We thank the patients who gave their consent and contributed to the publication.

ここでは、技術的に神経嚥下障害を有する患者における流涎症の治療のために使用される方法を記載します。我々は以前7公開されている有効性の結果、に焦点を当てることはありません。本論文では、結果のセクションでは、我々は、これらの患者は、ボツリヌス毒素で構成され、全人口の代表、と考えられている2014年から2016年に扱わ長期フォローアップと連続して5人の患者（3治療セッション）からのデータを提示しますサンルイジ・ゴンザーガ病院のサービス。プロトコルが承認され、人体実験上のローカル倫理基準委員会のガイドラインに従いました。 1.患者の募集注：このアプローチの対象患者は、大人のような抗コリン薬などの薬理学的治療への障害や禁忌の歴史を持つ神経学的嚥下障害への二次重度の流涎症に中等度に苦しんでいます。 <ol><li>患者はEXPによって評価されていることを確認BoNT注入前と流涎症の重症度と頻度がよだれ頻度および重症度スケール（DFSS）14で評価されるerienced神経科医。 注：DFSSスコアは（4 =常に1 =決して、2 =時折/ない毎日、その日の3 =頻繁/一部、）周波数の和と重症度（1 = droolsがありません、のみ2 =軽度またはであります4 =重度またはよだれ3 =中等度または唇とあごに湿った湿った唇は、サブスコア14）、手、トレイを、湿潤5 =おびただしいや衣服衣服に延びており、濡れたオブジェクト。サブスコアの両方におけるスコア&gt; 2は、資格のカットオフとして使用されます。 注：患者および/または介護者が提供する客観的かつ既往のデータに基づいて、神経学者のスコアスケール。また、視覚的アナログ尺度（VAS）は、流涎症に関連する患者の主観的苦痛の評価のために投与しなければなりません。 VASは、と10センチメートル水平線によって表される自己報告尺度であります患者の不快感の一方の端を表す各終わりにtatement（0 = &quot;極度の不快感」への100から=&quot;違和感のありません」）。 </li><li>治療の有効性を評価するための便利なツール（ 図1）のように、のBoNT注射の前に唾液アスピレーター（該当する場合）を介して、毎日唾液願望の数を収集します。 </li><li> 3と6ヶ月の治療後のフォローアップ、1、中にDFSS、毎日の唾液誤嚥性評価と一緒に神経学的評価を繰り返し、または流涎症の再発によると。毎日の願望の数は1ヶ月のフォローアップ評価に比べて50％以上増加すると特に、再治療が考慮されなければなりません。 </li><li>注射直後手順有害事象（局所疼痛、局所出血、および顔面神経麻痺）を収集します。フォローアップ評価時の治療の有害事象（局所疼痛、顔面神経麻痺、咀嚼弱さ、粘性唾液、口渇）を収集します。 </li></ol> 2.手順<ol><li> BoNT-準備 注：abobotulinumtoxinAは、ボツリヌス菌複合体ヘマグルチニンのA型ボツリヌス毒素です。それは、筋肉内または皮下注射用溶液のための粉末です。 <ol><li>成人の流涎症の治療のための、abobotulinumtoxinAの250 IU / mLを含む溶液を得るために、注射用の0.9％塩化ナトリウム溶液2mLで500 IU abobotulinumtoxinAを再構成します。 </li><li>各顎下腺では50 IUと75 IUをそれぞれの耳下腺に次のように患者あたりabobotulinumtoxinAの250 IUの合計を管理します。このように、薬剤浪費を避けるために、単一バイアルで2人の患者を治療します。 </li></ol></li><li>患者の準備<ol><li>手順のと治療の潜在的なリスクと利益の適切な説明の後、患者から書面によるインフォームドコンセントを得ます。 </li><li>超音波テーブルの上に患者を配置首と仰臥位と可能性を拡張します。 注：いないすべての神経学的状態は、首の完全な拡張を可能に流涎症につながることを考えてみましょう。 </li><li>耳下腺および防腐と顎下腺上の領域で皮膚を消毒します。