Name: ear plaster therapy as a safe and effective treatment for gestational vomiting
Uploaded: 2023-08-04T14:00:00.000+00:00
Duration: 5 min 33 s
Description: Watch this Scientific Journal Video about Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture at JoVE.com

这项研究由成都中医药大学附属妇科资助。

本研究所有程序均通过临床试验注册进行，并经成都中医药大学附属医院伦理机构批准（备案号：2022SL-015）。本研究中的所有患者都获得了充分的知情同意，并同意研究人员在试验期间使用数据、图像和相关视频拍摄。2023年1月至2023年4月，在成都中医药大学医院住院部通过传单、文字交流、医生推荐等方式招募符合条件的患者。
1. 患者选择
<ol><li>纳入标准<ol><li>确认宫内妊娠。参考美国内科医师学会 2018年 10 月发布的《NVP 诊断和管理指南》，确定早孕呕吐为主要主诉，并确保参与者符合临床 NVP 的诊断标准。</li>
		<li>确认参与者目前没有参加其他临床试验。</li>
	</ol></li>
	<li>排除标准<ol><li>排除患有引起 NVP 的其他病理状况的个体，例如妊娠剧吐、妊娠相关性病毒性肝炎或妊娠相关性急性胃肠炎。</li>
		<li>排除拒绝接受耳膏治疗的参与者。</li>
		<li>排除患有严重 NVP 或对药物或其赋形剂过敏的个体以及耳廓损伤的参与者。</li>
		<li>排除在过去 2 周内接受过 NVP 治疗的患者。</li>
	</ol></li>
	<li>辍学个案的处理<ol><li>如果参与者无法维持对治疗的依从性，则退出试验。如果参与者选择退出研究，允许他们自愿退出研究。</li>
	</ol></li>
	<li>终止试验的标准<ol><li>终止在研究期间出现严重并发症或出现疾病进展的参与者。如果参与者出现严重的不良反应，则停止试验。</li>
	</ol></li>
</ol>2. 患者分组和治疗方案
<ol><li>招募20名患者，并将他们随机分配到实验组或对照组。</li>
	<li>为对照组提供控制饮食并进行常规治疗，包括补液和补充维生素（详见结果部分）。</li>
	<li>对于实验组，除常规治疗外，还进行耳膏治疗。</li>
	<li>确保两组的休息管理保持不变，直到患者出院。</li>
</ol>3. 耳膏治疗程序的准备
<ol><li>收集必要的物品（图1）：剪刀，无菌棉签，镊子，医用胶带，75%酒精和牛草种子（见 材料表）。</li>
	<li>耳膏的准备<ol><li>将胶带切成 0.6 厘米 x 0.6 厘米的正方形。</li>
		<li>取 1 或 2 颗光滑的牛草种子（B. Wang 的种子，从制药公司获得，见 材料表），并将它们放在每个胶带正方形的中心，如图 2 所示。</li>
	</ol></li>
	<li>患者准备<ol><li>指导患者以舒适的姿势坐下。</li>
		<li>检查耳朵皮肤的状况。 注意： 在进行治疗之前，请确保耳朵皮肤完好无损且没有任何异常（例如炎症、溃疡、冻伤等）。不应在耳廓创伤或炎症区域进行耳膏治疗。只有在这些异常消退且创伤愈合后才能进行。如果患者对胶带过敏，请使用替代材料。</li>
	</ol></li>
	<li>穴位的选择<ol><li>定位耳朵上的穴位/敏感区域。用一只手的拇指和食指向上捏住和抬起耳螺旋，使该区域完全暴露，从而稳定耳廓。</li>
		<li>另一只手拿着无菌拭子，轻轻探查患者的耳朵，以确定胃（CO4）、贲门（CO3）、腹部（AH8）、神门（TF4）、皮层下（AT4）和肝脏（CO12）六个耳廓点附近的敏感压力点（图3）。 注意： 敏感点是指在施加压力时与其他区域相比有明显酸痛、麻木、肿胀或疼痛的区域。与其他常见的耳穴相比，这些敏感穴位显示出更好的治疗效果7。根据先前的临床研究，六个耳穴点（CO4、CO3、AH8、TF4、AT4 和 CO12）通常用于治疗 NVP，并具有突出的止吐和镇静作用11,12,13。如果未检测到耳朵上的敏感点，则可以选择上述六个点进行后续治疗。</li>
	</ol></li>
	<li>消毒<ol><li>使用浸有酒精的棉球对操作员的手进行消毒。</li>
		<li>使用蘸有 75% 酒精的无菌棉签对患者的耳廓进行消毒。 注意： 消毒区域应覆盖目标点周围约 1-2 平方厘米的耳廓皮肤。酒精有助于去除皮肤表面的油脂，确保胶带具有更好的粘合性能。如果患者对酒精过敏，可以使用碘伏作为替代药物。</li>
	</ol></li>
</ol>4. 耳膏治疗
<ol><li>一旦该区域干燥，用一只手的拇指和食指捏住耳螺旋，将其向后和向上抬起，以稳定耳廓。</li>
	<li>使用镊子，取出准备好的耳膏（步骤3.2），将牛草的中心种子放在选定的点上， 如图4所示。与患者确认种子放置对应于敏感点或疼痛区域。</li>
	<li>将拇指和食指放在耳廓的前后，以有节奏的按压和放松运动施加适度且可忍受的压力，以刺激耳廓部位的牛草种子。在每个部位按下并松开3-5分钟，保持均匀的节奏。 注意： 根据与患者的沟通调整压力强度，确保在不过度用力的情况下感觉到酸痛、麻木、肿胀和疼痛。</li>
	<li>治疗后监测患者的整体状况 15 分钟。 注意： 如果出现恐慌、胸部不适、头晕或大量出汗，请立即撕下胶带。</li>
	<li>指导患者或其家属每天揉搓种子三次：早上、中午和晚上。 注意：强调当患者感到恶心时需要对种子进行额外刺激。</li>
	<li>三天后取下耳膏，在对侧耳朵上重复上述步骤，在两只耳朵之间交替治疗。 注意：继续治疗，直到患者符合出院标准：PUQE 评分 ≤4 且尿酮体变为阴性。如果耳膏脱落，请重新涂抹。</li>
</ol>5. 患者诊断
<ol><li>从住院第一天开始，每 2 天收集一次新鲜尿液，以测量和记录尿酮水平。注意从治疗开始到尿酮水平转为阴性的持续时间。 注：尿酮水平是评估NVP患者的重要指标。尿酮水平阳性表明持续饥饿和脱水14,15。确保及时检测尿液样本，防止酮体蒸发引起的低值。</li>
	<li>指导患者每天完成妊娠特有的呕吐和恶心量化 （PUQE） 量表（见 表 1）。每天根据他们的实际症状记录分数，直到出院当天。 注意：PUQE 量表广泛用于全球各种实践指南中，以测量患者 NVP 症状的严重程度16.PUQE 分数越高表示病情越严重。</li>
</ol>6. 术后护理
<ol><li>建议患者保持耳朵清洁和干燥。 注意： 种子贴片的放置不会干扰日常活动，例如洗涤和沐浴。</li>
	<li>提供安慰和支持，以减轻患者的紧张和恐惧。</li>
	<li>指导患者在出现恶心和呕吐时进行吞咽动作或深呼吸。</li>
	<li>如果患者在治疗过程中出现局部过敏反应，例如皮肤瘙痒、发红或渗出，请立即撕下胶带并局部涂抹抗过敏软膏以缓解这些症状。</li>
	<li>如果发生感染，应将其作为普通感染进行管理。使用外用抗生素（适用于孕妇）或消炎镇痛软膏进行治疗。</li>
	<li>监测呕吐的频率和量，评估脱水体征，并定期测量尿酮水平。 注意：如果存在影响胎儿发育和母体安全且无法有效解决的情况，请考虑终止妊娠。</li>
</ol>

