This research was supported by the Hospital Foundation of Hospital of Chengdu University of Traditional Chinese Medicine (Y2023016) and the Second Postgraduate Research Innovation Practice Project of the School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine (LCYJSKT2023-35)&#160;and Sichuan Provincial Administration of Traditional Chinese Medicine General Program (2023MS005).

A brief graphical flow of the protocol is shown in Figure 1. The protocol was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Hospital of Chengdu University of Traditional Chinese Medicine (code: 470000013, 4300000011). The data were obtained with the informed consent of the patients. The patients voluntarily signed informed consent prior to the study. The inclusion criteria were as follows: the ability to follow the doctor&#39;s advice; signing the consent form; diagnosis of hemorrhoids; excision of hemorrhoids with Milligan-Morgan surgery (M-M surgery). The exclusion criteria were as follows: patients with serious organ diseases; patients with anxiety, depression, or other mental disorders; patients with drug allergies; patients who could not cooperate.
1. Instrument preparation
<ol>
	<li>Disinfect all the tools with iodophor cotton swabs, followed by sterile cotton swabs, and then hand sanitizer. No special treatment is needed to disinfect sterile tweezers. Use disposable sterile press needles with dimensions of 0.25 mm x 1.3 mm.</li>
	<li>Ensure that the pulverizer can accommodate more than 200 g of the medicine. Maintain the speed between 25,000-30,000 rpm. Choose a gauze bag with at least a length and width of 10 cm x 8 cm and a treatment towel with a length and width of 50 cm x 40 cm.</li>
	<li>Select a microwave oven with a rated power of 600-900 W and the capacity for the heat to reach between 80-90 &#176;C in medium or high mode.</li>
	<li>Obtain the following ironing medicine for acute pain: Fructus foeniculi 70 g, Fructus aurantii 20 g, Rhizoma curcumae longae 20 g, and Rhizoma corydalis 20 g. Obtain the following ironing medicine for chronic pain: Rhizoma chuanxiong 20 g, Fructus foeniculi 70 g, Radix paeoniae alba 20 g, and Rhizoma curcumae longae 20 g.</li>
	<li>Obtain a thermometer that is capable of measuring in the range of 10-110 &#176;C and allows for multiple measurements.</li>
</ol>
2. Doctor-patient preparation
<ol>
	<li>Before the operation, perform a patient assessment. Evaluate the skin condition in advance. Do not perform the operation when the skin is damaged, infected, or suffering from other skin diseases.</li>
	<li>Evaluate all the equipment. Check all the medical consumables if they are within the usage time, and check the press needles to ensure they are not bent, broken, or have burrs or barbs, etc.</li>
	<li>Disinfection
	<ol>
		<li>Use pre-sterilized operating instruments in the operation. Ensure they are all disposable medical consumables and are not sterilized in advance.</li>
		<li>Carry out operator disinfection by using hand sanitizer to perform the seven-step handwashing method30.</li>
		<li>Carry out disinfection of the acupoint needle-embedding site using an iodophor cotton swab; perform spiral disinfection of the operation area from the center to the outside. Ensure the diameter of the disinfection site is larger than 3 cm, and let the disinfectant stay for about 1 min until all the iodophor has been volatilized. 
		NOTE: Generally, one disinfectant is enough. If the local area is seriously polluted, three disinfections are required. Prepare the ironing site using warm water to remove the residual dirt on the skin. Additional disinfection is not required.</li>
	</ol>
	</li>
	<li>Prepare the ironing site after needle-embedding; do not perform this simultaneously.</li>
</ol>
3. Operation steps
<ol>
	<li>Needle-embedding
	<ol>
		<li>Carry out acupoint selection (international code). Locate three acupoints, including Erbai (EX-UE2), Chengshan (BL57), Sanyinjiao (SP6; see Figure 2) before the operation. Perform acupoint location selection as done in previous studies in the literature16,31.</li>
		<li>Use sterilized tweezers to grip the edge of the press needle with the left hand, and aim the needle at the selected acupoint.</li>
		<li>After positioning the needle, press the needle&#39;s tail (bottom side) with the right thumb within 1 s.</li>
		<li>After inserting the needle, use the right thumb to gently rotate the needle 20-25 times clockwise at 40-50 times/min. Then, rotate the needle 20-25 times counterclockwise at the same speed. The operation should last 60-90 s. 
		CAUTION: When massaging, the patient may have acid reflux, numbness, swelling, or pain. The practitioner should always ask how the patient feels; if they complain about an obvious pain or discomfort, the practitioner should reduce the strength of the massage or stop imminently.</li>
