Name: ultrasound-guided botulinum toxin-a injections: a method of treating sialorrhea
Uploaded: 2016-11-09T12:30:00.000+00:00
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在这里，我们在技术上描述用于在患者的神经系统的吞咽困难的治疗流涎的方法。我们不会集中在疗效的结果，这已先前7出版。在本文中，在结果部分，我们从连续5例治疗从2014年至2016年，这些患者被认为是代表全体人民，它由肉毒毒素的长期随访（3个疗程）显示数据圣路易吉Gonzaga大学医院的服务。该协议获得批准，是继人体实验地方的道德标准委员会的指导方针。 1.患者的招募注:患者符合这一做法是成年人患有中度至严重流涎继发于神经系统吞咽困难与故障或禁忌药物治疗的历史，如抗胆碱能药。 <ol><li>确保患者由EXP评价肉毒毒素注射前，而且严重程度和流涎的频率erienced神经学家进行评估与流口水的频率和严重程度量表（DFSS）14。 注:六西格玛得分是频率的总和（1 =从不，2 =偶尔/不是每天，3 =频繁/一天的部分，4 =持续）和严重性（1 =从不流口水，2 =轻度或仅嘴唇湿润，3 =中度或嘴唇和下巴湿，4 =严重或流口水延伸到衣服弄湿，5 =满头或衣服，手，托盘，和对象湿）子得分14。在两个子分数的评分&gt; 2被用作资格截止。 注:神经学家分数由患者和/或护理人员提供客观和回忆数据的基础上的刻度。此外，视觉模拟评分（VAS）必须为患者的相关的流涎主观默许的评价给药。在VAS是通过用如10厘米×水平线表示的自我报告规模tatement在代表病人的不适感的一个极端（100 ="无不适感"，以0 ="极度不适"）两端。 </li><li>每天收集唾液愿望的数量通过唾液吸引（如果适用）肉毒毒素注射前，作为治疗功效（ 图1）的评估的有用工具。 </li><li>在随访期间，图1中，处理3和6个月后重复的神经学评估与DFSS和每日唾液抽吸评估沿，或根据流涎再次发生。特别是，再治疗必须考虑到当日常愿望的数量相比，1个月的随访评估增加了50％以上。 </li><li>收集过程的不良事件（局部疼痛，局部出血，面瘫）注射后立即生效。收集在随访评估治疗的不良事件（局部疼痛，面神经麻痹，咀嚼无力，粘性唾液，口干等）。 </li></ol> 2.程序<ol><li>肉毒毒素-A制剂 注:abobotulinumtoxinA是肉毒杆菌复杂的血凝素的A型肉毒毒素。它是用于肌内或皮下注射溶液的粉末。 <ol><li>用于治疗成人流涎的，重构500 IU abobotulinumtoxinA用2ml的注射0.9％氯化钠溶液，以得到含250国际单位/毫升abobotulinumtoxinA的溶液。 </li><li>辖共有250 IU的abobotulinumtoxinA每个患者如下:50 IU在每个颌下腺和75 IU在每个腮腺。通过这种方式治疗两例单瓶，以避免药物浪费。 </li></ol></li><li>患者的准备<ol><li>程序和治疗的潜在风险和益处充分的说明后，获得患者的书面知情同意书。 </li><li>将患者在超声表仰卧位，并可能与颈部延长。 