用耳石膏治疗妊娠呕吐

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作者声明他们没有利益冲突。

妊娠期恶心和呕吐 （NVP） 是一种常见的疾病，可能对孕妇的健康构成风险，甚至会导致终止妊娠的并发症。通常用于止吐/抗恶心作用的临床药物，如昂丹司琼和异丙嗪，对孕妇有潜在风险，包括肌张力障碍、镇静和降低癫痫发作阈值22.因此，药物治疗有其自身的一系列危险。另一方面，今天通常采用的以症状为中心的治疗方法缺乏特异性，有时无效23.因此，产科医生应密切关注这种疾病。
本文介绍了耳膏疗法，这是一种用于治疗NVP的中医技术。该疗法简单、经济、安全，在临床实践中得到了患者的认可。我们的试验结果也支持这样一种观点，即当与常规治疗相结合时，耳膏疗法可有效缓解NVP。
本文介绍了对有限患者和一些局限性的回顾性临床观察。然而，据信耳膏药治疗的有效性将通过更大样本量的随机研究得到充分证明。目前，在NVP治疗中使用耳膏疗法存在一些挑战。首先，耳穴的选择依赖于患者的主观感知，由于患者描述或感知的差异，可能导致敏感点的识别不精确。其次，穴位刺激的方法、持续时间和强度缺乏定量指标，操作者采用不同的技术和刺激水平，可能导致刺激不足或过度。
在我们的实践中，我们观察到这种疗法后的治疗后护理经常被忽视。术后护理对于治疗结果、预防并发症和患者满意度至关重要。耳朵的皮下组织很薄，包含许多浅表血管。因此，使用胶带及其去除会导致皮肤损伤或感染，需要小心处理。为此，提供了具体的术后护理指导，包括观察治疗后的耳廓皮肤，保持耳朵的清洁和干燥，并建议患者在针刺当天避免接触液体和污染物。由于神经末梢广泛分布在耳朵中，一些患者在按压种子时可能会感到疼痛。如果疼痛可以忍受并且对耳朵没有伤害，则可以进行治疗。此外，根据术后评估进行调整也很重要。如果治疗两周后NVP缓解不够明显，则可能表明耳穴位选择不准确，应根据需要通过添加新穴位进行调整。
尽管使用耳膏疗法治疗NVP仍在探索中，但迄今为止所证明的益处令人印象深刻。随着临床经验的积累，我们相信这种疗法将越来越有效地减轻孕妇所经历的疼痛。

