22G Needle Research Articles

In vivo evaluation of a Nano-enabled therapeutic vitreous substitute for the precise delivery of triamcinolone to the posterior segment of the eye

This study focused on the design of a thermoresponsive, nano-enabled vitreous substitute for the treatment of retinal diseases. Synthesis of a hydrogel composed of hyaluronic acid and a poloxamer blend was undertaken. Poly(D,L-lactide-co-glycolide) acid nanoparticles encapsulating triamcinolone acetonide (TA) were synthesised with a spherical morphology and mean diameter of ~ 153 nm. Hydrogel fabrication and nanoparticle loading within the hydrogel was confirmed via physicochemical analysis. Gelation studies indicated that hydrogels formed in nine minutes and 10 min for the unloaded and nanoparticle-loaded hydrogels, respectively. The hydrogels displayed in situ gel formation properties, and rheometric viscoelastic studies indicated the unloaded and loaded hydrogels to have modulus values similar to those of the natural vitreous at 37 °C. Administration of the hydrogels was possible via 26G needles allowing for clinical application and drug release of triamcinolone acetonide from the nanoparticle-loaded hydrogel, which provided sustained in vitro drug release over nine weeks. The hydrogels displayed minimal swelling, reaching equilibrium swelling within 12 h for the unloaded hydrogel, and eight hours for the nanoparticle-loaded hydrogel. Biodegradation in simulated vitreous humour with lysozyme showed < 20% degradation within nine weeks. Biocompatibility of both unloaded and loaded hydrogels was shown with mouse fibroblast and human retinal pigment epithelium cell lines. Lastly, a pilot in vivo study in a New Zealand White rabbit model displayed minimal toxicity with precise, localised drug release behaviour, and ocular TA levels maintained within the therapeutic window for the 28-day investigation period, which supports the potential applicability of the unloaded and nanoparticle-loaded hydrogels as vitreous substitutes that function as drug delivery systems following vitrectomy surgery.Graphical Fig. aSchematic representation of the nano-enabled therapeutic vitreous substitute synthesis process. This figure was partly generated using Servier Medical Art, provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license

Assessing EUS-guided radiofrequency ablation in unresectable pancreatic ductal adenocarcinoma: a single-center historic cohort study

/aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative for the local treatment of unresectable pancreatic ductal adenocarcinoma (PDAC). We aim to assess the feasibility and safety of EUS-RFA in patients with unresectable PDAC. The following was a historic cohort compounded by locally advanced (LA) and metastatic (m) PDAC naïve patients, who underwent EUS-RFA between October 2019 to March 2022. EUS-RFA was performed with a 19-g needle electrode with a 10 mm active tip for energy delivery. Study primary endpoints were feasibility, safety, and clinical follow-up; secondary endpoints were performance status (PS), local control (LC) and overall survival (OS). Twenty-six patients were selected: 15/26 LA-PDAC and 11/26 mPDAC. Technical success was achieved in all patients with no major adverse events. Six months after EUS-RFA, OS was 11/26 (42.3%), with significant PS improvement (P=.03). LC was achieved, with tumor reduction from 39.5 to 26 mm (P=.04). Post-treatment hypodense necrotic area was observed at six-month follow-up in 11/11 alive cases. Metastatic disease was a significant factor for OS worsening (HR 5.021; IC 95% 1.589 - 15.87; P=.004) CONCLUSIONS: EUS-RFA of pancreatic adenocarcinoma is a minimally invasive and safe technique that may have an important role as targeted therapy for local treatment of unresectable cases, as well as an alternative for poor surgical candidates. Also, RFA may play a role in downstaging cancer with potential OS increase in non-metastatic cases. Large prospective cohorts are required to evaluate this technique in clinical practice.

Considering cell viability in 3D printing of structured inks: A comparative and equivalent analysis of fluid forces