注意:考虑到不导致流涎所有神经状况允许颈部的完全扩展。 </li><li>消毒在上方区域腮腺并用防腐剂颌下腺皮肤。麻醉与氯化乙烯喷雾每个皮肤访问网站。 </li></ol></li><li>超声引导 注意:用线性传感器的超声引导过程（5 - 10兆赫）用于压盖定位，以便获得肌肉，腺体，更大的船只或唾液管道，和其他周边结构的实时可视化，以及作为腺体组织内的正确针的位置。 <ol><li>打开超声系统上，并按下"开始 - 结束"按钮，开始考试。 </li><li>按"探头"按钮，选择高频探头（5 - 10兆赫）。 </li><li>按下"病人"按钮，并插入患者的姓名和surna我。 </li><li>按"议定书"按钮，选择相应的协议和子协议（ 即协议:"小组织"，子协议:"常规"）。 </li><li>按"深度"按钮，并指定来看深度5厘米。 </li><li>按"焦点访谈"按钮，选择2厘米的最大细节。 </li><li>放置换能器的下颌骨下，二腹肌的前部和后部的腹部之间，以可视化的颌下腺，这似乎与同质echotexture低回声区域比周围的组织。 注:考虑颌下腺最好分为两个象限，一是头颅和一个尾部。确定横向针访问的最宽腺直径。 </li><li>放置外耳道低于换能器以可视化的腮腺，这似乎与同质echotexture低回声区域比周围的组织。 不E:考虑腮腺地理位置分为四个象限，二头颅和两个尾。确定外耳道和下颌角，一个在颅部分，一个在腺体（ 补充图 ）尾椎部位注射之间的中间两个接入点。 </li></ol></li><li>肉毒毒素-A注射 注意:从传感器使用22克针注射，用针穿透至少0.5厘米换能器必须沿纵向，使针是为亮回声线可见被定向到针。以这种方式，针的穿透进入软组织可以在程序作为朝向目标针尖前进过程中被监控，防止受伤的神经血管结构。 <ol><li>使用横向短接入方式是在最宽直径腺体访问颌下腺。 </li><li> 25注射肉毒毒素IU-A到上颌下象限。注射后，略微缩回NEedle并改变朝向下颌下腺象限针尖的方向，注入25 IU的BoNT-A为总共50国际单位的每个颌下腺。 注意:在这种方式，二颌下区域（头部和尾部）被注入，腺体组织中提供药物的广泛扩散。 </li><li>用于腮腺注入两个接入点。确定两个访问外耳道及下颌角，一个在腺体的颅部分，一个在腺体的尾部部分的中点处。 </li><li>使用上部存取（在压盖的颅部），注入18 - 19 IU的BoNT-A到中间 - 颅象限。注射后，略微缩回针，不留腺体的颅部的部位，并改变对横向颅象限针尖的方向;注18 - 19 IU肉毒毒素-A。 </li><li>使用较低访问（腺体的尾部部分），注入18 - 19肉毒毒素-A在IU向内侧 - 尾象限。注射后，略微缩回针，不留腺体的尾部的部位，并改变朝向横向尾象限针尖的方向;注18 - 19 IU肉毒毒素-A。 注意:在这种方式，四腮腺区域（中间 - 颅，横向颅，内侧 - 尾和横向尾）注射，共75 IU的BoNT-A的，腺体组织中提供药物的广泛扩散。 </li><li>每次注射后，DAB任何用无菌纱布止血1 - 2分钟。重新评估一小时后的患者为任何潜在的不利事件。在持续疼痛的情况下施用非类固醇消炎药。 1个月后安排后续检查。 </li></ol></li></ol>

