This work was supported by Budget Project of Shanghai Municipal Education Commission (Grant Number 2021LK099) and the National Natural Science Foundation of China (Grant Number 82174506).

All procedures in the protocol were conducted on commercially available human simulation materials (see Table of Materials) rather than on humans, so no ethical issues were involved in this study. Informed consent was also obtained from all volunteers who participated in the study. The participants in this experiment were 20 students from the College of Acumox and Tuina at Shanghai University of Traditional Chinese Medicine. These students had completed coursework on the acupuncture lifting and thrusting technique as part of the &#34;Science of Acupuncture and Moxibustion&#34;27curriculum. Additionally, they had nearly a year of practical experience in human needling through lessons and hands-on practice. The details of the equipment and software used are listed in the Table of Materials.
1. Fabrication of the control cannula
<ol>
	<li>Prepare the cannula, the needle sleeve, and the adjustable stopper using 3D printing technology.</li>
	<li>Use white resin as the material for 3D printing to ensure a minimum precision of 0.1 mm, which prevents issues with structures not fitting together due to errors. This material is also more cost-effective and allows easier adjustment of the structure.</li>
</ol>
2. Videography
<ol>
	<li>Camera settings
	<ol>
		<li>Place two tripods in front of the operator&#39;s desk at an appropriate height and connect the two motion cameras. Set the angle between the two motion cameras to 60&#176;-120&#176; (Figure 2A).</li>
		<li>Adjust the camera settings as follows: resolution 1280 &#215; 720 pixels, format MP4, full manual mode (M), aperture F1.2, shutter speed 1/1000s, ISO 6400, auto white balance, and optical zoom 0 mm.</li>
	</ol>
	</li>
	<li>Calibration settings
	<ol>
		<li>Place a 3D calibration stand measuring 15 cm &#215; 15 cm &#215; 15 cm on the table (Figure 2B). Ensure it is within the coverage of the two motion cameras.</li>
	</ol>
	</li>
	<li>Tracking marker placement
	<ol>
		<li>Prepare a passive infrared reflective sphere with a diameter of 6.5 mm. Attach it to the fingernail cap of the participant&#39;s right thumb to measure the movement trajectory.</li>
	</ol>
	</li>
	<li>Experimental operation 
	NOTE: The twenty participants were instructed to perform lifting and thrusting manipulations on the human simulation material, including the following techniques: even lifting and thrusting, heavy thrusting with light lifting, and light thrusting with heavy lifting. Each participant completed the three types of manipulations on the human simulation material, both with and without a cannula set to an amplitude of 15 mm. They then repeated the three manipulations using cannulas with amplitudes of 5 mm, 10 mm, and 15 mm. A 30 min interval was provided between each manipulation session to ensure consistency among the participants. Each manipulation was repeated 10 times.
	<ol>
		<li>Perform lifting and thrusting manipulations without cannula
		<ol>
			<li>Even lifting and thrusting: Insert the needle to a depth of 20 mm. Lift the needle up and down at a uniform rate with an amplitude of 15 mm at a frequency of 60 times per minute.</li>
			<li>Heavy thrusting with light lifting: Insert the needle to a depth of 20 mm. Quickly insert the needle to a certain depth, then slowly withdraw it to the superficial layer with an amplitude of 15 mm at a frequency of 60 times per minute.</li>
			<li>Light thrusting with heavy lifting: Insert the needle to a depth of 20 mm. Slowly insert the needle to a certain depth, then rapidly withdraw it to a shallow layer with an amplitude of 15 mm at a frequency of 60 times per minute.</li>
		</ol>
		</li>
		<li>Perform lifting and thrusting manipulations with cannula 
		NOTE: Fabricate three cannulas that are compatible with the needle size. Adjust their amplitudes to 5 mm, 10 mm, and 15 mm by sliding the adjustable stoppers to the appropriate length.
		<ol>
			<li>Manipulate with the cannula with an amplitude of 5 mm
			<ol>
				<li>Even lifting and thrusting: Fix a needle in a needle sleeve. Place the needle sleeve in a cannula with an amplitude of 5 mm. Insert the needle to a depth of 20 mm and lift the cannula up and down at a uniform rate at a frequency of 60 times per minute.</li>
				<li>Heavy thrusting with light lifting: Use the same cannula. Insert the needle to a depth of 20 mm. Quickly insert the needle to the limited depth, then slowly withdraw it to the superficial layer at a frequency of 60 times per minute.</li>
				<li>Light thrusting with heavy lifting: Use the same cannula. Insert the needle to a depth of 20 mm. Slowly insert the needle to the limited depth, then rapidly withdraw it to the superficial layer at a frequency of 60 times per minute.</li>
			</ol>
			</li>
			<li>Manipulate with the cannula with an amplitude of 10 mm
			<ol>
				<li>Even lifting and thrusting: Fix a needle in a needle sleeve. Place the needle sleeve in a cannula with an amplitude of 10 mm. Insert the needle to a depth of 20 mm and lift the cannula up and down at a uniform rate at a frequency of 60 times per minute.</li>
				<li>Heavy thrusting with light lifting: Use the same cannula. Insert the needle to a depth of 20 mm. Quickly insert the needle to the limited depth, then slowly withdraw it to the superficial layer at a frequency of 60 times per minute.</li>
				<li>Light thrusting with heavy lifting: Use the same cannula. Insert the needle to a depth of 20 mm. Slowly insert the needle to the limited depth, then rapidly withdraw it to the superficial layer at a frequency of 60 times per minute.</li>
			</ol>
			</li>