		<li>Fix the needle with tape, and keep it at the acupoint. During the stagnation, press the tail of the needle with up and down floating pressure; the amplitude fluctuates at 1-2 cm, the frequency should range between 40-50 times/min, and each massage lasts 3 min. Perform two sessions per day for 2 weeks, once in the morning and once in the evening.</li>
		<li>Change the needles every 48 h.</li>
	</ol>
	</li>
	<li>Needle removal
	<ol>
		<li>After performing the seven-step hand disinfection process, remove the tape. Use tweezers to separate the base of the needle from the skin gently. When it is completely peeled off from the area, use tweezers to pull it out gently.</li>
		<li>When the operation is done, use an iodophor cotton swab to disinfect the broken skin. Use a sterile cotton swab to press and achieve hemostasis if the broken skin is bleeding.</li>
		<li>After completing the operation, perform the seven-step hand-washing method again for disinfection.</li>
	</ol>
	</li>
	<li>Management of acupuncture complications
	<ol>
		<li>If the needle is broken and the end is still inside the skin, clamp it out with tweezers.</li>
		<li>If the broken end of the needle is flat or slightly depressed within the skin, use the thumb and index finger of the left hand to squeeze the skin vertically downward so that the broken needle will be exposed outside the body, and then remove the needle with tweezers.</li>
		<li>If the broken needle is too deep, locate it under the X-ray, and remove it by surgery. 
		NOTE: For needlestick injuries or fainting during acupuncture, please see another protocol32.</li>
	</ol>
	</li>
	<li>Ironing
	<ol>
		<li>Refer to step 2.3.3 to disinfect the operation site, and make sure that the patient&#39;s urine is emptied before the operation.</li>
		<li>Operation sites include Qihai (CV29), Tianshu (ST25), and Changqiang (DU1)16,33 (see Figure 2).</li>
		<li>According to the characteristics of pain, crush the drug at a room temperature of 10-30 &#176;C and a humidity of 40%-70% for 3 min using a pulverizer at a speed of 25,000-30,000 rpm. After pulverization, pack 130 g of the drug into a gauze bag, and soak in 10-30 &#176;C water until it is fully saturated (about 60-80 s).</li>
		<li>Put the gauze bag in a microwave oven, and heat it for 2 min at 90-110 &#176;C. After the temperature drops to 40-45 &#176;C, wrap the medicated gauze bag firmly with a treatment towel.</li>
		<li>Place both hands on both sides of the top of the gauze bag, straighten both elbows, lean forward slightly, and press down slowly with the help of part of the body weight. The skin of the abdomen should sink by about 3-5 cm, and on the Changqiang acupoint, 2-3 cm is enough. Hold for 3-5 s, let the heat slowly penetrate the skin and subcutaneous tissue, and then release slowly. Repeat the procedure 60 times.</li>
		<li>Massage with the ironing medicine bag clockwise 60 times and counterclockwise 60 times. Each spiral massage lasts 1-2 s; repeat the whole procedure three times. 
		NOTE: For RN6 and ST25, the above methods can be applied with no differences. However, it is worth noting that DU1 is close to the anus, so excessive intensity of the operation may aggravate the patient&#39;s discomfort. Therefore, the operator can halve the massage time, and the temperature of the drug should be maintained at 35-40 &#176;C. In order to protect patient privacy, operations can be carried out with clothing in DU1.</li>
		<li>After the operation is completed, cover the operation part, and keep it warm. Perform the procedure twice per day, once in the morning and once in the evening, and reuse the ironing medicine bag up to four times. The treatment lasts for 2 weeks.</li>
	</ol>
	</li>
	<li>Scald management
	<ol>
		<li>For the treatment of burns, prevention is more important than operation. Strictly follow the above protocol, and do not extend the operation time or increase the operation intensity without authorization.</li>
		<li>If&#160;the burns occur that are limited below a deep partial degree burn, quickly rinse the scalded area with flowing cold water (5-15 &#176;C is preferred) for 30 min. Then, disinfect the damaged spot with iodophor swabs, cover it with gauze, and fix it with medical tape. If the damaged area is large, use antibiotic ointment. 
		NOTE: At the injury site, do not perform the treatment until the lesions have fully recovered. Puncturing of the blisters should not be done.</li>
		<li>If the scald reaches a deep partial degree, please consult with the burn department immediately.</li>
	</ol>
	</li>
</ol>

