Name: clinical effects of ultrasound-guided acupotomy in knee osteoarthritis treatment
Uploaded: 2024-04-26T14:20:00.000+00:00
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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

We are grateful to Shanghai Three-year Action Plan to Further Accelerate the Inheritance and Innovation of Traditional Chinese Medicine (ZY(2021-2023)-0201-01); Pudong New Area Health System Pudong Famous TCM Training Program (PWRzm2020-15); Chinese Medicine Rehabilitation Service Enhancement Project (Medical 032); Innovation project of Longhua Hospital: Clinical study of acupotomy combined with knee balance exercise in the treatment of knee osteoarthritis (CX202045); Clinical study of acupotomy combined with Mulligan dynamic joint loosening in the treatment of periarthritis of shoulder (PKJ2020-Y76); Pudong New Area Health Commission Pudong Famous Chinese Medicine Successor Training Plan (PWRzj2020-21); TCM special disease Brand Construction Doubling Plan - Small acupotomy Special Disease (PDZY-2021-0304).

All patients with KOA were evaluated in the outpatient Department of TCM Rehabilitation at Guangming Hospital of Shanghai Pudong New Area from June 2022 to June 2023 for a total of 60 cases. This study was approved by the ethics review committee at Guangming Hospital of Traditional Chinese Medicine of Shanghai Pudong New Area (Ethics number: GMEC-KY-2020034). Doctors informed patients and their families regarding the clinical significance, risks, and follow-up requirements of the study. Patients were included in the study after obtaining and signing informed consent either from the patients or their families. The surgeon was familiar with the anatomy of the knee joint and acupotomy treatment.
1. Patient recruitment
<ol>
	<li>Diagnostic criteria
	<ol>
		<li>Use the following diagnostic criteria to diagnose knee osteoarthritis, according to the Chinese Society of Osteology&#39;s guidelines for the diagnosis and treatment of osteoarthritis (GDTO)16. Check the affected knee for pain within the last month, and if any two of the following four criteria exist, diagnose as knee osteoarthritis: (1) radiographs (standing or weight-bearing) showing joint space narrowing, joint margin osteophyte formation, subchondral osteosclerosis, or cystic change; (2) age &#8805; 60 years; (3) morning stiffness of &#8804; 30 min; (4) bone grinding sound during activity.</li>
	</ol>
	</li>
	<li>Inclusion criteria
	<ol>
		<li>Use the following inclusion criteria to enroll patients in this study: (1) conform to the diagnostic criteria of KOA; (2) age between 40-75 years; (3) body mass index &#8804; 25 kg/m2; (4) no cognitive dysfunction; (5) no previous knee surgery or acupotomy within 1 month; (6) understands the relevant contents of the study in detail, and have good medical compliance and a high degree of cooperation; (7) agree and sign the informed consent.</li>
	</ol>
	</li>
	<li>Exclusion criteria
	<ol>
		<li>Use the following exclusion criteria to not include patients in this study: (1) pregnant and lactating women; (2) patients with infection and muscle necrosis or deep abscess at the treatment site (knee); (3) patients with a history of fainting with the use of needles; (4) patients with a severe meniscus tear, anterior or posterior cruciate ligament tear, medial or lateral collateral ligament injury; (5) patients with knee joint pain caused by neurological diseases; (6) patients with severe cardiovascular, liver, kidney or hematopoietic system disease; (7) patients receiving other treatment options; (8) lidocaine hydrochloride allergy; (9) patients who do not want to be followed up.</li>
	</ol>
	</li>
	<li>Dropout criteria
	<ol>
		<li>Use the following exit criteria to allow patient dropout in this study: (1) voluntary withdrawal by the patient; (2) occurrence of other complications.</li>
	</ol>
	</li>
</ol>
2. Acupotomy treatment
<ol>
	<li>Preoperative preparation
	<ol>
		<li>Material preparation (Figure 1): sterilize disposable medical plastic cups, forceps, absorbent cotton balls, self-adhesive dressing, ultrasonic instruments (portable color ultrasound system), sterile ultrasound coupler, sterile protective cover for probe, 40 mm small disposable sterile needle knife, marker pen, disposable medical mask, hygiene hat, type II skin disinfectant, disposable sterile towel, 2% lidocaine hydrochloride, sterile water for injection, 10 mL disposable sterile syringe, sterile needle for injection, and surgical rubber gloves.</li>
		<li>Operation site: Prepare a treatment room with air disinfectant capabilities.</li>
		<li>Check patient information: check all basic patient information like name, age, and treatment site. Explain the needle-knife therapy procedure, including the possible risks and benefits of treatment. Ensure that the patient understands needle-knife treatment and remains relaxed during the procedure.</li>
		<li>Patient position: Ask the patient to lie down in a supine position, with the affected knee joint fully exposed and a thin pillow placed under the affected knee joint to place the joint in a relaxed state. Abduct the contralateral knee slightly, providing more room for the surgeon.</li>