			<li>Manipulate with the cannula with an amplitude of 15 mm
			<ol>
				<li>Even lifting and thrusting: Fix a needle in a needle sleeve. Place the needle sleeve in a cannula with an amplitude of 15 mm. Insert the needle to a depth of 20 mm and lift the cannula up and down at a uniform rate at a frequency of 60 times per minute.</li>
				<li>Heavy thrusting with light lifting: Use the same cannula. Insert the needle to a depth of 20 mm. Quickly insert the needle to the limited depth, then slowly withdraw it to the superficial layer at a frequency of 60 times per minute.</li>
				<li>Light thrusting with heavy lifting: Use the same cannula. Insert the needle to a depth of 20 mm. Slowly insert the needle to the limited depth, then rapidly withdraw it to the superficial layer at a frequency of 60 times per minute.</li>
			</ol>
			</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
3. Project configuration of the motion capture and analysis software and video analysis
<ol>
	<li>Video export and renaming 
	NOTE: Transfer all video files from the camera to the designated storage disk on the computer. Rename the 3D calibration video files from cameras 1 and 2 to &#34;1.mp4&#34; and &#34;2.mp4,&#34; respectively.
	<ol>
		<li>Video storage
		<ol>
			<li>Save the operation videos to the computer-designated storage disk. Name them using the participants&#39; full initials in the format &#34;xxx-1&#34; and &#34;xxx-2.&#34;</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Reality motion system project configuration (motion capture and analysis software)
	<ol>
		<li>New project: Start the motion capture and analysis software and select New Project. Set the project name in the project tab, then click on Create and Save to store the project on the specified storage disk.</li>
		<li>Specification: Select Specification &#62; Points &#62; Thumb Tip, drag the tracking point from the predefined point box to the used point box, and click on the Close button to continue.</li>
		<li>Adding camera groups: Right-click on the Cameras &#62; Add Camera Group to add a new camera group.</li>
		<li>Select tracking file: Click on the Select File button in the Tracking box.</li>
		<li>Importing operation video: Click on Open Existing File and select the operation video xxx-1 in the popup window. Click on Apply to complete the video import.</li>
		<li>Import calibration video: Click on Select File in the 3D Calibration box to import the corresponding calibration video &#34;1.mp4.&#34;</li>
		<li>Importing other videos: Following the same steps as in step 3.2.5, import the operation video &#34;xxx-2&#34; and its corresponding calibration video &#34;2.mp4.&#34;</li>
	</ol>
	</li>
	<li>Video analysis
	<ol>
		<li>Opening a camera group: Open the camera group, then right-click on 1.mp4 &#62; Properties.</li>
		<li>Perform 3D calibration: Click on the 3D Calibration button in the 3D Calibration box, enter a description, and add 20 points by clicking on the Add Points button 20 times.</li>
		<li>Setting point parameters: Set the name and corresponding X, Y, Z values for each point, then click on Apply according to the calibration parameters.</li>
		<li>Finish calibration: After configuring all the points, click on each endpoint of the calibration video to complete the 3D calibration.</li>
		<li>Calibrate other cameras: Follow steps 3.3.1-3.3.4 to complete the 3D calibration of the other camera.</li>
		<li>Setting up 3D tracking: Right-click on Camera Group &#62; 3D Tracking, select all cameras, and click on the OK button to open the 3D tracking window.</li>
		<li>Apply mode matching tracking: Set Use Pattern Matching Tracking for both cameras. Manually click on the Thumb Tip point in the first frame.</li>
		<li>Start auto tracking: Click on the Auto Search button to begin automatic 3D tracking frame by frame.</li>
		<li>Complete other video tracking: Follow steps 3.3.6-3.3.8 to complete motion tracking for the other videos. 
		NOTE: If the tracking points are lost during auto 3D tracking, select the row where points are lost, right-click, and select Discard Points From Here. Then, click on the points and the Auto Search button again.</li>
	</ol>
	</li>
	<li>Data export
	<ol>
		<li>Creating 3D calculations: Right-click on Camera Group &#62; New 3D Calculation, select All Cameras, and check Update Data Continuously and Store Data Explicitly in the &#34;Create 3D Data&#34; window. Update data and explicitly store data in a file. Click on the OK button to proceed.</li>
		<li>Export settings: Right-click the folder Containing All the Data &#62; Export.</li>
		<li>Exporting data files: Click on the Export button to export a data file with a customized name (*.txt). Export the other data files in the same way.</li>
	</ol>
	</li>
</ol>
4. Data analysis
<ol>
	<li>Summarization of data
	<ol>
		<li>Measure the spatial dispersion by recording the maximum value of the moving range on the X-, Y-, and Z-axes of the passive infrared reflective sphere on the participants&#39; thumbnail cap (Figure 2C).</li>
		<li>Calculate the standard deviation and take the mean value. Store the data in Microsoft Office Excel files and calculate the mean &#177; standard deviation for graphing.</li>
	</ol>
	</li>
	<li>Analysis of data
	<ol>
		<li>Assess the differences between conditions with and without the cannula by conducting independent samples t-tests (for data consistent with normal distribution) or rank sum tests (for data not consistent with normal distribution).</li>
		<li>Then, perform a two-factor, three-level analysis of variance to evaluate the stability of different lifting and inserting amplitudes. Set the alpha level at p &#60; 0.05 and use the Statistical Package for data analysis to carry out all statistical analyses.</li>
	</ol>
	</li>
</ol>