<ol>
	<li>Kumar, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Swallowing+and+dysphagia+in+neurological+disorders.">Swallowing and dysphagia in neurological disorders.</a> Rev Neurol Dis. 7 (1), 19-27 (2010).</li><li>Lakraj, A. A., Moghimi, N., Jabbari, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sialorrhea:+anatomy,+pathophysiology+and+treatment+with+emphasis+on+the+role+of+botulinum+toxins.">Sialorrhea: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins.</a> Toxins (Basel). 5 (5), 1010-1031 (2013).</li><li>Reed, J., Mans, C. K., Brietzke, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+drooling:+a+meta-analysis.">Surgical management of drooling: a meta-analysis.</a> Arch Otolaryngol Head Neck Surg. 135 (9), 924-931 (2009).</li><li>Crysdale, W. S., White, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Submandibular+duct+relocation+for+drooling:+a+10-year+experience+with+194+patients.">Submandibular duct relocation for drooling: a 10-year experience with 194 patients.</a> Otolaryngol Head Neck. 101 (1), 87-92 (1989).</li><li>Squires, N., Wills, A., Rowson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+management+of+drooling+in+adults+with+neurological+conditions.">The management of drooling in adults with neurological conditions.</a> Curr Opin Otolaryngol Head Neck Surg. 20 (3), 171-176 (2012).</li><li>Pickett, A., Perrow, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Formulation+composition+of+botulinum+toxins+in+clinical+use.">Formulation composition of botulinum toxins in clinical use.</a> J Drugs Dermatol. 9 (9), 1085-1091 (2010).</li><li>Barbero, 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=Long-term+follow-up+of+ultrasound-guided+botulinum+toxin-A+injections+for+sialorrhea+in+neurological+dysphagia.">Long-term follow-up of ultrasound-guided botulinum toxin-A injections for sialorrhea in neurological dysphagia.</a> J Neurol. 262 (12), 2662-2667 (2015).</li><li>Guidubaldi, A., 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=Botulinum+toxin+A+versus+B+in+sialorrhea:+a+prospective,+randomized,+double-blind,+crossover+pilot+study+in+patients+with+amyotrophic+lateral+sclerosis+or+Parkinson's+disease.">Botulinum toxin A versus B in sialorrhea: a prospective, randomized, double-blind, crossover pilot study in patients with amyotrophic lateral sclerosis or Parkinson's disease.</a> Mov Disord. 26, 313-319 (2011).</li><li>Standring, S., Gray, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Gray's anatomy: The anatomical basis of clinical practice. 41st ed. , 527 (2016).</li><li>Standring, S., Gray, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Gray's anatomy: The anatomical basis of clinical practice. 41st ed. , 504 (2016).</li><li>Standring, S., Gray, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Gray's anatomy: The anatomical basis of clinical practice. 41st ed. , 528 (2016).</li><li>Gomez-Caravaca, M. T., 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=The+use+of+botulinum+toxin+in+the+treatment+of+sialorrhea+in+parkinsonian+disorders.">The use of botulinum toxin in the treatment of sialorrhea in parkinsonian disorders.</a> Neurol Sci. 36 (2), 275-279 (2015).</li><li>Walter, U., Dressler, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound-guided+botulinum+toxininjections+in+neurology:+technique,+indications+and+future+perspectives.">Ultrasound-guided botulinum toxininjections in neurology: technique, indications and future perspectives.</a> Expert Rev Neurother. 14 (8), 923-936 (2014).</li><li>Thomas-Stonell, N., Greenberg, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three+treatment+approaches+and+clinical+factors+in+the+reduction+of+drooling.">Three treatment approaches and clinical factors in the reduction of drooling.</a> Dysphagia. 3 (2), 73-78 (1988).</li><li>Sriskandan, N., Moody, A., Howlett, 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=Ultrasound-guided+submandibular+gland+injection+of+botulinum+toxin+for+hypersalivation+in+cerebral+palsy.">Ultrasound-guided submandibular gland injection of botulinum toxin for hypersalivation in cerebral palsy.</a> Br J Oral Maxillofac Surg. 48 (1), 58-60 (2010).</li><li>Contarino, M. F., 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=Botulinum+toxin+B+ultrasound-guided+injections+for+sialorrhea+in+amyotrophic+lateral+sclerosis+and+Parkinson's+disease.">Botulinum toxin B ultrasound-guided injections for sialorrhea in amyotrophic lateral sclerosis and Parkinson's disease.</a> Parkinsonism Relat Disord. 13 (5), 299-303 (2007).</li><li>Chinnapongse, R., 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=Safety+and+efficacy+of+botulinum+toxin+type+B+for+treatment+of+sialorrhea+in+Parkinson's+disease:+a+prospective+double-blind+trial.+Mov+Disord.">Safety and efficacy of botulinum toxin type B for treatment of sialorrhea in Parkinson's disease: a prospective double-blind trial. Mov Disord.</a> Mov Disord. 27 (2), 219-226 (2012).</li><li>Reid, S. M., 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=Secondary+effects+of+botulinum+toxin+injections+into+salivary+glands+for+the+management+of+pediatric+drooling.">Secondary effects of botulinum toxin injections into salivary glands for the management of pediatric drooling.</a> J Craniofac Surg. 24 (1), 28-33 (2013).</li><li>Chan, K. H., 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=Long-term+safety+and+efficacy+data+on+botulinum+toxin+type+A:+an+injection+for+sialorrhea.">Long-term safety and efficacy data on botulinum toxin type A: an injection for sialorrhea.</a> JAMA Otolaryngol Head Neck Surg. 139 (2), 134-138 (2013).</li><li>Petracca, M., 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=Botulinum+Toxin+A+and+B+in+sialorrhea:+Long-term+data+and+literature+overview.">Botulinum Toxin A and B in sialorrhea: Long-term data and literature overview.</a> Toxicon. 1 (107), 129-140 (2015).</li></ol>

