Gel Injection Research Articles

Injectable Fiducial Marker for Image-Guided Radiation Therapy Based on Gold Nanoparticles and a Body Temperature-Activated Gel-Forming System.

Injectable fiducial markers are crucial in image-guided radiation therapy (IGRT) due to their minimally invasive operations and improved patient compliance. This study presents the development of a ready-to-use injectable fiducial marker utilizing alginate stabilized-gold nanoparticles (alg-Au NPs) and a body temperature-activated in situ gel-forming system. Gram-scale alg-Au NPs were prepared in an hour by a green microwave-induced plasma-in-liquid process (MWPLP). Sodium alginate was introduced in this process to avoid aggregation between Au NPs, which ensured their stability and injectability. The gelation behavior of alginate with divalent cations and a temperature-dependent release of calcium source (glucono-delta-lactone (GDL) and CaCO3) served as the foundation of the body temperature-activated in situ gel-forming system. The injectable fiducial marker GDL/CaCO3/alg-Au NPs could maintain a liquid state at a low temperature for a higher injectability. After injection, on the other hand, Ca2+ would be released due to the body temperature-activated hydrolysis of GDL and the subsequent reaction with CaCO3, which would initiate the gelation of alginate. The injectable fiducial marker can be therefore delivered via injection and form gel at target site to avoid marker movement or Au NPs leakage after injection. Rheological measurements demonstrate the stability and gelation behavior of GDL/CaCO3/alg-Au NPs at different temperatures. Furthermore, the injectability and imaging ability of GDL/CaCO3/alg-Au NPs were also examined. In summary, ready-to-use injectable fiducial marker GDL/CaCO3/alg-Au NPs were developed via a green and facile method for IGRT.

Coreflooding Evaluation of Fiber-Assisted Recrosslinkable Preformed Particle Gel Using an Open Fracture Model

Summary Recrosslinkable preformed particle gels (RPPGs) have been used to treat the problem of void space conduits (VSC) and repair the “short-circuited” waterflood in Alaska’s West Sak field. Field results showed a 23% increase in success rates over typical preformed particle gel (PPG) treatments. In this paper, we evaluated whether adding fiber into RPPGs can increase the RPPG plugging efficiency and thus further improve the success rate. We designed open fracture models to represent VSC and investigated the effect of swelling ratio (SR), fracture size, and fiber concentration on gel injection pressure, water breakthrough pressure, and permeability reduction. Results show that fiber can increase RPPG strength and delay its initial swelling rate, but an optimized fiber concentration exists. Beyond that, the fiber entangling problem can result in the recrosslinked bulk gel inhomogeneously and impact gel quality. The injection pressure of fiber-assisted RPPGs increased with the SR and fracture width. During post-injection water process, the breakthrough pressure and residual resistance factor increased when the RPPG SR and fracture width decreased. Fiber-assisted RPPGs can dramatically reduce the permeability of the fractured core up to 1.8×106 times. It is observed that the fiber-assisted RPPGs used in the experiment remain in a bulk form in the fracture when we open the fracture after water injection. Not only does the addition of fiber improve the plugging efficiency, but it also prevents particle precipitation along vertical fractures or conduits.

Perioral Rejuvenation: Evaluation of Safety and Efficacy of High Molecular Weight Hyaluronic Acid and Amino Acid Treatment.