	</ol>
	</li>
	<li>Positioning (Figure 2)
	<ol>
		<li>Tenderness points positioning: Mark the point where significant pain occurred in the affected knee joint due to the operator&#39;s finger pressure, such as the peroneal collateral ligament and iliotibial band point, patellar lateral retinaculum point, quadriceps tendon and suprapatellar bursa point, patellar medial retinaculum point, tibial collateral ligament point, pes anserinus bursa point.</li>
		<li>Ultrasound positioning17: Use the ultrasound probe (frequency 8-15 MHz, depth 1-4 cm) to scan along the short and long axis of the quadriceps tendon, the long axis of the knee tibial collateral ligament, the long axis of the fibular collateral ligament of the knee, the long axis of the patellar tendon and the tenderness point. Mark the points of local thickening, reduced echo, and loss of lamellar structure in ultrasound on the body surface.</li>
	</ol>
	</li>
	<li>Operative steps (Figure 3)
	<ol>
		<li>Following aseptic procedures, wear masks, hats, and sterile gloves.</li>
		<li>Ask the surgical assistant to open a 5 mL 2% lidocaine and 5 mL sterile water vial. Place a 10 mL syringe, a 25G needle, and a 40 mm disposable small sterile needle knife into a sterile plastic cup.</li>
		<li>Ask the surgical assistant to use cotton balls and type II skin disinfectant to disinfect the 15 cm area around the marked point on the knee. Place a sterile towel so that the mark point is in the middle of the sterile towel.</li>
		<li>Extract 5 mL of 2% lidocaine and 5 mL of sterile water with a 10 mL syringe to prepare 10 mL of working 1% lidocaine solution. Replace the 22G needle with a 25G needle (using a thinner needle for pain control).</li>
		<li>Fit the sterile protective cover over the probe. Hold the ultrasound probe in the left hand and the syringe in the right hand. Extrude the sterile ultrasonic gel and apply it to the probe. 
		NOTE: The surgical assistant assists the surgeon with this.</li>
		<li>Place the probe in the marked position. Confirm the target in the ultrasound image. Insert the syringe needle into the skin from the probe side so that the syringe needle and the target are in the same field of view. Make sure no blood returns upon aspiration. Inject each target with 1-2 mL of 1% lidocaine working solution.</li>
		<li>Hold the needle knife in the right hand. Insert the needle knife into the lidocaine injection site. The needle knife insertion direction is parallel to the direction of muscle and ligament fibers to avoid cutting muscle fibers and ligament fibers. Make sure the needle knife and the target are in the same field of view. Avoid touching blood vessels and nerves.</li>
		<li>Perform a longitudinal incision,&#160;stripping, and release the adhesion18. The patient will feel local soreness and pain, and the surgeon will feel resistance under the knife needle. Remove the knife needle when the surgeon feels a sense of looseness under the knife.</li>
	</ol>
	</li>
	<li>Postoperative care (Figure 3)
	<ol>
		<li>Press the injection site with a dry sterile cotton ball for 1 min. Cover the surgical area with a sterile self-adhesive dressing. Help the patient get dressed and leave the operating room.</li>
		<li>Ask the patient to sit quietly at the door of the operating room for approximately 15 min to avoid postoperative discomfort. Ask the patient to remove the dressing after 24 h and avoid contact with water for 3 days to avoid infection19.</li>
	</ol>
	</li>
	<li>Perform ultrasound-guided acupotomy once a week for a total of three acupotomy treatments.</li>
</ol>
3. Follow up evaluation
<ol>
	<li>Parameters for evaluation10,11,12,13,14,15,16,17,18,19,20,21,22
	<ol>
		<li>Use the synovial thickness of the suprapatellar bursae, the Visual analog scale (VAS), the Hospital for Special Surgery Knee Score (HSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess the outcome. Take measurements before treatment and 1 week after the 3 treatments were completed.</li>
	</ol>
	</li>
	<li>Ultrasound-based evaluation
	<ol>
		<li>Use the ultrasound to measure the synovial membrane thickness of suprapatellar bursae.</li>
		<li>Press the Power button to turn on the ultrasound machine. Press the Patient button, click on New Patient, and enter the patient&#39;s name.</li>
		<li>Ask the patient to lie in a supine position. Place a thin pillow under the popliteal fossa of the affected knee joint to fully expose it.</li>
		<li>Use the head end of the probe to find the superior edge of the patella. Place the tail end on the quadriceps tendon. Adjust the direction of the probe. Make sure that the acoustic beam is made perpendicular to the tendon and located on the synovial membrane of the suprapatellar bursae.</li>
		<li>Press the Freeze button to save the ultrasound image. Press the Caliper button to test the synovial thickness of the suprapatellar bursa. Record the measurement results.</li>
	</ol>
	</li>
</ol>
4. Statistical analysis
<ol>
	<li>Use a statistical analysis software. Express the measurement data as mean &#177; standard deviation (SD). Use a T-test to compare the differences before and after treatment. Consider p &#60;0.05 as statistically significant.</li>
</ol>

