Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

BACKGROUND For parturients with paroxysmal uterine contraction pain,rapid analgesia is needed.We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor,and evaluated the usefulness of this technique in epidural labor analgesia.AIM To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.METHODS In this prospective randomized observational study,72 parturients were assigned to two groups(combined or palpation group).The target interspace of all parturients was first identified by the palpation technique.Then in the combined group,preprocedure ultrasound imaging was used before epidural puncture.In the palpation group,only the traditional anatomical landmarks technique(palpation technique)was performed.The primary outcome was total duration of the epidural procedure(for the ultrasound group,the duration of the preprocedure ultrasound imaging was included).The secondary outcomes were the number of skin punctures,the success rate at first needle pass,the number of needle passes,the depth from the skin to epidural space,and the complications of the procedure.RESULTS Total duration of the epidural procedure was similar between the two groups(406.5±92.15 s in the combined group and 380.03±128.2 s in the palpation group;P=0.318).A significant improvement was demonstrated for epidural puncture and catheterization in the combined group.The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group(P=0.001).The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group(P=0.398).The success rate at first needle pass was 88.89%in the combined group and 66.67%in the palpation group(P=0.045).CONCLUSION This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique,which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Artificial intelligence meets traditional Chinese medicine: a bridge to opening the magic box of sphygmopalpation for pulse pattern recognition

Artificial intelligence(AI) aims to mimic human cognitive functions and execute intellectual activities like that performed by humans dealing with an uncertain environment. The rapid development of AI technology provides powerful tools to analyze massive amounts of data, facilitating physicians to make better clinical decisions or even replace human judgment in healthcare.Advanced AI technology also creates novel opportunities for exploring the scientific basis of traditional Chinese medicine(TCM) and developing the standardization and digitization of TCM pulse diagnostic methodology. In the present study, we review and discuss the potential application of AI technology in TCM pulse diagnosis. The major contents include the following aspects:(1) a brief introduction of the general concepts and knowledge of TCM pulse diagnosis or palpation,(2) landmark developments in AI technology and the applications of common AI deep learning algorithms in medical practice,(3) the current progress of AI technology in TCM pulse diagnosis,(4) challenges and perspectives of AI technology in TCM pulse diagnosis. In conclusion, the pairing of TCM with modern AI technology will bring novel insights into understanding the scientific principles underlying TCM pulse diagnosis and creating opportunities for the development of AI deep learning technology for the standardization and digitalization of TCM pulse diagnosis.

Patent hemostasis of radial artery:Comparison of two methods

BACKGROUND Radial artery obstruction is the most common complication of coronary angiography performed via transradial access.Patent hemostasis can significantly reduce the risk of radial artery occlusion.Previous studies utilized sophisticated methods to evaluate radial artery patency.Simplified and easily applicable methods for successful patent hemostasis are currently lacking.AIM To determine which method(pulse oximeter vs the traditional radial artery palpation)is better to achieve patent hemostasis.METHODS This prospective,single center study included 299 consecutive patients who underwent coronary angiography or percutaneous coronary intervention between November 2017 and July 2019.Patients less than 18 years old,with a history of radial artery disease,or no palpable artery pulse were excluded from the study.Patients were randomly assigned to two groups.In the first group,radial artery flow was assessed by palpation of the artery during hemostasis(traditional method).In the second group,radial artery patency was estimated with the use of a pulse oximeter.Two different compression devices were used for hemostasis(air chamber and pressure valve).The primary study endpoint was the achievement of successful patent hemostasis.RESULTS The two groups(pulse oximeter vs artery palpation)had no significant differences in age,sex,body mass index,risk factors,or comorbidities except for supraventricular arrhythmias.The percentage of patients with successful patent hemostasis was significantly higher in the pulse oximeter group(82.2%vs 68.1%,P=0.005).A lower percentage of patients with spasm was recorded in the pulse oximeter group(9.9%vs 19.0%,P=0.024).The incidence of local complications,edema,bleeding,hematoma,vagotonia,or pain did not differ between the two groups.In the multivariate analysis,the use of a pulse oximeter(OR:2.35,95%CI:1.34-4.13,P=0.003)and advanced age(OR:1.04,95%CI:1.01-1.07,P=0.006),were independently associated with an increased probability of successful patent hemostasis.The type of hemostatic device did not affect patent hemostasis(P=0.450).CONCLUSION Patent hemostasis with the use of pulse oximeter is a simple,efficient,and safe method that is worthy of further investigation.Larger randomized studies are required to consider its clinical implications.

