This study was funded by a grant from the Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine.

All procedures of this study were conducted by clinical trial registration and were approved by the ethical institution of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Filing No. 2022SL-015). All patients in this study were fully provided with informed consent and consented to the investigators&#39; use of data, images, and related video filming during the trial. Eligible patients were recruited (from January 2023 to April 2023) through leaflets, word communication, and doctors&#39; recommendation in the inpatient department of the Hospital of Chengdu University of Traditional Chinese Medicine.
1. Patient selection
<ol>
	<li>Inclusion criteria
	<ol>
		<li>Confirm intrauterine pregnancy. Identify early pregnancy vomiting as the main complaint, referring to the Guidelines for the Diagnosis and Management of NVP published by the American College of Physicians in 201810, and ensure that the participants meet the diagnostic criteria for clinical NVP.</li>
		<li>Verify that participants are not currently participating in other clinical trials.</li>
	</ol>
	</li>
	<li>Exclusion criteria
	<ol>
		<li>Exclude individuals with other pathological conditions causing NVP, such as hyperemesis gravidarum, pregnancy-associated viral hepatitis, or pregnancy-associated acute gastroenteritis.</li>
		<li>Exclude participants who refuse treatment with ear plaster therapy.</li>
		<li>Exclude individuals with severe NVP or allergies to the medication or its excipients and participants with auricular injuries.</li>
		<li>Exclude those who have been treated for NVP within the last 2 weeks.</li>
	</ol>
	</li>
	<li>Disposal of dropout cases
	<ol>
		<li>Withdraw participants from the trial if they are unable to sustain adherence to the treatment. Allow participants to voluntarily withdraw from the study if they choose to do so.</li>
	</ol>
	</li>
	<li>Criteria for termination of the trial
	<ol>
		<li>Terminate the participants who develop serious complications or experience disease progression during the study. Cease the trial if participants develop serious adverse reactions.</li>
	</ol>
	</li>
</ol>
2. Patient grouping and treatment plan
<ol>
	<li>Recruit twenty patients and randomly assign them to either the experimental group or the control group.</li>
	<li>Provide the control group with a controlled diet and administer conventional treatment, including rehydration and vitamin supplementation (see Results section for details).</li>
	<li>For the experimental group, administer ear plaster therapy in addition to conventional treatment.</li>
	<li>Ensure that the rest management for both groups remains the same until the patients are discharged from the hospital.</li>
</ol>
3. Preparation for ear plaster therapy procedure
<ol>
	<li>Gather the necessary items (Figure 1): scissors, sterile cotton swabs, tweezers, medical tape, 75% alcohol, and cowherb seeds (see Table of Materials).</li>
	<li>Preparation of the ear plaster
	<ol>
		<li>Cut the adhesive tape into square pieces measuring 0.6 cm x 0.6 cm.</li>
		<li>Take 1 or 2 smooth cowherb seeds (seeds of B. Wang, obtained from a pharmaceutical company, see Table of Materials) and place them at the center of each tape square, as shown in Figure 2.</li>
	</ol>
	</li>
	<li>Patient preparation
	<ol>
		<li>Instruct the patient to sit in a comfortable position.</li>
		<li>Inspect the condition of the skin on the ear. 
		NOTE: Ensure that the skin of the ear is intact and free from any abnormalities (e.g., inflammation, ulceration, frostbite, etc.) before proceeding with the treatment. Ear plaster therapy should not be performed on areas with auricular trauma or inflammation. It should only be carried out after these abnormalities have subsided and the trauma has healed. If the patient is allergic to adhesive tape, use alternative materials.</li>
	</ol>
	</li>
	<li>Selection of acupoints
	<ol>
		<li>Locate points/sensitive areas on the ear. Stabilize the ear auricle by using the thumb and index finger of one hand to pinch and lift the ear helix backwards and upwards, fully exposing the area.</li>
		<li>With the sterile swab in the other hand, gently probe the patient&#39;s ear to identify sensitive pressure points near the six auricular points of the stomach (CO4), cardia (CO3), belly (AH8), shenmen (TF4), subcortex (AT4), and liver (CO12) (Figure 3). 