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...

流涎是唾液代表几个神经病症，包括中风，脑性麻痹，多发性硬化，和神经变性疾病1的共同和禁用并发症的过度流动。患者中度至严重流涎患有生命的质量受损，常由相关的并发症，如吸入性肺炎，口腔感染，龋齿，和浸软的皮肤2的恶化。各种治疗方法可用于治疗流涎，范围从手术药物治疗，以减少唾液分泌的目的。 手术选择包括去神经，唾液腺的切除和换位或结扎涎管3,4。然而，尽管其疗效，手术是通过定义与潜在的严重的不良事件，诸如唾液瘘和囊肿形成，感染，丧失侵入性手术味觉，听觉，构音障碍的损失，并在唾液腺生产3不可逆转的影响。此外，已经观察到该过程2,5后的唾液腺两年或两年以上手术方法可以仅具有临时有效性由于神经支配恢复。对于严重流涎更常见，微创治疗是采用全身用药与抗胆碱能性。然而，长期使用抗胆碱能药的通常与全身的副作用，如混乱，记忆问题，嗜睡，尿潴留，和麻痹性肠梗阻2,5相关联。 肉毒毒素（肉毒毒素）唾液喷射为用于流涎一个新兴的治疗选择。的BoNT是蛋白酶（七从A到G），由细菌肉毒梭菌产生，其能够从神经肌肉接头的突触前神经末梢制止乙酰胆碱释放，阻断肌肉收缩和腺活动在orthosympathetic和副交感神经节后突触。肉毒毒素A型（肉毒毒素-A）和B型（肉毒毒素-B）通常用于肌张力障碍和痉挛6的治疗管理。最近，由于缺乏疗效或显著副作用2,7,8存在下被证明是一个有用的治疗选择在中度至其他医学治疗不理想的反应严重流涎大唾液腺中的BoNT注射。 人类唾液腺分为两类:主要和次要。大唾液腺包括一对腮腺，一对颌下腺，和一对舌下腺的;小唾液腺包括口腔9的子黏膜内扩散约1000小腺体。大约0.5升唾液是每天分泌。三对主要唾液腺负责的唾液产生的90％以上，约划分如下:20％F或腮腺，65％为颌下腺和5％，舌下腺9。腮腺是最大的之一，位于外耳道下方，下颌骨和胸锁乳突肌之间;它向前突出咬肌10的表面上。重要结构穿过压盖，如面神经，颈外动脉，和下颌后静脉等几个重要的神经血管结构是靠近压盖。颌下腺是浆粘液腺位于后面，下颌骨升支的下方，在颌下三角的区域，二腹肌的前部和后部的肚子之间和周围的肌肉下颌舌骨11的后缘。 的BoNT唾液腺注射是有潜力的本地处理以避免不适和/或全身性的副作用与其他疗法，如口服，TR相关ansdermal和手术方式的选择。在这里，我们展现出可靠的，容易复制的方法，以获得令人满意的和持久的减少流口水的同时，极力限制严重发生的治疗下，超声在腮腺肉毒毒素-A注射和颌下腺流涎（美国）指导不良事件。在流口水在没有美国的指导对肉毒毒素-A注射疗效的数据文献报道12;然而，腺体和其周围组织的超声引导标识，与针位置的实时可视化一起允许在不利事件的降低和更精确的注射，导致增加的疗效和结果再现性7,13。

