This work was supported by the National Natural Science Foundation of China (grant numbers 82071078, 81870798, and 82170927).

This study was approved by the Institutional Review Board of the College of Stomatology, Xi&#39;an Jiaotong University (xjkqll[2022]NO.034). Informed consent was available from the patients involved in this study.
1. Adjunctive diode laser therapy in the non-surgical treatment of periodontitis
<ol>
	<li>Eligibility criteria
	<ol>
		<li>Use the following inclusion criteria: age &#8805; 18 years; probing pocket depth (PPD) &#8805; 5 mm; detectable clinical attachment loss (CAL) and radiographic bone loss (RBL).</li>
		<li>Use the following exclusion criteria: patients with systematic diseases or under medication that may affect the inflammation and healing process; patients who had received periodontal treatment within 6 months; smokers or alcoholics; pregnant or lactating patients; periodontal-endodontic combined lesions; class III tooth mobility.</li>
	</ol>
	</li>
	<li>Clinical examination
	<ol>
		<li>Measure full-mouth PPD, bleeding on probing (BOP) at six sites per tooth (i.e., mesiobuccal, buccal, distobuccal, distolingual, lingual, and mesiolingual), and mobility of each tooth, excluding third molars. Measure CAL for teeth with PPD &#8805; 5 mm. Detect the cementoenamel junction by probing to calculate the CAL.</li>
		<li>Record the baseline parameters on a periodontal chart (Supplementary File 1).</li>
	</ol>
	</li>
	<li>Disinfection and anesthesia
	<ol>
		<li>Gargle with 3% hydrogen peroxide for 1 min, followed by pure water. Disinfect the operating area with 1% iodophor. Administer a local injection of primacaine adrenaline for anesthesia.</li>
	</ol>
	</li>
	<li>Mechanical debridement by scaling and root planing (SRP) 
	NOTE: SRP is necessary for treating periodontitis including ultrasonic or manual cleaning. Dental scaling removes the plaque and calculus from the surface of the tooth above and below the gumline. Root planing usually follows dental scaling and attempts to smooth out the rough surface of the root and helps the gums to reattach to the teeth.
	<ol>
		<li>Firstly, use an ultrasonic device to perform SRP for teeth with PPD &#62; 3 mm. Secondly, use hand-held instruments (Gracey curettes 5/6, 7/8, 11/12, and 13/14) to perform SRP for teeth with PPD &#62; 3 mm (Figure 1). Thirdly, use an ultrasonic device to perform SRP for these teeth a second time. 
		NOTE: The diode laser alone is not effective in eliminating calculus, so a thorough SRP cannot be omitted. If the patient has a large number of affected teeth, only one quadrant can be treated at each appointment. The ultrasonic and manual SRP can be performed within 1-4 appointments.</li>
		<li>Rinse the periodontal pockets with 3% hydrogen peroxide and gargle with pure water.</li>
		<li>Apply polishing paste to the teeth surface, polish the full-mouth teeth surfaces using a low-speed handpiece with a rubber cap, and then gargle with pure water.</li>
	</ol>
	</li>
	<li>Adjunctive diode laser therapy 
	NOTE: Choose teeth with PPD &#8805; 5 mm for laser treatment. Choose one of the following two usage modes (i.e., steps 1.5.1 or 1.5.2).
	<ol>
		<li>Inside pocket laser irradiation (only one session of laser appointment per tooth is suggested) (Figure 2A).
		<ol>
			<li>Ensure that both the operator and patient wear protective goggles to protect the eyes from laser damage.</li>
			<li>Prepare the diode laser device (wavelength = 980 nm, output power = 1 W, power density = 1414.7 W/cm2, continuous wave, 300 &#181;m fiber optic delivery system). 
			NOTE: Improperly increasing the power may cause thermal damage; please consult the laser manufacturer and follow the manufacturer&#39;s instructions before use.</li>
			<li>Calibrate the length of the fiber tip exposed to 1 mm less than the measured PPD (Figure 2B). 
			NOTE: To prevent bleeding due to the insertion of the fiber tip too deep into the periodontal pocket, it is generally recommended that the exposed fiber tip length is 1 mm less than the measured periodontal pocket depth.</li>
			<li>Gently insert the fiber tip into the periodontal pocket 1 mm less than the measured PPD, and slowly sweep the tip both in mesial-distal and apical-coronal directions for 30 s per tooth (Figure 2B,C). 