妊娠期恶心和呕吐 （NVP） 很常见，不同程度地影响约 50%-80% 的孕妇1。当NVP进展到中度或重度水平时，它会增加母亲和胎儿不良妊娠结局的风险。因此，NVP 的早期干预可能有助于预防妊娠剧吐2 的发生。NVP 的确切原因在现代生物医学中尚不清楚，但据信它与怀孕期间人绒毛膜促性腺激素血清水平的变化和某些维生素3 的缺乏等因素有关。目前 NVP 的治疗方法包括禁食、输液和纠正电解质失衡，但这些方法都不被认为是可靠的4。因此，找到一种不影响胚胎或胎儿发育的有效治疗方法是一项重大的临床挑战。
耳膏疗法是一种传统的中医治疗方法，涉及使用小而圆的物体，通常是牛草的种子，刺激耳朵上的特定穴位，以预防和治疗疾病5.牛痘的干燥和成熟种子，也称为牛草，用于这种疗法，因为它们被认为可以调节血液和通道，增强血液循环，促进泌乳。耳廓（耳朵的外侧）富含神经，包含许多针灸和敏感穴位6。通过刺激这些穴位，耳朵的软组织可能产生局部无菌炎症，进而可能调节神经内分泌系统，包括垂体-肾上腺皮质和交感神经-肾上腺皮质腺。此外，这种疗法可以潜在地激活人体的非特异性免疫反应，从而产生治疗效果7.耳膏疗法通过靶向耳朵上主要调节自主神经功能障碍、减少胃肠道反应和减轻呕吐感的特定穴位来有效治疗 NVP。它还可以增加Motilin的水平，Motilin是一种促进肠道蠕动的激素8，并恢复孕妇的食欲。此外，以前的一些研究表明，耳膏疗法可能对 NVP 相关的情绪障碍产生有利影响9，因为它在缓解焦虑方面表现出与镇静剂相似的作用。
耳膏疗法是一种简单且易于管理的治疗方法。它可以与常规治疗结合使用，以缓解NVP的症状，同时将母亲和胎儿与药物使用相关的潜在风险降至最低。该协议提供了有关如何进行这种治疗以及在此过程中要考虑的事项的详细说明。我们希望耳膏治疗能够得到更多的关注，并在临床实践中得到推广和利用。

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ear plaster therapy as a safe and effective treatment for gestational vomiting

妊娠期恶心和呕吐 （NVP） 是常见症状，通常使许多女性的妊娠早期复杂化。虽然禁食、输液和营养支持等临床治疗通常用于管理 NVP，但其有效性各不相同。然而，传统的耳膏疗法提供了一种很有前途的替代方案，可以有效缓解症状，并且对胚胎或胎儿的发育没有已知的风险。这种疗法以其易于应用、成本效益和良好的结果而闻名。先前的研究表明，将耳膏疗法与常规治疗相结合在缓解孕妇恶心和呕吐症状方面的有效性超过了单独使用常规治疗所取得的结果。本文介绍的方案描述了一种使用应用于特定耳点的圆形、光滑和坚硬的牛草种子来缓解NVP的方法。利用穴位按摩的原理，将这些种子轻轻擦到耳朵表面。通过刺激指定的耳穴，该程序旨在调节身体的能量流动并恢复平衡，从而降低NVP的严重程度和频率。将牛草种子涂抹在特定的耳穴上是一种简单的技术，医疗保健专业人员可以在适当的指导下轻松实施或由孕妇自行管理。总体而言，耳膏疗法提供了一种安全、有效和经济的方法来控制妊娠呕吐，为女性提供了一种潜在的解决方案，以减轻怀孕期间的不适。