Managing Knee Osteoarthritis Using Ultrasound-Guided Acupotomy

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The authors report no conflict of interest.

There are three aspects of the treatment procedure that need special attention. The first is tenderness point localization. The surface of the total knee joint should be pressed to mark the location of the patient&#39;s pain response through the patient&#39;s complaint and the doctor&#39;s palpation. Peroneal collateral ligament and iliotibial band point, patellar lateral retinaculum point, quadriceps tendon and suprapatellar bursa point, patellar medial retinaculum point, tibial collateral ligament point, pes anserinus ...

Knee osteoarthritis (KOA) is the most common degenerative disease of the knee joint, causing knee pain, bony enlargements, morning stiffness, knee activity limitations, and other symptoms. Knee pain and limited function are the primary factors affecting daily life and work in patients with KOA. Most people with KOA experience a partial or complete loss of the ability to work and self-care, which is the primary cause of chronic disability1. Epidemiological data2,3 show that the prevalence of KOA is positively correlated with age. With the aging Chinese population, the incidence of KOA is increasing every year. Globally, approximately 250 x 106 patients have osteoarthritis, and its incidence is increasing annually. By 2030, osteoarthritis will be one of the main causes of disability4, with approximately 85% of osteoarthritis cases of the knee5,6, which seriously affects the quality of life of patients and causes pain in their life and work, leading to a heavy economic burden to the country and individuals7,8. Therefore, finding safe and minimally invasive treatments for patients with KOA is an area of intense research in orthopedics.
The main treatments for KOA include conservative therapies like patient education, lifestyle adjustments, physical therapy, orthopedic aids and orthotics, and medication and surgery. The vast majority of intra-knee surgery is performed through arthroscopic surgery with little trauma and a low infection rate. However, arthroscopic surgery still has some traumatic effects. Patients with KOA often undergo surgery after conservative treatment has failed9.
Acupotomy is a less invasive surgery than arthroscopy. Acupotomy can be performed in conjunction with conservative treatment. The needle knife is generally about 10-15 cm long and 0.4-1.2 mm in diameter. The needle knife consists of three parts: handle, needle body, and blade. The blade is thin and sharp. Its width is equal to the diameter of the needle body. Traditional acupotomy refers to the treatment of tendon pain points by a surgeon under the condition that the internal tissue structure of the human body cannot be directly observed; the interventional treatment is carried out according to his/her own experience and knowledge of the local anatomical tissue, combined with the symptoms and tender points of the patient. Due to the high risk of the procedure, including damage to the surrounding soft tissues, nerves, and blood vessels, infection, uncertain effects, and the possibility of multiple procedures, the use of traditional acupotomy is quite limited. With the development of imaging technology, the use of visualization has become a developing trend in acupotomology10 and has broadened the clinical application of acupotomy. Ultrasound can be used to visualize muscle and fascial lesions in real-time, allowing complete identification of the relative anatomy and the lesions11,12, improving the accuracy and safety of acupotomy13. Currently, it is primarily used to treat joint pain in the neck, shoulder, waist, and leg14,15. Ultrasound-guided acupotomy has the advantages of being a precisely targeted therapy, low risk, few complications, and high safety. Therefore, this study evaluated ultrasound-guided acupotomy as a new therapeutic approach for KOA.