<table><tbody><tr><td>abobotulinumtoxinA (Dysport)</td><td>IpsenBiopharm, Wrexham, UK</td><td></td><td>Delivered drug</td></tr><tr><td>MyLab Twice</td><td>Esaote</td><td></td><td>Ultraonograph</td></tr><tr><td>LA523 5&amp;ndash;10 MHz</td><td>Esaote</td><td></td><td>Linear transducer</td></tr></tbody></table>

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.

在超声引导下注射是获得实时的和精确的针可视化在唾液腺的BoNT施用一种有效的技术。这种方法提供了可靠的流涎处理，具有延长的疗效和没有严重不良事件。事实上，腺体，并通过本文提出的超声引导下的做法提供的针入度的可视化允许肉毒毒素A的有显著而持久的成果大唾液腺内的一种普遍的管理。流口水减少可通过唾液吸引容易观察1瓦特处理后通过DFSS和增值业务的...

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.

超声引导下肉毒毒素-A注射液:治疗流涎的一种方法

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

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

22.7K 次观看.  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.

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

Subcutaneous Administration of Muscarinic Antagonists and Triple-Immunostaining of the Levator Auris Longus Muscle in Mice

Hind limb muscles of rodents, such as gastrocnemius and tibialis anterior, are frequently used for in vivo pharmacological studies of the signals essential for the formation and maintenance of mammalian NMJs. However, drug penetration into these muscles after subcutaneous or intramuscular administration is often incomplete or uneven and many NMJs can remain unaffected. Although systemic administration with devices such as mini-pumps can improve the spatiotemporal effects, the invasive nature of this approach can cause confounding inflammatory responses and/or direct muscle damage. Moreover, complete analysis of the NMJs in a hind limb muscle is challenging because it requires time-consuming serial sectioning and extensive immunostaining. 
The mouse LAL is a thin, flat sheet of muscle located superficially on the dorsum of the neck. It is a fast-twitch muscle that functions to move the pinna. It contains rostral and caudal portions that originate from the midline of the cranium and extend laterally to the cartilaginous portion of each pinna. The muscle is supplied by a branch of the facial nerve that projects caudally as it exits the stylomastoid foramen. We and others have found LAL to be a convenient preparation that offers advantages for the investigation of both short and long-term in vivo effects of drugs on NMJs and muscles. First, its superficial location facilitates multiple local applications of drugs under light anesthesia. Second, its thinness (2-3 layers of muscle fibers) permits visualization and analysis of almost all the NMJs within the muscle. Third, the ease of dissecting it with its nerve intact together with the pattern of its innervation permits supplementary electrophysiological analysis in vitro9,5. Last, and perhaps most importantly, a small applied volume (&tilde;50&mu;l) easily covers the entire muscle surface, provides a uniform and prolonged exposure of all its NMJs to the drug and eliminates the need for a systemic approach1,8.

We describe procedures for repeated administration of inhibitors of muscarinic signaling to the levator auris longus (LAL) muscle of young adult mice and for subsequent immunostaining of its neuromuscular junctions (NMJs) in wholemounts. The LAL muscle has unique advantages for revealing in vivo pharmacological effects on NMJs.

皮下给药的毒蕈碱受体拮抗剂和上睑提的Auris在小鼠体内长肌的三重免疫染色

Hind limb muscles of rodents, such as gastrocnemius and tibialis anterior, are frequently used for in vivo  pharmacological studies of the signals ...