这项临床研究的所有 20 名参与者都成功完成了试验。4例患者符合出院标准，第5天出院，其余16例患者符合出院标准，住院后2周内出院。
试验期间，对照组接受控制饮食和静脉滴注，包括以下成分：维生素C 2g+0.9%氯化钠注射液500 mL、维生素B6 0.2 g+0.9%氯化钠注射液500 mL、甲萘醌钾镁20 mL+5%葡萄糖注射液500 mL、氯化钾15 mL+葡萄糖注射液500 mL、0.9%氯化钠注射液500 mL、 和维生素 B1 200 mg（见材料表），肌内注射，每日一次。当食物摄入量增加时，液体输注量逐渐减少10、17、18、19、20。
实验组患者除了接受与对照组相同的输液治疗外，还接受耳膏治疗，直至出院。分析治疗持续时间、尿酮体阴性时间和每日PUQE评分。测量值表示为（x ̄± s），采用 t检验 比较两组。
妊娠特有呕吐定量 （PUQE） 用于测量妊娠期间恶心和呕吐 （NVP） 的严重程度（表 1）。PUQE 总分分类如下：轻度 NVP 得分为 ≤6，中度 NVP 得分为 7-12，重度 NVP 得分为 ≥13。
两组产妇年龄和孕周的比较见 表2。该表表明，两组在产妇年龄和孕周数方面无统计学差异（p > 0.05）。两组孕妇的年龄和怀孕时间相似。
表3 显示了两组孕妇住院时间和酮体转阴所需的时间（x ̄± s）的比较。与对照组相比，实验组的平均住院时间明显缩短了 2.5 天。同样，实验组酮体转阴的时间缩短了2.4天。两者差异均有统计学意义（p < 0.05）。这些结果表明，耳膏治疗可以有效减少NVP的治疗时间。
两组孕妇的PUQE评分见 表4。在治疗之前，两组之间的PUQE评分无统计学差异（p > 0.05）。然而，在治疗五天后，实验组和对照组的PUQE评分与初始评分相比均显著降低（p < 0.05）。在实验组中，平均PUQE评分从12.6下降到5.0，而在对照组中，它从12.5下降到6.9。此外，在治疗期间，实验组的得分始终低于对照组，并且这种差异具有统计学意义（p < 0.05）。这些发现表明，该治疗对两组均有效，实验组的疗效优于对照组。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65549/65549fig01.jpg"> 图1：耳针治疗所需的项目。 它包括各种物品：（A）剪刀，（B，C）无菌棉签和镊子，（D）医用胶带，（E）75%酒精和（F）牛草种子。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65549/65549fig02.jpg"> 图 2：治疗中使用的准备好的耳罩。 该图显示了治疗中使用的耳罩的图片。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig02large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/65549/65549fig03.jpg"> 图 3：治疗中使用的耳廓点的位置。 该图基于中华人民共和国国家标准《耳穴名称及定位》（GB/T13734-2008）21。它突出了六个特定的耳点：胃 （CO4）、贲门 （CO3）、腹部 （AH8）、神门 （TF4）、皮层下 （AT4） 和肝脏 （CO12）。该图包括红色圆圈，用于指示这些点的相应位置。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig03large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/65549/65549fig04.jpg"> 图 4：耳针灸手术中涉及的关键步骤。 步骤如下：（1）和（2）表示消毒操作，（3）表示探测耳压点，（4）、（5）和（6）表示耳针操作。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig04large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td colspan="5">妊娠特有的呕吐量化 （PUQE）</td>
		</tr><tr><td colspan="5">在下面圈出最适合您情况的答案</td>
		</tr><tr><td colspan="5">1. 前一天感到恶心和呕吐多久了？</td>
		</tr><tr><td>从不</td>
			<td>≤1小时</td>
			<td>2-3小时</td>
			<td>4-6小时</td>
			<td>≥6小时</td>
		</tr><tr><td>1 分</td>
			<td>2 积分</td>
			<td>3 分</td>
			<td>4 积分</td>
			<td>5 积分</td>
		</tr><tr><td colspan="5">2. 你前一天呕吐了多少次？</td>
		</tr><tr><td>从不</td>
			<td>1-2次</td>
			<td>3-4次</td>
			<td>5-6次</td>
			<td>≥7 次</td>
		</tr><tr><td>1 分</td>
			<td>2 积分</td>
			<td>3 分</td>
			<td>4 积分</td>
			<td>5 积分</td>
		</tr><tr><td colspan="5">3. 你前一天干了多少次？</td>
		</tr><tr><td>从不</td>
			<td>1-2次</td>
			<td>3-4次</td>
			<td>5-6次</td>
			<td>≥7 次</td>
		</tr><tr><td>1 分</td>
			<td>2 积分</td>
			<td>3 分</td>
			<td>4 积分</td>
			<td>5 积分</td>
		</tr></tbody></table>表 1：用于评估妊娠期间恶心和呕吐严重程度 （NVP） 的妊娠独特呕吐量化 （PUQE） 评分系统。 总分分为以下几类：轻度NVP（≤6分）、中度NVP（7-12分）和重度NVP（≥13分）。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>A组</td>
			<td>B组</td>
			<td>n</td>
			<td>年龄/年</td>
			<td>妊娠周/周</td>
		</tr><tr><td>实验组</td>
			<td>实验组</td>
			<td>10</td>
			<td>25.4 ± 1.57762</td>
			<td>7.9 ± 2.46982</td>
		</tr><tr><td>对照组</td>
			<td>对照组</td>
			<td>10</td>
			<td>25.5 ± 1.84089</td>
			<td>8.2 ± 1.98886</td>
		</tr></tbody></table>表2：两组产妇年龄和孕周数的比较。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>群</td>
			<td>n</td>
			<td>住院时间/天</td>
			<td>酮体/天呈负值的时间</td>
		</tr><tr><td>实验组</td>
			<td>10</td>
			<td>6.2 ± 1.13529</td>
			<td>6.0 ± 0.94281</td>
		</tr><tr><td>对照组</td>
			<td>10</td>
			<td>8.7 ± 1.49443</td>
			<td>8.4 ± 1.50555</td>
		</tr></tbody></table>表3：两组孕妇住院时间和酮体转阴时间的比较。 A 组和 B 组的平均住院时间和酮体转为阴性所需的时间用 x ̄± s 表示，x ̄± s 表示每组中各自测量值的平均值和标准差值。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td rowspan="2">群</td>
			<td rowspan="2">n</td>
			<td colspan="6">PUQE评分</td>
		</tr><tr><td>治疗前</td>
			<td>治疗第 1 天</td>
			<td>治疗第 2 天</td>
			<td>治疗第 3 天</td>
			<td>治疗第 4 天</td>
			<td>治疗第 5 天</td>
		</tr><tr><td>实验组</td>
			<td>10</td>
			<td>12.6 ± 0.84327</td>
			<td>9.7 ± 0.82327</td>
			<td>8.6 ± 1.17379</td>
			<td>7.0 ± 1.26930</td>
			<td>5.9 ± 1.44914</td>
			<td>5.0 ± 1.69967</td>
		</tr><tr><td>对照组</td>
			<td>10</td>
			<td>12.5 ± 0.84984</td>
			<td>10.9 ± 1.10050</td>
			<td>10.0 ± 1.41421</td>
			<td>9.0 ± 1.41421</td>
			<td>8.1 ± 1.52388</td>
			<td>6.9 ± 1.19722</td>
		</tr></tbody></table>表4：两组孕妇PUQE评分比较。 A 组和 B 组的平均 PUQE 分数用 x ̄± s 表示，x ̄± s 表示每组中相应测量值的平均值和标准差值。