In conventional extrusion-based three-dimensional (3D) printing (E3DP), smaller needles reduce cell viability due to increased fluid forces like pressure and shear stress. A novel E3DP approach has emerged, involving 3D printing with structured inks. Fluid forces in both conventional and structured ink-based methods were evaluated through computational fluid dynamics (CFD) simulations. By employing 18G needles, we showcased the advantages of structured inks, including 2-symmetric, 4-symmetric, vascular-like, and hepatic lobule analogue-like inks, which demonstrated consistently lower pressures and shear stress compared with conventional inks. Specifically, vascular-like inks with a 2:1:1 extruded fiber layer distance showed significantly lower shear stress (average 6.595e+0 Pa, maximum 2.069e+2 Pa) than conventional methods. Equivalent analyses explored commonly used symmetric and core&amp;ndash;shell inks, examining fluid forces on cells. Particularly, in core&amp;ndash;shell inks with a 2.8 mm core layer radius, cells in the flow domain of the shell layer experienced an equivalent viscosity of 3.70 Pa&amp;middot;s, while in the core layer, it was 1.72 Pa&amp;middot;s. The analyses revealed a positive correlation between equivalent homogeneous ink viscosity and shear stress. The proposed workflow, emphasizing cell viability, offers an efficient approach for structured ink design. Also, experiments that used vascular-like ink-based printing as an example indicated significantly higher cell viability when compared with conventional printing. This research provides valuable insights for enhancing cell viability in 3D printing and advancing printing material design.

Platelet activation and blood extracellular vesicles: The influence of venepuncture and short blood storage

Extracellular vesicles (EVs) as membrane-bound particles released by various cells are potential tools for diagnosis and treatment. Blood cells, particularly platelets, are the source of circulating EVs. MaterialEVs were enriched with gradient ultracentrifugation and measured by nanoparticle tracking assay. A flow cytometric multiplex assay was used for cellular source determination. Activation of platelets was measured as a percentage of CD62p+/CD61+ platelets and correlated with the concentration and size of released EVs. ResultsIn general there was no statistically significant correlation between EVs` concentration and degree of platelet activation. EVs from different cellular sources were detected. Comparing different needle thicknesses, there was a decrease in the EVs concentration for the 16G needle versus the 21G needle, but no difference was observed for EVs` size and phenotype or platelets activation. During blood storage, platelet activation increased, but there was no effect on the EVs` concentration, size, or phenotype. ConclusionsPreanalytical factors like needle thickness and storage time can affect the MVs' properties. Activation of platelets during blood collection or blood storage occurs; however, it is difficult to determine its effect on the physiological properties of EVs since the mechanisms of EVs` biogenesis and especially clearness are not precisely known.

Subjective Discomfort during Botulinumtoxin Injections Dependent on Injection Site and Needle Size: A Comparison Between 30G, 33G and 34G Needles

BackgroundBotulinumtoxin application in the face is amongst the most common aesthetic procedures in the head and neck region. It also has numerous medical uses. One of the main reasons for patients to refrain from it is the subjective discomfort that is experienced during injections.ObjectivesThe study at hand aimed to determine whether needles with 33G and 34G offer an advantage in terms of individual pain perception during botulinumtoxin injections.MethodsWe conducted a prospective study where patients were asked to grade subjective discomfort on a visual analogue scale for each region (forehead, glabella, temple) that was treated directly after treatment and 15 minutes after. Patients were treated with 30G, 33G or 34G needles, respectively.ResultsNinety-nine patients that underwent treatment of 189 regions were included in the study. Patients were evenly distributed amongst the different needle sizes and regions. Subjective discomfort was greatest in all regions for 30G needles (3.9 ± 1.6 forehead, 4.3 ± 1.7 glabella and 4.0 ± 1.6 temple) followed by 33G (2.7 ± 1.5 forehead, 2.7 ± 1.9 glabella and 2.2 ± 1.2 temple) and 34G (1.7 ± 1.2 forehead, 1.6 ± 1.4 glabella and 1.6 ± 1.4 temple). All differences between needle size were statistically significant (p < 0.05)Conclusion33G and 34G needles seem to offer smaller discomfort during BTX treatments of the head and neck, with 34G being superior to 33G.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Powdered Cross-Linked Gelatin Methacryloyl as an Injectable Hydrogel for Adipose Tissue Engineering.

The tissue engineering field is currently advancing towards minimally invasive procedures to reconstruct soft tissue defects. In this regard, injectable hydrogels are viewed as excellent scaffold candidates to support and promote the growth of encapsulated cells. Cross-linked gelatin methacryloyl (GelMA) gels have received substantial attention due to their extracellular matrix-mimicking properties. In particular, GelMA microgels were recently identified as interesting scaffold materials since the pores in between the microgel particles allow good cell movement and nutrient diffusion. The current work reports on a novel microgel preparation procedure in which a bulk GelMA hydrogel is ground into powder particles. These particles can be easily transformed into a microgel by swelling them in a suitable solvent. The rheological properties of the microgel are independent of the particle size and remain stable at body temperature, with only a minor reversible reduction in elastic modulus correlated to the unfolding of physical cross-links at elevated temperatures. Salts reduce the elastic modulus of the microgel network due to a deswelling of the particles, in addition to triple helix denaturation. The microgels are suited for clinical use, as proven by their excellent cytocompatibility. The latter is confirmed by the superior proliferation of encapsulated adipose tissue-derived stem cells in the microgel compared to the bulk hydrogel. Moreover, microgels made from the smallest particles are easily injected through a 20G needle, allowing a minimally invasive delivery. Hence, the current work reveals that powdered cross-linked GelMA is an excellent candidate to serve as an injectable hydrogel for adipose tissue engineering.

Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of patients with biliary tract cancer, especially with intrahepatic cholangiocarcinoma.

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC. CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022. Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy. EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

Applications Used to Increase the Accuracy Rate of Transthoracic Lung Biopsies Performed in Centers for Molecular Biological Diagnosis and Targeted Therapy for Oncology.

Purpose This study aims to assess the significance of imaging techniques and needle thickness employed in transthoracic core needle biopsy for determining the cancer type and subtypes, ultimately guiding the treatment of lung cancer. Material and methods Between 2018 and 2023, a cohort of 350 patients (69.7% male, 30.3% female) underwent CT-guided lung biopsy, predominantly utilizing core biopsies. Fine needle aspiration biopsies employed 18 or 20 G Chiba needles, while core needle biopsies utilized 16 or 18-gauge coaxial system semi-automatic needles. The preferred needle and biopsy sample size were 16 G in thickness and 2 cm in length. Pre-procedure positron emission tomography-computed tomography (PET-CT) images aided in identifying the most homogenous lesion with the highest SUV max value, guiding biopsy sample extraction. Post-procedure control CT evaluated complications according to the Society of Interventional Radiology (SIR) reporting standard. Results The average age of biopsied patients was 65.48 +/- 12.32 SD (range: 18-90). Tru-cut biopsy was predominant (69.7%), utilizing a larger number of 16G needles. Pathological diagnoses were mostly malignant (76.6%), with lesion sizes averaging 35.98 +/- 17.90 SD (range: 5-105 mm) and distances to pleura averaging 13.48 +/- 13.54 SD (range: 0-86 mm). Malignancy prevalence was higher in males (56.8%), tru-cut biopsies (72.7%), 16G needles used for tru-cut (47.7%), and PET-CT evaluation (59.1%). Complications were identified in 22% of cases, with distance to pleura significantly associated (p < 0.001). No significant differences in complication risk were observed between FNAB and tru-cut and between needle gauges (20 G-18 G and 16 G) (p: 0.734, p: 0.638, respectively). Conclusion The study underscores the paramount importance of biopsy sample size in diagnosing lung cancers and determining targeted therapy. Optimal biopsy localization, informed by pre-procedure imaging techniques, is crucial. Hence, the recommendation is to utilize the thickest needles and largest samples for lung biopsies.

Comparison of diagnostic outcomes, safety, and cost of Franseen-tip 19G versus 22G needles for endoscopic ultrasound-guided liver biopsies.

Background and study aims Favorable outcomes were noted with refinement in newer endoscopic ultrasound-guided liver biopsy (EUS-LB) needle tips. Still, the overall usefulness and benefit are yet to be well explored. Patients and methods This was a retrospective analysis of patients with EUS-LB (Franseen-tip 19G versus 22G FNB needle) over 2 years. EUS-LB was obtained in a one-pass, two-actuation, modified wet suction technique. Diagnostic yield, fragmentation rate, aggregate specimen length (AL), number of complete portal tracts (CPT), length of longest intact core (LIC), adverse events (AEs) (early), and cost of the procedure (1USD = 82 INR) were compared. Results Fifty-four patients (33 [61.1%], female) successfully underwent EUS-LB with a median age of 46 years (interquartile range [IQR] 34-54); the majority 32 (59.2%) underwent 19G biopsies. There was a significantly increased median (IQR) AL in the 19G compared with 22G (20 mm [19-21] vs. 15 [14-15], P < 0.001), respectively. Similarly, significantly lengthier median LIC and CPT were seen, respectively. A nonsignificant diagnostic yield was noted (100% vs. 90.9%, P = 0.082), respectively. The fragmentation rate was higher in 22G FNB needles (36.4% [95% CI 16-56] vs. 12.5% [95% CI 1-24], respectively; P = 0.038). Seven patients (12.9%) had mild AEs with no difference between groups. The average procedure cost with 19G was INR 63000 (768$), and with 22G needle was INR 54500 (664$). Conclusions The Franseen-tip 19G outperforms 22G with a significantly lower fragmentation rate, longer AL, LIC, and a higher number of CPT with a marginal increase in the procedure cost, without any difference in diagnostic yield and safety.