科研

神经科学

Subcutaneous Neurotrophin 4 Infusion Using Osmotic Pumps or Direct Muscular Injection Enhances Aging Rat Laryngeal Muscles

Laryngeal dysfunction in the elderly is a major cause of disability, from voice disorders to dysphagia and loss of airway protective reflexes. Few, if any, therapies exist that target age-related laryngeal muscle dysfunction. Neurotrophins are involved in muscle innervation and differentiation of neuromuscular junctions (NMJs). It is thought that neurotrophins enhance neuromuscular transmission by increasing neurotransmitter release. The neuromuscular junctions (NMJs) become smaller and less abundant in aging rat laryngeal muscles, with evidence of functional denervation. We explored the effects of NTF4 for future clinical use as a therapeutic to improve function in aging human laryngeal muscles. Here, we provide the detailed protocol for systemic application and direct injection of NTF4 to investigate the ability of aging rat laryngeal muscle to remodel in response to NTF4 application. In this method, rats either received NTF4 either systemically via osmotic pump or by direct injection through the vocal folds. Laryngeal muscles were then dissected and used for histological examination of morphology and age-related denervation.

Here, we present a protocol to describe the use of neurotrophin 4 (NTF4) systemically and directly to remodel rat aging laryngeal muscles.

使用渗透泵或直接肌肉注射的皮下神经营养因子4输液增强老化大鼠喉肌肉

Laryngeal dysfunction in the elderly is a major cause of disability, from voice disorders to dysphagia and loss of airway protective reflexes. Few, if ...

发育生物学

Retroductal Nanoparticle Injection to the Murine Submandibular Gland

Two common goals of salivary gland therapeutics are prevention and cure of tissue dysfunction following either autoimmune or radiation injury. By locally delivering bioactive compounds to the salivary glands, greater tissue concentrations can be safely achieved versus systemic administration. Furthermore, off target tissue effects from extra-glandular accumulation of material can be dramatically reduced. In this regard, retroductal injection is a widely used method for investigating both salivary gland biology and pathophysiology. Retroductal administration of growth factors, primary cells, adenoviral vectors, and small molecule drugs has been shown to support gland function in the setting of injury. We have previously shown the efficacy of a retroductally injected nanoparticle-siRNA strategy to maintain gland function following irradiation. Here, a highly effective and reproducible method to administer nanomaterials to the murine submandibular gland through Wharton's duct is detailed (Figure 1). We describe accessing the oral cavity and outline the steps necessary to cannulate Wharton's duct, with further observations serving as quality checks throughout the procedure.

Local drug delivery to the submandibular glands is of interest in understanding salivary gland biology and for the development of novel therapeutics. We present an updated and detailed retroductal injection protocol, designed to improve delivery accuracy and experimental reproducibility. The application presented herein is the delivery of polymeric nanoparticles.

Retroductal 纳米微粒注射液对小鼠颌下腺的治疗

Two common goals of salivary gland therapeutics are prevention and cure of tissue dysfunction following either autoimmune or radiation injury. By locally ...

生物工程

Retroductal Submandibular Gland Instillation and Localized Fractionated Irradiation in a Rat Model of Salivary Hypofunction

Normal tissues that lie within the portals of radiation are inadvertently damaged. Salivary glands are often injured during head and neck radiotherapy. Irreparable cell damage results in a chronic loss of salivary function that impairs basic oral activities, and increases the risk of oral infections and dental caries. Salivary hypofunction and its complications gravely impact a patient's comfort. Current symptomatic management of the condition is ineffective, and newer therapies to assuage the condition are needed. 
Salivary glands are exocrine glands, which expel their secretions into the mouth via excretory ducts. Cannulation of these ducts provides direct access to the glands. Retroductal delivery of a contrast agent to major salivary glands is a routine out-patient procedure for diagnostic imaging. Using a similar procedure, localized treatment of the glands is feasible. However, performing this technique in preclinical studies with small animals poses unique challenges. In this study we describe the technique of retroductal administration in rat submandibular glands, a procedure that was refined in Dr. Bruce Baum's laboratory (NIH)1, and lay out a procedure for local gland irradiation.