The lips and perioral area play a crucial role in facial aesthetics. Signs of aging, such as wrinkles, decreased muscle tone, and thinning skin, frequently appear first in this anatomical area and, subsequently, in other areas. This may explain why the lips and perioral area are frequently requested focus areas for aesthetic treatments that retain the client’s natural features. To assess the safety and efficacy of the rejuvenation of the perioral area with an injectable product containing high-molecular-weight (HMW) native hyaluronic acid (HA) and a cluster of amino acids (AAs). In this open-label observational study, 37 female patients underwent 3 monthly sessions of intradermal injections with HMW HA gel with a cluster of AAs. Follow-up investigations were performed after 30, 60, and 180 days. Outcomes were evaluated subjectively using a patient questionnaire, the Global Aesthetic Improvement Scale (GAIS) questionnaire, and objectively using a 3D photosystem. All patients completed the study. The subjective evaluations made by patients and by the investigator during follow up and at the end of the study were positive, and all patients showed improvement in the perioral area. The objective evaluation showed a statistically significant improvement in pores condition and wrinkles. The protocol for rejuvenation of the perioral area with injections of HMW HA gel and AA is safe and effective. J Drugs Dermatol. 2022;21(9):968-973.doi:10.36849/JDD.6875.

Isolated Colonic Lymphangiectasia Secondary to Submucosal Injection.

CASE REPORT An 81-year-old woman with a medical history of tobacco use and family history of colon cancer was referred for colonoscopy because of a reported weight loss of 25 pounds over 10 months. Colonoscopy revealed a 15 mm flat polyp in the ascending colon with a mucus cap (Figure 1). A submucosal injection of ORISE gel revealed a large whitish discoloration of the mucosa encompassing the polyp and surrounding mucosa (Figure 2). The polyp was removed with a cold snare in a piecemeal manner. Biopsy specimens of the surrounding mucosa revealed dilated lymphatics (4× magnification, hematoxylin and eosin stain) (Figure 3), which were interpreted as isolated colonic lymphangiectasia secondary to submucosal injection.Figure 1.: Flat polyp in the ascending colon with a mucus cap.Figure 2.: Large whitish discoloration of the mucosa encompassing the polyp and surrounding mucosa after submucosal injection with ORISE gel.Figure 3.: Colonic specimen (4× magnification, hematoxylin and eosin stain) showing dilated lymphatics.Primary intestinal lymphangiectasia is a rare disease of an unknown worldwide incidence that primarily affects the small intestine in children younger than 3 years, usually with other congenital abnormalities.1 However, it is increasingly being recognized in adults because of direct visualization of the small bowel with imaging modalities, such as capsule endoscopy and double-balloon enteroscopy.2,3 Isolated colonic lymphangiectasias are even more rare, and their clinical significance in an asymptomatic patient is unclear. DISCLOSURES Author contributions: S. Tomar wrote and edited the article, reviewed the literature, and is the article guarantor. E. Alqassim provided the images and revised the article for intellectual content. S. Mahmood provided the images and critically reviewed the article. All authors approved the final version of the manuscript. Financial disclosures: None to report. Informed consent was obtained for this case report.

Recent advances in the stereolithographic three-dimensional printing of ceramic cores: Challenges and prospects

The increasing demand for geometrically complex structures—specifically, higher-inlet-temperature turbine blades for the fifth-generation or other high-generation machines of advanced fighter aircrafts—has made the development of more complex double-walled three-layer hollow-cavity structures a necessity. However, this requires the preparation of complex ceramic cores and advanced, integrated technologies. Stereolithographic three-dimensional printing (SLA-3DP) technology, with digital control upon material morphology, composition, and structure, is a high integration and versatile technique that is superior to the traditional manufacturing techniques for ceramic cores, including gel casting, injection molding, and hot pressing. The latent capacity of this technique is contingent on the progress of processing routes that significantly reduce the distortion and defect formation in response to the elimination of the reacted organic monomer phase during photo-curing. Despite the tremendous progress in the field, multiple challenges remain, such as the preparation of high-solid-content and low-viscosity suspensions, SLA-3DP of large double-walled ceramic cores with complex structures, and process optimization and sinter strengthening for the fabrication of ceramic cores. These challenges have prevented the broader applications and reduced the impact of the SLA-3DP technology. This review discusses cutting-edge research on the crucial factors governing this production method. Specifically, we outline the existing challenges within the field and provide our perspective on the upcoming research work and progress.

