<td></td>
			<td>statistical analysis software&#160;</td>
		</tr>
		<tr>
			<td>sterile gloves</td>
			<td>Fitone Latex Products Co.,Ltd Guangdong.</td>
			<td>20172140158</td>
			<td></td>
		</tr>
	</tbody>
</table>

acupoint catgut embedding for treatment of chronic pelvic pain due to the sequelae of pelvic inflammatory disease

염증성 골반 질환의 후유증으로 인한 만성 골반 통증은 여성 골반 통증의 흔한 임상 질환입니다. 현재 치료의 주요 과제는 통증 완화의 효과가 제한적이고 증상이 자주 재발하여 환자의 삶의 질에 큰 영향을 미치고 상당한 심리적 부담을 준다는 것입니다. 이 질환은 임상적으로 어려운 질병입니다. 수년간의 치료 경험을 요약한 후, 저자의 팀은 경혈 캣굿 임베딩이 골반 염증성 질환 후유증으로 인한 만성 골반 통증 관리에서 주목할 만한 임상적 효능을 입증했다는 것을 발견했습니다. 기존 서양의학의 치료방법에 비해 경혈 캣굿 임베딩은 진통 효과가 좋고, 재발률이 낮으며, 경제적 이점이 있으며, 시술이 비교적 간단하다는 장점이 있습니다. 이 기사는 골반 염증성 질환의 후유증으로 인한 여성의 만성 골반 통증을 치료하기 위해 환자의 경혈에 흡수성 고양이 내장을 삽입하는 방법에 대한 포괄적인 가이드를 제공합니다.

이 임상 연구에서는 총 88명의 참가자가 처음에 등록되었으며 8명의 사례가 중도탈락했습니다(치료군에서 4명, 다른 치료군에서 4명). 나머지 80명의 참가자는 난수 표를 사용하여 치료군과 대조군으로 나뉘었고 각 그룹에는 40명의 참가자가 있었습니다. 치료 과정에는 10일에 한 번씩 캣거트 삽입을 포함하고, 월경 기간을 피하고, 3개월 동안 연속적으로 시행하는 것이 포함되었습니다. 치료군의 환...

Read this Scientific Article Protocol about Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain due to the Sequelae of Pelvic Inflammatory Disease at JoVE.com

저자 스포트라이트: Enhancing Women's Chronic Pelvic Pain Management Through Acupoint Catgut Embedding (경혈 캣거트 임베딩을 통한 여성의 만성 골반 통증 관리 강화)

이 기사에서는 골반 염증성 질환의 후유증으로 인한 만성 골반 통증에 대한 경혈 캣굿 삽입 요법에 대해 설명합니다.

골반 염증성 질환의 후유증으로 인한 만성 골반 통증 치료를 위한 Acupoint Catgut Embedding

Chronic pelvic pain caused by the sequelae of inflammatory pelvic disease is a common clinical condition of pelvic pain in women. At present, the main ...

우리의 연구는 골반 염증성 질환의 후유증으로 인한 만성 골반 통증에 대한 효과적인 치료법을 개발하는 데 중점을 둡니다. 우리의 연구는 경혈이 환자의 임상 증상과 삶의 질을 향상시킬 수 있다는 것을 발견했습니다. 기존 서양의학의 치료방법에 비해 경혈 캣굿 임베딩은 진통 효과가 좋고, 재발률이 낮으며, 경제적 이점이 있으며, 시술이 비교적 간단하다는 장점이 있습니다.우리는 여성의 만성 골반 통증 완화를 위한 외부 한의학의 효능과 치료 프로토콜의 개발에 중점을 둘 것입니다.

acupoint-catgut-embedding-for-treatment-chronic-pelvic-pain-due-to

Research

JoVE Journal

Medicine

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain Due to the Sequelae of Pelvic Inflammatory Disease

502 조회수.  Hospital of Chengdu University of Traditional Chinese Medicine. 우리의 연구는 골반 염증성 질환의 후유증으로 인한 만성 골반 통증에 대한 효과적인 치료법을 개발하는 데 중점을 둡니다. 우리의 연구는 경혈이 환자의 임상 증상과 삶의 질을 향상시킬 수 있다는 것을 발견했습니다. 기존 서양의학의 치료방법에 비해 경혈 캣굿 임베딩은 진통 효과가 좋고, 재발률이 낮으며, 경제적 이점이 있으며, 시술이 비교적 간단하다는 장점이 있습?...