			NOTE: During this process, inserting the fiber too deeply into the periodontal pocket can irritate periodontal bleeding and thus prevent the laser from acting. Remove the granulation attached to the fiber tip using a cotton ball containing 75% alcohol to avoid jeopardizing the laser effectiveness.</li>
		</ol>
		</li>
		<li>Outside pocket laser irradiation (a total of 3-5 sessions of laser appointments per tooth is suggested) (Figure 3A).
		<ol>
			<li>Ensure that both the operator and patient wear protective goggles to protect the eyes from laser damage.</li>
			<li>Prepare the diode laser device (wavelength = 980 nm, output power = 0.4 W, power density = 566.2 W/cm2, continuous wave, 300 &#181;m fiber optic delivery system).</li>
			<li>Irradiate the gingival surface of the pocket for approximately 15 s per pocket, with the laser fiber tip 5 mm (2-10 mm) away from the gingival surface and directed at an angle of 90&#176; (Figure 3B,C).</li>
			<li>Repeat the same outside pocket laser treatment after 1, 3, 5, and 7 days.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Give oral hygiene instruction (OHI) to each patient, including Bass brushing technique, interdental floss, and brush19.</li>
	<li>Clinical examination
	<ol>
		<li>Measure the PPD, CAL, and BOP for each tooth 4-6 weeks, 3 months, and 6 months after periodontal treatment. Record the postoperative parameters on a new periodontal chart (Supplementary File 1).</li>
		<li>Compare the baseline and postoperative parameters.</li>
	</ol>
	</li>
</ol>
2. Adjunctive probiotic therapy in the nonsurgical treatment of peri-implant mucositis (Figure 4A)
<ol>
	<li>Eligibility criteria
	<ol>
		<li>Use the following inclusion criteria: age &#8805; 18 years; at least one implant with erythema, swelling, suppuration, or BOP in the peri-implant mucosa; radiographic bone loss (RBL) &#60; 2 mm.</li>
		<li>Use the following exclusion criteria: peri-implantitis (RBL &#8805; 2 mm); implants with mobility; patients with systematic diseases or under medication that may affect the inflammation and healing process; patients who had received periodontal treatment within 6 months; smokers or alcoholics; pregnant or lactating patients.</li>
	</ol>
	</li>
	<li>Clinical examination
	<ol>
		<li>Measure the clinical parameters PPD, BOP at six sites per implant (i.e., mesiobuccal, buccal, distobuccal, distolingual, lingual, and mesiolingual), and plaque index (PI) at four sites per implant (i.e., mesial, buccal, distal, and lingual).</li>
		<li>Record the baseline parameters on a periodontal chart (Supplementary File 1).</li>
	</ol>
	</li>
	<li>For disinfection, gargle with 3% hydrogen peroxide for 1 min, followed by pure water.</li>
	<li>Mechanical debridement by supragingival scaling
	<ol>
		<li>Use a titanium ultrasound tip to perform supragingival scaling for the mucositis implants, adjusting the mode to medium power (Figure 4B). Rinse the pockets with 3% hydrogen peroxide, and then gargle with pure water. 
		NOTE: Supragingival scaling removes the plaque and calculus from the surface of the implant denture above the gumline.</li>
	</ol>
	</li>
	<li>Professional administration of probiotic
	<ol>
		<li>Grind the probiotic tablet into powder using a sterilized mortar (Figure 4C). 
		NOTE: If there are lumpy particles in the powder, they can easily clog the syringe.</li>
		<li>Make a solution of probiotic powder and sterile saline in a 1:3 ratio (Figure 4D). Deliver the probiotic solution into the peri-implant sulcus using a 5 mL syringe with a blunted and soft tip (Figure 4E).</li>
	</ol>
	</li>
	<li>Home administration of probiotics
	<ol>
		<li>Instruct the patients to dissolve one tablet for approximately 10 min in the oral cavity every 12 h, twice a day for 1 month (Figure 4A).</li>
	</ol>
	</li>
	<li>Give OHI to each patient, including Bass brushing technique, interdental floss, and brush19.</li>
	<li>Clinical examination
	<ol>
		<li>Measure the PPD, PI, and BOP for each implant 4-6 weeks, 3 months, and 6 months after treatment. Record the postoperative parameters on a new periodontal chart (Supplementary File 1).</li>
		<li>Compare the baseline and postoperative parameters.</li>
	</ol>
	</li>
</ol>

The authors have no conflicts of interest.