Thermal-insulation and temperature-resistant foamed gel for thermal management of heavy oil steam flooding

Foamed clayey hydrogel Bent-5/PAM-2, with hierarchically double-network structure and abundant CO 2 air chambers inside, maintains low thermal conductivity and good plugging performance at high temperature, effectively reducing heat loss of heavy oil thermal recovery. • Clayey foamed hydrogel, with hierarchically double networks, was synthesized by one-pot method. • Foamed gel shows low thermal conductivity, high strength and good mobility at 300 °C. • Thermal effectiveness of steam flooding is obviously improved after foamed gel injection. Due to the serious gravity overriding and large heat loss, thermally insulated and temperature-resistant plugging agents are highly desired in steam flooding. In this work, a physically-crosslinked clayey foamed hydrogel Bent/PAM, with low thermal conductance, high thermal stability and good mobility, was synthesized by one-pot process, using bentonite as matrix and polyacrylamide as cross-linking agent. Bent/PAM has hierarchically 3D porous structure and double network. Specifically, abundant meso-sized air chambers in gel endows it with low thermal conductivity. And, its outer clay percolated network with micro-sized meshes provides a temperature-resistant coating, while the inner polymer-clay composite network with nano-sized meshes affords a high strength. On the other hand, the easily slidable clay platelets make its outer percolated network turn into a lubricating film, offering the foamed gel with low friction and viscosity. From the core flooding experiments, the Bent-5/PAM-2 gel (the optimal sample) possesses large plugging rate, plugging intensity and oil recovery (EOR), up to 83.7%, 321 KPa and 63.5%, respectively.

Outcome of hyaluronic acid gel injection in glans penis for treatment of lifelong premature ejaculation: A pilot study

ABSTRACT Objective To assess safety and efficacy of hyaluronic acid (HA) gel injection in glans penis for treatment of premature ejaculation (PE) using our new five puncture technique. Patients and methods This is a prospective, non-randomized clinical trial on HA gel injection in glans penis for all patients with lifelong PE; all patients were circumcised having heterosexual normal marital life and sexually active. Patients with history of ejaculatory medication use within the previous 3 months, psychiatric disorders, erectile dysfunction, lower urinary tract symptoms (LUTS) due to prostatitis and acquired PE were excluded from the study. A local anesthetic was applied to the skin of glans penis for 30 minutes before the injection of 2 ml HA in glans penis via 30-gauge needle using our new Five-puncture technique. Intra-vaginal ejaculatory latency time (IELT) was measured at 1, 3, 6 and 12 months after injection. Results Thirty patients completed our study follow up schedule. Mean age of the patients was 41.72 ± 8.50, while mean age of female partner was 37.23 ± 8.54 years. IELT was highly significantly increased (P-value < 0.001) after HA gel injection from baseline, which was in maximum 37.83 ± 11.01 sec at baseline to 323.03 ± 42.06, 281.07 ± 41.05, 241.03 ± 43.09 and 235.6 ± 41.87 sec after 1, 3, 6 and 12 months, respectively, after injection. Three patients complained from discomfort at the site of injection, two from bullae formation at the site of injection and one from ecchymosis, and all resolved spontaneously after 1 week to 10 days after injection. Conclusion HA gel injection in glans penis using our new five-puncture technique is a safe and effective method that ensures a modest long-term significant increase in IELT and improves ejaculatory control.

Availability and Access to Medications for Puberty Induction and Maintenance in Adolescents with Hypogonadism in the Arab Region.