비디오: 저자 스포트라이트: Enhancing Women's Chronic Pelvic Pain Management Through Acupoint Catgut Embedding (경혈 캣거트 임베딩을 통한 여성의 만성 골반 통증 관리 강화)

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

약시의 억제의 측정 및 치료

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

연구

의학

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.

Loss of peritoneal integrity provides a new paradigm to understand and treat chronic pelvic pain in women with mild forms of endometriosis and can be easily detected using intraoperative instillation of dye at the time of laparoscopy.

미묘한 Endometriosis의 Intraoperative 감지 : 복막 무결성의 손실과 관련된 골반 통증의 감지 및 치료를위한 소설 패러다임

Endometriosis is a  common disease affecting 40 to 70% of reproductive-aged women with chronic  pelvic pain (CPP) and/or infertility. The purpose of this ...

Urinary Bladder Distention Evoked Visceromotor Responses as a Model for Bladder Pain in Mice

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition characterized by increased urgency and frequency of urination, as well as nocturia and general pelvic pain, especially upon bladder filling or voiding. Despite years of research, the cause of IC/BPS remains elusive and treatment strategies are unable to provide complete relief to patients. In order to study nervous system contributions to the condition, many animal models have been developed to mimic the pain and symptoms associated with IC/BPS. One such murine model is urinary bladder distension (UBD). In this model, compressed air of a specific pressure is delivered to the bladder of a lightly anesthetized animal over a set period of time. Throughout the procedure, wires in the superior oblique abdominal muscles record electrical activity from the muscle. This activity is known as the visceromotor response (VMR) and is a reliable and reproducible measure of nociception. Here, we describe the steps necessary to perform this technique in mice including surgical manipulations, physiological recording, and data analysis. With the use of this model, the coordination between primary sensory neurons, spinal cord secondary afferents, and higher central nervous system areas involved in bladder pain can be unraveled. This basic science knowledge can then be clinically translated to treat patients suffering from IC/BPS.

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition characterized in part by pelvic pain. In order to study nervous system contributions to the condition, a physiological model of urinary bladder pain is used in mice and rats.

쥐의 방광 통증 모델로 방광 팽창 유발 내장 운동 응답

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition ...

Chronic Constriction Injury of the Rat's Infraorbital Nerve (IoN-CCI) to Study Trigeminal Neuropathic Pain

Animal models are important tools to study the pathophysiology and pharmacology of neuropathic pain. This manuscript describes the surgical and behavioral procedures to study trigeminal neuropathic pain in rats. To meet the specificity of trigeminal neuropathic pain syndromes, the infraorbital nerve (IoN) is subjected to a chronic constriction injury (CCI) by loosely ligating the nerve. An intra-orbital approach is presented here to expose and ligate the IoN in the orbital cavity. After IoN ligation, rats exhibit changes in spontaneous behavior and in response to von Frey hair stimulation that are indicative of persistent pain and mechanical allodynia. Two phases can be defined in the development of the behavioral changes. During the first week following IoN-CCI (phase 1), rats show an increased and asymmetric face grooming activity, i.e., with face wash strokes primarily directed to the nerve-injured IoN territory. A distinction is made between face grooming behavior that is part of a more general body grooming behavior, which remains largely unaffected by IoN-CCI, and face grooming that is neither preceded nor followed by body grooming, which is significantly increased after IoN-CCI. During this period, responsiveness to mechanical stimulation of the IoN territory is reduced. This hyporesponsiveness is abruptly replaced by an extreme hyperresponsiveness whereby even very weak stimulus intensities provoke nocifensive behavior (phase 2). The phenomenological similarities between these behavioral alterations and reported signs of facial pain (i.e., responses to noxious stimulation of the face) suggest the presence of dysesthesia/paresthesia and mechanical allodynia in the ligated IoN territory.