Although diode laser has been widely utilized in periodontal therapy, the clinical effectiveness remains controversial among current clinical trials15,20. As demonstrated, the laser usage mode and application regimen have significant impacts on the efficacy of periodontal laser therapy12. Most researchers, however, ignore the potential role, eliciting results that are hard to explain. Under different usage modes, excessive or insufficient ...

Periodontal disease is a chronic multifactorial infection resulting in progressive destruction of periodontium1. Its severe form, periodontitis, affects up to 50% population worldwide2 and is regarded as a major cause of tooth loss in adults3. Replacement of missing teeth with dental implants has been extensively favored over traditional options4. The implants show prominent functional and aesthetic performances with a long-term survival rate of 96.1% after 10 years5,6. The implants, however, can suffer from peri-implant disease leading to mucosal inflammation (peri-implant mucositis) or surrounding bone loss (peri-implantitis)7, which may cause the implant failure8. Therefore, it is of utmost necessity to manage the periodontal and peri-implant diseases effectively, in order to preserve natural teeth or improve the survival rate of dental implants.
Periodontal and peri-implant diseases share similar etiology9, i.e., both are initiated by exposure to dental plaque, consisting mainly of anaerobic and microaerophilic bacteria10. Mechanical debridement is considered a reliable modality to achieve efficient disruption of pathogenic deposits on root or implant surfaces11. Nevertheless, it has restricted accessibility using instruments when there is complex tooth anatomy (i.e., root furcation and groove), leading to insufficient decontamination12. Under this context, the application of lasers and probiotics has emerged to supplement mechanical debridement13,14.
A variety of lasers have been proposed for periodontal treatment, such as Nd:YAG; CO2; Er:YAG; Er,Cr:YSGG; and diode laser15. Among these, the diode laser is the most popular choice for clinical treatment due to its portability and low cost16. The diode laser has been recommended as an ideal adjunct in destroying biofilms, eliminating inflammation, and facilitating wound healing due to its photobiomodulation and photothermal effects12,13. The diversity of laser usages, nonetheless, leads to significant clinical heterogeneity among current studies. Thus, in our recent publication, we evaluated 30 clinical trials and summarized the optimal combination of laser usage mode and application regimen12. However, few studies report the detailed procedure of the combination protocol. On the other hand, probiotic Lactobacillus has been drawing increasing attention as a potential adjuvant in treating peri-implant disease, due to its antimicrobial and anti-inflammatory performances17,18. The clinical benefits, however, have not reached an agreeable consensus. One critical account referred to the variety of probiotic administration protocols17.
Based on the current evidence, this article describes two modified clinical protocols: the existing protocol for the use of adjunctive diode laser in treating periodontitis is improved based on two laser usage modes (inside or outside pocket) and two application regimens (single or multiple sessions of appointment)12. For the adjunctive probiotic Lactobacillus therapy in treating peri-implant disease, a combination of professional local use and home administration of probiotic is described17.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1% iodophor</td>
			<td>ADF, China</td>
			<td>21031051</td>
			<td>100 mL</td>
		</tr>
		<tr>
			<td>3% hydrogen peroxide</td>
			<td>Hebei Jianning, China</td>
			<td>210910</td>
			<td>500 mL</td>
		</tr>
		<tr>
			<td>75% alcohol</td>
			<td>Shandong Anjie, China</td>
			<td>2021100227</td>
			<td>500 mL</td>
		</tr>
		<tr>
			<td>Diode laser (FOX 980)</td>
			<td>A.R.C, Germany</td>
			<td>PS01013</td>
			<td>300-&#956;m fiber tip</td>
		</tr>
		<tr>
			<td>Gracey curettes</td>
			<td>Hu-Friedy, USA</td>
			<td>5/6, 7/8, 11/12, 13/14</td>
			<td></td>
		</tr>
		<tr>
			<td>Low-speed handpiece</td>
			<td>NSK, Japan</td>
			<td>0BB81855</td>
			<td></td>
		</tr>
		<tr>
			<td>Periodontal probe</td>
			<td>Shanghai Kangqiao Dental Instruments Factory, China</td>
			<td>44759.00</td>
			<td></td>
		</tr>
		<tr>
			<td>Periodontal ultrasonic device (PT3)</td>
			<td>Guilin zhuomuniao Medical Instrument, China</td>
			<td>P2090028PT3</td>
			<td></td>
		</tr>
		<tr>
			<td>Polishing paste</td>
			<td>Datsing, China</td>
			<td>21010701</td>
			<td></td>
		</tr>
		<tr>
			<td>Primacaine adrenaline</td>
			<td>Produits Dentaires Pierre Rolland, France</td>
			<td>S-52</td>
			<td>1.7 mL</td>
		</tr>
		<tr>
			<td>Probiotic</td>
			<td>Biogaia, Sweden</td>
			<td>Prodentis</td>
			<td>30 probiotic tablets (24 g)</td>
		</tr>
		<tr>
			<td>Titanium ultrasound tip (P59)</td>
			<td>Guilin Zhuomuniao Medical Instrument, China</td>
			<td>200805</td>
			<td></td>
		</tr>
	</tbody>
</table>

