The authors thank Dr. Wen Yi and other medical staff of the Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine for their help.

All procedures of this study were conducted in accordance with clinical trial registration and have been approved by the Ethics Committee of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Filing No. 2021KL-004). All patients in this study provided informed consent to the investigators&#39; use of data, images, and related video filming during the trial.
1. Preparation before operation
<ol>
	<li>Set the inclusion criteria as follows: include patients meeting the diagnostic criteria for pelvic inflammatory disease in Western medicine8,9 and the dampness heat stasis syndrome type in traditional Chinese medicine10, aged 20-25 years old.</li>
	<li>Set the following exclusion criteria: other causes of pelvic pain or lower abdominal pain; pregnancy, lactation, or preparing for pregnancy within the past 6 months; severe conditions affecting the heart, liver, kidneys, and hematopoietic system that make treatment intolerable; inability or unwillingness to cooperate; individuals prone to allergies or keloid formation; history of similar medication or physical treatments within the last month.</li>
	<li>Get the following materials ready: sterile gloves, disposable catgut embedding needles, disposable thread embedding kit (treatment tray, sterile gauze, sterile cotton swab, iodophor cotton swab, tweezers, &#34;0&#34; catgut, medical patches; Figure 1).</li>
	<li>Ask the patient to lie on her back, relax, and fully expose the abdomen and lower limbs.</li>
	<li>Check the skin condition of the target acupoint location and proceed with the procedure if there are no abnormalities. 
	NOTE: Patients with infection, ulceration, or scars on the skin at the acupoint should not undergo the embedding. Patients should not have the procedure right away if they are extremely hungry, fatigued, or under significant mental stress. Avoid performing the procedure on a menstruating patient.</li>
	<li>Have the physician perform routine hand disinfection and wear sterile gloves.</li>
	<li>Check whether the core of the disposable thread embedding needle and the needle tube match smoothly (Figure 2A).</li>
	<li>Holding tweezers in the right hand, place the catgut into the needle tube (Figure 2B). 
	NOTE: The catgut needs to be completely inserted into the needle tube.</li>
</ol>
2. Operating steps
<ol>
	<li>Select the following acupoints (international code): Zhongji (RN3), Guanyuan (RN4), Qihai (RN6), Guilai (ST29), Zigong (EX-CA1), Xueha (SP10), Zusanl (ST36), Yinlingquan (SP9), and Sanyinjiao (SP6; Figure 3).</li>
	<li>Needle insertion
	<ol>
		<li>Tighten the skin of the needle insertion site with the left hand, and pinch the needle tube with the thumb, index, and middle fingers of the right hand.</li>
		<li>Quickly insert the needle downwards at a 90&#176; angle to the skin (Figure 2C,D).</li>
		<li>When the patient experiences getting qi (needle sensation) such as soreness, numbness, and bloating, stop inserting the needle, push the needle core, and withdraw the needle tube, leaving the catgut in the qi-receiving area.</li>
	</ol>
	</li>
	<li>Needle extraction: Press the skin of the acupoint with the left hand and pull out the needle core and barrel with the right hand. 
	NOTE: The catgut thread must be fully intradermal and should not be left subcutaneous or exposed outside the hypodermic.</li>
	<li>Compress the needle hole with a sterilized dry cotton ball for 30 s and apply a medical application to the needle hole for 2 days.</li>
</ol>
3. Precautions after embedding the catgut
<ol>
	<li>Ensure that the embedded site does not come into contact with water within the first 48 h.</li>
	<li>Advise the patient to avoid strenuous physical activities, especially around the area where the thread was embedded, for 7 days following the procedure.</li>
</ol>
4. Adverse reactions and management
<ol>
	<li>Patient discomfort
	<ol>
		<li>Pain
		<ol>
			<li>Advise patients that pain is a common adverse reaction11 and that their pain will mostly disappear after 5-7 days.</li>
			<li>Use fine thread-embedding needles and catgut bodies during the procedure.</li>
			<li>Consider preoperative oral analgesics for patients who are sensitive to pain and have no known contraindications11; If necessary, administer local anesthesia with lidocaine before embedding the catgut12.</li>
		</ol>
		</li>
		<li>Needle-related fainting 