Background Inducing puberty in hypogonadal patients enables achieving normal final adult height and healthy bone mass accrual and improves fertility potential. Reliable availability and access to medicines remain a challenge around the world, particularly in low-income countries. Aim We aimed to describe the availability/access to medications used for inducing and maintaining puberty in centers within the Arab region. Method A cross-sectional survey was conducted using a link to an online questionnaire, which was emailed to paediatric endocrinologists in the Arab region. The questionnaire consisted of three questions related to the availability of various forms of sex hormones. Results 99 physicians from 16 countries participated in the study. The commonest available form of estrogen was conjugated estrogen (29% of centers), followed by ethinylestradiol (26%). Depot estradiol was available in 11 centers, while topical estrogen preparations of gel and patches were available in 6 and 10 centers, respectively. Medroxy progesterone was available in 26% of the centers, followed by norethisterone (24%). The combined forms of oral and transdermal patches of estrogen/progesterone were available in 35% and 9% of centers, respectively. Intramuscular testosterone (Sustanon) was the most commonly available preparation of testosterone, followed by the depot injection (Nebido), oral testosterone, and testosterone gel and cream. Conclusions We report the first available data on medications used for puberty induction and maintenance in paediatric hypogonadism in the Arab region. Recommended preparations for this purpose are not widely available. Creating an essential list of medications used in paediatric endocrinology disorders might improve availability, access, and consequently practice.

Patient Comfort, Safety, and Effectiveness of Resilient Hyaluronic Acid Fillers Formulated With Different Local Anesthetics.

Maximizing patient comfort during hyaluronic acid gel injection is a common concern that is usually addressed by selecting fillers with lidocaine. Two randomized, double-blinded, split-face trials aimed to demonstrate noninferiority of specific hyaluronic acid fillers incorporating mepivacaine (RHA-M) versus their lidocaine controls, at providing pain relief. Thirty subjects per trial received injections of RHA R -M versus RHA R , and RHA4-M versus RHA4, respectively, in the perioral rhytids (PR) and nasolabial folds (NLF). Pain was assessed on a visual analog scale; aesthetic effectiveness was evaluated with validated scales, and safety was monitored based on common treatment responses (CTRs) and adverse events (AEs). RHA-M fillers proved as effective as their lidocaine counterparts at reducing pain (noninferior, p < .0002 and p < .0001). Bilateral wrinkle improvement was measured both in the PR (-1.5 ± 0.6 points on each side) and in the NLF (-1.8 ± 0.6 and -1.9 ± 0.5 points) trials at one month, with virtually identical responder rates (≥96.7%). Common treatment responses and AEs were similar between treated sides, and none was clinically significant. Resilient hyaluronic acid fillers with either mepivacaine or lidocaine are equally effective at reducing pain during treatment and equally performant and safe for correction of dynamic facial wrinkles and folds.

Comparison of implant methods for penis enlargement

Male dissatisfaction with the penis size is the most common manifestation of penile dysmorphophobia. Despite the diversity of penis enlargement methods a single safe technique that fully satisfies patients has not yet been developed.The aim of this work is to compare the results of a combined operation on installation of a silicone implant or a collagen matrix impregnated with autologous stem cells with simultaneous ligamentotomy to increase the length and circumference of the penis.In 2017–2022 there were performed penis enlargement surgeries in 2 centers. In Public Non-Profit Organization Of The Kharkiv District Council «Kharkiv Regional Clinical Center Of Urology And Nephrology Named After V.I.Shapoval (Kharkiv, Ukraine) 38 patients from Ukraine and Poland were operated by Professor Knigavko O.V. with implantation of a porous Max Pol matrix (manufactured by Dersmithson, M.D. Choi), and in the “Mexico phalloplastic center” (Mexico city, Mexico) by Dr. Aguilar I.E. implantation of non-absorbable silicone implants in 36 patients was perfomed. The results of penis enlargement were evaluated in the early (2 months) and long-term (6 months) terms.While implanting a silicone implant the majority of the patients – 31 (86.1%) are satisfied with the result, 27 (75%) patients mention an improvement in sexual life, 31 (86.1%) also mention an increase in their own self-sufficiency. At the same time, some patients mentioned the following complications: 2 (5.6%) patients mentioned displacement of the silicone matrix, 1 (2.8%) patient mentioned prolapse of the matrix, 1 (2.8%) patient mentioned a decrease in erection (which did not improve after removal of the matrix), in 1 (2.8%) case the silicone implant had to be removed due to the fact that the patient did not liked the appearance.While using a collagen-like matrix made of polymerized polylactic acid impregnated with own stem cells in 38 patients, we haven’t seen any complications that caused the removal of the matrix. However, 5 (13.2%) patients required additional polylactic acid gel injections between 6 and 36 (97.4%) months to optimize the shape or volume of the penis. 34 (89.5%) patients mentioned an improvement in the sexual function and sexual sensations of their partner, harmonization of relationships in a couple, and 36 (97.4%) men – an increase in a sense of self-sufficiency.Thus, modern implants can improve the size and appearance of the penis, improve the quality of sexual life and the feeling of self-sufficiency in operated men. The use of silicone implants is simpler, almost does not require specific rehabilitation after surgery, however, in a small part of patients prolapse of the prosthesis and dissatisfaction with the final result are present. Most of operated patients were satisficed results of silicone implant. The use of a polymer matrix impregnated with own stem cells requires a special laboratory, more time for preoperative and postoperative rehabilitation, however, it is more physiological and can be considered as a standard for safe penis enlargement.