adjunctive diode laser therapy and probiotic lactobacillus therapy in the treatment of periodontitis and peri-implant disease

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

Periodontal pockets with PPD &#8805; 5 mm require laser irradiation after SRP, as it is difficult to obtain complete debridement by SRP alone (Figure 1A,B). After SRP, if the periodontal pockets bleed profusely and clot on the tooth surface, the operator needs to stop the bleeding and remove the clot by rinsing and gargling several times. This is because a large amount of blood will prevent the laser from working (Figure 1C,D).<...

Watch this Scientific Journal Video about Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease at JoVE.com

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

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

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

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

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2.3K Views.  Xi’an Jiaotong University. This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

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

Production and Detection of Reactive Oxygen Species (ROS) in Cancers

Reactive oxygen species include a number of molecules that damage DNA and RNA and oxidize proteins and lipids (lipid peroxydation). These reactive molecules contain an oxygen and include H2O2 (hydrogen peroxide), NO (nitric oxide), O2- (oxide anion), peroxynitrite (ONOO-), hydrochlorous acid (HOCl), and hydroxyl radical (OH-).
Oxidative species are produced not only under pathological situations (cancers, ischemic/reperfusion, neurologic and cardiovascular pathologies, infectious diseases, inflammatory diseases 1, autoimmune diseases 2, etc&hellip;) but also during physiological (non-pathological) situations such as cellular metabolism 3, 4. Indeed, ROS play important roles in many cellular signaling pathways (proliferation, cell activation 5, 6, migration 7 etc..). ROS can be detrimental (it is then referred to as "oxidative and nitrosative stress") when produced in high amounts in the intracellular compartments and cells generally respond to ROS by upregulating antioxidants such as superoxide dismutase (SOD) and catalase (CAT), glutathione peroxidase (GPx) and glutathione (GSH) that protects them by converting dangerous free radicals to harmless molecules (i.e. water). Vitamins C and E have also been described as ROS scavengers (antioxidants).
Free radicals are beneficial in low amounts 3. Macrophage and neutrophils-mediated immune responses involve the production and release of NO, which inhibits viruses, pathogens and tumor proliferation 8. NO also reacts with other ROS and thus, also has a role as a detoxifier (ROS scavenger). Finally NO acts on vessels to regulate blood flow which is important for the adaptation of muscle to prolonged exercise 9, 10. Several publications have also demonstrated that ROS are involved in insulin sensitivity 11, 12.
Numerous methods to evaluate ROS production are available. In this article we propose several simple, fast, and affordable assays; these assays have been validated by many publications and are routinely used to detect ROS or its effects in mammalian cells. While some of these assays detect multiple ROS, others detect only a single ROS.

Production and Detection of Reactive Oxygen Species ROS in Cancers

Here we propose simple methods to test and evaluate the presence of reactive oxygen species in cells.

Reactive oxygen species include a number of molecules that damage DNA and RNA and oxidize proteins and lipids (lipid peroxydation). These reactive ...