エチレンクロリドスプレーで各皮膚のアクセス部位を麻酔。 </li></ol></li><li>超音波誘導 注：線形変換器と超音波ガイド下の手順（5から10 MHzの）は、リアルタイムの筋肉、腺、より大きな血管または唾液管の可視化、および他の周囲の構造を得るためには、同様の腺のローカライズに使用されます腺組織内の正しい針位置。 <ol><li>超音波システムの電源をオンにし、試験を開始し、「開始 - 終了」ボタンを押してください。 </li><li> （ - 10 MHzの5）高周波プローブを選択するために、「プローブ」ボタンを押してください。 </li><li> 「患者」ボタンを押して、患者の名前とsurnaを挿入私。 </li><li> （：「小さな組織」、サブプロトコル：「一般」、 すなわち 、プロトコル）適切なプロトコルおよびサブプロトコルを選択するには、「プロトコル」ボタンを押してください。 </li><li> 「深」ボタンを押してから5 cmのビューの深さを指定します。 </li><li> 2センチメートルの最大の詳細を選択するために「フォーカス」ボタンを押してください。 </li><li>周囲の組織に比べて均質echotextureと低エコー領域として表示される顎下腺を、可視化するために、二腹筋の前部および後部の腹の間に、下顎の下にトランスデューサーを配置します。 注：理想的には2つの象限、1頭側と1尾に分かれ顎下腺を考えてみましょう。横針アクセスのための最も広いグランド径を特定します。 </li><li>周囲の組織に比べて均質echotextureと低エコー領域として表示されます耳下腺を、可視化するために外耳道以下トランスデューサを配置します。 NOTE：理想的には4つの象限、2頭側と2尾に分かれ耳下腺を考えてみましょう。外耳道および下顎角、頭蓋部分に1つ、腺（ 補足図 ）の尾の部分で1間の噴射途中のための2つのアクセス部位を特定します。 </li></ol></li><li> BoNT注射 注：変換器から針貫通少なくとも0.5 CMに、注射用22 G針を使用してください。針が明るい反響行として表示されるように、変換器は、針に長手方向に配向されなければなりません。針の先端は、神経血管構造の損傷を防止する、目標に向かって進むように、このようにして、軟組織への針の侵入は、処置中に監視することができます。 <ol><li>顎下腺へのアクセスに最も広い腺径で横型短アクセスアプローチを使用します。 </li><li>上部の顎下の象限に25 IUのBoNT-Aを注入します。注入後、少しねを撤回各顎下腺に50 IUの合計25 IUのBoNT-Aを注入し、下顎下の象限に向かって針先の方向をedleと変更。 注：このようにして、2つの顎下領域（頭蓋および尾）は腺組織内の薬剤の広範な拡散を提供し、注入されます。 </li><li>耳下腺注入のための2つのアクセス部位を使用してください。 2は、外耳道および下顎角、腺の頭蓋部分に1つ、腺の尾の部分における1の中間にアクセスし確認します。 </li><li>内側頭蓋象限に19 IUのBoNT-A - （腺の頭蓋部分的に）上位アクセスを使用して、18を注入します。注入後、わずか腺の頭蓋一部のサイトを離れることなく、針を撤回し、横方向の頭蓋象限に向かって針の先端の向きを変えます。 19 IUのBoNT-A - 18を注入します。 </li><li> 19のBoNT-IU - （腺の尾の部分で）下のアクセスを使用して、18を注入中央 - 尾側の象限に。注入後、わずか腺の尾の部分のサイトを離れることなく、針を撤回し、横尾側象限に向かって針の先端の向きを変えます。 19 IUのBoNT-A - 18を注入します。 注：このように、4耳下腺の領域（内側 - 頭蓋、横頭蓋、内側 - 尾側と横尾）は腺組織内の薬剤の広範な拡散を提供する、75 IUのBoNT-Aの合計を注射します。 </li><li> 2分 - 各注入の後、任意の1のために、滅菌ガーゼで出血を軽くたたきます。任意の潜在的な有害事象のために1時間後の患者を再評価。痛みを永続化する場合には、非ステロイド性抗炎症薬を投与します。 1ヶ月後のフォローアップ検査をスケジュールします。 </li></ol></li></ol>