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

作者聚焦：通过安全有效的耳针缓解怀孕期间的恶心和呕吐 

所提出的方案描述了一种传统的中医治疗程序，以其在管理妊娠呕吐方面的安全性和有效性而闻名。

耳膏疗法是一种安全有效的妊娠呕吐治疗方法

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

我们的研究重点是开发治疗怀孕期间恶心和呕吐的有效方法。我们的目标是探索在不影响胎儿发育的情况下最好地缓解此类患者症状的方法。治疗妊娠呕吐的最新进展包括许多药物，如维生素 B6、多西拉明和某种抗胆碱能药。此外，一些心理支持已被证明对康复很重要。耳膏治疗简单、经济、安全，在临床实践中被患者高度接受。这种疗法与传统的对症治疗相辅相成，在缓解孕妇呕吐和恶心症状方面更有效。我们的研究证明了我们的眼针治疗妊娠呕吐的有效性和安全性。现在需要更多的随机对照研究和临床试验来评估其疗效和副作用风险。

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

Unit 1

Drugs for Nausea and Vomiting

SCIENTISTS IN ACTION

1.2K 次观看.  Hospital of Chengdu University of Traditional Chinese Medicine. 我们的研究重点是开发治疗怀孕期间恶心和呕吐的有效方法。我们的目标是探索在不影响胎儿发育的情况下最好地缓解此类患者症状的方法。治疗妊娠呕吐的最新进展包括许多药物，如维生素 B6、多西拉明和某种抗胆碱能药。此外，一些心理支持已被证明对康复很重要。耳膏治疗简单、经济、安全，在临床实践中被患者高度接受。这种疗法与传统的对症治疗相辅相成，?...

视频: 作者聚焦：通过安全有效的耳针缓解怀孕期间的恶心和呕吐 

Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)1,2. Injection studies of twin placentas have shown that such anastomoses are almost invariably present in monochorionic twins and extremely rare in dichorionic twins1. Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses1,2. 
Injection of monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in monochorionic twins and is a required test to reach the diagnosis of TAPS2. In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses3-5. This additional information is of paramount importance for all perinatologists involved in the management and care of monochorionic twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

Twin-to-twin transfusion syndrome and twin anemia polycythemia sequence are two potentially devastating problems in perinatal medicine. Both disorders occur only in monochorionic twins and result from unbalanced blood flow through placental vascular anastomoses. We provide a simple protocol to accurately evaluate the presence of vascular anastomoses using colored dye injection of placental vessels after birth.

在单绒毛膜胎盘血管吻合用有色染料的精确和简单的评价

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia ...