Effect of ozoniotherapy in the treatment of necrosis after hair transplantation: case report

Introduction: Nowadays, ozone plays an important role in wound healing and tissue repair as a therapy and as antimicrobial, bactericidal and fungicidal agent. It attains recognition in hair transplantation as a treatment for necrosis due to hypoxic-ischemic local syndrome. Objective: to demonstrate the therapeutic evolution of ischemia in a hair transplant after ozone therapy sessions. Methods: The patient was evaluation and gave consent to photographic records. He went through 30 topic applications of ozonated oil, with a 10 drop dosage daily; 12 bag ozone sessions for 10 minutes; besides subcutaneous applications, with 30% ozone concentration and a very small gas volume (1-2 ml) with 30G needle. Results: Evolution of the case was registered with images and tissue coloring and changes evidenced. Conclusion: It is clear that ozone therapy made wound healing and tissue repair faster, since there was an increase of epithelial cells and neoangiogenesis due to therapy, resulting in almost complete repair of the patient’s hair transplant at the end of the sessions.

Optimized Kalinnikov-Dinh technology for effective pre-Descemet's endothelial keratoplasty (PDEK) graft preparation and preservation.

We report an optimized Kalinnikov-Dinh technology for pre-Descemet's endothelial keratoplasty (PDEK) that involves the use of a ring fixator, base, 30G needle connected to a 5-ml syringe with a spring-loaded plunger, and storage media. Our method allows to minimize graft preparation failure and preserves the PDEK graft efficiently, by reducing complications associated with the formation of type 1 big bubbles, including bubble rupture, perforation of Descemet's membrane and endothelium, and formation of type 2 or mixed type of big bubbles, and may contribute to increasing the number of surgeons performing PDEK around the globe.

Implementation of Kidney Biopsy in One of the Poorest Countries in the World: Experience from Zinder Hospital (Niger)

Kidney biopsy (KB) has become essential in the nephrologist’s approach to kidney diseases, both for diagnosis, treatment, and prognosis. Our objective is to describe the preliminary results of KBs in Niger, one of the poorest countries in the world. This is a descriptive cross-sectional study that took place over 36 months in the nephrology/dialysis department of the Zinder National Hospital. Biopsy results were obtained in less than 5 working days. Patients were responsible for covering the cost of the kidney biopsy. The data collected were analyzed using Epi Info V7 software. We performed 120 kidney biopsies during the study period. The average age of the patients was 35 years ± 15.4 [5–68]. The male/female sex ratio was 2:1. Patients’ medical history included herbal medicine use in 33% of cases and high blood pressure in 27.5% of cases. Proteinuria was present at a rate of ≥3 g/24 h in 46.6% of them. The primary indication for kidney biopsy was glomerular syndrome in 62.5% of cases, including 50% with nephrotic syndrome. All kidney biopsies were performed with real-time ultrasound guidance, using an automatic gun fitted with a 16G needle. Regarding complications, macroscopic hematuria was present in 12.5% of cases. Inadequate kidney biopsy was infrequent (5.8% of cases). The most common findings were (i) glomerular diseases (58.4%), such as membranoproliferative glomerulonephritis (13.3%), focal-segmental glomerulosclerosis (10.6%), lupus nephritis (8.8%), minimal change disease (8%), and membranous nephropathy (2.7%), and (ii) tubulointerstitial changes (31.8%). Diabetic nephropathy was rare (2.6%), as was IgA nephropathy (0.9%). We have demonstrated that implementing a sustainable kidney biopsy program in a very poor country is feasible, thanks to the dedication of a specialized renal pathologist. Having a clear diagnosis can assist in properly treating these renal patients according to international guidelines, thereby delaying the progression to end-stage kidney disease.

