Injection Of Cs Research Articles

Association between intra-articular hyaluronic acid injections in delaying total knee arthroplasty and safety evaluation in primary knee osteoarthritis: analysis based on Health Insurance Review and Assessment Service (HIRA) claim database in Republic of Korea

BackgroundThe prevalence of knee osteoarthritis (KOA), a progressive degenerative disease, is gradually increasing, and it is a progressive degenerative disease. In patients with mild-to-moderate KOA, intra-articular hyaluronic acid (IA-HA) has been shown to be an effective non-operative treatment option that can provide significant pain relief and symptom improvement by increasing intra-articular viscoelasticity. This study aimed to evaluate the efficacy of IA-HA injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database.MethodsFor this retrospective cohort study, the study population included patients aged ≥ 50 years with a first diagnosis of KOA between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Republic of Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration.ResultsIn all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60–0.62) than non-IA-HA group after adjusting for covariates, which included age, sex, medical history, number of hospital beds, and CS injection. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53–0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents (multiple injection regimen 7.0% vs. single injection regimen 3.6%) and concurrent IA-CS use (concurrent IA-CS use 13.9% vs. IA-HA only 6.7%) were associated with higher infection risk.ConclusionIA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings could suggest the use of IA-HA as an effective non-operative intervention option for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use could play a role in delaying the time to TKA and reducing complications.

Liraglutide protects against microvascular dysfunction and sepsis-mediated inflammation and organ injury

Introduction: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection characterized by increased systemic inflammation and microvascular injury. Recently, commonly used diabetes and obesity medications, glucagon-like peptide-1 (GLP-1) receptor agonists, have demonstrated unexpected anti-inflammatory effects. We tested GLP-1 receptor agonist liraglutide in a clinically relevant two-hit murine model of polymicrobial abdominal sepsis and hyperoxia and microvascular endothelial injury in vitro, hypothesizing that GLP-1 receptor agonists exert protective effects during sepsis, limiting microvascular permeability, inflammation, organ injury and death. Methods: Sepsis was induced in male and female mice by intraperitoneal (IP) injection of cecal contents (CS;1.8 mg/g body weight) collected from euthanized donor mice. Mice were also exposed to hyperoxia (FiO2 90-96%) for 24 hours. Six and 18 hours after CS injection, mice were administered saline or liraglutide (0.1 mg/kg). At 12 hours, mice were given fluids and antibiotics. At 24 hours, mice were euthanized for plasma and bronchoalveolar lavage (BAL; right lung) collection. Plasma cytokines, organ injury markers, and BAL immune cells and protein were measured. The left lung was tied off and excised to measure wet-to-dry lung weight ratios. Additionally, for in vitro studies, primary human lung microvascular endothelial cells (HLMVECs) were treated with saline or liraglutide for 24 hours prior to saline (control) or LPS (100 ng/mL). HLMVEC barrier dysfunction was quantified using express permeability testing (XPerT) assay or Electric Cell-Substrate Impedance Sensing (ECIS) to measure transendothelial electrical resistance (TER). Results: In murine sepsis, illness severity scores and lung injury were improved in mice pretreated with liraglutide (N=12). Plasma blood urea nitrogen (BUN; P=0.0581), alanine transaminase (ALT; P=0.0311) and aspartate aminotransferase (AST; P=0.0263), and cytokines IL-1β (P=0.0078), IL-6 (P=0.0038), and TNF-α (P=0.0183) in plasma were reduced in mice treated with liraglutide. In HLMVECs, liraglutide (1.5 nM) significantly reduced LPS-induced barrier dysfunction measured by XPerT assay (P=0.0030) and ECIS (P=0.0075). Conclusion: Liraglutide reduces illness severity, inflammation, and organ injury in a two-hit model of sepsis-induced ALI. Liraglutide has direct effects in the microvascular endothelium, limiting LPS-mediated barrier dysfunction. These findings support a protective role for GLP-1 receptor agonism in sepsis, mediated through the microvasculature. HL150783, AG075341, HL158906. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sciatica after intra articular corticosteroids injection