		NOTE: Sensitive points refer to areas where there is significant soreness, numbness, swelling, or pain compared to other areas when applying pressure. These sensitive points have demonstrated better therapeutic effects compared to other common auricular points7. Based on previous clinical studies, the six auricular points (CO4, CO3, AH8, TF4, AT4, and CO12) are commonly used in the treatment of NVP and have prominent antiemetic and calming effects11,12,13. If sensitive points on the ear are not detected, the six mentioned points can be selected for the subsequent treatment round.</li>
	</ol>
	</li>
	<li>Disinfection
	<ol>
		<li>Disinfect the hands of the operator using an alcohol-soaked cotton ball.</li>
		<li>Disinfect the patient&#39;s auricle using a sterile cotton swab dipped in 75% alcohol. 
		&#8203;NOTE: The disinfection area should cover approximately 1-2 cm&#178; of the auricular skin surrounding the target point. Alcohol helps remove oil from the skin surface, ensuring better adhesive properties of the tape. If the patient is allergic to alcohol, iodophor can be used as an alternative.</li>
	</ol>
	</li>
</ol>
4. Ear plaster therapy
<ol>
	<li>Once the area is dry, stabilize the auricle by pinching the ear helix with the thumb and index finger of one hand, lifting it backward and upward.</li>
	<li>Using forceps, take the prepared ear plaster (step 3.2) and place the central seeds of the cowherb onto the selected point, as shown in Figure 4. Confirm with the patient that the seed placement corresponds to a sensitive point or sore area.</li>
	<li>Position the thumb and index finger in front of and behind the auricle, applying moderate and tolerable pressure with a rhythmic pressing and relaxing motion to stimulate the cowherb seeds at the auricular site. Press and release for 3-5 min at each site, maintaining an even rhythm. 
	NOTE: Adjust the intensity of pressure based on communication with the patient, ensuring that soreness, numbness, swelling, and pain are felt without excessive force.</li>
	<li>Monitor the patient&#39;s overall condition for 15 min following the treatment. 
	NOTE: In case of panic, chest distress, dizziness, or profuse sweating, promptly remove the adhesive tape.</li>
	<li>Instruct the patient or their family to rub the seeds three times a day: morning, midday, and evening. 
	NOTE: Emphasize the need for additional stimulation of the seeds when the patient experiences nausea.</li>
	<li>Remove the ear plaster after three days and repeat the above steps on the opposite ear, alternating treatment between the two ears. 
	&#8203;NOTE: Continue treatment until the patient meets the discharge criteria: PUQE score &#8804;4 and urinary ketone bodies turn negative. If the ear plaster becomes dislodged, reapply it.</li>
</ol>
5. Patient diagnosis
<ol>
	<li>Starting from the first day of hospitalization, collect fresh urine every 2 days to measure and record urinary ketone levels. Note the duration from the start of treatment to the time when the urinary ketone levels turn negative. 
	NOTE: Urinary ketone levels serve as an important indicator for assessing patients with NVP. A positive urine ketone level indicates ongoing starvation and dehydration14,15. Ensure timely testing of urine samples to prevent low values caused by ketone body evaporation.</li>
	<li>Instruct patients to complete the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale (see Table 1) on a daily basis. Record the scores based on their actual symptoms each day until the day of discharge. 
	&#8203;NOTE: The PUQE scale is widely used in various practice guidelines globally to measure the severity of NVP symptoms in patients16. A higher PUQE score indicates a more severe condition.</li>
</ol>
6. Post-operative care
<ol>
	<li>Advise the patient to keep the ear clean and dry. 
	NOTE: The placement of the seed patch does not interfere with daily activities such as washing and bathing.</li>
	<li>Provide reassurance and support to alleviate the patient&#39;s nervousness and fear.</li>
	<li>Instruct the patient to perform swallowing movements or take deep breaths when experiencing feelings of nausea and vomiting.</li>
	<li>If the patient experiences local allergic reactions such as itching, redness, or exudation on the skin during treatment, immediately remove the adhesive tape and apply anti-allergy ointment topically to alleviate these symptoms.</li>
	<li>If an infection occurs, manage it as a common infection. Use topical antibiotics (appropriate for pregnant women) or anti-inflammatory and analgesic ointments for treatment.</li>
	<li>Monitor the frequency and amount of vomiting, assess for signs of dehydration, and regularly measure urinary ketone levels. 
	NOTE: In cases where conditions affecting fetal development and maternal safety are present and cannot be effectively addressed, consider termination of the pregnancy.</li>
</ol>