Comparison the effect of different irrigation on post-operative pain in cases with irreversible pulpitis

the aim of this study was to evaluate the effect of different types of irrigants solution on postoperative pain after root canal treatment.&#x0D; Materials and method: 75 patients with irreversible pulpitis on the lower mandibular premolars teeth, after diagnosis all cases were treated in a single visit in a private clinic over a period of 18 months. selected for this investigation endodontic treatment for the teeth using a wave one technique and then we divided the patients into 3 groups each group consist of 25 patients : in G.I irrigated with sodium hypochlorite (NaOCl).G.II irrigated with chlorhixdine and GIII irrigated with NaOCl, followed by EDTA 17% then CHX ( using conventional needle irrigation was performed with a 27-G (Appli-Vac) needle and syringe). The needle was placed short of the binding point or 2mm from the working length and irrigant was expressed over 30 seconds.)after irrigation the canals Will dried with paper point then obuterated it with guttapercha , a temporary filling covered the teeth after that we asked the patient to record the postoperative pain after 6_12h , 24_48 h &amp; one week , by using annual scale(AVS)the results show that the pain in G.III is the lowest pain than the other two groups.&#x0D; Conclusion the uses of the combination of irrigants solution resulting in less postoperative pain after endodontic treatment.&#x0D; The aim is to compare the effect of different irrigants solution on postoperative pain after root canal treatment.

Feasibility demonstration of a device for vitreous liquid biopsy incidental to intravitreal injection.

VitreoDx is an experimental device enabling push-button collection of a neat vitreous liquid biopsy incidental to an intravitreal injection. We explored the ability of the device to collect a sample usable for proteomic biomarker discovery and testing. Pilot study using ex vivo human eyes. Non-vitrectomized, human eyes from nine donors 75-91 years of age were refrigerated in BSS and used within 5 days of death. Four VitreoDx devices fitted with 25G needles, and four staked needle insulin syringes with 30G needles, were inserted at equal intervals through the pars plana of each eye and held in place by a fixture. The sampling mode of each VitreoDx device was triggered to attempt to acquire a liquid biopsy up to 70 μL. The plunger of each insulin syringe was retracted to attempt to obtain a liquid biopsy with a maximum volume of 50 μL. Samples acquired with the VitreoDx were extracted to polypropylene cryovials, refrigerated to -80 ºC, and sent for offsite proteomic analysis by proximity extension assay with a focus on panels containing approved and pipelined drug targets for neovascular disease and inflammatory factors. Of the attempted liquid biopsies with the novel 25G VitreoDx, 92% (66 of 72) resulted in successful acquisition (>25 μL) while 89% (64 of 72) attempted by a traditional 30G needle resulted in a successful acquisition. Sample volume sufficient for proteomics array analysis was acquired by the VitreoDx for every eye. Detectable protein was found for 151 of 166 unique proteins assayed in at least 25% of eyes sampled by VitreoDx. The high acquisition rate achieved by the prototype was similar to that achieved in previous clinical studies where a standard syringe was used with a 25G needle to biopsy vitreous fluid directly prior to standard intravitreal injection. Successful aspiration rates were likewise high for 30G needles. Together, these suggest that it is possible to routinely acquire liquid vitreous biopsies from patients who typically receive intravitreal injections with an injection device using a standard size needle without a vitreous cutter. Protein analysis shows that proteins of interest survive the sampling mechanism and may have potential to direct care in the future.

Comparison of 19G FNA Versus 22G FNB Needles for Endoscopic Ultrasound-Guided Fine-Needle Sampling of Subepithelial Tumors: Is Bigger Better?

To compare the diagnostic efficiency of 19G fine-needle aspiration (FNA) and 22G fine-needle biopsy (FNB) in endoscopic ultrasound (EUS)-guided sampling for subepithelial tumors (SETs). The data of patients with SETs who underwent 19G FNA or 22G FNB were reviewed retrospectively in two tertiary hospitals. Tissue cores were assessed by macroscopic on-site evaluation (MOSE). Cytological or histological diagnosis were classified as definite, suspect, or no diagnosis. Seventy five patients (mean age: 55 years, 44 males) underwent 19G EUS-FNA (31) or 22G EUS-FNB (44). The overall diagnostic yield was 82.7%. The rate of definite cytological diagnoses was 9.7% (3/31) in 19G and 13.6% (6/44) in 22G group (x2 = 1.520, P = .468). In terms of MOSE, 19G needle, requiring only two punctures, achieved a higher good tissue core rate than 22G group (100.0% [31/31] versus 84.1% [37/44], x2 = 5.440, P = .020]). For histological diagnosis, the 19G group achieved higher definite rate than the 22G group, 93.6% (29/31) versus 65.9% (29/44) (x2 = 7.957, P = .019) on the first puncture, 90.3% (28/31) versus 63.6% (28/44) (x2 = 7.139, P = .028) on the second puncture, 96.8% (30/31) versus 70.5% (31/44) (x2 = 7.319, P = .026) on both the first and second punctures, and 96.8% (30/31) versus 72.7% (32/44) (x2 = 7.538, P = .023) on all three punctures. The 19G EUS-FNA requires only two punctures to achieve better tissue core quality by MOSE and yields a higher rate of histological diagnosis than 22G ProCore needle for SETs. The bigger 19G FNA needle seems to play an important role in the evaluation of SETs.

Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study.

Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.

Microfluidic Delivery of High Viscosity Liquids Using Piezoelectric Micropumps for Subcutaneous Drug Infusion Applications.

Goal: Auto-injectors for self-administration of drugs are usually refrigerated. If not warmed up prior to the injection, ejection of the total drug volume is not guaranteed, as their spring and plunger mechanism cannot adjust for a change in viscosity of the drug. Here, we develop piezoelectric micro diaphragm pump that allows these modifications possible while investigating the effectiveness of this alternative dosing method. Methods: The dosing of highly viscous liquid of 25 mPa·s is made possible using application-specific micropump design. By comparing the analytical with experimental results, the practicality of the concept is verified. Results: Using a powerful piezoelectric stack actuator, the micropump achieves high fluid pressures of up to (368 ± 17) kPa. In order to assess the influence of viscosity, we characterize the fluidic performance of the designed micropump through 27G gauge needle for various water-glycerin mixtures. We find maximum flow rates of 2 mL/min for viscosities of up to 25 mPa·s. Conclusions: The developed micro diaphragm pump enables the development of smart auto-injectors with flow rate regulation to achieve drug delivery for high viscosity drugs through 27G needles.

The Effectiveness of Using a Combination of Saponin and Vaccine Given In Ovo on Hatchability and Early Growth Performance of Local Chickens

A study has been carried out to determine the correct dosage for using a combination of saponin and vaccine in an in ovo formula on hatchability and early growth performance. There were four levels of saponin use (0.0; 1.5; 3.0; 4.5 microgram) arranged using a factorial design with two factors, namely saponin level as the first factor, while whether or not vaccine was used as the second factor, so there were eight formula combinations. Each formula combination was dissolved in phosphate buffered saline, then injected into the amnion of fertile eggs of Sentul chickens during incubation for 18 days (0.5 ml/egg) using an automatic injector machine with a 20G needle. The results showed that increasing saponin levels combined with vaccines as an ingredient in the in ovo feeding formula results in decreased hatchability. A very significant decrease occurred at the 4.5 µg level. The average hatchability of vaccine treatment was significantly better than those treated without vaccine. There is no interaction effect of the two materials on hatchability. However, the interaction effect was seen in all parameters of early growth performance of Sentul chicken during the 4 weeks of observation. The vaccine treatment will be more effective if it is used separately or not mixed with saponin (0.0 µg), while the use of saponin without vaccine will produce the best weight gain and feed efficiency when used at the highest dose level (4.5 µg).

Post dural puncture headache following subarachnoid block for caesarean section: A comparision between 25G and 27G Quincke spinal needle

Post dural puncture headache following subarachnoid block for caesarean section: A comparision between 25G and 27G Quincke spinal needle

Incidence and Management of Post-dural Puncture Headache among Parturients: A Retrospective Analysis

Background: Postdural puncture headache (PDPH) is a known complication following spinal and epidural anesthesia. Study Design: This is a retrospective study to assess the incidence, risk factors, severity, and management of PDPH. Materials: The data were extracted from the medical records. All parturients who gave birth under spinal anesthesia or epidural analgesia were included. Maternal demographics, the size of the needle, the position of the parturient, and the day of onset of the headache were noted. Categorical variables were expressed using frequency and percentage and numerical variables as mean and standard deviation. One-way analysis of variance test was used for cross-comparison between groups. Results: A total of 35 patients developed PDPH. It was managed conservatively in 65.71%, with Sphenopalatine ganglion block (SPGB) in 28.57% and by epidural blood patch (EBP) in 5.72%. The mean age was 28.6 years and body mass index was 27.2. 25G spinal needle was used in 54.3% and 23G in 28.6%. At 30 minute, pain score was &lt;4 in SPGB and EBP. At 2 hours, pain score was &lt;4 in all patients. The difference in the drop in pain score was statistically significant with a P value of &lt; .002 at all time points. On cross-comparison, conservative management with SPGB and blood patch was statistically significant. Conclusion: The incidence of PDPH was 0.8%. We can continue with the 23G and 25G Whitacre needles due to the incidence of PDPH being lower. The use of SPGB and EBP is effective in management of severe PDPH.