Control Cannula Improves Precision and Stability in Acupuncture Manipulation

<ol>
	<li>Hang, X. et al. Efficacy of frequently-used acupuncture methods for specific parts and conventional pharmaceutical interventions in treating post-stroke depression patients: A network meta-analysis. Complement Ther Clin Pract. 45, 101471 (2021).</li>
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	<li>Cao, J. et al. The regulations on cortical activation and functional connectivity of the dorsolateral prefrontal cortex-primary somatosensory cortex elicited by acupuncture with reinforcing-reducing manipulation. Front Hum Neurosci. 17, 1159378 (2023).</li>
	<li>Yoon, D. E., Lee, I. S., Chae, Y. Identifying dose components of manual acupuncture to determine the dose-response relationship of acupuncture treatment: A systematic review. Am J Chin Med. 50 (3), 653-671 (2022).</li>
	<li>Zhu, J. et al. Acupuncture, from the ancient to the current. Anatomical Rec. 304 (11), 2365-2371 (2021).</li>
	<li>Fu, G. et al. Efficacy comparison of acupuncture and balanced acupuncture combined with TongduZhengji manipulation in the treatment of acute lumbar sprain. Am J Trans Res. 14 (7), 4628-4637 (2022).</li>
	<li>Kelly, R. B., Willis, J. Acupuncture for Pain. Am Fam Physician. 100 (2), 89-96 (2019).</li>
	<li>Lu, J. et al. Acupuncture with reinforcing and reducing twirling manipulation inhibits hippocampal neuronal apoptosis in spontaneously hypertensive rats. Neural Regen Res. 12 (5), 770-778 (2017).</li>
	<li>Yin, N. et al. Mast cells and nerve signal conduction in acupuncture. Evid Based Complement Alternat Med. 3524279 (2018).</li>
	<li>Yoon, D. E., Lee, I. S., Chae, Y. Comparison of the acupuncture manipulation properties of traditional East Asian medicine and Western medical acupuncture. Integr Med Res. 11 (4), 100893 (2022).</li>
	<li>Xu, G. et al. Rearch statusand progresson acupuncture technique parameter quantitation. Zhong Hua Zhong Yi Yao Xue Kan. 9 (35), 2255-2258 (2017).</li>
	<li>Tang, W. C. et al. Motion video-based quantitative analysis of the &#39;lifting-thrusting&#39; method: A comparison between teachers and students of acupuncture. Acupunct Med. 36 (1), 21-28 (2018).</li>
	<li>Errington-Evans, N. Acupuncture for anxiety. CNS Neurosci Ther. 18 (4), 277-284 (2012).</li>
	<li>Seo, Y. et al. Motion patterns in acupuncture needle manipulation. Acupunct Med. 32 (5), 394-399 (2014).</li>
	<li>Lin, S. K. et al. Incidence of iatrogenic pneumothorax following acupuncture treatments in Taiwan. Acupunct Med. 37 (6), 332-339 (2019).</li>
	<li>Chen, H. N., Chang, C. Y., Chen, L. Z., Chang, Y. J., Lin, J. G. Using ultrasonography measurements to determine the depth of the GB 21 acupoint to prevent pneumothorax. J Acupunct Meridian Stud. 11 (6), 355-360 (2018).</li>
	<li>Lyu, R. et al. Stimulation parameters of manual acupuncture and their measurement. evidence-based complementary and alternative medicine : eCAM. Evid Based Complement Alternat Med. 2019, 1725936 (2019).</li>
	<li>Cao, J. et al. Cerebral responses to different reinforcing-reducing acupuncture manipulations: study protocol for a randomized crossover functional near-infrared spectroscopy (fNIRS) trial. Eur J Integr Med. 53, 102150, (2022).</li>
	<li>Su, Q. et al. Intervention of the syndrome-position point selection method on idiopathic tinnitus of phlegm-fire stagnation pattern: A randomized controlled study. J Healthc Eng. 2022, 9664078 (2022).</li>
	<li>Chen, B., Lin, K., Xu, L., Cao, J., Gao, S. A piezoelectric force sensing and gesture monitoring-based technique for acupuncture quantification. IEEE Sens J. 21 (23), 26337-26344 (2021).</li>
	<li>Wang, F. et al. Role of acupoint area collagen fibers in anti-inflammation of acupuncture lifting and thrusting manipulation. Evid. Based Complement. Alternat Med. 2017, 2813437 (2017).</li>
	<li>Lin, J. G. et al. Understandings of acupuncture application and mechanisms. Am J Transl Res. 14 (3), 1469-1481 (2022).</li>
	<li>Si, X. et al. Acupuncture with deqi modulates the hemodynamic response and functional connectivity of the prefrontal-motor cortical network. Front Neurosci. 15, 693623 (2021).</li>
	<li>Hu, N. et al. Influence of the quickness and duration of deqi on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern. J Tradit Chin Med. 39 (2), 258-266 (2019).</li>
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</ol>

This study innovatively designed a cannula to improve the stability and safety of acupuncture lifting and inserting manipulations and conducted experiments to evaluate its effectiveness. The researchers used 3D modeling for the structural design and white resin as the material for 3D printing. Compared to manufacturing a metal mold, 3D printing technology offers the advantages of lower cost and easier structural adjustments. Additionally, since the disposable needle is positioned sideways in the groove of the needle sleeve (Figure 2), there is no direct human contact with the needle during acupuncture, reducing the risk of infection in clinical use.
In this study, Simi Motion 3D, a three-dimensional motion tracking software, was employed to capture the movement amplitude of the lifting and thrusting manipulations. Compared with manual measurement using a ruler, tracking the position of the operator&#39;s fingers through 3D motion software provided more efficient and accurate measurements of the different depths in each lifting and thrusting movement. The analysis of coordinate data exported from the motion 3D software demonstrated that the needle cannula reduced errors in both the horizontal direction and the depth of lifting and inserting manipulations. The cannula was particularly effective for methods involving amplitudes of 10 mm or more. Clinically, errors in the horizontal direction can result in misplacement of the needle, leading to deviation from the targeted acupuncture point or causing additional pain to the patient. Errors in vertical orientation can alter the depth of needle penetration into subcutaneous tissue, potentially causing harm. For example, excessive depth at acupoints with shallow subcutaneous tissue or near vital organs and arteries could damage deep organs. This is especially concerning at acupoints like QiMen (LR14) in the 6th intercostal space, Zhongfu (LU1) on the anterior chest wall, and Yunmen (LU2) near the subclavian fossa, all of which are close to the lungs27. The needle cannula developed in this study can significantly reduce these errors, enhancing safety and minimizing the risk of medical accidents during acupuncture.
In the process of performing acupuncture, the safety and stability of the operation are among the most important factors affecting clinical efficacy, and the spatial stability of the operation depends entirely on the experience and proficiency of the operator, which is the most challenging aspect of learnin28. In clinical practice, experienced practitioners can naturally apply techniques flexibly. However, in acupuncture efficacy experiments, it is more important to have a well-defined system of rules and mature control methods to strictly control variables, ensuring the validity and scientific rigor of the experiment29,30,31. The cannula designed in this study helps limit the scope of the lifting and thrusting manipulation to address this need.
Moreover, acupuncture requires high technical precision and adherence to strict procedures, where operators must master a series of techniques from needle insertion to withdrawal. Acupuncture education emphasizes the stability of manipulation. Introducing new technology to quantify acupuncture techniques can make education more effective than traditional teaching methods32,33. For acupuncture students and beginners, this project provides a tool to improve needling skills by training them to control the depth and position of manipulation.
However, the needle cannula designed in this study is limited to lifting and thrusting manipulation and cannot be used for other techniques, such as twisting manipulation. The cannula&#39;s utility could be significantly enhanced if its structure were adapted to support a wider range of acupuncture techniques.