Managing Gestational Vomiting with Ear Plaster Therapy

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C., 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=Promethazine+compared+with+metoclopramide+for+hyperemesis+gravidarum:+A+randomized+controlled+trial.">Promethazine compared with metoclopramide for hyperemesis gravidarum: A randomized controlled trial.</a> Obstetrics &amp; Gynecology. 115, 975-981 (2010).</li><li>Liu, H. Z., Liu, Q. F., Wang, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interventional+nursing+of+ear+acupoint+application+for+severe+vomiting+in+early+pregnancy+patients.">Interventional nursing of ear acupoint application for severe vomiting in early pregnancy patients.</a> Journal of Practical Clinical Medicine. 21 (10), 184-185 (2017).</li><li>Liu, C. F., Wei, S. B., Liu, S. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+application+of+ear+point+pressing+in+gynecological+clinical+practice.">The application of ear point pressing in gynecological clinical practice.</a> Journal of Changchun University of Traditional Chinese Medicine. 29 (01), 183-185 .</li><li>Zheng, S. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+analysis+of+the+exploration+pattern+of+A-Yi+acupoint+based+on+phenotypic+diversity+and+localization+uncertainty[J].">An analysis of the exploration pattern of A-Yi acupoint based on phenotypic diversity and localization uncertainty[J].</a> Journal of Traditional Chinese Medicine. 63 (11), 1026-1031 (2022).</li><li>Wu, X. H., Hu, L. S., Chen, X. Y., Wu, S. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+auricular+point+sticking+therapy+on+motilin+level+in+patients+with+hyperemesis+gravidarum.">The effect of auricular point sticking therapy on motilin level in patients with hyperemesis gravidarum.</a> Research on Integrated Traditional and Western Medicine. 7 (02), 57-59 (2015).</li><li>Ma, M. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychological+Nursing+of+Hyperemesis+gravidarum.">Psychological Nursing of Hyperemesis gravidarum.</a> World's Latest Medical Information Abstract. 7 (02), 57-59 (2015).</li><li>Committee on Practice Bulletins-Obstetrics. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ACOG+Practice+Bulletin+No.189:nausea+and+vomiting+of+pregnancy.">ACOG Practice Bulletin No.189:nausea and vomiting of pregnancy.</a> Obstetrics &amp; Gynecology. 131 (1), e15-e30 (2018).</li><li>Tan, J. Y., Molassiotis, A., Suen, L. K. P., Liu, J., Wang, T., Huang, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+auricular+acupressure+on+chemotherapy-induced+nausea+and+vomiting+in+breast+cancer+patients:+a+preliminary+randomized+controlled+trial.">Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial.</a> BMC Complementary Medicine and Therapies. 22 (1), 87 (2022).</li><li>Wu, S. S., Gao, X., Shi, Z. X. <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+pressured+beans+on+vomiting+and+sleep+in+lung+cancer+patients+undergoing+chemotherapy.">Effect of pressured beans on vomiting and sleep in lung cancer patients undergoing chemotherapy.</a> World Latest Medicine Information. 18 (24), 154-155 (2018).</li><li>Eghbali, M., Yekaninejad, M. S., Varaei, S., Jalalinia, S. F., Samimi, M. A., Sa'Atchi, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+auricular+acupressure+on+nausea+and+vomiting+caused+by+chemotherapy+among+breast+cancer+patients.+Complementary+Therapies+in+Clinical+Practice.">The effect of auricular acupressure on nausea and vomiting caused by chemotherapy among breast cancer patients. Complementary Therapies in Clinical Practice.