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The authors have nothing to disclose.

This protocol describes US-guided BoNT-A injection in the parotid and submandibular glands for the treatment of moderate to severe sialorrhea. Sialorrhea secondary to dysphagia is a frequent complication of the advanced stages of different neurological diseases, and when pharmacological therapy with anticholinergic agents demonstrates scarce efficacy or tolerability, salivary gland BoNT injection represents a useful therapeutic option2,7. However, salivary gland BoNT injection guided by anatomical landmarks ma...

流涎症は、脳卒中、脳性麻痺、多発性硬化症、および神経変性疾患1を含むいくつかの神経学的障害の共通の無効な合併症を表す唾液の過剰な流れです。中等度から重度の流涎症に罹患している患者は、生活の質が損なわれ、多くの場合、皮膚2の誤嚥性肺炎、口腔感染症、虫歯、および浸軟などの相関合併症、悪化しています。様々な治療オプションは、唾液の生産を減少させる目的で、手術からの薬物療法に至るまで、流涎症の治療のために利用可能です。 外科的選択肢は除神経、唾液腺の切除、および唾液の転置またはライゲーションが3,4ダクト含まれます。しかし、その有効性にもかかわらず、手術は定義により、このような唾液瘻と嚢胞形成、感染症の損失などの潜在的に重篤な有害事象、と侵襲的処置であります味、聴覚、構音障害、および唾液腺の生産3に対する不可逆的影響の損失。また、唾液がプロシージャ2,5-後2年以上腺の外科的アプローチが原因で再神経支配にのみ一時的効果を有し得ることが観察されています。重度の流涎症のためのより一般的かつ低侵襲性の治療は抗コリン作用特性を持つ全身薬の使用です。しかしながら、抗コリン作動薬の長期使用は、多くの場合、混乱、記憶障害、眠気、尿閉、および麻痺性イレウス2,5などの全身副作用を伴います。 ボツリヌス毒素毒素（BoNT）唾液注入は、流涎症のための新たな治療の選択肢です。 BoNTはで筋肉の収縮や腺の活動を阻止する、神経筋接合部のシナプス前神経終末からのアセチルコリン放出を停止することができます細菌のボツリヌス菌によって産生される（AからGへの7、）プロテアーゼ、あります交感神経性の副交感神経節後シナプス。 BoNTタイプA（のBoNT-A）およびタイプB（のBoNT-B）は、一般的ジストニアおよび痙縮6の治療管理のために使用されます。最近では、大唾液腺内のBoNT注射は、有効性の欠如または重大な副作用2,7,8の存在による他の医療療法に対する最適以下の応答を伴う重度の流涎症中等度において有用な治療選択肢であることが判明しました。 メジャーとマイナー：ヒト唾液腺には2つのグループに分類されます。大唾液腺は耳下腺のペア、顎下腺のペア、および舌下腺のペアを含みます。小唾液腺は口腔9のサブ粘膜内に広がる約1,000の小さな腺で構成されています。唾液の約0.5リットルは、一日あたりの分泌されます。大唾液腺の三対は、以下のようにおよそ分割、唾液産生の90％以上を担っている：20％Fまたは舌下腺9のための耳下腺、顎下腺のための65％、5％、。耳下腺は最大のものであり、下顎骨と胸鎖乳突筋との間で、外耳道の下に配置されています。それは咬筋10の表面には前方に突出します。重要な構造は、顔面神経、外頸動脈、および下顎後静脈、およびいくつかの他の重要な神経血管構造として、グランドを通過するには、腺の近くにあります。顎下腺は、顎下三角形の領域では、二腹筋の前部および後部の腹の間および顎舌骨筋11の後縁の周りに、下顎骨の枝の後ろと下に位置する混合腺です。 BoNT唾液腺注射は不快感および/または経口、TRなどの他の治療と相関全身性副作用を回避する可能性を有する局所治療でありますansdermal、および外科的選択肢。ここで、我々は強く、深刻なの発生を制限しながら、よだれの満足と長期的な減少を得るためのガイダンス（米国）超音波下耳下腺と顎下腺でのBoNT-Aの注射で流涎症を治療するために、簡単に信頼性と再現性のある方法を示し、有害事象。米国の指導の不在下で流涎症でのBoNT注入の有効性に関するデータは、文献12に報告されています。しかし、腺とその周囲組織のUS-導かれた識別は、針位置のリアルタイム可視化に伴って、増加した有効性と結果の再現性7,13につながる有害事象の低減と、より正確な注入を可能にします。