The authors have nothing to disclose.

Surgical procedures for hemorrhoids have developed rapidly. In addition to the traditional M-M surgery, procedures such as rubber band ligation (RBL), the procedure for prolapse and hemorrhoids (PPH), tissue-selecting therapy stapler (TST), hemorrhoidal artery ligation, and infrared photocoagulation have also been widely used37,38,39. However, the advantages of M-M surgery, such as the high cure rate, low price, and simple opera...

Postoperative pain is one of the most common complications in anorectal surgery. Among these conditions, pain caused by hemorrhoid surgery is particularly prevalent1. Generally speaking, postoperative pain may be caused by anxiety after surgery2, improper surgical methods3, obstruction of blood and lymph flow4, surgical wound infection, and spasm of the internal anal sphincter5. In most cases, postoperative pain is a normal physiological response, but excessive or persistent pain causes discomfort to the patients, aggravates psychological pressure, and, thus, hinders recovery6.
For mild pain, non-steroid anti-inflammatory drugs (NSAIDs), calcium channel blockers, and surface anesthetics can fulfill the treatment requirements7,8. For severe pain, morphine and tramadol seem to be an appropriate selection9. However, analgesics are associated with poor pain relief effects in anorectal surgery, and the risks of gastrointestinal bleeding or gastric ulcers caused by NSAIDs make clinicians hesitant to prescribe them10,11. Furthermore, the addictiveness of opioids can have a huge impact on the patients&#39; living standards12. Optimizing the surgical procedure to prevent postoperative pain, such as by including lateral internal anal sphincterotomy, has been criticized due to its risk of anal incontinence13.
Acupoint needle embedding is a branch of acupuncture treatment, and its analgesic effect has been recognized for a long time. Ashi acupoint has a good analgesic effect, but its practice is limited because of the anus&#39; physiological function and anatomical structure, as directly stimulating the anus only increases the pain for the patients14. In recent years, stimulation on other acupoints to release pain has been reported15,16. Wang et al.17 achieved significant pain relief effects after hemorrhoid surgery by stimulating acupoints such as Changqiang (DU1), Chengshan (BL57), and Erbai (EX-UE2) with pestle needles. A more comprehensive study found that in the sham acupuncture group, pain relief was lower at 5 h, 7 h, and 8 h after treatment than in the acupuncture stimulation group18. Meanwhile, according to several meta-analyses, stimulation of acupoints can reduce postoperative pain with a better therapeutic effect than NSAIDs19,20. In TCM theory, stimulating acupoints can reduce the anxiety state of patients. In addition, it can promote local blood circulation to accelerate the resolution of inflammation and tissue repair17. A study has reported that acupuncture can also promote the release of endogenous analgesic substances, such as enkephalins and endorphins, to block the transmission of pain signals in nerve cells21. Acupuncture treatment is not only effective in relieving postoperative pain in hemorrhoids, but it has also been reported to be effective in relieving musculoskeletal pain22, back pain23, and primary dysmenorrhea24. Summarizing the previous clinical trials, we believe that acupuncture point stimulation is effective for pain relief after hemorrhoid surgery.