科研

医学

Mouse In Vivo Placental Targeted CRISPR Manipulation

The placenta is an essential organ that regulates and maintains mammalian development in utero. The placenta is responsible for the transfer of nutrients and waste between the mother and fetus and the production and delivery of growth factors and hormones. Placental genetic manipulations in mice are critical for understanding the placenta's specific role in prenatal development. Placental-specific Cre-expressing transgenic mice have varying effectiveness, and other methods for placental gene manipulation can be useful alternatives. This paper describes a technique to directly alter placental gene expression using CRISPR gene manipulation, which can be used to modify the expression of targeted genes. Using a relatively advanced surgical approach, pregnant dams undergo a laparotomy on embryonic day 12.5 (E12.5), and a CRISPR plasmid is delivered by a glass micropipette into the individual placentas. The plasmid is immediately electroporated after each injection. After dam recovery, the placentas and embryos can continue development until assessment at a later time point. The evaluation of the placenta and offspring after the use of this technique can determine the role of time-specific placental function in development. This type of manipulation will allow for a better understanding of how placental genetics and function impact fetal growth and development in multiple disease contexts.

Mouse In Vivo Placental Targeted CRISPR Manipulation

Here we describe a time-specific method to effectively manipulate critical developmental pathways in the mouse placenta in vivo. This is performed through the injection and electroporation of CRISPR plasmids into the placentas of pregnant dams on embryonic day 12.5.

小鼠 体内 胎盘靶向CRISPR操作

The placenta is an essential organ that regulates and maintains mammalian development in utero. The placenta is responsible for the transfer of nutrients ...

遗传学

Ex Vivo Perfusion of the Rodent Placenta

The placenta is a key organ during pregnancy that serves as a barrier to fetal xenobiotic exposure and mediates the exchange of nutrients for waste. An assay is described here to perfuse an isolated rat placenta and evaluate the maternal-to-fetal translocation of xenobiotics ex vivo. In addition, the evaluation of physiological processes such as fluid flow to the fetus and placental metabolism may be conducted with this methodology. This technique is suitable for evaluating maternal-to-fetal kinetics of pharmaceutical candidates or environmental contaminants. In contrast to current alternative approaches, this methodology allows the evaluation of the isolated maternal-fetal vasculature, with the systemic neural or immune involvement removed, allowing any observed changes in physiological function to be attributable to local factors within the isolated tissue.

Here is presented a protocol of ex vivo maternal-fetal vascular perfusion to enable the administration of a test article into maternal vasculature and to evaluate placental transfer of xenobiotic particles or pharmacological agents in addition to alterations in placental physiology.

啮齿类动物胎盘的体外灌注

The placenta is a key organ during pregnancy that serves as a barrier to fetal xenobiotic exposure and mediates the exchange of nutrients for waste. An ...

发育生物学

A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset (Callithrix jacchus)

Hearing research has long been facilitated by rodent models, although in some diseases, human symptoms cannot be recapitulated. The common marmoset (Callithrix jacchus) is a small, easy-to-handle New World monkey which has a similar anatomy of the temporal bone, including the middle ear ossicular chains and inner ear to humans, than in comparison with that of rodents. Here, we report a reproducible, safe, and rational surgical approach to the cochlear round window niche for the drug delivery to the inner ear of the common marmoset. We adopted posterior tympanotomy, a procedure used clinically in human surgery, to avoid manipulation of the tympanic membrane that may cause conductive hearing loss. This surgical procedure did not lead to any significant hearing loss. This approach was possible due to the large bulla structure of the common marmoset, although the lateral semicircular canal and vertical portion of the facial nerve should be carefully considered. This surgical method allows us to perform the safe and accurate administration of drugs without hearing loss, which is of great importance in obtaining pre-clinical proof of concept for translational research.

A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset Callithrix jacchus

We report a surgical method to administrate drugs to the inner ear of a non-human primate, the common marmoset (Callithrix jacchus), via the round window membrane.

一种非人类灵长类常见狨中内耳药物的外科手术方法 (Callithrix jacchus)

Hearing research has long been facilitated by rodent models, although in some diseases, human symptoms cannot be recapitulated. The common marmoset ...

Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over the world have increased their skills in this field and can provide support to help position the infant at the breast, the impact of their intervention might be limited in the presence of stiff structures in the infants. Here we present a protocol for a randomized controlled trial to assess the efficacy of osteopathic treatment, coupled with lactation consultation, for infants&#39; biomechanical suckling difficulties. It proposes a set-up and a sequence of actions to ensure an optimal context for treatment, as well as a blinding of parents and LCs to the intervention. Data such as the infant&#39;s latch ability measured with the LATCH Assessment Tool, the mother&#39;s nipple pain with a visual analog scale (VAS), and the mother&#39;s perceptions are collected by LCs four times over a 10-day period. Osteopathic lesions are documented by the osteopath, using a standardized assessment grid. Structures of interest are coherent with the anatomical zones involved in latching onto the breast. This protocol also proposes a strategy to document systematically an osteopathic profile of infants with biomechanical suckling difficulties in their first weeks of life. The implementation of this protocol confirms its feasibility for osteopathic assessment and treatment and paves the way for future trials to further explore the efficacy of osteopathic techniques for infants with biomechanical suckling difficulties.

Osteopathy is an emerging field of clinical research. Here we present a protocol to assess the efficacy of an osteopathic intervention coupled with lactation consultation, in infants with biomechanical issues impeding breastfeeding.

骨科治疗婴儿生物力学损伤对吸血效果的评价

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over ...