<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

The protocol presented here demonstrates the operation method of ultrasound-guided acupotomy for knee osteoarthritis (KOA), including patient recruitment, preoperative preparation, manual operation, and postoperative care. The purpose of this protocol is to relieve pain and improve knee function in patients with KOA. A total of 60 patients with KOA admitted between June 2022 and June 2023 were treated with ultrasound-guided acupotomy. Pathological changes and knee function scores were compared before and after the treatment. After 1 week of treatment, the synovial thickness of the suprapatellar bursae was significantly lesser than before treatment (p &lt; 0.05), the Hospital for Special Surgery Knee Score (HSS) was significantly higher than before treatment (p &lt; 0.05), the Visual analogue scale (VAS) was significantly lower than those of the control group (p &lt; 0.05) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were significantly lower than those of the control group (p &lt; 0.05). Therefore, ultrasound-guided acupotomy for the treatment of KOA can reduce synovial thickness, relieve pain, improve knee joint function, and have a remarkable curative effect.

During the study, one patient received additional other treatments (intra-articular steroid injection) due to increased pain. In one patient, the synovial thickness of the suprapatellar bursae could not be detected on ultrasonography. One patient developed swelling and subcutaneous stasis around the wound after treatment, which improved after ice application without affecting normal treatment and follow-up. Two patients terminated the experiment, and the remaining 58 patients were included in the final statistical analys...

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Author Spotlight: Minimally Invasive Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment

This paper introduces the operation method of ultrasound-guided acupotomy for knee osteoarthritis, which can reduce synovial thickness and improve knee joint function. It has the advantages of precise target, low treatment risk, few complications, and high safety.

Clinical Effects of Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment

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

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Research

JoVE Journal

Medicine

429 Views.  Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine. De incidentie van knieartrose neemt toe met de vergrijzing van de bevolking. Daarom zijn we geïnteresseerd in het onderzoeken van veilige en minimaal invasieve behandelingen voor patiënten met KOA. De belangrijkste behandelingen voor KOA omvatten conservatieve therapieën, zoals patiëntenvoorlichting, aanpassingen van de levensstijl, fysiotherapie, orthopedische hulpmiddelen en orthesen, en medicatie en intra-kniechirurgie.Patiënten met KOA ondergaan vaak een operatie na het falen ...

Video: Auteur in de schijnwerpers: minimaal invasieve echogeleide acupotomie bij de behandeling van knieartrose

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.

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

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.

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).

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.

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.

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.

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.

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.

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.

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

Establishment of the KOA Model in Rabbits Using the Modified Videman Method

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.

Author Spotlight: Investigating the Mechanism of Action of Acupotomy in Treating Knee Osteoarthritis

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.

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

Clinical Effects of Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment

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