Chronic Constriction Injury of the Rat's Infraorbital Nerve IoN-CCI to Study Trigeminal Neuropathic Pain

This manuscript describes a rodent model to study trigeminal neuropathic pain. The methods described include surgical procedures to perform a chronic constriction injury of the rat&#8217;s infraorbital nerve and the post-surgical behavioral tests to measure the changes in spontaneous and evoked behavior that are indicative of persistent pain and allodynia.

삼차 신경 병증 성 통증을 연구하기 위해 쥐의 눈꺼풀의 신경 (이온 CCI)의 만성 수축 부상

Animal models are important tools to study the pathophysiology and pharmacology of neuropathic pain. This manuscript describes the surgical and behavioral ...

Transvaginal Mesh Insertion in the Ovine Model

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms. Parous sheep underwent the dissection of the rectovaginal septum, followed by the insertion of an implant with or without four anchoring arms, both designed to fit the ovine anatomy. The anchoring arms were put in place using a trocar and an "outside-in" technique. The cranial arms were passed through the obturator, gracilis, and adductor magnus muscles. The caudal arms were fixed near the sacrotuberous ligament, through the coccygeus muscles. This technique allows for the mimicking of surgical procedures performed in women suffering from pelvic organ prolapse. The anatomical spaces and elements are easily identified. The most critical part of the procedure is the insertion of the cranial trocar, which can easily penetrate the peritoneal cavity or the surrounding pelvic organs. This can be avoided by a more extensive retroperitoneal dissection and by guiding the trocar more laterally. This approach is designed only for experimental testing of novel implants in large animal models, as trocar-guided insertion is currently not used clinically.

This protocol describes mesh implantation in the ovine rectovaginal septum using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms.

양돈장 모델에서의 질식 삽입

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided ...

Development of Recombinant Proteins to Treat Chronic Pain

Chronic pain is difficult to treat and new approaches to resolve persistent pain are urgently needed. Anti-inflammatory cytokines are promising candidates for treating debilitating pain conditions due to their capacity to regulate aberrant neuro-immune interactions. However, physiologically they work in a network of various cytokines, and therefore their therapeutic effect may not be optimal when used as stand-alone drugs. To overcome this limitation, we developed a fusion protein of the anti-inflammatory cytokines IL4 and IL10. Here, we describe the methods for production and quality control of IL4-10 recombinant fusion protein and we test the effectiveness of the IL4-10 fusion protein to resolve pain in a mouse model of persistent inflammatory pain.

In this paper we provide details for the methods of production and quality control of an IL4-10 recombinant fusion protein. We also show how to test the effectiveness of this protein to resolve pain in a mouse model of inflammatory pain.

만성 통증 치료에 재조합 단백질의 개발

Chronic pain is difficult to treat and new approaches to resolve persistent pain are urgently needed. Anti-inflammatory cytokines are promising candidates ...

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse (POP) Quantification System

Anogenital distance (AGD) is a sexually dimorphic attribute, twice longer in males than in females, and a marker of intrauterine hormonal environment. Interest in AGD measurements is increasing due to mounting evidence on their potential clinical implications. A parallel set of perineal measurements, the Pelvic Organ Prolapse Quantification System (POP-Q), include similar, but not exactly the same, landmarks: the perineal body (PB) and the genital hiatus (GH) lengths. However, clinical reproducibility of both perineal measurements and their usefulness to describe perineal anthropometry needs to be elucidated. To our knowledge, there is no publication in video format showing the methodology of these measurements. The main objective of this work is to show how to properly perform perineal anthropometry, including measurements of the AGD in its two variants [anoclitoral (AGDAC) and anofourchette (AGDAF)], genital hiatus (GH) and perineal body (PB). Moreover, we explored if there were differences in these measurements in women with and without Pelvic Organ Prolapse (POP). We research whether the anthropometric characteristics of the perineum, such as AGD (which is determined prenatally), may be altered in these women and be an independent etiological factor for pelvic floor dysfunction. We show two different ways of measuring perineal lengths, as they might be quite comparable. Our suggestion is that unifying perineal measurements could be useful for clinical and biomedical investigation. More studies are needed in order to compare GH and PB measurements and its AGD counterparts to analyze which procedures are more reproducible with less intra and interobserver variability.