Salivary gland hypofunction, a major adverse effect of head and neck radiotherapy diminishes a patient's quality of life. The demonstration of efficacy of new therapies in animal models is a prerequisite before clinical transition. This protocol describes retroductal administration and local irradiation of rat submandibular glands.

Retroductal颌下腺灌输和本地化分割照射在涎腺功能减退症大鼠模型

Normal tissues that lie within the portals of radiation are inadvertently damaged. Salivary glands are often injured during head and neck radiotherapy. ...

医学

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. Neuromodulation techniques for chronic facial pain include deep brain stimulation and motor cortex stimulation, which are complex to perform. Subcutaneous nerve field stimulation is certified for chronic back pain and is the least invasive form of neuromodulation. We applied this technique to treat chronic and neuropathic trigeminal pain as an individual therapy concept. First, trial stimulation is performed. Subcutaneous leads are placed in the painful trigeminal dermatome under local anesthesia. The leads are connected to an external neurostimulator that applies constant stimulation. Patients undergo a 12 day outpatient trial to assess the effect of the stimulation. Electrodes are removed after the trial. If the patient reports pain reduction of at least 50% in intensity and/or attack frequency, a reduction in medication or increase in quality of life, permanent implantation is scheduled. New electrodes are implanted under general anesthesia and are subcutaneously tunneled to an infraclavicular internal pulse generator. Patients are able to turn stimulation on and off and to increase or decrease the stimulation amplitude as needed.
This technique represents a minimal invasive alternative to other more invasive means of neuromodulation for trigeminal pain such as motor cortex stimulation or deep brain stimulation.

Treating chronic or neuropathic facial pain can be challenging when medical or standard treatment fails. Subcutaneous nerve field stimulation is the least invasive form of neuromodulation and is used for chronic back pain. We applied this technology to treat chronic and neuropathic trigeminal facial pain.

皮下三叉神经场刺激难治性面部疼痛

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. ...

Retrograde Parotid Gland Infusion through Stensen's Duct in a Non-Human Primate for Vectored Gene Delivery

Salivary glands are an attractive tissue target for gene therapy with promising results already leading to human trials. They are inherently capable of secreting proteins into the bloodstream and are easily accessible, making them potentially superior tissue sites for replacement hormone production or vaccination by gene transfer. Suggested methods for gene delivery include transcutaneous injection and retrograde infusion through salivary ducts. We demonstrate how to perform Retrograde Salivary Gland Infusion (RSGI) in non-human primates. We describe the important anatomic landmarks including identification of the parotid papilla, an atraumatic method of cannulating and sealing Stensen&#39;s Duct utilizing basic dental tools, polyethylene tubing, and cyanoacrylate, and the appropriate rate of infusion. While this is the least traumatic method of delivery, the method is still limited by the volume able to be delivered (&#60;0.5 mL) and the potential for trauma to the duct and gland. We demonstrate using fluoroscopy that an infusate can be fully delivered into the gland, and further demonstrate by immunohistochemistry the transduction of a typical vector and expression of the delivered gene.

Salivary glands have been proposed as a tissue target site for gene therapy, especially in the area of vaccination by gene transfer. We demonstrate gene delivery in a non-human primate model utilizing retrograde parotid infusion.

逆行帕罗蒂德格兰德输液通过斯滕森的管道在非人类灵长类病原体矢量基因交付

Salivary glands are an attractive tissue target for gene therapy with promising results already leading to human trials. They are inherently capable of ...