</a> Complementary Therapies in Clinical Practice. 24, 189-194 (2016).</li><li>Morali, G. A., Braverman, D. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Abnormal+liver+enzymes+and+ketonuria+in+hyperemesis+gravidarum.+A+retrospective+review+of+80+patients.">Abnormal liver enzymes and ketonuria in hyperemesis gravidarum. A retrospective review of 80 patients.</a> Journal of Clinical Gastroenterology. 12 (3), 303-305 (1990).</li><li>Quinlan, J. D., Hill, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nausea+and+vomiting+of+pregnancy.">Nausea and vomiting of pregnancy.</a> American Family Physician. 68 (1), 121-128 (2003).</li><li>Koren, G., Cohen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+the+severity+of+nausea+and+vomiting+of+pregnancy;+a+20-year+perspective+on+the+use+of+the+pregnancy-unique+quantification+of+emesis+(PUQE).">Measuring the severity of nausea and vomiting of pregnancy; a 20-year perspective on the use of the pregnancy-unique quantification of emesis (PUQE).</a> Journal of Obstetrics and Gynaecology. 41 (3), 335-339 (2021).</li><li>Cowan, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hyperemesis+gravidarum:+implications+for+home+care+and+infusion+therapies.">Hyperemesis gravidarum: implications for home care and infusion therapies.</a> Journal of Intravenous Nursing. 19 (1), 46-58 (1996).</li><li>American College of Obstetricians and Gynecologists: Practice Bulletin No. 153: nausea and vomiting of pregnancy. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Obstetrics &amp; Gynecology. 126, e12-e24 (2015).</li><li>Li, Z. X., Zhou, R. S., Cao, Z. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Observation+on+the+therapeutic+effect+of+acupoint+application+combined+with+magnesium+aluminate+carbonate+and+fluid+replacement+on+hyperemesis+gravidarum.">Observation on the therapeutic effect of acupoint application combined with magnesium aluminate carbonate and fluid replacement on hyperemesis gravidarum.</a> Journal of Anhui University of Traditional Chinese Medicine. 42 (01), 59-63 (2023).</li><li>Giugale, L. E., Young, O. M., Sreltman, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ltrogenic+Wernicke+ecepalpatly+in+a+patient+with+severe+hyperemesis+gravidarum.">ltrogenic Wernicke ecepalpatly in a patient with severe hyperemesis gravidarum.</a> Obstetrics &amp; Gynecology. 125, 1150-1152 (2015).</li><li>General Administration of Quality Supervision, Inspection and Quarantine of the People's Republic of China, National Standardization Administration of China. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> National Standard of the People's Republic of China (GB/T 13734 2008): Ear acupoint names and positioning [S]. , (2008).</li><li>Braude, D., Crandall, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ondansetron+versus+promethazine+to+treat+acute+undifferentiated+nausea+in+the+emergency+department:+a+randomized,+double-blind,+noninferiority+trial.">Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: a randomized, double-blind, noninferiority trial.</a> Academic Emergency Medicine. 15, 209-215 (2008).</li><li>Deruelle, P., 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=Expert+consensus+from+the+College+of+French+Gynecologists+and+Obstetricians:+Management+of+nausea+and+vomiting+of+pregnancy+and+hyperemesis+gravidarum.">Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum.</a> French College of Obstetricians and Gynecologists. S2468-7189 (22), 00261-002666 (2022).</li></ol>