Ironing therapy is one of the most widely used treatment methods throughout human history. It involves using heat to penetrate the skin and accelerate blood flow, promote tissue metabolism, and regulate sensory nerves to reduce pain25. Furthermore, heat can also relieve the contraction of the muscles26. Massage techniques can be added to this treatment to increase the effect of pain relief. A previous clinical trial demonstrated that massage on the suprapubic and sacral regions could relieve pain in the perineal region27. It works by blocking pain signals from reaching the central nervous system while increasing sympathetic nerve activity and reducing the pain caused by negative emotions28,29.
The operating procedures included in the protocol increased the safety of the operation, shortened the hospitalization days, reduced the level of postoperative pain, and decreased the incidence of urinary retention and anal edema. Acupoint needle-embedding combined with ironing treatment is a characteristic traditional Chinese medical method for postoperative pain from hemorrhoids and is recommended for healthy adults with no contraindications. It is expected to become an important complementary treatment for patients with postoperative pain.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>diclofenac sodium enteric-coated capsules</td>
			<td>Temmler Ireland Co., Ltd., Kerry, Ireland</td>
			<td>H20170098</td>
			<td></td>
		</tr>
		<tr>
			<td>fructus aurantii</td>
			<td>Traditional Chinese Medicine Co., Ltd., Sichuan, China</td>
			<td>220209</td>
			<td></td>
		</tr>
		<tr>
			<td>fructus foeniculi</td>
			<td>Traditional Chinese Medicine Co., Ltd., Sichuan, China</td>
			<td>220210</td>
			<td></td>
		</tr>
		<tr>
			<td>gauze bag</td>
			<td>Anhui Meijianan Household Products Co., Ltd, Anhui, China</td>
			<td>M921</td>
			<td></td>
		</tr>
		<tr>
			<td>hand sanitizer</td>
			<td>Suolang Medical Disinfectants Co., Ltd., Zhejiang, China</td>
			<td>200561121Q</td>
			<td></td>
		</tr>
		<tr>
			<td>iodophor cotton swabs</td>
			<td>Jiabeier Medical Technology Co., Ltd., Zhejiang, China</td>
			<td>20162140536</td>
			<td></td>
		</tr>
		<tr>
			<td>microwave oven</td>
			<td>Galanz Group Co., Ltd., Guangdong, China</td>
			<td>P70D20L-ED(W0)</td>
			<td></td>
		</tr>
		<tr>
			<td>press needle</td>
			<td>Suzhou Acupuncture Supplies Co., Ltd. Zhejiang, China</td>
			<td>20162200591</td>
			<td></td>
		</tr>
		<tr>
			<td>pulverizer</td>
			<td>Zhaofenger Industry and Trade Co., Ltd., Hunan, China</td>
			<td>J80031</td>
			<td></td>
		</tr>
		<tr>
			<td>radix paeoniae alba</td>
			<td>Guoqiang Pharmaceutical Co., Ltd., Sichuan, China</td>
			<td>220601</td>
			<td></td>
		</tr>
		<tr>
			<td>rhizoma chuanxiong</td>
			<td>Yuankang Pharmaceutical Co., Ltd., Sichuan, China</td>
			<td>220603</td>
			<td></td>
		</tr>
		<tr>
			<td>rhizoma corydalis</td>
			<td>Xinhehua Pharmaceutical Co., Ltd., Sichuan, China</td>
			<td>2206071</td>
			<td></td>
		</tr>
		<tr>
			<td>rhizoma curcumae longae</td>
			<td>Traditional Chinese Medicine Co., Ltd., Sichuan, China</td>
			<td>220216</td>
			<td></td>
		</tr>
		<tr>
			<td>sterile cotton swabs</td>
			<td>Zhongxin Sanitary Materials Co., Ltd., Sichuan, China</td>
			<td>20180021</td>
			<td></td>
		</tr>
		<tr>
			<td>sterile tweezers</td>
			<td>Weigao Grope Medical Polymer Co., Ltd., Shandong, China</td>
			<td>20182640148</td>
			<td></td>
		</tr>
		<tr>
			<td>thermometer</td>
			<td>Beierkang Medical Devices Co., Ltd., Guangdong, China</td>
			<td>20162200505</td>
			<td></td>
		</tr>
		<tr>
			<td>treatment towel</td>
			<td>Sichuan Hualikang Medical Technology Co., Ltd, Sichuan, China</td>
			<td>2111901</td>
			<td></td>
		</tr>
	</tbody>
</table>

acupoint needle-embedding combined with ironing therapy for postoperative pain after anal surgery