Intramural injection of pluronic gel loaded with drugs to alleviate arterial injury.

Balloon angioplasty, stent implantation, and application of an arterial clamp during surgery can induce artery injury such as elastin breaks and endothelium injury, but there is little research focused on the injury induced by these therapeutic manipulations. We established a simple and reproducible small animal aortic injury model and examined intramural injection as a potential therapeutic method to alleviate injury. The abdominal aorta of male Sprague Dawley (SD) rats or C57BL/6J mice was clamped sequentially throughout its length. Transforming growth factor β1 (TGFβ1), SB431542, lipopolysaccharide (LPS), Necrostatin-1 (Nec-1), rapamycin, or MHY1485 contained in Pluronic gel was injected intramurally at day 0 or day 7. Animals were fed with chow containing 0.25% beta-aminopropionitrile (BAPN) to evaluate the influence of BAPN. All samples were harvested and examined by immunohistochemistry and immunofluorescence. The clamped rat aorta showed luminal dilation, elastin fiber breaks, neointimal hyperplasia, and dissection (days 0-90). Intramural injection of TGFβ1, rapamycin and Nec-1 showed a protective effect on the injured aorta, whereas SB431542, MHY1485 and LPS showed more severe wall damage. The aortic lumen in rats fed with BAPN was significantly larger than in control rats (day 7). Mouse aorta showed similar injury with neointimal hyperplasia and elastin fiber breaks. The rodent arterial injury model is reproducible and may mimic early changes of arterial injury. The model accommodates intramural injection of different drugs that may show mechanisms of arterial injury. Although this is a preliminary animal model, the intramural injection method may have potential clinical application in the future.

Treatments for AIDS/HIV-related Kaposi sarcoma: A systematic review of the literature.

Treatment guidelines are not well established in AIDS-related Kaposi sarcoma (KS). We aim to review the evidence on efficacy of treatments for AIDS-related Kaposi sarcoma. We searched the Cochrane Library, PubMed, and Embase Database from date of database inception till July 2020. Randomized controlled trials reporting intervention consisting of any type of treatment compared to control/placebo to a different treatment modality or different combination of treatment/treatment doses with a diagnosis of AIDS-related KS are selected. Primary outcomes were response rates defined as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Secondary outcomes were cosmesis and adverse outcomes such as pain and erythema. Thirteen out of 536 articles met our eligibility criteria. Three studies reported the efficacy of chemotherapy, two studies looked at different doses of radiotherapy regimes, and three studies compared different antiretroviral therapy (ART) and chemotherapy regimens. Other studies reported topical therapies such as alitretinoin gel, IM862, and bHCG injection which showed varied efficacies. Lack of standardization classification of disease activity and clinical outcomes and treatment modalities precluded meaningful comparison of studies. The evidence of efficacy of any particular intervention is overall varied and there was insufficient evidence to recommend any particular intervention. We have provided an overview of treatments for KS but larger studies need to be carried out to verify the efficacy of treatment options reported in the literature.