Needling manipulation is performed after the needle is inserted into the patient&#39;s skin to either induce a needle sensation known as &#34;DeQi&#34; (which refers to the sensation of meridian qi induction at the acupuncture point) or to adjust the direction and intensity of the needle sensation. As an essential part of acupuncture, different needling techniques produce varying effects1. Needling manipulation is a critical factor that affects the effectiveness of acupuncture treatment2,3. Research has shown that the signals activated by the lifting-thrusting technique are stronger than those induced by other needling methods4.
The therapeutic effect of acupuncture is closely related to the intensity of stimulation5,6,7, which, in turn, depends on the type of needling manipulation used. As a result, the quantitative-effect relationship of acupuncture manipulation is a key area of experimental research8,9,10. Standardization and reproducibility are crucial to ensuring the scientific validity of acupuncture research11. Both the lifting-thrusting and twisting methods require specific frequency and amplitude of operation12,13, and the selection of acupoints is also important for treating diseases14. However, manual acupuncture relies on human operators, making it difficult to maintain consistent frequency and amplitude during needle manipulation15. Additionally, precautions must be taken to avoid complications such as pneumothorax by carefully controlling the depth and direction of needle insertion in certain areas of the body16,17.
Thus, one of the most urgent challenges in the scientific study of acupuncture manipulation is the development of controllers to improve the stability of needling techniques, which is vital for ensuring the safety and standardization of acupuncture practices18.
Lifting-thrusting is one of the most commonly used basic acupuncture techniques. It involves lifting the needle up and thrusting it down after inserting it into the acupoint at a specific depth. The upward movement is called lifting, while the downward movement is known as thrusting. This process is repeated to achieve the desired clinical effect, with the level of stimulation depending on the amplitude and frequency of the lifting and thrusting motions19,20,21,22. Currently, the amplitude of the lifting and thrusting technique is mainly controlled by the practitioner, and its effectiveness is often evaluated based on the sensation of &#34;De Qi&#34; (the feeling of meridian qi induction at the acupuncture point)23,24,25. However, there is no established standard to evaluate the stability and safety of this technique, and the depth of needle insertion is entirely dependent on the practitioner&#39;s skill.
To promote standardization in acupuncture, several new techniques have been developed to replace traditional manual acupuncture, including pulsed electro-acupuncture, ultrasonic acupuncture, microwave acupuncture, laser acupuncture, and extracorporeal shock wave acupuncture26. While these methods help to some extent in standardizing the effects of acupuncture, they cannot fully replace traditional manual acupuncture in clinical practice. Therefore, standardizing the manipulation of manual acupuncture remains essential.
To address the aforementioned issues, this study designed an acupuncture needle cannula that improves the safety and stability of the lifting and thrusting technique. The control cannula used in the study was manufactured using 3D printing technology (see Table of Materials), and the overall structure consists of three components: the cannula, the needle sleeve, and the adjustable stopper, along with disposable acupuncture needles (Figure 1). The cannula, needle sleeve, and adjustable stopper were all produced through 3D printing technology (see Supplementary File 1, Supplementary File 2, and Supplementary File 3).
The cannula offers several advantages: first, the amplitude is controlled by the stopper, which significantly reduces the burden on practitioners; second, the separation of the needle and cannula prevents contamination during acupuncture; and third, the adjustable scale allows for precise control of the needle&#39;s depth and amplitude, enabling free adjustment as needed. The results of this study provide a safe auxiliary tool for experimental research on acupuncture manipulation, which is crucial for advancing the standardization of acupuncture techniques.

<table><tbody><tr><td>Blender</td><td>Blender Institute B.V.</td><td>Blender 4.2.2 LTS</td><td>Blender is the free and open source 3D creation suite. It supports the entirety of the 3D pipeline&amp;mdash;modeling, rigging, animation, simulation, rendering, compositing and motion tracking, even video editing and game creation. Advanced users employ Blender&#039;s API for Python scripting to customize the application and write specialized tools; often these are included in Blender&#039;s future releases. Blender is well suited to individuals and small studios who benefit from its unified pipeline and responsive development process.</td></tr><tr><td>Human simulation materials</td><td>Dongguan Jiangzhao silicon industry Co., LTD</td><td>Acupuncture exercise skin model</td><td>Portable acupuncture practice skin model, simulated skin, with a ductile layer, can better simulate the feeling of acupuncture.</td></tr><tr><td>IBM SPSS Statistics</td><td>IBM</td><td>R26.0.0.0</td><td>The IBM SPSS Statistics software provides advanced statistical analysis for users of all experience levels. Offering a comprehensive suite of capabilities, it delivers flexibility and usability beyond traditional statistical software.</td></tr><tr><td>Prism 9</td><td>GraphPad Software, LLC.</td><td>GraphPad Prism 9.5.0 (525)</td><td>Prism is a software to draw graphs.</td></tr><tr><td>Simi Reality Motion Systems</td><td>Simi Reality Motion Systems GmbH</td><td>Simi Motion 2D/3D</td><td>Simi Motion provides an&amp;nbsp;extensive platform for motion capture and 2D/3D movement analysis.</td></tr></tbody></table>

a mechanical construction to enhance the stability and safety of lifting and thrusting manipulation of acupuncture

The therapeutic effectiveness of acupuncture relies on both safety and stability, making these factors essential in acupuncture manipulation research. However, manual manipulation introduces unavoidable inaccuracies, which can impact the reliability of research findings. To address this challenge, a unique lifting and thrusting manipulation control cannula was designed in this study, offering flexible adjustment of movement amplitude. The cannula was created using 3D printing technology, and its effectiveness in maintaining stability was verified by recording the acupuncture needle's movement range with optical sensor technology. The study's results show that the control cannula significantly enhances the stability of acupuncture manipulation, reducing human error. This innovation suggests that the cannula could serve as a valuable auxiliary tool for ensuring both the precision and safety of acupuncture-related experimental research. Its adoption could also contribute to the standardization of acupuncture practices, ensuring more consistent and accurate research outcomes, which is essential for future advancements in acupuncture research and clinical applications.