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is guided by traditional Chinese medicine (TCM) syndrome differentiation theory and employs acupoint stimulation and heat to alleviate pain. Although prior research has shown that these are dependable methods for pain relief, the combined effect of the two techniques has not been described. In our research, we found that compared to using diclofenac sodium enteric-coated capsules alone, adding acupoint needle-embedding combined with ironing therapy was more effective for reducing pain levels at different stages after hemorrhoid surgery. Although this technique is efficient and commonly used in clinics, due to its invasive practice, acupoint needle embedding still carries risks relating to hospital-acquired infections and broken needles. Ironing therapy, on the other hand, can result in burns and connective tissue injuries. Therefore, there is an urgent need to develop a standardized protocol for medical staff. Our protocol refines the traditional techniques and provides detailed instructions on patient preparation, operation techniques, and postoperative care to ensure the therapy is carried out safely and efficiently. By standardizing this therapy, this technique is expected to become an important complementary therapy for postoperative pain relief&#160;in hemorrhoids, which will significantly improve patients &#39;life quality after anal surgery.

Statistical analysis 
Collect and analyze the data using SPSS 22.0. In this work, normally distributed continuous variables were expressed as mean &#177; standard (SD), and comparisons between two groups were made using the Student&#39;s t-test. Continuous variables with skewed distributions were described using the median and 25% and 75% interquartile range, M (QL, QU), and comparisons between groups were performed using the Mann-Whitney U-test. Dichotomous variables were tested using the Chi-squar...

Watch this Scientific Journal Video about Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery at JoVE.com

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery

The high incidence of pain after anal surgery is due to the physiological structure and pathological status of the anus. At present, the use of painkillers cannot provide satisfactory pain relief, which makes complementary therapy important. This paper proposes acupoint needle-embedding combined with ironing therapy to relieve postoperative pain.

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is ...

acupoint-needle-embedding-combined-with-ironing-therapy-for

Research

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Medicine

1.3K Views.  Hospital of Chengdu University of Traditional Chinese Medicine. The high incidence of pain after anal surgery is due to the physiological structure and pathological status of the anus. At present, the use of painkillers cannot provide satisfactory pain relief, which makes complementary therapy important. This paper proposes acupoint needle-embedding combined with ironing therapy to relieve postoperative pain.

Video: Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery

A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration

Surgery is commonly used to improve and maintain quality of life. Unfortunately, in vulnerable patients such as the elderly, complications may occur and significantly diminish the outcome. Indeed, after routine orthopedic surgery to repair a fracture, as many as 50% of elderly patients suffer from neurologic complications like delirium. Also, the capacity to heal and regenerate tissue after surgery decreases with age, and can impact the quality of fracture repair and even osseous integration of implants. Thus, a better understanding of mechanisms that drive these age-dependent changes could provide strategic targets to minimize risk for such complications and optimize outcomes. Here, we introduce a clinically relevant mouse model of tibial fracture. The postoperative changes in these mice mimic some of the cognitive impairments commonly observed after routine orthopedic surgery in humans. Briefly, an incision is performed in the right hind limb under strictly aseptic conditions. Muscles are disassociated, and a 0.38-mm stainless steel pin is inserted into the upper crest of the tibia, inside the intramedullary canal. Osteotomy is then performed, and the wound is stapled. We have used this model to investigate the effects of surgical trauma on postoperative neuroinflammation and behavioral changes. By applying this fracture model in combination with parabiosis, a surgical model in which 2 mice are anastomosed, we have studied cells and secreted factors that systemically rejuvenate organ function and tissue regeneration after injury. By following our step-by-step protocol, these models can be reproduced with high fidelity, and can be adapted to interrogate many biologic pathways that are altered by surgical trauma.