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System

This manuscript describes the procedures to perform anogenital distance (AGD) and perineal measurements standardized by the Pelvic Organ Prolapse Quantification System (POP-Q): perineal body (PB) and genital hiatus (GH). These measurements are compared in women with and without pelvic organ prolapse.

Anogenital 거리 및 골반 장기 탈출 (POP) 정량화 시스템의 교장 측정

Anogenital distance (AGD) is a sexually dimorphic attribute, twice longer in males than in females, and a marker of intrauterine hormonal environment. ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

로봇 보조 총 중각 절제술 및 측면 골반 림프절 해부 국소 고급 중간 낮은 직장 암

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore apical support for treating POP. Sacrocolpopexy and pectopexy are indicated for apical prolapse. Using a synthetic mesh in these techniques increases success by enhancing apical support. However, the implantation of synthetic mesh is associated with mesh-related complications. In addition, the exorbitant cost of synthetic mesh and lack of universal access limit the popularity of these procedures. The current study develops a unique technique known as laparoscopic non-mesh cerclage pectopexy (LNMCP), in which permanent cervical cerclage sutures are embedded in the round ligament until the iliopectineal ligament. The iliopectineal ligament was sutured, resulting in a firm cervical suspension. The procedure was successfully performed in 16 cases in the hospital. The surgical duration was 67.8 min &plusmn; 15.5 min, and the blood loss was 73.1 mL &plusmn; 51.1 mL. No procedural complications were seen. LNMCP is associated with an objective success rate of 100% and a subjective success rate of 93.8%. LNMCP for patients with apical prolapse obviates the need for a mesh, thereby avoiding complications associated with mesh erosion and reducing medical costs. In addition, it is easy to perform even in resource-poor areas without access to synthetic mesh.

The present pilot study describes the development of laparoscopic non-mesh cerclage pectopexy to treat pelvic organ prolapse. The procedure can be used to prevent any complications associated with the use of mesh.

골반 장기 탈출증에 대한 복강경 Non-Mesh Cerclage Pectopexy

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore ...

Partial Sciatic Nerve Ligation: A Mouse Model of Chronic Neuropathic Pain to Study the Antinociceptive Effect of Novel Therapies

Management of chronic pain remains challenging to this day, and current treatments are associated with adverse effects, including tolerance and addiction. Chronic neuropathic pain results from lesions or diseases in the somatosensory system. To investigate potential therapies with reduced side effects, animal pain models are the gold standard in preclinical studies. Therefore, well-characterized and well-described models are crucial for the development and validation of innovative therapies. 
Partial ligation of the sciatic nerve (pSNL) is a procedure that induces chronic neuropathic pain in mice, characterized by mechanical and thermal hypersensitivity, ongoing pain, and changes in limb temperature, making this model a great fit to study neuropathic pain preclinically. pSNL is an advantageous model to study neuropathic pain as it reproduces many symptoms observed in humans with neuropathic pain. Furthermore, the surgical procedure is relatively fast and straightforward to perform. Unilateral pSNL of one limb allows for comparison between the ipsilateral and contralateral paws, as well as evaluation of central sensitization. 
To induce chronic neuropathic hypersensitivity, a 9-0 non-absorbable nylon thread is used to ligate the dorsal third of the sciatic nerve. This article describes the surgical procedure and characterizes the development of chronic neuropathic pain through multiple commonly used behavioral tests. As a plethora of innovative therapies are now being investigated to treat chronic pain, this article provides crucial concepts for standardization and an accurate description of surgeries required to induce neuropathic pain.

Partial sciatic nerve ligation induces long-lasting chronic neuropathic pain, characterized by exaggerated responses to thermal and mechanical stimuli. This mouse model of neuropathic pain is commonly used to study innovative therapies for pain management. This article describes in detail the surgical procedure to improve standardization and reproducibility.

부분 좌골 신경 결찰: 새로운 치료법의 항통각수용 효과를 연구하기 위한 만성 신경병성 통증의 마우스 모델

Management of chronic pain remains challenging to this day, and current treatments are associated with adverse effects, including tolerance and addiction. ...