Effect of the cannula on the stability of the lifting and thrusting manipulation 
Graphs were generated based on the data from one operator, as shown in Figure 3, Figure 4, and Figure 5. The horizontal axis in each figure represents time, and the vertical axis represents the position of the tracking point on the operator&#39;s thumb tip, recording the motion trail of this point. Two lines of different colors illustrate the motion trails with and without the cannula.
The ranges of motion during the lifting and thrusting manipulations in the X-axis, Y-axis, and Z-axis are shown in Figure 6. The X-axis and Y-axis represent the operator&#39;s motion deviation in the anterior-posterior and left-right directions, respectively. The closer the motion amplitude is to 0, the more stable the lifting and thrusting manipulation. The Z-axis represents the up-and-down motion deviation, which is the primary observation index in this experiment. The closer the motion amplitude is to the prescribed 15 mm, the better the stability of the manipulation. The stability of the three lifting and thrusting techniques along the X-axis was significantly improved with the use of the cannula compared to without it. As shown in Figure 6A, the range of motion for all three techniques was lower when using the cannula, and the differences were statistically significant. No significant differences were observed in the stability of the techniques along the Y-axis. As shown in Figure 6B, the range of motion with and without the cannula was similar, and the differences were not statistically significant. The stability of the three lifting and thrusting techniques along the Z-axis was significantly better when using the cannula. As shown in Figure 6C, the motion ranges for even lifting and thrusting, heavy thrusting with light lifting, and light thrusting with heavy lifting were all closer to the target amplitude of 15 mm when using the cannula compared to not using it. These differences were statistically significant.
In the figures, even lifting and thrusting, heavy thrusting with light lifting, and light thrusting with heavy lifting are labeled as &#34;even,&#34; &#34;thrust,&#34; and &#34;lift,&#34; respectively. A &#34;*&#34; symbol above the bars in the charts indicates a statistically significant difference between the two bars (p &#60; 0.05). In conclusion, this cannula improves the stability of lifting and thrusting manipulations in both the anterior-posterior direction and in controlling depth.
Impact of manipulation amplitudes on the stability control ability of the cannula 
In this experiment, the researchers measured the lifting and thrusting manipulations with amplitudes of 5 mm, 10 mm, and 15 mm (up and down) following the insertion of a 20 mm needle into the material. The goal was to observe the ranges of motion along the X-axis, Y-axis, and Z-axis and to quantitatively analyze the spatial stability of different lifting and thrusting amplitudes.
Graphs based on the data from the operator are presented in Figures 7, Figure 8, and Figure 9. The horizontal axis represents time, and the vertical axis represents the position of the tracking point on the operator&#39;s thumb tip. Three lines of different colors represent the motion trails for the different amplitudes.
The ranges of motion on the X-axis and Y-axis for various lifting and thrusting amplitudes and techniques are shown in Figures 10A,B. The range of motion on these axes indicates the operator&#39;s motion deviation in the anterior-posterior and left-right directions. The closer the range of motion is to 0, the better the stability. Since the ranges of motion on the Z-axis do not directly reflect motion deviation, the researchers used the error rate (Actual value - Predicted value &#247; Actual value &#215; 100%) to evaluate the deviation in the up and down directions. This is the primary observation index in the experiment, and the results are shown in Figure 10C. The closer the error rate is to 0, the better the stability. As shown in Figure 10A, for even lifting and thrusting, stability on the X-axis improved as the amplitude increased, with the differences being statistically significant. For heavy thrusting with light lifting and light thrusting with heavy lifting, stability at an amplitude of 15 mm was better than at 5 mm and 10 mm, with statistically significant differences. As shown in Figure 10B, the amplitude and type of manipulation did not have a significant effect on stability along the Y-axis, and the differences were not statistically significant. As shown in Figure 10C, the closer the error rate is to 0, the better the stability along the Z-axis. Manipulations at amplitudes of 10 mm and 15 mm had better stability than at 5 mm, with statistically significant differences.
In the figures, even lifting and thrusting, heavy thrusting with light lifting, and light thrusting with heavy lifting are labeled as &#34;even,&#34; &#34;thrust,&#34; and &#34;lift,&#34; respectively. A &#34;*&#34; symbol above the bars in the charts indicates that the difference between each pair of bars is statistically significant (p &#60; 0.05). In summary, the larger the manipulation amplitude, the greater the safety and stability in the anterior-posterior direction and depth. The cannula is most effective at improving the stability of lifting and thrusting manipulations when used with an amplitude of at least 10 mm.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/66941/66941fig01.jpg" /> 
Figure 1: Structure of the control cannula. (A) The cannula. It is hollow and has a sliding strip on one side. The scale range is marked next to the sliding strip, spanning 4 cm with 1 mm intervals. The lower end has a fixed stopper that limits the maximum insertion depth. The hollow part allows for the movement of the needle sleeve. During operation, the assistant hand holds the cannula, while the operating hand manipulates the needle sleeve to perform the lifting and thrusting action. (B) The needle sleeve. It&#160;is hollow and holds the disposable acupuncture needle. Two fixed stoppers at the lower end limit the lifting and thrusting movement, ensuring stability in the amplitude of the manipulations. The operator holds the needle sleeve for these actions. (C) An adjustable stopper. It has a sliding strip on the side, which fits into the cannula&#39;s sliding strip to set the minimum insertion depth. It has concave grooves to align with the fixed stopper on the needle sleeve. The stopper is positioned in the cannula, and after the needle sleeve is inserted, it is rotated 90 degrees to lock the sleeve in place for controlled manipulations. (D) Combination of the control cannula. The needle sleeve is inserted into the cannula, with the adjustable stopper fixed along the sliding strip of the cannula. (E) Sample of the assembled device. A disposable acupuncture needle is placed in the needle sleeve. The left-hand holds the cannula, while the right hand operates the needle sleeve for lifting and thrusting manipulations. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/66941/66941fig02.jpg" /> 