Background. The intra-articular cortico-steroid (IA-CS) injections treatment are still debatable despite its effectiveness. The failure can cause sciatica which IA-CS injected at the sacroiliac joint (SIJ). The study was done to determine non-technical factors that cause recurrent LBP after optimal SIJ IA-CS injections. Methods. A prospective-clinical study was done that looked at recurring sciatica variables in the cases that received intra-articular injection of CS. Cases were diagnosed with sciatica according to the IASP criteria. All patients had intra-articular CS injections. The numerical rating scale (NRS) was used for rating the pain in the SIJ on a range of (0-10). The scale was reviewed 3, 6, and 9 months post treatment. Age, gender, BMI, trauma history, long-term standing, NSAID used and knee pain were all documented as intra-articular injection treatment possible failure factors. Results. In total, 50 subjects were enrolled, with more females (60%) than males (40%). The mean of age was 55.8±7.4 years. History of trauma was reported in 60%. Long sitting and standing history presented in 70% and 20%, respectively. The recurrence of sciatica affected 30(60%) patients. The right sciatica was affecting more than half of the cases (60%). The vast majority of cases (80%) used NSAID. The pain began within the last three months in 80% of the patients. History of CS injection was recorded in 38% of the cases. Lower limb pain was reported in 80% of the cases. Cases with and without recurrence had the mean age of 55.9 ± 9.5 years and 50.6 ± 14.9 years, respectively. The SIJ pain recurrence is strongly connected with elderly and long sitting in logistic regression analysis. Conclusions. Elderly, NSAID utilize, and uni-lateral sciatica involvement are protective factors against SIJ discomfort recurrence.

The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma).

The aim of this European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus is to provide recommendations based on evidence and expert opinion to improve indications, decision-makingand administration-related aspects when using blood-derived orthobiologics (for simplicity indicated as PRP-platelet-rich plasma-with PRP being the most common product) for the management of knee osteoarthritis (OA). Leading European expert clinicians and scientists were divided into a steering group, a rating group and a peer review group. The steering group prepared 28 question-statement sets divided into three sections: PRP rationale and indications, PRP preparation and characterisationand PRP protocol. The quality of the statements received grades of recommendation ranging from A (high-level scientific support)to B (scientific presumption), C (low-level scientific support) or D (expert opinion). The question-statement sets were then evaluated by the rating group, and the statements scored from 1 to 9 based on their degree of agreement with the statements produced by the steering group. Once a general consensus was reached between the steering and rating groups, the document was submitted to the peer review group who evaluated the geographic adaptability and approved the document. A final combined meeting of all the members of the consensus was held to produce the official document. The literature review on the use of blood-derived products for knee OA revealed that 9 of 28 questions/statements had the support of high-level scientific literature, while the other 19 were supported by a medium-low scientific quality. Three of the 28 recommendations were grade A recommendations: (1) There is enough preclinical and clinical evidence to support the use of PRP in knee OA. This recommendation was considered appropriate with a strong agreement (mean: 8). (2) Clinical evidence has shown the effectiveness of PRP in patients for mild to moderate degrees of knee OA (KL ≤ 3). This recommendation was considered appropriate with a strong agreement (mean: 8.1). (3) PRP injections have been shown to provide a longer effect in comparison to the short-term effect of CS injections. They also seem to provide a safer use profile with less potential related complications. This recommendation was considered appropriate with a very strong agreement (mean: 8.7). Six statements were grade B recommendations, 7 were grade C and 12 were grade D. The mean rating score was 8.2 ± 0.3. The consensus group reached a high level of agreement on all the questions/statements despite the lack of clear evidence for some questions. According to the results from this consensus group, given the large body of existing literature and expert opinions, PRP was regarded as a valid treatment option for knee OAand as a possible first-line injectable treatment option for nonoperative management of knee OA, mainly for KL grades 1-3. Level II.