The authors declare that they have no conflict of interest.

Nausea and vomiting in pregnancy (NVP) is a common condition that can pose risks to the health of pregnant women, even leading to complications despite terminating pregnancies. Clinical drugs often used for antiemetic/antinauseant effects, such as ondansetron and promethazine, carry potential risks for pregnant women, including dystonia, sedation, and lowered seizure thresholds22. Consequently, pharmacological treatments come with their own set of dangers. On the other hand, the symptom-centered t...

Nausea and vomiting during pregnancy (NVP) are common, affecting approximately 50%-80% of pregnant women to varying degrees1. When NVP progresses to moderate or severe levels, it increases the risk of adverse pregnancy outcomes for both the mother and the fetus. Therefore, early intervention for NVP may be beneficial in preventing the development of hyperemesis gravidarum2. The exact cause of NVP is not well understood in modern biomedicine, but it is believed to be associated with factors such as changes in the serum level of human chorionic gonadotropin during pregnancy and deficiencies of certain vitamins3. Current treatments for NVP include fasting, fluid infusion, and correction of electrolyte imbalances, but none of these approaches are considered reliable4. Consequently, finding an effective treatment that does not impact the development of the embryo or fetus is a significant clinical challenge.
Ear plaster therapy is a traditional Chinese medicine treatment method that involves the use of small, rounded objects, typically the seeds of cowherb, to stimulate specific points on the ear for disease prevention and treatment5. The dried and mature seeds of Vaccaria hispanica, also known as cowherb, are used in this therapy as they are believed to regulate blood and channels, enhance blood circulation, and promote lactation. The auricle (outer part of the ear) is rich in nerves, containing numerous acupuncture and sensitive points6. By stimulating these points, the soft tissues of the ear may produce localized aseptic inflammation, which in turn may regulate the neuroendocrine system, including the pituitary-adrenal cortex and sympathetic-adrenal cortical glands. Additionally, this therapy can potentially invigorate the body's non-specific immune response, leading to therapeutic effects7. Ear plaster therapy effectively treats NVP by targeting specific points on the ear that primarily regulate autonomic dysfunction, reduce gastrointestinal responses, and alleviate the sensation of vomiting. It can also increase the level of Motilin, a hormone that promotes intestinal motility8, and restore the appetite of pregnant women. Moreover, some previous studies suggest that ear plaster therapy may have a favorable impact on NVP-related mood disturbances9, as it exhibits similar actions to sedatives in relieving anxiety.
Ear plaster therapy is a simple and easily administered treatment method. It can be used in conjunction with conventional treatments to alleviate the symptoms of NVP while minimizing the potential risks associated with medication use for both the mother and the fetus. This protocol provides detailed instructions on how to perform this therapy and what to consider during the process. We hope ear plaster therapy will receive increased attention and be promoted and utilized in clinical practice.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Alcohol cotton ball</td>
			<td>Yangzhou Longhu Medical Instrument Co., Ltd</td>
			<td>20172142183</td>
			<td></td>
		</tr>
		<tr>
			<td>Cowherb seeds</td>
			<td>Anhui Kangyunnuo Biotechnology Co., Ltd</td>
			<td>SC10334161107893</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable tweezers</td>
			<td>Yangzhou Guilong Medical Instrument Co., Ltd</td>
			<td>20182010440</td>
			<td></td>
		</tr>
		<tr>
			<td>Glucose Injection</td>
			<td>Jichuan Pharmaceutical Group Co., Ltd</td>
			<td>H32024826</td>
			<td></td>
		</tr>
		<tr>
			<td>Omnifilm</td>
			<td>Paul Hartmann AG</td>
			<td>20210605</td>
			<td></td>
		</tr>
		<tr>
			<td>Potassium Aspartate and Magnesium Aspartate Injection</td>
			<td>Hangzhou Minsheng Pharmaceutical Co., Ltd</td>
			<td>H33020038</td>
			<td></td>
		</tr>
		<tr>
			<td>Potassium Chloride Injection</td>
			<td>Shandong Qidu Pharmaceutical Co., Ltd</td>
			<td>H20153283</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissor</td>
			<td>BERNAL DENTAS</td>
			<td>20190961</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Chloride Injection</td>
			<td>Chenxin Pharmaceutical Co., Ltd</td>
			<td>H20056758</td>
			<td></td>
		</tr>
		<tr>
			<td>Swab</td>
			<td>Bicon,LLC</td>
			<td>20151479</td>
			<td></td>
		</tr>
		<tr>
			<td>Vitamin B1 Injection</td>
			<td>Chengdu Beite Pharmaceutical Co., Ltd</td>
			<td>H32021525</td>
			<td></td>
		</tr>
		<tr>
			<td>Vitamin B6 Tablets</td>
			<td>Gansu Chengji Biopharmaceutical Co., Ltd</td>
			<td>H62020314</td>
			<td></td>
		</tr>
		<tr>
			<td>Vitamin C Tablets</td>
			<td>Xinxiang Changle Pharmaceutical Co., Ltd</td>
			<td>H41021516</td>
			<td></td>
		</tr>
	</tbody>
</table>

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.