		NOTE: This refers to the sudden occurrence of dizziness, blurred vision, palpitations, nausea, and even syncope during the acupoint catgut-embedding treatment.
		<ol>
			<li>If the patient faints, immediately stop the catgut embedding and observe the patient&#39;s vital signs. For milder cases, ask the patient to lie down for a while and receive warm water or a sugary drink. In cases where there is no alleviation of the symptoms, employ modern first-aid measures.</li>
		</ol>
		</li>
		<li>Bleeding or local hematoma
		<ol>
			<li>If postoperative bleeding occurs at the embedding site, apply gentle pressure with a dry cotton swab at the local site to stop it.</li>
			<li>If a hematoma forms, apply a cold compress within 24 h, followed by warm compresses after 24 h to promote hematoma absorption. 
			NOTE: If the bleeding persists or is substantial, it may indicate vascular damage, necessitating surgical intervention.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Catgut body rejection reaction
	<ol>
		<li>Fever 
		NOTE: Any fever generally disappears within 1 week.
		<ol>
			<li>Instruct the patients to drink plenty of water. Treat continuous fever with physical cooling or oral antipyretic medications.</li>
			<li>When prolonged high fever occurs, ensure prompt cooling and removal of the embedded catgut by a surgical specialist.</li>
		</ol>
		</li>
		<li>Allergic reactions
		<ol>
			<li>Look for allergic symptoms such as local redness, rash, and itching; provide antihistamine drugs (such as chlorpheniramine maleate, cetirizine, loratadine) or corticosteroids (such as dexamethasone) for allergy management, and if necessary, remove the embedded catgut from the body.</li>
		</ol>
		</li>
		<li>Nodules or masses
		<ol>
			<li>Small nodules usually resolve on their own. For localized firm masses, employ methods like moxibustion and acupoint injections13.</li>
		</ol>
		</li>
		<li>Thread overflow
		<ol>
			<li>Manage thread overflow by trimming or extracting the extruded catgut and then re-embedding it.</li>
		</ol>
		</li>
		<li>Infection
		<ol>
			<li>During the first 5 days after catgut embedding, there may be varying degrees of inflammation at the local site. If there is excessive discharge at the embedding site or signs of purulent changes, treat with antibiotics for infection control. If necessary, seek surgical intervention.</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
5. Observation indicators
<ol>
	<li>Clinical efficacy evaluation14
	<ol>
		<li>Define recovery as the improvement of all related symptoms and signs such as pelvic pain, with a score decrease of &#8805;95%.</li>
		<li>Define a significant effect as 70% &#8804; score reduction &#60; 95%.</li>
		<li>Consider the treatment to be effective if 30% &#8804; score reduction &#60; 70%.</li>
		<li>Consider the treatment to be invalid if the score reduction is &#60;30%.</li>
	</ol>
	</li>
	<li>Use the simplified McGill Pain Scale (SF-MPQ)15 to evaluate pain emotions and severity before and after treatment, with higher scores indicating more severe pain.</li>
	<li>Use the Traditional Chinese Medicine Damp Heat Stasis Syndrome Scale to score Traditional Chinese Medicine Syndrome16. The higher the score, the more severe the symptoms.</li>
	<li>Evaluate abdominal tenderness or rebound pain, uterine tenderness, neck elevation and swing pain, and accessory tenderness before and after treatment using the Pelvic Physical Signs Scale17. The higher the score, the more severe the pelvic pain.</li>
	<li>Use the World Health Organization quality of life (WHOQOL) - BREF scale18 to rate the quality of survival of the patients, and count the domain scores positively, meaning that the higher the score, the better the quality of life.</li>
</ol>
6. Statistical analysis
<ol>
	<li>Express measurement data conforming to a normal distribution as mean &#177; standard deviation (SD).</li>
	<li>Use an independent samples t-test for group comparisons and a paired samples t-test for comparisons before and after treatment.</li>
	<li>Express data not conforming to a normal distribution as M (25%,75%).</li>
	<li>Conduct group comparisons using the rank-sum test and comparisons before and after treatment using the paired rank-sum test.</li>
	<li>Express counts or ordinal data as component ratios.</li>
	<li>Perform group comparisons using Fisher&#39;s exact probability method or the Chi-square test.</li>
	<li>Use a paired-design t-test for pre and post control. Perform bilateral hypothesis testing to &#945;= 0.05; consider P &#60; 0.05 to be statistically significant.</li>
</ol>