Virtual Prism Adaptation Therapy: Protocol for Validation in Healthy Adults

Hemispatial neglect is a common impairment after stroke. It is associated with poor functional and social outcomes. Therefore, an adequate intervention is imperative for the successful management of hemispatial neglect. However, the clinical use of various interventions is limited in real clinical practice. Prism adaptation therapy is one of the most evidence-based rehabilitation modalities to treat hemispatial neglect. To overcome any possible shortcoming that may occur with prism therapy, we developed a new system using immersive virtual reality and depth-sensing camera to create a virtual prism adaptation therapy (VPAT). To validate the VPAT system, we designed an experimental protocol investigating the behavioral errors and changes in cortical activation via the VPAT system. Cortical activation was measured by functional near infrared spectroscopy (fNIRS). The experiment consisted of four phases. All four included clicking, pointing or rest applied to right-handed healthy people. Clicking versus pointing was used for investigating the cortical region related with the gross motor task, and pointing with VPAT versus pointing without VPAT was used for investigating the cortical region associated with visuospatial perception. The preliminary results from four healthy participants showed that pointing errors by the VPAT system was similar to the conventional prism adaptation therapy. Further analysis with more participants and fNIRS data, as well as a study in patients with stroke may be required.

This experimental protocol demonstrates the use of virtual prism adaptation therapy (VPAT) in healthy adults and the association between VPAT and functional near infrared spectroscopy to determine the effect of VPAT on cortical activation. Results suggest that VPAT may be feasible and could induce similar behavioral adaptation as conventional prism adaptation therapy.

虚拟棱镜适应疗法:健康成人验证协议

Hemispatial neglect is a common impairment after stroke. It is associated with poor functional and social outcomes. Therefore, an adequate intervention is ...

Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, we propose that a concomitant laparoscopic oocyte retrieval for cryopreservation is performed. Oocyte retrieval is pursued at the beginning of the laparoscopy. Right and left 5 mm trocars are positioned, through which a 17 G ovum aspiration needle is used for puncture of the right and left ovaries, respectively. To facilitate exposure of the follicles, the ovaries are mobilized and held with laparoscopic forceps.
When aspirating multiple follicles near each other, the needle tip is retained in the ovary to reduce the number of times that the ovarian cortex is transfixed and due to the inherent risk of bleeding. Subsequent steps are unchanged compared to the Davydov laparoscopic modified technique for vaginoplasty. Prior to surgery, controlled ovarian stimulation is performed with a gonadotropin hormone-releasing hormone (Gn-RH) antagonist protocol, and the concomitant procedure of oocyte retrieval and vaginoplasty is scheduled 36 h after the final follicular maturation trigger. Follicular fluid is collected in the same 10 mL sterile tubes used during transvaginal oocyte retrieval and transferred in a warming block (37 &#176;C) to the assisted reproduction laboratory, where mature (metaphase II) oocytes are vitrified.
In this case, a series of 23 women with MRKH, oocytes were successfully retrieved and cryopreserved in all patients; vaginoplasty was subsequently conducted without modifications, and the inpatient and outpatient postoperative care (day of urinary catheter removal, day of hospital discharge, dilator use, and comfort at follow-up) remained unaffected. One postoperative complication occurred in one patient (fever developing on day 5 post surgery and intraperitoneal fluid detection on transabdominal ultrasound) and resolved after conservative treatment. Rather than performing surgical vaginoplasty and delaying oocyte retrieval in MRKH patients, this approach combines both procedures in a single laparoscopy, thereby minimizing surgical invasiveness and anesthesiologic risks.

A dedicated team can offer Mayer-Rokitansky-Kuster-Hauser patients the option to perform controlled ovarian stimulation and oocyte cryopreservation at the time of laparoscopic vaginoplasty.

阴道成形术中的腹腔镜卵母细胞提取和冷冻保存治疗Mayer-Rokitansky-Kuster-Hauser综合征

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, ...

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. Traditional Chinese medicine&#39;s acupuncture techniques offer an alternative&#160;approach to treating digestive disorders&#160;by controlling gastrointestinal secretion, improving gastrointestinal motility, and minimizing side effects. Transabdominal intestinal ultrasonography has proven effective in assessing gastrointestinal injury in critically ill patients. This study aims to evaluate the therapeutic effect of acupuncture in AGI patients using ultrasound. The main steps of the study include the syndrome-based selection of appropriate acupuncture points, including&#160;Hegu (LI4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), and Xiajuxu (ST 39), followed by a 30 min Deqi acupuncture session once a day for 1 week. The treatment&#39;s effectiveness is assessed by an experienced physician using abdominal gastrointestinal ultrasonography. This article provides a detailed account of how to standardize the use of acupuncture in treating gastrointestinal dysfunction in critically ill patients.

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury AGI: A Preliminary Study

Acute gastrointestinal injury (AGI) is a prevalent occurrence in intensive care units and has been linked to unfavorable patient outcomes. The current approaches focus on addressing the primary disease and providing symptomatic relief. The protocol here demonstrates the implementation of acupuncture as a therapeutic intervention for AGI.