Deep Orbital Hyaluronic Acid Gel Filler for Volume Augmentation in Orbital Dysplasia.

Orbital dysplasia is caused by congenital microphthalmos, anophthalmos, or eye atrophy. Orbital volume growth is known to parallel ocular growth and the absence of an eye results in noticeable hemifacial deformity that affects patients' lives. The aim of this study was to observe the effects of injections of hyaluronic acid gel into the orbit combined with ocular prosthesis to treat orbital dysplasia. Three patients with orbital dysplasia who were 3 to 7 years old treated in our department. Each year, the hyaluronic acid gel was injected into each patient intraconal and extraconal posterior orbit and each wore an ocular prosthesis. The length of the palpebral fissure and orbital volume were measured before and after the injections. A total of 9 injections were performed on 3 patients ages 7, 5, and 4 years old, respectively. The follow-up periods were 5, 5, and 2 years. The authors observed significant improvements in patient appearance. The length of the palpebral fissure and the volume of the orbit increased linearly with the increasing age, and there were no complications, such as intraorbital hemorrhage or local hyperplastic stimulation. Orbital hyaluronic acid gel injection and combined with an ocular prosthesis is a safe, convenient, and effective treatment for orbital dysplasia.

Testosterone in men with hypogonadism and transgender males: a systematic review comparing three different preparations.

Testosterone therapy is the cornerstone in the care of men with hypogonadism and transgender males. Gel and intramuscular injections are most frequently used and are registered and included in the international guidelines. The specific preparation should be selected according to the patient’s preference, cost, availability, and formulation-specific properties. As the majority of men with hypogonadism and transgender males require lifelong treatment with testosterone, it is important to utilize a regimen that is effective, safe, inexpensive, and convenient to use with optimal mimicking of the physiological situation. This systematic review reviews current literature on differences between the three most used testosterone preparations in adult men with hypogonadism and transgender males. Although it appeared hardly any comparative studies have been carried out, there are indications of differences between the preparations, for example, on the stability of testosterone levels, hematocrit, bone mineral density, and patient satisfaction. However, there are no studies on the effects of testosterone replacement on endpoints such as cardiovascular disease in relation to hematocrit or osteoporotic fractures in relation to bone mineral density. The effect of testosterone therapy on health-related quality of life is strongly underexposed in the reviewed studies, while this is a highly relevant outcome measure from a patient perspective. In conclusion, current recommendations on testosterone treatment appear to be based on data primarily from non-randomized clinical studies and observational studies. The availability of reliable comparative data between the different preparations will assist in the process of individual decision-making to choose the most suitable formula.

Study of adhesive self-degrading gel for wellbore sealing

In this study, a self-degrading gel with high adhesion was synthesized by acrylamide, acrylic acid and an unstable cross-linker. It was used for the pressurized operation of oil and gas wells. The degradation time, adhesion and plugging performance of the gel were investigated by degradation experiments, adhesion experiments and plugging experiments. To a certain extent, it was found that the concentration of the reactants had different effects on the degradation time and adhesion friction of the gels. In addition, the adhesion friction varies due to compressional deformation of the gel by compression. The blocking ability of the gels was mainly related to the adhesion friction. The blocking capacity of high-strength horizontal gels is linearly related to the adhesion friction. The sealing capacity of low strength horizontal gel is non-linearly related to the adhesion friction. Compared with conventional gel blocking operation, the gel breaking operation at the end of gel blocking operation does not require additional injection of gel breaking agent due to the introduction of unstable crosslinker. The gel degradation time can be controlled by designing the formulation to achieve rapid gel breakage and rejection. It saves time cost and economic cost. The highly viscous self-degrading gel can be used as a wellbore pressure packer for oil and gas wells under pressure.