Non-invasive reversal of intraluminal vas deferens polymer injection-induced azoospermia——technology

Aim: The rationale and technique underlying a novel concept of non-invasive removal of an intravasal vas deferens poly-meric contraceptive drug to reverse drag injection-induced azoospermia are explained. Thus the conventional methods ofsurgical exploration to remove vas deferens plugs and intravasal injection of solvents to flush out contraceptive drugs are tobe replaced by steps which will be readily accepted by subjects. Methods: The approach is based upon the non-invasiveapplication of specific forces to various segments of the vas deferens so that non-sclerosing and non-tissue-adherent com-pounds, in particular styrene maleic anhydride (SMA) can be expelled. Forces are generated by palpation; percuta-neous electrical stimulation; vibration application; and percussion. The forces help to propel the intravasal polymer to-wards the ejaculatory duct for expulsion during ejaculation. All aspects of the total technique are clinically acceptable,simple, atraumatic, unlikely to cause pain and discomfort even without tranquilizers, local or general anaesthetics. Theprocedure may be repeated several times in different sittings spaced apart by about one week to achieve adequate plug ex-pulsion. Results: Model experiments demonstrated the feasibility of the concept. The polymer was nonadherent andcould be moved within the vas deferens by the application of specific forces. Sufficient removal was possible to enablespermatic fluid to be transported along a region previously occupied by the polymer. A corroborating subhuman primatestudy by an independent investigator has shown that the semen profile becomes normal following the reversal. Conclu-sion: Adoption of the new technique may provide a means of non surgical restoration of normal semen profile after a pe-riod of fertility control obtained by intravasal drag injection. (Asian J Androl 1999 Sep ; 1: 131 - 134)

Development of a Finger-Shaped Muscle Hardness Tester and Its Measurement Cases

As the background of our study, we requested that practitioners use muscle hardness testers to conduct a digital assessment of muscle hardness layers that they can feel by palpation. We developed muscle hardness testers to assess muscle hardness digitally from the reaction force and the depth in pushing a finger-shaped indenter, thereby simulating palpation. To assess muscle hardness digitally, we proposed this means using the reaction force and depth that are measured when the indenter is pushed, along with the elastic constant, and the differential elastic modulus. The tester is designed to be useful to ascertain effects of, or follow the course of, muscle layer treatment applied for shoulder stiffness and other conditions. As described herein, we confirmed the effectiveness of digital assessment using foam rubber consisting of an upper layer and a lower layer, respectively simulating the cortical and muscle layers of a human body. Additionally, monitoring six subjects, we digitally assessed the change of hardness of the trapezius muscle by changing the position of the upper extremity. Next, we were able to measure the change of hardness before and after treatment for 21 subjects with shoulder stiffness.

Corticosteroid Injection by Palpation Guide versus Palpation Guide and Needling Method for Coccydynia

Background: Coccydynia is a painful condition with tenderness and ache in sacrococcygeal area which may radiate to the buttocks and lower back. Coccydynia is a multifactorial disorder and the most common cause of it is trauma. The initial treatment of the disease is conservative methods. One of the most common conservative treatments of chronic coccydynia is the local corticosteroid injection, which performed usually by palpation-guided method. This study was conducted to compare the effectiveness of local corticosteroid injection using palpation and needling method with palpation method alone. Patients and Methods: In this prospective study, 50 patients with the diagnosis of coccydynia were enrolled between 2010 and 2017. All patients had chronic coccydynia which did not respond to conservative therapy for at least three months. Participants were divided into two groups and each group consisted of 25 individuals. Patients who underwent local corticosteroid injection using palpation guide technique alone were assigned as group A and others who underwent palpation guiding injection with needling technique were considered as group B. Results: There was a statistically significant difference between the mean VAS scores in preinjection and final follow up visit in each groups (P value < 0.001). Moreover, the difference between the mean VAS scores of the final visit in groups A and B was statistically significant (P value < 0.001). Conclusion: Local corticosteroid injection using palpation guiding technique with needling is an uncomplicated, inexpensive, and effective invasive conservative treatment for refractory chronic coccydynia.