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. ...

Surgical Treatment of Gastroparesis

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are combined in a multidisciplinary fashion to improve the quality of life in this patient population. Starting with lifestyle changes, adjustments are made to the types and amounts of food consumed, medical conditions are optimized, and the use of narcotic pain medications as well as smoking is discontinued. For many, these changes are not enough, and antiemetics and promotility agents are used to control symptoms. Finally, when these measures fail, patients turn to surgery, which can include surgical alterations to the stomach, implantation of a gastric stimulator, placement of drainage tubes, and possibly even the complete removal of different organs, including the stomach or gallbladder. In our clinic, patients not only see a surgeon but also a gastroenterologist, dietitian, and psychologist. We strongly believe in a multidisciplinary approach to this condition. The goal is to provide patients with hope and help them live fuller and happier lives.
The study primarily addresses technical considerations and the surgical approach for patients diagnosed with gastroparesis. It outlines the entire process, starting from preparations before the surgery, encompassing the preoperative work-up, and detailing the steps involved in the surgical procedure. One of the key diagnostic challenges faced in treating gastroparesis patients is determining the underlying cause of the condition, as this information is critical for selecting the appropriate surgical intervention. Once the patient&#39;s condition has been categorized based on the cause, the medical team engages in a discussion with the patient regarding potential treatment options, which may include endoscopic procedures, minimally invasive techniques, or open surgery.

Gastroparesis is a condition in which the stomach does not empty properly. While it is initially managed with lifestyle modifications and medications, some patients eventually require surgical intervention. This study focuses on the technical considerations and surgical approaches for dealing with gastroparesis patients, which include endoscopic, minimally-invasive, and open surgical techniques.

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are ...

加强 CINV 管理：传统中医方法

Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting

Chemotherapy-induced nausea and vomiting (CINV) refers to the nausea and vomiting experienced by patients after the application of chemotherapy drugs, significantly affecting their quality of life and physical recovery, as well as increasing the pain of the patients. Basic medicine primarily focuses on acid suppression, gastric protection, and vomiting suppression, but there are still many patients with nausea and vomiting symptoms that cannot be alleviated. Traditional Chinese medicine (TCM) can effectively alleviate nausea and vomiting through acupoint stimulation and pressure, while also offering advantages such as simplicity, affordability, and fewer side effects. The aim of this article is to introduce the method of using acupoint application combined with acupressure as an adjunctive therapy for CINV, using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT) tablet scale as a questionnaire. The article details aspects such as acupoint selection, production, and the use of acupoint application, massage techniques, and operating procedures, all with the goal of ensuring the safety and efficacy of acupoint application combined with acupressure as an adjuvant therapy, thereby improving patients&#39; clinical symptoms and quality of life.

作者聚焦： 使用穴位应用和穴位按压对化疗引起的恶心和呕吐进行有效的非药物管理

Acupoint application combined with acupressure-assisted treatment has a good effect on chemotherapy-induced nausea and vomiting and is more convenient and cost-effective.

穴位应用联合穴位按压作为化疗引起的恶心呕吐的辅助治疗

Chemotherapy-induced nausea and vomiting (CINV) refers to the nausea and vomiting experienced by patients after the application of chemotherapy drugs, ...

耳膏疗法是一种安全有效的妊娠呕吐治疗方法

副本

摘要

探索更多视频

此视频中的章节

在单绒毛膜胎盘血管吻合用有色染料的精确和简单的评价

小鼠体内胎盘靶向CRISPR操作

啮齿类动物胎盘的体外灌注

一种非人类灵长类常见狨中内耳药物的外科手术方法 (Callithrix jacchus)

骨科治疗婴儿生物力学损伤对吸血效果的评价

虚拟棱镜适应疗法:健康成人验证协议

阴道成形术中的腹腔镜卵母细胞提取和冷冻保存治疗Mayer-Rokitansky-Kuster-Hauser综合征

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study

Surgical Treatment of Gastroparesis

穴位应用联合穴位按压作为化疗引起的恶心呕吐的辅助治疗

耳膏疗法是一种安全有效的妊娠呕吐治疗方法

副本

摘要

探索更多视频

此视频中的章节

在单绒毛膜胎盘血管吻合用有色染料的精确和简单的评价

小鼠 体内 胎盘靶向CRISPR操作

啮齿类动物胎盘的体外灌注

一种非人类灵长类常见狨中内耳药物的外科手术方法 (Callithrix jacchus)

骨科治疗婴儿生物力学损伤对吸血效果的评价

虚拟棱镜适应疗法:健康成人验证协议

阴道成形术中的腹腔镜卵母细胞提取和冷冻保存治疗Mayer-Rokitansky-Kuster-Hauser综合征

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study

Surgical Treatment of Gastroparesis

穴位应用联合穴位按压作为化疗引起的恶心呕吐的辅助治疗

小鼠体内胎盘靶向CRISPR操作