Experimental and Numerical Investigation on Oil Displacement Mechanism of Weak Gel in Waterflood Reservoirs.

The production performance of waterflood reservoirs with years of production is severely challenged by high water cuts and extensive water channels. Among IOR/EOR methods, weak gel injection is particularly effective in improving the water displacement efficiency and oil recovery. The visualized microscopic oil displacement experiments were designed to comprehensively investigate the weak gel mechanisms in porous media and the numerical simulations coupling equations characterizing weak gel viscosity induced dynamics were implemented to understand its planar and vertical block and movement behaviors at the field scale. From experiments, the residual oil of initial water flooding mainly exists in the form of cluster, column, dead end, and membranous, and it mainly exists in the form of cluster and dead end in subsequent water flooding stage following weak gel injection. The porous flow mechanism of weak gel includes the preferential plugging of large channels, the integral and staged transport of weak gel, and the residual oil flow along pore walls in weak gel displacement. The profile-control mechanism of weak gel is as follows: weak gel selectively enters the large channels, weak gel blocks large channels and forces subsequent water flow to change direction, weak gel uses viscoelastic bulk motion to form negative pressure oil absorption, and the oil droplets converge to form an oil stream, respectively. The numerical simulation indicates that weak gel can effectively reduce the water-oil mobility ratio, preferentially block the high permeability layer and the large pore channels, divert the subsequent water to flood the low permeability layer, and improve the water injection swept efficiency. It is found numerically that a weak gel system is able to flow forward under high-pressure differences in the subsequent water flooding, which can further improve oil displacement efficiency. Unlike the conventional profile-control methods, weak gels make it possible to displace the bypassed oil in the deep inter-well regions with significant potential to enhance oil recovery.

Evaluation of a single-shot of a high-density viscoelastic solution of hyaluronic acid in patients with symptomatic primary knee osteoarthritis: the no-dolor study

BackgroundPronolis®HD mono 2.5% is a novel, one-shot, high-density sterile viscoelastic solution, recently available in Spain, which contains a high amount of intermediate molecular weight hyaluronic acid (HA), highly concentrated (120 mg in 4.8 mL solution: 2.5%). The objective of the study was to analyze the efficacy and safety of this treatment in symptomatic primary knee osteoarthritis (OA).MethodsThis observational, prospective, multicenter, single-cohort study involved 166 patients with knee OA treated with a single-shot of Pronolis®HD mono 2.5% and followed up as many as 24 weeks.ResultsCompared with baseline, the score of the Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC) pain subscale reduced at the 12-week visit (primary endpoint, median: 9 interquartile range [IQR]: 7–11 versus median: 4; IQR: 2–6; p < 0.001). The percentage of patients achieving > 50% improvement in the pain subscale increased progressively from 37.9% (at 2 weeks) to 66.0% (at 24 weeks). Similarly, WOMAC scores for pain on walking, stiffness subscale, and functional capacity subscale showed significant reductions at the 12-week visit which were maintained up to the 24-week visit. The EuroQol visual analog scale score increased after 12 weeks (median: 60 versus 70). The need for rescue medication (analgesics/nonsteroidal anti-inflammatory drugs) also decreased in all post-injection visits. Three patients (1.6%) reported local adverse events (joint swelling) of mild intensity.ConclusionsIn conclusion, a single intra-articular injection of the high-density viscoelastic gel of HA was associated with pain reduction and relief of other symptoms in patients with knee OA.Trial registrationClinicalTrial# NCT04196764

Single-Port, Robot-Assisted Transanal Harvest of Rectal Mucosa Grafts for Substitution Urethroplasty