Figure 2: Placement of the videography setup. (A) Camera settings. Two motion cameras are positioned on tripods in front of the operator&#39;s desk to capture the motion trails of the measured point. (B) Calibration settings. A 3D calibration stand is placed on the table to ensure accurate measurement of spatial positions. (C) X-, Y-, and Z-axes. Schematic diagram showing the spatial positions used in the analysis. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/66941/66941fig03.jpg" /> 
Figure 3: Motion trail of even lifting and thrusting with and without the cannula. (A) Motion trail on the X-axis of even lifting and thrusting. The X-axis motion trail with and without the cannula is shown in two different colors. (B) Motion trail on the Y-axis of even lifting and thrusting. The Y-axis motion trail with and without the cannula is shown in two different colors. (C) Motion trail on the Z-axis of even lifting and thrusting. The Z-axis motion trail with and without the cannula is shown in two different colors. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/66941/66941fig04.jpg" /> 
Figure 4: Motion trail of heavy thrusting with light lifting with and without the cannula. (A) Motion trail on the X-axis of heavy thrusting with light lifting. The X-axis motion trail with and without the cannula is shown in two different colors. (B) Motion trail on the Y-axis of heavy thrusting with light lifting. The Y-axis motion trail with and without the cannula is shown in two different colors. (C) Motion trail on the Z-axis of heavy thrusting with light lifting. The Z-axis motion trail with and without the cannula is shown in two different colors. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/66941/66941fig05.jpg" /> 
Figure 5: Motion trail of light thrusting with heavy lifting with and without the cannula. (A) Motion trail on the X-axis of light thrusting with heavy lifting. The X-axis motion trail with and without the cannula is shown in two different colors. (B) Motion trail on the Y-axis of light thrusting with heavy lifting. The Y-axis motion trail with and without the cannula is shown in two different colors. (C) Motion trail on the Z-axis of light thrusting with heavy lifting. The Z-axis motion trail with and without the cannula is shown in two different colors. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/66941/66941fig06.jpg" /> 
Figure 6: Range of motion for different manipulation methods with and without the cannula. (A) Range of motion on the X-axis for different manipulation methods. The X-axis motion range with and without the cannula is shown in two different colors. &#34;Even&#34; refers to even lifting and thrusting, &#34;thrust&#34; to heavy thrusting with light lifting, and &#34;lift&#34; to light thrusting with heavy lifting. An asterisk (*) indicates a statistically significant difference between the bars (p &#60; 0.05). (B) Range of motion on the Y-axis for different manipulation methods. Same notations and interpretation as (A). (C) Range of motion on the Z-axis for different manipulation methods. Same notations and interpretation as (A). <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig06large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/66941/66941fig07.jpg" /> 
Figure 7: Motion trail of even thrusting and lifting with the cannula at different amplitudes. (A) Motion trail on the X-axis of even thrusting and lifting. The X-axis motion trail with different amplitudes is shown in three different colors. (B) Motion trail on the Y-axis of even thrusting and lifting. Same as (A) for the Y-axis. (C) Motion trail on the Z-axis of even thrusting and lifting. Same as (A) for the Z-axis. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig07large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/66941/66941fig08.jpg" /> 
Figure 8: Motion trail of heavy thrusting with light lifting with the cannula at different amplitudes. (A) Motion trail on the X-axis of heavy thrusting with light lifting. The X-axis motion trail with different amplitudes is shown in three different colors. (B) Motion trail on the Y-axis of heavy thrusting with light lifting. Same as (A) for the Y-axis. (C) Motion trail on the Z-axis of heavy thrusting with light lifting. Same as (A) for the Z-axis. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig08large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/66941/66941fig09.jpg" /> 
Figure 9: Motion trail of light thrusting with heavy lifting with the cannula at different amplitudes. (A) Motion trail on the X-axis of light thrusting with heavy lifting. The X-axis motion trail with different amplitudes is shown in three different colors. (B) Motion trail on the Y-axis of light thrusting with heavy lifting. Same as (A) for the Y-axis. (C) Motion trail on the Z-axis of light thrusting with heavy lifting. Same as (A) for the Z-axis. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig09large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 10" class="xfigimg" src="/files/ftp_upload/66941/66941fig10.jpg" /> 
Figure 10: Range of motion for different manipulation methods and ranges. (A) Range of motion on the X-axis for different manipulation methods and ranges. The X-axis motion range for different amplitudes is shown in three different colors. &#34;Even&#34; refers to even lifting and thrusting, &#34;thrust&#34; to heavy thrusting with light lifting, and &#34;lift&#34; to light thrusting with heavy lifting. An asterisk (*) indicates a statistically significant difference between the bars (p &#60; 0.05). (B) Range of motion on the Y-axis for different manipulation methods and ranges. Same notations and interpretation as (A). (C) Error rate on the Z-axis for different manipulation methods and ranges. Same notations and interpretation as (A). <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/66941fig10large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Supplementary File 1: STL file for fabricating the cannula. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/Figure 1.zip" target="_blank">Please click here to download this File.</a>
Supplementary File 2: STL file for fabricating the needle sleeve. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/Figure 2.zip" target="_blank">Please click here to download this File.</a>
Supplementary File 3: STL file for fabricating the adjustable stopper. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/66941/Figure 3.zip" target="_blank">Please click here to download this File.</a>