Dreaming Forward: Postidentity and the Generative Thresholds of Tourism

This manuscript from Hollinshead and Vellah calls for researchers in Tourism Studies and related Fields to reflect upon their own role in refreshing the social imaginaries of“after-colonialism”under the nomadisms of our time.Deleuzian in outlook,it positions the“post”of postcolonialism not as an end to colonialism’s imperatives but as a generative-portal through which new-seeds-of-”becoming”are discernable as the postidentities(rather than the“identities”)of populations are interpretable in multidirectional,non-hierarchical,and not easily-predictable ways.In provoking(after Deleuze)thought per rhizomatic processes(rather than via fixed concepts),the manuscript-critiquing these dynamic matters of“postidentity”-then harnesses the insights of(Leela)Ghandi’s on hybrid-nomadic-subjects,and of Venn on alternative-(com)possible-futures.Thereafter,these concerns of and about“after-colonialism”are critically contextualised within Aboriginal“Australia”,via the views of a pool of Indigenous intellectuals there,who synthesise the disruptive dialectics of belonging-cum-aspiration which they maintain that they and fellow Aboriginal people(of many sorts)face today.Throughout this manuscript,the agency and authority of tourism hovers in its sometimes-manifest/sometimes-latent generative power to project empowering postidentities for the world’s“host”or“visited”populations today.

Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit:a review

Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients,point-of-care ultrasound is widely used in the field of emergency and critical care medicine.Researchers have established several classic operating protocols for different diseases,such as acute respiratory failure,shock,and cardiac arrest,in the emergency department and intensive care unit.With further development in the portability and popularity of ultrasonic equipment,it is expected to be used as a new type of technology for physical examination,including inspection,palpation,percussion,auscultation,and insonation,which will improve the clinical medicine practice in the future.

Pulse Waveform Analysis as A Bridge between Pulse Examination in Chinese Medicine and Cardiology

Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables （frequency, rhythm, wideness, length, deepness, and qualities） developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories： the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yin- yang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiologyto provide a more evidence-based medical practice.

Clinical observation on Wang Juyi＇s applied channel theory in treating stroke-sequel patients

OBJECTIVE:To explore the advantages of acupuncture treatment guided by channel palpation on stroke-sequel patients.METHODS:This research was randomized,traditional acupuncture controlled trial using channel palpation acupuncture to treat stroke-sequel patients.Totally 148 patients who were randomly assigned to two experimental groups.The treatment group,i.e,the channel palpation group was treated with Dr.Wang Juyi's Channel Palpation.Patients in control group received acupuncture according to New Century Acupuncture.Every patient was needled at Renzhong(GV 26),Baihui(GV 20),Neiguan(PC 6),Jiquan(HT 1),Chize(LU 5),Weizhong(BL 40),Sanyinjiao(SP 6),Zusanli(ST 36),and each acupuncture treatment was modified according different syndrome differentiations including liver yang rising [Taichong(LR 3),Taixi(KI 3)],wind-phlegm blocking collaterals [Fenglong(ST 40),Hegu(LI 4)],phlegm-heat occupying in the Fu-organs [Quchi(LI11),Neiting(ST 44),Fenglong(ST 40)],Qi deficiency with blood stasis [Qihai(CV 6),Xuehai(SP 10)],Yin Deficiency with wind [Taixi(KI 3),Fengchi(GB 20)];for wry mouth,add Jiache(ST 6),Dicang(ST 4);for paralyzed arms,add Jianyu(LI 15),Quchi(LI 11),Shousanli(LI 10) and Hegu(LI 4),for paralyzed legs,add Huantiao(GB 30),Yinlingquan(SP 9) and Fengshi(GB 31).The duration of each treatment was 6 weeks.Then the Fugl-Meyer score,the Stroke Specific Quality of Life scale(SS-QOL),and the National Institute of Health Stroke Scale(NIHSS) were assessed before treatments,after 6 and 12 weeks of treatments to evaluate the acupuncture effect in each group.The data were collected and analyzed after the completion of treatment by SPSS 17 using paired sample t-test.RESULTS:Totally 148 participants were recruited,and 136 eligible patients were included in this study.The results showed that for FMA motor function and Fugl-Meyer balance function and NIHSS,there is no statistic difference between two groups at the baseline period,after 6-week treatment and after 12-week follow-up(P > 0.05);However,for NIHSS and SS-QOL,there is no statistic difference between two groups at the baseline period and 6 weeks after treatment(P > 0.05).However,statistical difference starts to appear after 12-week(P =0.028,0.037 < 0.05).CONCLUSION:We conclude that as for improving the nerve function and the quality of life,Dr.Wang Juyi's Applied Channel Theory presents a better clinical result.

Personal Experience on Palpation of the Spine

In addition to conventional palpation method, examination on vertebral range of motion(ROM) and mobility can help to determine a pathological displacement and thus provide solid basis for spinal tuina manipulation.