All twenty participants in this clinical study successfully completed the trial. Four patients met the discharge criteria and were discharged on day 5, while the remaining 16 patients met the discharge criteria and were discharged within 2 weeks of hospitalization.
During the trial, the control group received a controlled diet and intravenous drips, which included the following components: vitamin C 2g + 0.9% sodium chloride injection 500 mL, vitamin B6 0.2 g + 0.9% sodium chloride injection 5...

Watch this Scientific Journal Video about Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture at JoVE.com

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.

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 ...

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Drugs for Nausea and Vomiting

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1.2K Views.  Hospital of Chengdu University of Traditional Chinese Medicine. The presented protocol describes a traditional Chinese medicine treatment procedure known for its safety and effectiveness in managing gestational vomiting.

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

Human Neuroendocrine Tumor Cell Lines as a Three-Dimensional Model for the Study of Human Neuroendocrine Tumor Therapy

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human malignancies.1 Other than surgery for the minority of patients who present with localized disease, there is little or no survival benefit of systemic therapy. Therefore, there is a great need to better understand the biology of NETs, and in particular define new therapeutic targets for patients with nonresectable or metastatic neuroendocrine tumors. 3D cell culture is becoming a popular method for drug screening due to its relevance in modeling the in vivo tumor tissue organization and microenvironment.2,3 The 3D multicellular spheroids could provide valuable information in a more timely and less expensive manner than directly proceeding from 2D cell culture experiments to animal (murine) models.
To facilitate the discovery of new therapeutics for NET patients, we have developed an in vitro 3D multicellular spheroids model using the human NET cell lines. The NET cells are plated in a non-adhesive agarose-coated 24-well plate and incubated under physiological conditions (5% CO2, 37 &deg;C) with a very slow agitation for 16-24 hr after plating. The cells form multicellular spheroids starting on the 3rd or 4th day. The spheroids become more spherical by the 6th day, at which point the drug treatments are initiated. The efficacy of the drug treatments on the NET spheroids is monitored based on the morphology, shape and size of the spheroids with a phase-contrast light microscope. The size of the spheroids is estimated automatically using a custom-developed MATLAB program based on an active contour algorithm. Further, we demonstrate a simple method to process the HistoGel embedding on these 3D spheroids, allowing the use of standard histological and immunohistochemical techniques. 
This is the first report on generating 3D spheroids using NET cell lines to examine the effect of therapeutic drugs. We have also performed histology on these 3D spheroids, and displayed an example of a single drug's effect on growth and proliferation of the NET spheroids. Our results support that the NET spheroids are valuable for further studies of NET biology and drug development.

We present a simple agarose overlay platform to grow 3D multicellular spheroids using neuroendocrine cancer cell lines. This method provides a very convenient way to examine the effect of therapeutic drugs on the neuroendocrine tumor cells. It could also help us establish human neuroendocrine tumor spheroids for cancer therapy.

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human ...

Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071 and resulted in the hospitalization of 1.1 million patients2. With an average length of in-patient hospital stay of five days2, pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 20053. Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence4. (Figure 1)

Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients&#8217; length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone5. The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians6. When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems7,8, 9, 10.

The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and lymphatic systems. Specifically, we will discuss and demonstrate four routine techniques that address autonomics, lymph drainage, and rib cage mobility: 1) Rib Raising, 2) Thoracic Pump, 3) Doming of the Thoracic Diaphragm, and 4) Muscle Energy for Rib 1.5,11

Pneumonia is one of the top ten leading causes of death in the U.S. Osteopathic manipulative techniques (OMT) may be utilized as an adjunctive therapy in the treatment of pneumonia to enhance biomechanical and immune function; and ultimately, to reduce hospital stay, duration of antibiotics, incidence of respiratory failure, and mortality. In this video-article, we will review randomized controlled studies on the use of OMT in pneumonia patients, as well as demonstrate specific hands-on techniques that are routinely practiced by osteopathic physicians when treating pulmonary infections.

Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071 and resulted in ...

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 ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-rTMS work should include sham-controlled studies to confirm its clinical efficacy in MDD.

Here we outline the procedure for MRI-guided repetitive transcranial magnetic stimulation to the dorsomedial prefrontal cortex as an experimental treatment for major depressive disorder.

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial ...

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes.
The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.

The aim of this article is to describe the methodology of exclusively endoscopic cadaveric middle ear dissection. Moreover, we aim to provide a comprehensive guide to endoscopic middle ear anatomy.

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal ...

External Cephalic Version: Is it an Effective and Safe Procedure?

External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the methodology of this procedure. The main objective is to show how to perform ECV with a specific protocol with tocolysis before the procedure and analgesia. Moreover, we describe and analyze the factors associated with successful ECV, and also compare to deliveries in the general pregnant population.
A retrospective and descriptive analysis of ECV carried out at the Hospital Clinico Universitario Virgen de la Arrixaca in Murcia (Spain) between 1/1/2014 and 12/31/2018 was assessed. The latest data available of labor deliveries in the local center, which is the biggest maternity department in Spain, were from 2018.
320 patients were recruited and 3 pregnant women were lost during the study. ECV was carried out at 37&#177;3 weeks gestation. ECV was successful in 82.5% (N=264). 19 complications were reported (5.9%): 8 vaginal bleeding (2.5%), 9 fetal bradycardia (2.8%), 1 preterm rupture of membranes (0.3%) and 1 cord prolapse (0.3%). A previous vaginal delivery increases the success rate of ECV ORadjusted=3.03 (1.62-5.68). Maternal Body Mass Index (BMI) affects the success of ECV ORadjusted=0.94 (0.89-0.99). Patients with BMI&#62;40 kg/m2 have an ORadjusted=0.09 (0.009-0.89) compared with those with BMI &#60;25 kg/m2. If ECV was successful, the cesarean delivery index is 22.2% (17.5-27.6%), the eutocic delivery index is 52.1% (46.1-58.1%) and the instrumented vaginal delivery index is 25.7% (20.7-31.2%). There are no differences in cesarean and eutocic delivery indexes after successful ECV. However, a successful ECV is associated with a 6.29% increase in the instrumented delivery rate (OR=1.63).
ECV is an effective procedure to reduce the number of cesarean sections for breech presentations. Maternal BMI and previous vaginal delivery are associated with ECV success. Successful ECV does not modify the usual delivery pattern.

This article shows how to perform the external cephalic version (ECV) by two experienced obstetricians in the obstetric operating room in the presence of an anesthesiologist and a midwife. The ECV is carried out with analgesia and tocolysis. Two attempts are made under ultrasonography control.

External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the ...

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.

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.

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

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway or high ventilation pressures. Endotracheal intubation is a challenging skill,&#160;requiring a minimum number of successful endotracheal intubations to achieve a high success rate under optimal conditions, which is often unachievable for non-anaesthesiology researchers. Due to the specific porcine airway anatomy, a difficult airway can usually be assumed. The impossibility of establishing a secure airway can result in injury, adverse events, or death of the laboratory animal. Using a prospective, randomized, controlled evaluation approach, it has been shown that fiberoptic-assisted endotracheal intubation takes longer but has a higher first-pass success rate than conventional intubation without causing clinically relevant drops in oxygen saturation. This model presents a standardized regimen for endoscopically guided endotracheal intubation, providing a secured airway, especially for researchers who are inexperienced in the technique of endotracheal intubation via direct laryngoscopy. This procedure is expected to minimize animal suffering and unnecessary animal losses.

The use of pigs in research has increased in recent years. Nevertheless, pigs are characterized by difficult airway anatomy. By demonstrating how to perform endoscopically guided endotracheal intubation, the present protocol aims to further increase laboratory animals' safety to avoid animal suffering and unnecessary death.

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...