This protocol describes a mouse model of orthopedic surgery that has been used to study mechanisms of postoperative neuroinflammation and behavioral changes, and when combined with parabiosis, to study tissue regeneration during aging.

Surgery is commonly used to improve and maintain quality of life. Unfortunately, in vulnerable patients such as the elderly, complications may occur and ...

Mechanical Micronization of Lipoaspirates for Regenerative Therapy

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of cell products using collagenase. Here, we present a protocol to generate an injectable mixture of SVF cells and native extracellular matrix from adipose tissue by a purely mechanical process. Lipoaspirates are put into a centrifuge and spun at 1,200 x g for 3 min. The middle layer is collected and separated into two layers (high-density fat at the bottom and low-density fat on the top). The upper layer is directly emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance under the oil layer is collected and defined as the extracellular matrix (ECM)/SVF-gel. The oil on the top layer is collected. Approximately 5 mL of oil is added to 15 mL of high-density fat and emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance is also ECM/SVF-gel. After the transplantation of the ECM/SVF-gel into nude mice, the graft is harvested and assessed by histologic examination. The result shows that this product has the potential to regenerate into normal adipose tissue. This procedure is a simple, effective mechanical dissociation procedure to condense the SVF cells embedded in their natural supportive ECM for regenerative purposes.

Here, we present a protocol to obtain stromal vascular fraction from adipose tissue through a series of mechanical processes, which include emulsification and multiple centrifugations.

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of ...

Structured Motor Rehabilitation After Selective Nerve Transfers

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning.
Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation.

Here, we present a protocol for the motor rehabilitation of patients with severe nerve injuries and selective nerve transfer surgery. It aims at restoring the motor function proposing several stages in patient education, early-stage therapy after surgery and interventions for rehabilitation after successful re-innervation of the nerve&#8217;s target.

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on ...

A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible

Valid comparisons of postoperative accuracy results in computer-assisted reconstruction of the mandible are difficult due to heterogeneity in imaging modalities, mandibular defect classification, and evaluation methodologies between studies. This guideline uses a step-by-step approach guiding the process of imaging, classification of mandibular defects and volume assessment of three-dimensional (3D) models, after which a legitimized quantitative accuracy evaluation method can be performed between the postoperative clinical situation and the preoperative virtual plan. The condyles and the vertical and horizontal corners of the mandible are used as bony landmarks to define virtual lines in the computer-assisted surgery (CAS) software. Between these lines the axial, coronal, and both sagittal mandibular angles are calculated on both pre- and postoperative 3D models of the (neo)mandible and subsequently the deviations are calculated. By superimposing the postoperative 3D model to the preoperative virtually planned 3D model, which is fixed to the XYZ axis, the deviation between pre- and postoperative virtually planned dental implant positions can be calculated. This protocol continues and specifies an earlier publication of this evaluation guideline.

Here, we propose a practical, feasible and reproducible evaluation guideline for computer-assisted reconstruction of the mandible in order to create uniformity between studies regarding postoperative accuracy evaluation. This protocol continues and specifies an earlier publication of this evaluation guideline.

Valid comparisons of postoperative accuracy results in computer-assisted reconstruction of the mandible are difficult due to heterogeneity in imaging ...

OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte retrieval with routine gynecological surgery. OP-IVM is suitable for patients undergoing benign gynecological surgery who have the need for fertility preservation (FP) or infertility treatments such as in vitro fertilization and embryo transfer (IVF-ET). In the operating room, patients undergoing benign gynecological surgery are first anesthetized and receive ultrasound-guided immature follicle aspiration (IMFA) treatment. As the subsequent gynecological surgery is performed, the cumulus-oocyte complexes (COCs) are examined, and the immature COCs are transferred into the IVM medium and cultured for 28-32 hours in the IVF laboratory. After assessment, mature oocytes in the MII stage will be selected and cryopreserved in liquid nitrogen for FP or fertilized by intracytoplasmic sperm injection (ICSI) for IVF-ET. By combining IVM with gynecological surgery, immature oocytes that would have been discarded can be saved and used for assisted reproductive technology (ART). The procedure, significance and critical aspects of OP-IVM are described in this article.