Author Spotlight: Development of a Standardized Acupuncture Tool Inspired by Advanced Techniques for Improved Safety and Precision

This protocol designs a cannula that can be used to control the range of motion for the lifting and thrusting manipulation in acupuncture, thereby improving stability and safety. It can thus serve both the clinical application and scientific research of acupuncture treatment.

A Mechanical Construction to Enhance the Stability and Safety of Lifting and Thrusting Manipulation of Acupuncture

The therapeutic effectiveness of acupuncture relies on both safety and stability, making these factors essential in acupuncture manipulation research. ...

a-mechanical-construction-to-enhance-stability-safety-lifting

Universidad San Sebastian

Research

JoVE Journal

Medicine

259 Views.  Shanghai University of Traditional Chinese Medicine. This protocol designs a cannula that can be used to control the range of motion for the lifting and thrusting manipulation in acupuncture, thereby improving stability and safety. It can thus serve both the clinical application and scientific research of acupuncture treatment.

Video: Author Spotlight: Development of a Standardized Acupuncture Tool Inspired by Advanced Techniques for Improved Safety and Precision

Quantitative Visualization and Detection of Skin Cancer Using Dynamic Thermal Imaging

In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death 1. To date, the only effective treatment for melanoma remains surgical excision, therefore, the key to extended survival is early detection 2,3. Considering the large numbers of patients diagnosed every year and the limitations in accessing specialized care quickly, the development of objective in vivo diagnostic instruments to aid the diagnosis is essential. New techniques to detect skin cancer, especially non-invasive diagnostic tools, are being explored in numerous laboratories. Along with the surgical methods, techniques such as digital photography, dermoscopy, multispectral imaging systems (MelaFind), laser-based systems (confocal scanning laser microscopy, laser doppler perfusion imaging, optical coherence tomography), ultrasound, magnetic resonance imaging, are being tested. Each technique offers unique advantages and disadvantages, many of which pose a compromise between effectiveness and accuracy versus ease of use and cost considerations. Details about these techniques and comparisons are available in the literature 4.
Infrared (IR) imaging was shown to be a useful method to diagnose the signs of certain diseases by measuring the local skin temperature. There is a large body of evidence showing that disease or deviation from normal functioning are accompanied by changes of the temperature of the body, which again affect the temperature of the skin 5,6. Accurate data about the temperature of the human body and skin can provide a wealth of information on the processes responsible for heat generation and thermoregulation, in particular the deviation from normal conditions, often caused by disease. However, IR imaging has not been widely recognized in medicine due to the premature use of the technology 7,8 several decades ago, when temperature measurement accuracy and the spatial resolution were inadequate and sophisticated image processing tools were unavailable. This situation changed dramatically in the late 1990s-2000s. Advances in IR instrumentation, implementation of digital image processing algorithms and dynamic IR imaging, which enables scientists to analyze not only the spatial, but also the temporal thermal behavior of the skin 9, allowed breakthroughs in the field.
In our research, we explore the feasibility of IR imaging, combined with theoretical and experimental studies, as a cost effective, non-invasive, in vivo optical measurement technique for tumor detection, with emphasis on the screening and early detection of melanoma 10-13. In this study, we show data obtained in a patient study in which patients that possess a pigmented lesion with a clinical indication for biopsy are selected for imaging. We compared the difference in thermal responses between healthy and malignant tissue and compared our data with biopsy results. We concluded that the increased metabolic activity of the melanoma lesion can be detected by dynamic infrared imaging.

We demonstrated that malignant pigmented lesions with increased metabolic activity generate quantifiable amounts of heat and the measurement of the transient thermal response of the skin to a cooling excitation allows quantitative identification of melanoma and other skin cancers (vs. non-proliferative nevi) at an early stage of the disease.

In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death 1. To date, the only effective treatment ...

Visualizing Motion Patterns in Acupuncture Manipulation

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture manipulation techniques skillfully. The Acupuncture Manipulation Education System (AMES) is an open source software system designed to enhance acupuncture manipulation skills using visual feedback. Using a phantom acupoint and motion sensor, our method for acupuncture manipulation training provides visual feedback regarding the actual movement of the student's acupuncture manipulation in addition to the optimal or intended movement, regardless of whether the manipulation skill is lifting, thrusting, or rotating. Our results show that students could enhance their manipulation skills by training using this method. This video shows the process of manufacturing phantom acupoints and discusses several issues that may require the attention of individuals interested in creating phantom acupoints or operating this system.

Here, we present a protocol for using the Acupuncture Manipulation Education System (AMES) in the training of acupuncture manipulation skills using phantom acupoints.

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture ...

Behavior

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

Design and Implementation of a Bespoke Robotic Manipulator for Extra-corporeal Ultrasound

With the potential for high precision, dexterity, and repeatability, a self-tracked robotic system can be employed to assist the acquisition of real-time ultrasound. However, limited numbers of robots designed for extra-corporeal ultrasound have been successfully translated into clinical use. In this study, we aim to build a bespoke robotic manipulator for extra-corporeal ultrasound examination, which is lightweight and has a small footprint. The robot is formed by five specially shaped links and custom-made joint mechanisms for probe manipulation, to cover the necessary range of motion with redundant degrees of freedom to ensure the patient&#39;s safety. The mechanical safety is emphasized with a clutch mechanism, to limit the force applied to patients. As a result of the design, the total weight of the manipulator is less than 2 kg and the length of the manipulator is about 25 cm. The design has been implemented, and simulation, phantom, and volunteer studies have been performed, to validate the range of motion, the ability to make fine adjustments, mechanical reliability, and the safe operation of the clutch. This paper details the design and implementation of the bespoke robotic ultrasound manipulator, with the design and assembly methods illustrated. Testing results to demonstrate the design features and clinical experience of using the system are presented. It is concluded that the current proposed robotic manipulator meets the requirements as a bespoke system for extra-corporeal ultrasound examination and has great potential to be translated into clinical use.

This paper introduces the design and implementation of a bespoke robotic manipulator for extra-corporeal ultrasound examination. The system has five degrees of freedom with lightweight joints made by 3D printing and a mechanical clutch for safety management.