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

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

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

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

A Quick Phenotypic Neurological Scoring System for Evaluating Disease Progression in the SOD1-G93A Mouse Model of ALS

The SOD1-G93A transgenic mouse is the most widely used animal model of amyotrophic lateral sclerosis (ALS). At ALS TDI we developed a phenotypic screening protocol, demonstrated in video herein, which reliably assesses the neuromuscular function of SOD1-G93A mice in a quick manner. This protocol encompasses a simple neurological scoring system (NeuroScore) designed to assess hindlimb function. NeuroScore is focused on hindlimb function because hindlimb deficits are the earliest reported neurological sign of disease in SOD1-G93A mice. The protocol developed by ALS TDI provides an unbiased assessment of onset of paresis (slight or partial paralysis), progression and severity of paralysis and it is sensitive enough to identify drug-induced changes in disease progression. In this report, the combination of a detailed manuscript with video minimizes scoring ambiguities and inter-experimenter variability thus allowing for the protocol to be adopted by other laboratories and enabling comparisons between studies taking place at different settings. We believe that this video protocol can serve as an excellent training tool for present and future ALS researchers.

This video protocol describes a sensitive, reliable, and quick method for evaluating the neuromuscular deficits in a transgenic mouse model of amyotrophic lateral sclerosis.

The SOD1-G93A transgenic mouse is the most widely used animal model of amyotrophic lateral sclerosis (ALS). At ALS TDI we developed a phenotypic screening ...

Development of an Alpha-synuclein Based Rat Model for Parkinson's Disease via Stereotactic Injection of a Recombinant Adeno-associated Viral Vector

In order to study the molecular pathways of Parkinson&#39;s disease (PD) and to develop novel therapeutic strategies, scientific investigators rely on animal models. The identification of PD-associated genes has led to the development of genetic PD models. Most transgenic &#945;-SYN mouse models develop gradual &#945;-SYN pathology but fail to display clear dopaminergic cell loss and dopamine-dependent behavioral deficits. This hurdle was overcome by direct targeting of the substantia nigra with viral vectors overexpressing PD-associated genes. Local gene delivery using viral vectors provides an attractive way to express transgenes in the central nervous system. Specific brain regions can be targeted (e.g. the substantia nigra), expression can be induced in the adult setting and high expression levels can be achieved. Further, different vector systems based on various viruses can be used. The protocol outlines all crucial steps to perform a viral vector injection in the substantia nigra of the rat to develop a viral vector-based alpha-synuclein animal model for Parkinson&#39;s disease.

Development of an Alpha-synuclein Based Rat Model for Parkinson&#039;s Disease via Stereotactic Injection of a Recombinant Adeno-associated Viral Vector

This manuscript describes how viral vector-mediated local gene delivery provides an attractive way to express transgenes in the central nervous system. The protocol outlines all crucial steps to perform a viral vector injection in the substantia nigra of the rat to develop a viral vector-based animal model for Parkinson's disease.

In order to study the molecular pathways of Parkinson&#39;s disease (PD) and to develop novel therapeutic strategies, scientific investigators rely on ...

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

Managing Gestational Vomiting with Ear Plaster Therapy

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

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as fasting, fluid infusion, and nutritional support are conventionally applied to manage NVP, their effectiveness varies. However, traditional ear plaster therapy offers a promising alternative that effectively relieves symptoms and poses no known risk to the development of embryos or fetuses. This therapy is known for its ease of application, cost-effectiveness, and favorable outcomes. Previous studies have demonstrated the efficacy of combining ear plaster therapy with conventional treatments in alleviating symptoms of nausea and vomiting in pregnant women, surpassing the results achieved with conventional treatment alone. The protocol presented herein describes a method to relieve NVP using round, smooth, and hard cowherb seeds applied to specific ear points. These seeds are gently rubbed onto the surface of the ear, utilizing the principles of acupressure. By stimulating the designated ear points, this procedure aims to regulate the body's energy flow and restore balance, thereby reducing the severity and frequency of NVP. The application of cowherb seeds on specific ear points is a straightforward technique that healthcare professionals can easily implement or self-administered by pregnant women under appropriate guidance. Overall, ear plaster therapy presents a safe, effective, and economical approach for managing gestational vomiting, offering women a potential solution to alleviate their discomfort during pregnancy.