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			<td>abobotulinumtoxinA (Dysport)&#160;</td>
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			<td>Delivered drug</td>
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			<td>MyLab &#160;Twice&#160;</td>
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			<td>LA523 5&#8211;10 MHz&#160;</td>
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ultrasound-guided botulinum toxin-a injections: a method of treating sialorrhea

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an impaired quality of life, often worsened by correlated complications such as aspiration pneumonia, oral infections, dental caries, and maceration of the skin. Diverse therapeutic approaches have been proposed for the treatment of sialorrhea, including surgery and the use of anticholinergic agents, with limited results and the possible occurrence of serious adverse events. Recently, botulinum toxin (BoNT) injection within the major salivary glands has been proposed in patients refractory to anticholinergic therapy, with the aim of inhibiting local acetylcholine release and gland activity. 
In order to obtain a better outcome in terms of reduction of saliva production, efficacy, duration, and avoidance of major adverse events, we developed an ultrasound-guided BoNT-type A injection technique accurately described in the text. Here we present a method of treating sialorrhea with bilateral parotid and submandibular gland BoNT-type A injections under ultrasound guidance. Four quadrants of the parotid gland and two quadrants of the submandibular gland are visualized and injected using two accesses and one access, respectively. 
The ultrasound-guided procedure provides a simple, non-invasive, real-time visualization of the muscular and glandular tissues and their surrounding structures, optimizing treatment efficacy and safety.

US-導かれた注射は、リアルタイムおよび唾液腺中のBoNT投与のための正確な針の可視化を得るための有効な手法です。このアプローチは、長期の有効性および重篤な有害事象が存在しないと、信頼性の流涎症の治療を提供します。確かに、ここで提案されているUS-導かれたアプローチが提供する腺の針の浸透の可視化は重要かつ長期的な成果と大唾液腺内のBoNT-Aの広?...

Watch this Scientific Journal Video about Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea at JoVE.com

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Botulinum toxin is injected into the salivary glands for the treatment of sialorrhea. The ultrasound-guided botulinum toxin injection in both the parotid and submandibular glands demonstrates a sustained efficacy and the absence of serious side effects.

ボツリヌス毒素Aの注射を超音波誘導：唾液分泌過多を治療する方法

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an ...

ultrasound-guided-botulinum-toxin-injections-method-treating

Research

JoVE Journal

Medicine

22.6K ビュー.  University of Torino, San Luigi Gonzaga Hospital. Botulinum toxin is injected into the salivary glands for the treatment of sialorrhea. The ultrasound-guided botulinum toxin injection in both the parotid and submandibular glands demonstrates a sustained efficacy and the absence of serious side effects.

ビデオ: Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Ultrasound-guided Transthoracic Intramyocardial Injection in Mice

Murine models of cardiovascular disease are important for investigating pathophysiological mechanisms and exploring potential regenerative therapies. Experiments involving myocardial injection are currently performed by direct surgical access through a thoracotomy. While convenient when performed at the time of another experimental manipulation such as coronary artery ligation, the need for an invasive procedure for intramyocardial delivery limits potential experimental designs. With ever improving ultrasound resolution and advanced noninvasive imaging modalities, it is now feasible to routinely perform ultrasound-guided, percutaneous intramyocardial injection. This modality efficiently and reliably delivers agents to a targeted region of myocardium. Advantages of this technique include the avoidance of surgical morbidity, the facility to target regions of myocardium selectively under ultrasound guidance, and the opportunity to deliver injectate to the myocardium at multiple, predetermined time intervals. With practiced technique, complications from intramyocardial injection are rare, and mice quickly return to normal activity on recovery from anesthetic. Following the steps outlined in this protocol, the operator with basic echocardiography experience can quickly become competent in this versatile, minimally invasive technique.

Echocardiography-guided percutaneous intramyocardial injection represents an efficient, reliable, and targetable modality for the delivery of gene transfer agents or cells into the murine heart. Following the steps outlined in this protocol, the operator can quickly become competent in this versatile, minimally invasive technique.

マウスにおける超音波ガイド下経胸壁心筋内注射

Murine models of cardiovascular disease are important for investigating pathophysiological mechanisms and exploring potential regenerative therapies. ...