ObjectiveTo describe a novel single-port, endorobotic technique for harvesting rectal mucosa grafts (RMGs) for urethral reconstruction. MethodsA 57-year-old man with prior transurethral procedures developed recurrent obstructive voiding symptoms. Urethrography revealed a panurethral stricture, meatus to the bulbomembranous junction. It was decided to proceed with surgical repair. Owing to the stricture's length, available oral mucosa would require additional material, and repair with a single rectal mucosa graft was offered instead. Single-port (SP) endorobotic approach offered ideal access for transanal harvest. With the patient placed in a modified lithotomy position, a GELPOINT Path transanal access platform was inserted through the anal canal. Pneumorectum was established at 12 mmHg with an AirSeal CO2 insufflator. A Da Vinci SP surgical system was docked, equipped with Maryland bipolar forceps and a monopolar spatula. After injection of ORISE gel, endorobotic submucosal dissection began posteriorly proximal to the dentate line. ResultsProceeding cranially through the rectal submucosa, a 21 ✕ 3 cm strip of mucosa was obtained with appropriate hemostasis. The resulting graft was thoroughly thinned. The robot was undocked, and the patient repositioned to high lithotomy. The patient underwent a penis-inverting, dorsolateral approach augmentation urethroplasty. With an indwelling catheter placed, the patient was discharged on postoperative day 2 with no postoperative complications. ConclusionTransanal rectal mucosal dissection with a single-port endorobotic approach can be an enticing and minimally invasive harvesting technique to provide substitution grafts for long-segment urethral reconstruction.

Factors contributing to changes in viscosity and flow rate of a dedicated gel for gel immersion endoscopy.

Background and study aims Gel immersion endoscopy is a novel technique for securing the visual field during endoscopy. Clinical application of a dedicated gel for this technique with an appropriate viscosity to prevent mixing with blood and its efficacy was reported. The aim of this study was to evaluate changes in gel viscosity and flow rate under different conditions. Methods The viscosity of the gel after injection and flow rate were measured under various conditions changing the injection route and method. Gel viscosity was measured at 25, 10, and 4 °C. Results A decrease in gel viscosity was found when the gel was injected via the water jet channel compared to the accessory channel. The flow rate and decrease in viscosity of the gel injected via the water jet channel were 220 mL/min and 63.2 %, while when injected via the accessory channel with a clip device inserted were 560 mL/min and 35.8 %. When the gel was kept at a low temperature, the viscosity increased. Conclusions Gel injection via the accessory channel should be the first choice for efficient use considering the viscosity and flow rate.

Subcutaneous Administration of a Nitric Oxide-Releasing Nanomatrix Gel Ameliorates Obesity and Insulin Resistance in High-Fat Diet-Induced Obese Mice.

Nitric oxide (NO) is a gaseous signaling molecule, which plays crucial roles in various biological processes, including inflammatory responses, metabolism, cardiovascular functions, and cognitive function. NO bioavailability is reduced with aging and cardiometabolic disorders in humans and rodents. NO stimulates the metabolic rate by increasing the mitochondrial biogenesis and brown fat activation. Therefore, we propose a novel technology of providing exogenous NO to improve the metabolic rate and cognitive function by promoting the development of brown adipose tissue. In the present study, we demonstrate the effects of the peptide amphiphiles-NO-releasing nanomatrix gel (PANO gel) on high-fat diet-induced obesity, insulin resistance, and cognitive functions. Eight-week-old male C57BL/6 mice were subcutaneously injected in the brown fat area with the PANO gel or vehicle (PA gel) every 2 weeks for 12 weeks. The PANO gel-injected mice gained less body weight, improved glucose tolerance, and decreased fasting serum insulin and leptin levels compared with the PA gel-injected mice. Insulin signaling in the muscle, liver, and epididymal white adipose tissue was improved by the PANO gel injection. The PANO gel reduced inflammation, increased lipolysis in the epididymal white adipose tissue, and decreased serum lipids and liver triglycerides. Interestingly, the PANO gel stimulated uncoupled protein 1 gene expression in the brown and beige fat tissues. Furthermore, the PANO gel increased the cerebral blood flow and improved learning and memory abilities. Our results suggest that using the PANO gel to supply exogenous NO is a novel technology to treat metabolic disorders and cognitive dysfunctions.