Acupoint Catgut Embedding for Chronic Pelvic Pain Management

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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=Acupuncture+combined+with+western+medication+on+chronic+pelvic+pain+after+pelvic+inflammatory+disease:+a+multi-center+randomized+controlled+trial.">Acupuncture combined with western medication on chronic pelvic pain after pelvic inflammatory disease: a multi-center randomized controlled trial.</a> Zhongguo Zhen Jiu. 41 (1), 31-35 (2021).</li><li>Xiang, D. F., Sun, Q. Z., Liang, X. F. <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+abdominal+acupuncture+on+pain+of+pelvic+cavity+in+patients+with+endometriosis.">Effect of abdominal acupuncture on pain of pelvic cavity in patients with endometriosis.</a> Zhongguo Zhen Jiu. 31 (2), 113-116 (2011).</li></ol>

The authors declare that they have no conflicts of interest.

There is no record of chronic pelvic pain in ancient Chinese medicine books, and according to its symptom characteristics, it can be mutually referenced with diseases such as &#34;abdominal pain,&#34; &#34;women&#39;s abdominal pain,&#34; and &#34;menstrual abdominal pain.&#34; According to traditional Chinese medicine theory, when the blood vessels are open, improper care may lead to the invasion of pathogenic factors, such as dampness and evil heat, which can stagnate in the uterus and its channels, leading to a strugg...

Chronic pelvic pain (CPP) refers to pelvic pain that persists for over 6 months, is non-periodic, and is unresponsive to non-opioid drugs. The latest research shows that the global incidence rate of CPP is ~5%-26%1. Sequential pelvic inflammatory disease (SPID) is one of the main conditions causing CPP, accounting for 23%-30% of all cases of chronic pelvic pain in females2. Due to the limited efficacy of existing analgesics in alleviating this pain, over 50% of CPP patients may seek non-pharmacological treatment3. Currently, the main non-pharmacological treatments include pelvic floor physical therapy, psychological therapy, neuroregulation, and dietotherapy. However, they also have limitations, such as suboptimal pain relief and difficulties in achieving long-term control. Most SPID women with CPP experience anxiety, depression, and decreased quality of life due to recurrent pain4. Therefore, finding an effective treatment method that can alleviate patients' pain symptoms has become a pressing clinical concern.
Acupuncture and moxibustion, two of the main external therapeutic methods in traditional Chinese medicine, have shown good efficacy in treating pain-related conditions and have been widely used in clinical practice, especially in the relief of chronic pain, where their effectiveness surpasses other non-pharmacological treatments for CPP5,6. In a cross-sectional study on the treatment of CPP with traditional Chinese medicine, 7.63% of chronic pain patients were chosen to receive acupuncture and moxibustion treatment, resulting in excellent therapeutic outcomes7. The acupoint catgut embedding introduced in this article is an extension and development of acupuncture and moxibustion. It refers to a traditional Chinese medicine external treatment technique that uses specially designed disposable medical devices to implant absorbable catgut into corresponding acupoints, providing prolonged and continuous acupoint stimulation to achieve analgesic effect. The author's team has employed this technology to treat recurrent and incurable pelvic pain in women caused by SPID, yielding positive outcomes. It can be utilized either as a standalone treatment or as an important component of a comprehensive traditional Chinese medicine treatment plan or a combination of traditional Chinese and Western medicine. This article takes the most common traditional Chinese medicine syndrome (dampness heat stasis type) patients with SPID as an example to provide a detailed demonstration of the procedures for acupoint catgut embedding.

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

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 challenges in its treatment are the limited effectiveness of pain relief and the frequent recurrence of symptoms, which significantly impact patients' quality of life and impose a considerable psychological burden on them. It is a clinically challenging disease. After summarizing years of treatment experience, the author's team discovered that acupoint catgut embedding demonstrated notable clinical efficacy in managing chronic pelvic pain stemming from pelvic inflammatory disease sequelae. Compared to existing Western medicine treatment methods, acupoint catgut embedding offers advantages such as a good analgesic effect, lower recurrence rate, economic benefits, and a relatively straightforward procedure. This article provides a comprehensive guide on embedding absorbable catgut into patients' acupoints for the treatment of chronic pelvic pain in females resulting from the sequelae of pelvic inflammatory disease.

In this clinical study, a total of 88 participants were initially enrolled, with 8 cases dropping out (4 from the treatment group and 4 from the other one). The remaining 80 participants were divided using a random number table into the treatment and control groups, with 40 participants in each group. The course of treatment included catgut embedding once every 10 days, avoiding menstrual periods, for a continuous duration of 3 months. The patients in the treatment group also took a dose of Traditional Chinese Medicine d...

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

Author Spotlight: Enhancing Women's Chronic Pelvic Pain Management Through Acupoint Catgut Embedding

This article outlines acupoint catgut embedding therapy for chronic pelvic pain caused by the sequelae of pelvic inflammatory diseases.

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

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 ...

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496 Views.  Hospital of Chengdu University of Traditional Chinese Medicine. This article outlines acupoint catgut embedding therapy for chronic pelvic pain caused by the sequelae of pelvic inflammatory diseases.

Video: Author Spotlight: Enhancing Women's Chronic Pelvic Pain Management Through Acupoint Catgut Embedding

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.

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

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.

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.

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.

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.

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.

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 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.

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.

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.

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