医学

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

気管支超音波ガイド下経気管支穿刺吸引を使用して、胸骨下甲状腺生検

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

Performing Subretinal Injections in Rodents to Deliver Retinal Pigment Epithelium Cells in Suspension

The conversion of light into electrical impulses occurs in the outer retina and is accomplished largely by rod and cone photoreceptors and retinal pigment epithelium (RPE) cells. RPE provide critical support for photoreceptors and death or dysfunction of RPE cells is characteristic of age-related macular degeneration (AMD), the leading cause of permanent vision loss in people age 55 and older. While no cure for AMD has been identified, implantation of healthy RPE in diseased eyes may prove to be an effective treatment, and large numbers of RPE cells can be readily generated from pluripotent stem cells. Several interesting questions regarding the safety and efficacy of RPE cell delivery can still be examined in animal models, and well-accepted protocols used to inject RPE have been developed. The technique described here has been used by multiple groups in various studies and involves first creating a hole in the eye with a sharp needle. Then a syringe with a blunt needle loaded with cells is inserted through the hole and passed through the vitreous until it gently touches the RPE. Using this injection method, which is relatively simple and requires minimal equipment, we achieve consistent and efficient integration of stem cell-derived RPE cells in between the host RPE that prevents significant amount of photoreceptor degeneration in animal models. While not part of the actual protocol, we also describe how to determine the extent of the trauma induced by the injection, and how to verify that the cells were injected into the subretinal space using in vivo imaging modalities. Finally, the use of this protocol is not limited to RPE cells; it may be used to inject any compound or cell into the subretinal space.

Here we present a community accepted protocol in multimedia format for subretinally injecting a bolus of RPE cells in rats and mice. This approach can be used for determining rescue potentials, safety profiles, and survival capacities of grafted RPE cells upon implantation in animal models of retinal degeneration.

懸濁液中の網膜色素上皮細胞を送達するげっ歯類における網膜下注射の実行

The conversion of light into electrical impulses occurs in the outer retina and is accomplished largely by rod and cone photoreceptors and retinal pigment ...

Ultrasound-guided Intracardiac Injection of Human Mesenchymal Stem Cells to Increase Homing to the Intestine for Use in Murine Models of Experimental Inflammatory Bowel Diseases

Crohn&#39;s disease (CD) is a common chronic inflammatory disease of the small and large intestines. Murine and human mesenchymal stem cells (MSCs) have immunosuppressive potential and have been shown to suppress inflammation in mouse models of intestinal inflammation, even though the route of administration can limit their homing and effectiveness 1,3,4,5. Local application of MSCs to colonic injury models has shown greater efficacy at ameliorating inflammation in the colon. However, there is paucity of data on techniques to enhance the localization of human bone marrow-derived MSCs (hMSCs) to the small intestine, the site of inflammation in the SAMP-1/YitFc (SAMP) model of experimental Crohn&#39;s disease. This work describes a novel technique for the ultrasound-guided intracardiac injection of hMSCs in SAMP mice, a well-characterized spontaneous model of chronic intestinal inflammation. Sex- and age-matched, inflammation-free AKR/J (AKR) mice were used as controls. To analyze the biodistribution and the localization, hMSCs were transduced with a lentivirus containing a triple reporter. The triple reporter consisted of firefly luciferase (fl), for bioluminescent imaging; monomeric red fluorescent protein (mrfp), for cell sorting; and truncated herpes simplex virus thymidine kinase (ttk), for positron emission tomography (PET) imaging. The results of this study show that 24 h after the intracardiac administration, hMSCs localize in the small intestine of SAMP mice as opposed to inflammation-free AKR mice. This novel, ultrasound-guided injection of hMSCs in the left ventricle of SAMP mice ensures a high success rate of cell delivery, allowing for the rapid recovery of mice with minimal morbidity and mortality. This technique could be a useful method for the enhanced localization of MSCs in other models of small-intestinal inflammation, such as TNF&#916;RE6. Future studies will determine if the increased localization of hMSCs by intra-arterial delivery can lead to increased therapeutic efficacy.

Murine studies in models of colonic inflammation have demonstrated that a small percentage (1 - 5%) of mesenchymal stem cells (MSC) injected intravenously or intraperitoneally home to the inflamed colon1,2. This study shows that ultrasound-guided intracardiac injections of MSCs result in increased localization to the intestine.