In vitro maturation (IVM) before gynecological operation (OP-IVM) combines IVM following oocyte retrieval with routine gynecological surgery and serves as an extension of conventional IVM applications for fertility preservation.

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte ...

Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death

Controlled donation after circulatory death (cDCD) has contributed to increasing donor numbers all over the world. Experiences published in the last years confirm that the outcomes after lung transplantation from cDCD are similar to those from brain death donors; however, the utilization of lungs from asystole donors remains low. Several reasons may be involved: different legal frameworks among countries and centers with different premortem interventions, inadequate lung donor care before procurement, or even poor experience with cDCD procedures and protocols.
Initially, the rapid recovery technique was commonly employed for the procurement of thoracic and abdominal organs in cDCD, but, in the last decade, abdominal normothermic regional perfusion (ANRP) with extracorporeal membrane oxygenation devices has become a useful method to restore blood flow to abdominal organs, allowing their quality improvement and their functional assessment prior to transplantation. This makes the donation procedure more complex and generates doubts about injury to the grafts due to dual temperature.
The aim of this article is to describe a protocol based on a single center experience with Maastricht III donors combining lung cooling rapid recovery in the thorax and abdominal normothermic regional perfusion. Tips and tricks focused on premortem interventions and lung procurement procedure techniques are explained. This may help to minimize the reluctance among professionals to use this combined technique and encourage other donor centers to use it, despite the increased complexity of the procedure.

The protocol combines a lung cooling rapid recovery technique with abdominal normothermic regional perfusion for abdominal graft procurement in controlled asystole donors, which is a safe and useful method to expand the donor pool.

Controlled donation after circulatory death (cDCD) has contributed to increasing donor numbers all over the world. Experiences published in the last years ...

Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to be maintained during laparoscopic hepatectomy, with a residual liver volume of &gt;40% in cirrhotic patients and &gt;30% in non-cirrhotic patients. The high incidence of complications such as bleeding, bile leakage, or liver failure due to the exposure and difficulty of the resection of specific liver segments such as S2 and S7 reduces the success rate of liver resection. At present, microwave ablation is mainly applied in the treatment of liver metastasis using a percutaneous approach, which makes it difficult to identify hidden parts or small lesions. For some liver segments, the percutaneous puncture of liver segment 7 (S7) is likely to pass through the thoracic cavity, and the percutaneous puncture of liver segment 2 (S2) adjacent to the diaphragm is likely to injure the diaphragm and heart; these issues restrict the application of percutaneous ablation in colorectal cancer liver metastasis. Considering multiple lesions, laparoscopic microwave ablation combined with hepatectomy was performed in this study. The location of the lesions was determined by contrast-enhanced ultrasound under laparoscopy, and small lesions that were difficult to detect before the operation were identified. For the scattered lesions, which had diameters less than 3 cm and were difficult to resect, ablation was adopted to substitute hepatectomy. This technique helped to more explicitly locate the tumors, simplified the operation procedures, reduced the risk of complications such as bleeding and bile leakage, shortened the operation time, accelerated the postoperative recovery, significantly improved the success rate of operation, and enhanced the clinical prognosis of colorectal cancer liver metastasis by surgical resection.

This protocol describes the laparoscopic resection of colorectal cancer liver metastases combined with ultrasound-guided microwave ablation. This technique can safely, effectively, and accurately treat refractory liver metastases &lt;3 cm, reduce postoperative complications, and accelerate the postoperative rehabilitation of patients.

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to ...