With the potential for high precision, dexterity, and repeatability, a self-tracked robotic system can be employed to assist the acquisition of real-time ...

Engineering

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Three-Dimensional Finger Motion Tracking during Needling: A Solution for the Kinematic Analysis of Acupuncture Manipulation

Three-dimensional (3D) motion tracking has been used in many fields, such as the researches of sport and medical skills. This experiment aimed to use 3D motion tracking technology to measure the kinematic parameters of the joints of fingers during acupuncture manipulation (AM) and establish three technical indicators "amplitude, velocity and time". This method can reflect the operation characteristics of AM and provide quantitative parameters along three axes of multiple finger joints. The current evidence shows that the method has great potential for future applications such as the study of the dose-effect relationship of acupuncture, teaching, and learning of AM, and the measurement and preservation of famous acupuncturists' AM.

This experimental method describes a solution for the kinematic analysis of acupuncture manipulation with three-dimensional finger motion tracking technology.

Three-dimensional (3D) motion tracking has been used in many fields, such as the researches of sport and medical skills. This experiment aimed to use 3D ...

Rat Jackets to Enhance Suspension Fixation During Electroacupuncture on Rats

Improved Suspension Fixation Using Rat Jacket in Rat Acupuncture Experiments

In basic experimental acupuncture research, rats are commonly used as laboratory animals. However, it is difficult for them to maintain a fixed posture. During electroacupuncture procedures, proper immobilization of rats is essential. Various methods of rat fixation are currently used, including anesthesia fixation, high-platform fixation, binding fixation, and fixation with a self-made rat coat. However, these methods have their limitations, which may affect the efficiency and operability of the experiment to some extent. This protocol introduces a method of suspending and fixing rats using rat clothes. Firstly, rats are clothed with rat jackets that match their body shape, taking advantage of their preference for darkness and burrowing. The needling operation can then be carried out after the rats have worn rat clothes. When suspended, the rats are relatively still, as their limbs cannot move. This fixation method offers not only economical and user-friendly benefits but also ensures a stable and reliable fixation of the rats in a comfortably relaxed position. It also effectively minimizes time consumption, experimental space, and manpower resources. Additionally, this method allows for the exposure of most acupoints used for acupuncture in rats. This article primarily concentrates on the device's composition, encompassing a specially designed rat jacket, an elevated fixation rack, and their connecting structures. Additionally, an illustrative example will be presented to demonstrate the application of the rat clothing-based suspension fixation method in rat electroacupuncture procedures.

Author Spotlight: Efficient Rat Clothing for Improved Rat Fixation During Electroacupuncture 

Here, we present an improved suspension fixation method using a rat jacket to effectively immobilize rats during acupuncture experiments. Furthermore, the structure and application of this fixation apparatus, as well as instructions and evaluation for its utilization in electroacupuncture therapy, is elucidated.

In basic experimental acupuncture research, rats are commonly used as laboratory animals. However, it is difficult for them to maintain a fixed posture. ...

Osteoporosis Management in Rats Through Lingnan Fire-Needle Therapy

Operation Procedure and Precautions of Lingnan Fire-Needle Therapy in Osteoporosis Model Rats

Compared to filiform needle therapy, fire-needle therapy has both the stimulation of needles and the warming effect of heat, making it have unexpected effects on some chronic diseases and incurable diseases. Osteoporosis (OP) has a high incidence in postmenopausal women and middle-aged and elderly men, and the treatment cycle is long. According to Traditional Chinese Medicine (TCM), Lingnan fire-needle therapy has shown potential in treating osteoporosis. However, there is still a long way to go before it can be widely used. This article focuses on the application of Lingnan fire-needle therapy in the intervention of OP in rats. It covers the selection of needle tools, acupuncture point selection, positioning of rats' bodies, and fixation methods. We also outline the steps and precautions to be taken during and after needling with fire needles. The experiment was done with three groups: a normal group, a model group, and a fire-needle group, each containing 10 rats. The rats in the fire-needle group were treated with fire-needle intervention for six sessions. After the intervention period, we collected femoral specimens and performed micro-CT scans. The results suggest that fire needling can enhance bone morphology and mineral density in OP rats. This information can serve as a methodological basis for conducting basic research on fire-needle therapy.

Author Spotlight: Exploring the Impact of Lingnan Fire-Needle Therapy in Osteoporosis Intervention

Here, we present a protocol for the application of Lingnan Fire-Needle therapy in the intervention of osteoporosis model rats.

Compared to filiform needle therapy, fire-needle therapy has both the stimulation of needles and the warming effect of heat, making it have unexpected ...

Using a 3D Printed Holder for Bulk Electroacupuncture in Small Animals

Bulk Electroacupuncture Operation for Mice or Young Rats

Electroacupuncture (EA) is widely used to treat various health conditions. However, the underlying mechanism of EA treatment remains unclear, hindering its promotion. The mechanistic study requires mouse or rat models to address this issue. However, these animals are not obedient to the experimental process, which is time-consuming. To solve these problems, we designed a 3D-printed small animal body bulk fixator to improve the efficiency of EA's animal experiments. This video shows in detail how to use the fixator to perform bulk EA on mice or young rats. For the selection of acupoints, the anterior oblique line of vertex temporal (MS6 head) and Tianshu point (ST25 belly) were chosen to verify the effect of the fixation device with prone positioning and supine positioning. Using the 3D-printed small animal holder allows multiple rodents to be immobilized and treated simultaneously, reducing the time and resources required for the experiment. This technique could be applied to other animal models by 3D printing different sizes and could potentially be used for various fixing conditions. The device is beneficial for the promotion of experimental scientific research in EA.

Author Spotlight: Using a 3D-Printed Holder for Simultaneous Multiple Electroacupuncture Operation

Here, we present a protocol for efficient and rapid electroacupuncture (EA) in mice or young rats using a three-dimensional (3D) printed holder. This technique allows simultaneous operation on multiple animals, saving time and increasing experimental efficiency.

Electroacupuncture (EA) is widely used to treat various health conditions. However, the underlying mechanism of EA treatment remains unclear, hindering ...