実験的炎症性腸病気のマウスモデルで使用するため、腸管へのホーミングを増加するヒト間葉系幹細胞の超音波ガイド下心臓内注射

Crohn&#39;s disease (CD) is a common chronic inflammatory disease of the small and large intestines. Murine and human mesenchymal stem cells (MSCs) have ...

Mechanical and Controlled PRP Injections in Patients Affected by Androgenetic Alopecia

23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the Norwood-Hamilton classification scale, and female pattern hair loss (FPHL) in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with non-activated autologous platelet-rich plasma (A-PRP). Autologous blood (55 mL) was harvested using sodium citrate as an anticoagulant. A-PRP (23 mL) was produced for all cases using a closed system according to the transfusion service protocol. Following centrifugation (260 x g for 10 min) the A-PRP was inserted in a laser light selector device, and after the centrifugation, 9 mL of A-PRP was collected.
The scalp of the patients affected by androgenetic alopecia (AGA) was divided into four areas (frontal, parietal, vertex, and occipital); local anesthesia was not performed. Interfollicular A-PRP injections (0.2 mL x cm2) were performed by controlled and mechanical injections scheduled at a depth of 5 mm using a medical injector gun. Treatment sessions were performed with a 30-day interval. For each patient, three treatment sessions were performed.
PRP was injected in the androgen-related areas of scalp affected by hair loss. Placebo (normal saline solution) was loaded in another syringe (10 mL) and injected on the adjacent side in a similar fashion.

This paper aims to describe the interfollicular autologous platelet-rich plasma injections (0.20 mL x cm2) in the scalp of 23 patients affected by androgenetic alopecia at a depth of 5 mm using a medical injector gun equipped with a 30 gauge needle, in three sessions.

アンドロゲン性脱毛症の影響を受ける患者における力学と制御された PRP 注射

23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the ...

A New Best Practice for Validating Tail Vein Injections in Rat with Near-infrared-Labeled Agents

Intravenous (IV) administration of agents into the tail vein of rats can be both difficult and inconsistent. Optimizing tail vein injections is a key part of many experimental procedures where reagents need to be introduced directly into the bloodstream. Unwittingly, the injection can be subcutaneous, possibly altering the scientific outcomes. Utilizing a nanoemulsion-based biological probe with an incorporated near-infrared fluorescent (NIRF) dye, this method offers the capability of imaging a successful tail vein injection in vivo. With the use of a NIRF imager, images are taken before and after the injection of the agent. An acceptable IV injection is then qualitatively or quantitatively determined based on the intensity of the NIRF signal at the site of injection.

Here we present a method to validate tail vein injections in rats by utilizing near-infrared fluorescence imaging data from dyes incorporated into agents or biological probes. The tail is imaged before and after the injection, the fluorescent signal is quantified, and an assessment of the injection quality is made.

近く-赤外線-ラベル エージェントとラットの尾静脈注射を検証するための新しいベスト プラクティス

Intravenous (IV) administration of agents into the tail vein of rats can be both difficult and inconsistent. Optimizing tail vein injections is a key part ...

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Pneumothorax is a common emergency and critical disease in newborn infants that needs rapid, clear diagnosis and timely treatment. Diagnosis and treatment based on chest X-rays are associated with delayed management and radiation damage. Lung ultrasound (US) provides useful guidance for rapid, accurate diagnosis and the precise thoracentesis of pneumothorax.

新生児気胸超音波診断と超音波誘導胸腔穿刺術のための国際専門家のコンセンサスと勧告

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic ...