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture 

The presented protocol describes a traditional Chinese medicine treatment procedure known for its safety and effectiveness in managing gestational vomiting.

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

Ultrasound Evaluation of Achilles Tendon Morphology

Measurement of Healthy and Injured Triceps Surae Morphology

Achilles tendon injuries occur throughout the lifespan and can negatively affect quality of life and overall health. Achilles tendinopathy is generally classified as an overuse injury associated with fusiform tendon thickening, neovascularization, and interstitial tendon degeneration. Current literature suggests these structural changes are associated with&#160;symptoms and lower physical activity levels, as well as&#160;symptoms and lower extremity function in the long term. Surgically and non-surgically managed Achilles tendon ruptures result in increased tendon cross-sectional area (CSA) and a lengthened Achilles tendon. Both structural outcomes have clinical implications, as larger CSA positively predicts function, whereas increased tendon lengthening predicts reduced function after Achilles tendon rupture. Given the relationship between structural changes associated with Achilles tendon injuries for both injury severity and injury recovery, it is critical to be able to quantify Achilles tendon structure reliably and accurately. Silbernagel&#39;s group has established a valid and reliable method for efficiently evaluating triceps surae muscle and tendon structure. In this protocol, B-mode musculoskeletal ultrasound imaging is used to measure triceps surae structure, including Achilles tendon thickness and CSA, soleus thickness, and the presence of additional findings (calcifications and bursitis). B-mode extended field-of-view is used to measure Achilles tendon length and gastrocnemius anatomical CSA. Finally, power Doppler is used to identify intratendinous neovascularization. Quantification of triceps surae structure allows for comparison between limbs as well as longitudinal changes in response to exercise and treatment for healthy individuals and those with Achilles tendon injuries. This protocol has been used in many research studies to date and proves valuable in understanding the relationship between tendon structure and injury development, severity, and recovery. As ultrasound devices are becoming more affordable and portable, this protocol proves promising as a clinical tool, given its quick and efficient methods.

Author Spotlight: Exploring the Complexities of Achilles Tendon Injuries &#8212; Research and Future Directions

Ultrasound imaging is becoming more accessible in clinical and research settings, and a consistent protocol will be beneficial for comparison between studies and for clinical interpretations. This protocol for ultrasound evaluation is a valid and reliable method to evaluate Achilles tendon morphology in healthy, tendinopathic, and ruptured tendons.

Achilles tendon injuries occur throughout the lifespan and can negatively affect quality of life and overall health. Achilles tendinopathy is generally ...

Osteoporosis Management in Rats Through Lingnan Fire-Needle Therapy

Operation Procedure and Precautions of Lingnan Fire-Needle Therapy in Osteoporosis Model Rats

Compared to filiform needle therapy, fire-needle therapy has both the stimulation of needles and the warming effect of heat, making it have unexpected effects on some chronic diseases and incurable diseases. Osteoporosis (OP) has a high incidence in postmenopausal women and middle-aged and elderly men, and the treatment cycle is long. According to Traditional Chinese Medicine (TCM), Lingnan fire-needle therapy has shown potential in treating osteoporosis. However, there is still a long way to go before it can be widely used. This article focuses on the application of Lingnan fire-needle therapy in the intervention of OP in rats. It covers the selection of needle tools, acupuncture point selection, positioning of rats' bodies, and fixation methods. We also outline the steps and precautions to be taken during and after needling with fire needles. The experiment was done with three groups: a normal group, a model group, and a fire-needle group, each containing 10 rats. The rats in the fire-needle group were treated with fire-needle intervention for six sessions. After the intervention period, we collected femoral specimens and performed micro-CT scans. The results suggest that fire needling can enhance bone morphology and mineral density in OP rats. This information can serve as a methodological basis for conducting basic research on fire-needle therapy.

Author Spotlight: Exploring the Impact of Lingnan Fire-Needle Therapy in Osteoporosis Intervention

Here, we present a protocol for the application of Lingnan Fire-Needle therapy in the intervention of osteoporosis model rats.

Compared to filiform needle therapy, fire-needle therapy has both the stimulation of needles and the warming effect of heat, making it have unexpected ...