FSN Therapy for Knee Osteoarthritis Pain Management

Fu's Subcutaneous Needling for Knee Osteoarthritis Pain

Fu's subcutaneous needling (FSN) is a new acupuncture and dry needling technique based on traditional Chinese medicine. It rapidly produces long-lasting effects in soft tissue injuries, particularly in painful musculoskeletal conditions, by providing stimulation primarily in the subcutaneous area. Osteoarthritis (OA) is the most common joint disease in adults worldwide and is often accompanied by a painful syndrome of structural changes in the peripheral joints of the knee. However, the etiology of OA pain is not fully understood, though myofascial trigger points (MTrPs) are commonly found in the lower limb muscles (so-called "tightened muscles") of patients with knee OA. 
FSN has been used in many fields for the treatment of acute pain problems and can relieve muscle contraction from MTrPs, thereby improving the local circulation. This study recruited patients with pain from knee OA into an FSN group or a transcutaneous electrical nerve stimulation (TENS) group with three treatment sessions and a follow-up over the course of 2 weeks. The results showed that FSN was effective in treating soft tissue pain around the knee with OA. This study aimed to establish and visualize three key technical indicators during FSN therapy, including the FSN needle insertion point and layer; the frequency and duration of the swaying movement; and the manipulation of the reperfusion approach. These findings have great potential for future applications in myofascial pain treatment, especially for pain management. Following this protocol could enhance FSN skills.

Author Spotlight: Fu's Subcutaneous Needling for Knee Osteoarthritis Pain  

We present a protocol for using Fu's subcutaneous needling for knee osteoarthritis pain, which combines swaying movement and reperfusion approach techniques. This protocol has great potential for future applications in myofascial pain treatment and could enhance Fu's subcutaneous needling (FSN) manipulation skills.

Fu's subcutaneous needling (FSN) is a new acupuncture and dry needling technique based on traditional Chinese medicine. It rapidly produces long-lasting ...

Acupoint Application Combined with Acupoint Massage for Treating Constipation in a Patient with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease in elderly patients, with a tendency for progressive exacerbation. Constipation that reduces the quality of life and triggers the risk of diseases is a common concomitant symptom in patients with COPD. Currently, western medical treatment does not achieve the desired results for patients. A high recurrence rate accompanies it, whereas traditional Chinese medicine (TCM) has a long history and rich experience in treating chronic diseases. Both acupoint application and acupoint massage are characteristic therapies of TCM, with minor side effects, high safety, simple operation, and outstanding advantages. They are effective in treating constipation for patients with COPD and are considered an ideal alternative therapy for patients with chronic constipation. The purpose of this article is to introduce the method of acupoint application combined with acupoint massage for the treatment of constipation in patients with COPD, including the selection of points, items, treatment time, and operation procedure.

Here we demonstrate acupoint application combined with acupoint massage for treating constipation in a patient with chronic obstructive pulmonary disease (COPD).

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease in elderly patients, with a tendency for progressive exacerbation. ...

Acupuncture Stimulation of Ears to Alleviate Sleeping Disorders in COPD Patients

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic respiratory symptoms. It has a wide spectrum of complications, and sleep disorders, as part of it, are common in severe cases, especially in elderly patients. Long-term lack of sleep may lead to the aggravation of the original disease, reducing patients' quality of life. Benzodiazepines are mainly used for symptomatic treatment of COPD combined with sleep disorders. However, such drugs have the side effect of respiratory central inhibition and could probably aggravate hypoxia symptoms. Auricular acupuncture is a special method of treating physical and psychosomatic dysfunctions by stimulating specific points in the ear. This article explains the specific methods of clinical operation of auricular acupuncture in detail, including assessment of patient eligibility, medical devices used, acupuncture points, course of treatment, post-treatment care, responses to emergencies, etc. The Pittsburgh sleep quality index (PSQI) and chronic obstructive pulmonary disease assessment scale (CAT) were used as the observational index of this method. So far, clinical reports have proved that auricular acupuncture has a definite curative effect in the treatment of COPD combined with sleep disorders, and its advantages of simple operation, few adverse reactions are worthy of further study and promotion, which provide a reference for the clinical treatment of such diseases.

Author Spotlight: Utilizing Traditional Chinese Acupuncture of the Ear to Improve Sleep Disorders 

This protocol introduces an effective method to improve the sleep condition of patients with chronic obstructive pulmonary disease and alleviate cough symptoms by using auricular acupuncture techniques to percutaneously stimulate specific acupoints in the patients' ears.