免疫与感染

干燥综合征的唾液腺超声检查技术

Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular manifestations including arthralgia, cytopenia, and lymphoma. The presence of autoantibodies against SSA/Ro, labial salivary gland biopsy, ocular staining, Schirmer's test, or salivary flow assessment are included in the current classification criteria of SS. However, the availability and invasiveness of these procedures limit their widespread use in clinical settings. Salivary gland ultrasonography (SGUS) is a non-invasive imaging modality for the evaluation of the salivary gland parenchyma and is increasingly utilized to aid diagnosis and monitoring in SS. 
This article presents the protocol of SGUS for image acquisition at the parotid and submandibular glands. The objective is to present a standardized, reproducible, and practical approach to diagnostic SGUS for SS in daily clinical settings. Major salivary glands are scanned in a stepwise approach, beginning at the angle of the mandible for the superficial lobe of the parotid gland, followed by the deep lobe below the ramus of the mandible. Submandibular areas are then scanned for the submandibular glands. The steps in obtaining salivary gland images at each anatomical site are explained in the accompanying video. The echogenicity and echotexture at the thyroid gland are taken as a reference. The homogeneity, the presence and distribution of hypoechoic areas within the glands, and the border of the salivary glands are examined. The sizes and features of intra-/peri-glandular lymph nodes are recorded. The most distinctive sonographic feature in SS is glandular heterogeneity with the presence of hypoechoic/hyperechoic areas within the glands. 
In summary, while SGUS cannot diagnose SS on its own, it can supplement the current classification criteria of SS and guide the clinical decision for salivary gland biopsy to support the diagnosis of SS in patients with sicca syndrome or suspicious systemic features, combined with autoantibody testing.

作者聚焦：结缔组织病研究中标准化唾液腺超声方案的重点

Salivary gland ultrasonography is a promising tool for the diagnosis and evaluation of disease activity and complications in Sjogren's syndrome (SS). The scanning technique for salivary gland ultrasound examination relevant to SS is described in the article.

干燥综合征唾液腺的超声评估：诊断和监测见解

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular ...

Innovative Approach to Minimize Serious Complications in Cosmetic Dermal Filling

Cosmetic dermal filling represents a significant advance in aesthetic medicine, providing non-invasive treatments with immediate and durable outcomes. Despite the generally safe nature of dermal fillers and avoidable complications with proper technique and planning, they are still risky, with potential complications varying from mild and transient to severe and enduring. This study introduces innovative strategies designed to decrease the risk of serious complications, such as vascular occlusion. These include the use of ultrasound guidance, the application of ice, auxiliary gestures, effective withdrawal, etc. Throughout our research, we observed no severe complications like embolism, skin necrosis, or ocular issues. However, minor complications such as erythema, edema, and bruising were noted. It is important to recognize that while most severe complications can be avoided with meticulous technique and planning, the inherent risk of unexpected outcomes persists in any medical procedure. Our findings suggest that with these innovative strategies, the safety of cosmetic dermal filling can be significantly enhanced, thereby minimizing the risk of severe adverse effects.

The protocol proposes an innovative approach to cosmetic dermal filling focusing on ultrasound, icing, pressing, auxiliary gestures, and effective withdrawal to reduce the risk of serious complications like vascular occlusion. Despite the general safety of dermal fillers, accidents can still occur because of the inherent risks.

Cosmetic dermal filling represents a significant advance in aesthetic medicine, providing non-invasive treatments with immediate and durable outcomes. ...

超声引导下肉毒毒素-A注射液:治疗流涎的一种方法

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此视频中的章节

皮下给药的毒蕈碱受体拮抗剂和上睑提的Auris在小鼠体内长肌的三重免疫染色

使用渗透泵或直接肌肉注射的皮下神经营养因子4输液增强老化大鼠喉肌肉

Retroductal 纳米微粒注射液对小鼠颌下腺的治疗

Retroductal颌下腺灌输和本地化分割照射在涎腺功能减退症大鼠模型

皮下三叉神经场刺激难治性面部疼痛

逆行帕罗蒂德格兰德输液通过斯滕森的管道在非人类灵长类病原体矢量基因交付

干燥综合征唾液腺的超声评估：诊断和监测见解

干燥综合征唾液腺的超声评估：诊断和监测见解

干燥综合征唾液腺的超声评估：诊断和监测见解

Innovative Approach to Minimize Serious Complications in Cosmetic Dermal Filling