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary biliary drainage method whenever possible. Percutaneous Transhepatic Biliary Drainage (PTBD) is used as a salvage method if ERCP fails. Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) provides a feasible alternative biliary drainage method where one of the methods is EUS guided Hepaticogastrostomy (EUS-HGS). Here we describe the EUS-HGS technique in a case of unresectable malignant hilar biliary obstruction to achieve biliary drainage.
Presented here is the case of a 71-year-old female with painless jaundice and weight loss for 2 weeks. Computed Tomography (CT) imaging showed a 4 x 5 cm hilar tumor with lymphadenopathy and liver metastasis. EUS fine needle biopsy (FNB) of the lesion was consistent with cholangiocarcinoma. Her bilirubin levels were 212 &#181;mol/L (&lt;15) during presentation.
A linear echoendoscope was used to locate the left dilated intrahepatic ducts (IHD) of the liver. The segment 3 dilated IHD was identified and punctured using a 19 G needle. Contrast was used to opacify the IHDs under fluoroscopic guidance. The IHD was cannulated using a 0.025-inch guidewire. This was followed by the dilation of the fistula tract using a 6 Fr electrocautery dilator along with a 4 mm biliary balloon dilator. A partially covered metallic stent of 10 cm in length was deployed under fluoroscopic guidance. The distal part opens in the IHD and the proximal part was deployed within the working channel of the echoendoscope that subsequently released into the stomach. The patient was discharged three days after the procedure. Follow up performed in the second and fourth weeks showed that the bilirubin levels were 30 &#181;mol/L and 14 &#181;mol/L, respectively. This indicates that EUS-HGS is a safe method for biliary drainage in unresectable malignant biliary obstruction.

Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) is an alternative method of biliary decompression in malignant biliary obstruction. Here we describe the technique of EUS guided-Hepaticogastrostomy (EUS-HGS) in a case of unresectable malignant hilar biliary obstruction.

内視鏡超音波誘導胆道排液:悪性胆道閉塞における内視鏡超音波誘導肝胃瘻切除術

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

Ultrasound-Guided Induced Pluripotent Stem Cell-Derived Cardiomyocyte Implantation in Myocardial Infarcted Mice

The key objective of cell therapy after myocardial infarction (MI) is to effectively enhance the cell grafted rate, and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are a promising cell source for cardiac repair after ischemic damage. However, a low grafted rate is a significant obstacle for effective cardiac tissue regeneration after transplantation. This protocol shows that multiple hiPSC-CM ultrasound-guided percutaneous injections into an MI area effectively increase cell transplantation rates. The study also describes the entire hiPSC-CM culture process, pretreatment, and ultrasound-guided percutaneous delivery methods. In addition, the use of human mitochondrial DNA help detect the absence of hiPSC-CMs in other mouse organs. Lastly, this paper describes the changes in cardiac function, angiogenesis, cell size, and apoptosis at the infarcted border zone in mice 4 weeks after cell delivery. It can be concluded that echocardiography-guided percutaneous injection of the left ventricular myocardium is a feasible, relatively invasive, satisfactory, repeatable, and effective cellular therapy.

Ultrasound-guided cell delivery around the site of myocardial infarction in mice is a safe, effective, and convenient way of cell transplantation.

心筋梗塞マウスにおける超音波ガイド下多能性幹細胞由来心筋細胞移植術

The key objective of cell therapy after myocardial infarction (MI) is to effectively enhance the cell grafted rate, and human induced pluripotent stem ...

Intravitreal Injections in the Ovine Eye

There are several methods for the delivery of therapeutic agents to the retina, including intravitreal (IVT), subretinal, suprachoroidal, periocular, or topical administration. IVT drug delivery involves an injection into the vitreous humor of the eye, a gelatinous substance that fills the posterior chamber of the eye and maintains the shape of the eye globe. Although the IVT route is less specifically targeted than subretinal delivery, it is much less invasive and is widely used in clinical settings for a range of ocular diseases. 
We previously demonstrated the efficacy of intravitreal delivery of an adeno-associated virus (AAV)-mediated gene therapy product (AAV9.CLN5) in sheep with a naturally occurring CLN5 form of neuronal ceroid lipofuscinosis (NCL). Affected sheep received IVT gene therapy in one eye, with the other untreated eye serving as an internal control. Retinal structure and function were maintained in the treated eye up to 15 months after treatment, while the untreated eye displayed progressively declining function and severe atrophy during postmortem examination. Based on the sheep studies, the CLN5 gene therapy product was cleared as a candidate investigational new drug (IND) by the United States Food and Drug Administration in September 2021. This paper details the surgical protocol for IVT delivery of a therapeutic viral vector to the ovine eye.

Intravitreal injections were performed in the sheep eye with the aim of delivering viral-mediated gene therapy to the retina.

ヒツジの目の硝子体内注射

There are several methods for the delivery of therapeutic agents to the retina, including intravitreal (IVT), subretinal, suprachoroidal, periocular, or ...