Effect due to Cs injection upon current oscillation of the beam extracted from the J-PARC negative hydrogen ion source

A high-speed emittance measurement system installed at the J-PARC RF negative hydrogen (H-) ion source test stand can construct emittance diagrams of the beam of a specific frequency component. The driving 2 MHz RF power produces small amplitude oscillating components at 2 MHz and at higher harmonic frequencies in the total H- ion beam detected by a Faraday installed downstream of the emittance measurement system. Magnitudes of oscillating component at 2 MHz and 4 MHz frequencies become appreciable as the slits of the emittance measurement system separate the H- ion beam into the position/angle resolved phase space elements. The reconstructed emittance diagrams of H- ion beams for the operation condition with continuous supply of Cs realizing large H- ion current to total extraction current ratios indicate that 2 MHz and 4 MHz frequency oscillating beam components propagate surrounding the center DC beam. Both 2 MHz and 4 MHz oscillating beam components comprise two to three beam particle groups in the phase space. The DC component of the H- ion beam exhibit a single peak in the angular distribution. Meanwhile, oscillating components often take the minima where the DC H- ion beam takes the maximum in the angular distribution diagram. Thus, the regions that produce large amplitude oscillations of the H- ion beam are considered located at the circumference of the beam extraction aperture. One possible explanation for observing larger amplitude beam oscillation can be the enhanced H- ion surface production at the plasma facing the wall of the beam extraction aperture. The operation without the Cs delivery to the source increased electron current coextracted with H- ions and changed the structure of the beam emittance diagram. In the direction perpendicular to the magnetic fields created by a magnetic filter and electron suppression magnets, the peak of the 4 MHz oscillating beam components appeared at the center of the DC beam. This observation suggests the extraction of H- ions formed in the central region by the volume production process near the internal RF antenna. Mechanisms that can excite and diminish the beam fluctuation amplitudes of the extracted H- ion beam are discussed.

The negative beam source with single driver for CRAFT NNBI: design and conditioning results

The Comprehensive Research Facility for Fusion Technology (CRAFT) is a large scientific facility that is preferentially deployed for the construction of major national science and technology infrastructures. A negative beam source based neutral beam injector (NNBI) with beam energy of 200–400 keV, beam power of 2 MW and beam duration of 100 s is one of the devices. A giant radio frequency (RF) based negative beam source was designed for the CRAFT NNBI system. In order to understand the physics and pre-study the engineering problems for RF negative beams source, several beam sources with different scales will be designed and tested. According to the R&D schedule, a negative beam source with a single driver was designed, developed and tested first. The single driver beam source is a quarter of the size of the full size negative beam source. It contains an RF driver, an expansion chamber and a negative ion accelerator with three electrodes, which are a plasma grid (PG), extraction grid (EG) and ground grid (GG). To enhance the negative ion production, Cesium is injected into the plasma chamber and a magnetic filter filed is produced by current flow through the PG to decrease the electron temperature. The negative beam source was tested on the test facility after assembly, including RF plasma generation, negative ion production, extraction and acceleration. The characteristic of plasma discharge, beam extraction and acceleration was studied without and with Cs injection. The long pulse of 105 seconds negative ion beam was achieved successfully. The extracted negative ion current is 4 A and the ratio of electron and negative ion is around 0.8. It lays a good foundation for the R&D of negative ion source with a multi-driver for the CRAFT NNBI system. The details of the design and experimental results of beam source was shown in this paper.

Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection

ObjectivesCorticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections.MethodsPatients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant–Murley score (CMS) were also obtained.ResultsThe baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS).ConclusionIntralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection.Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004.

A RANDOMIZED CONTROLLED STUDY OF AUTOLOGOUS TENOCYTE INJECTION (ATI) VERSUS CORTICOSTEROID INJECTION FOR INTERSTITIAL ROTATOR CUFF TEAR AND IMPINGEMENT SYNDROME

Interstitial supraspinatus tears can cause persistent subacromial impingement symptoms despite non operative treatment. Autologous tendon cell injection (ATI) is a non-surgical treatment for tendinopathies and tear. We report a randomised controlled study of ATI compared to corticosteroid injection (CS) as treatment for interstitial supraspinatus tears and tendinopathy.Inclusion criteria were patients with symptom duration > 6 months, MRI confirmed intrasubstance supraspinatus tear, and prior treatment with physiotherapy and ≥ one CS or PRP injection. Participants were randomised to receive ATI to the interstitial tear or corticosteroid injection to the subacromial bursa in a 2:1 ratio, under ultrasound guidance. Assessments of pain (VAS) and function (ASES) were performed at baseline, and 1, 3, 6 and 12 months post treatment.30 participants (19 randomised to ATI) with a mean age of 50.5 years (10 females) and a mean duration of symptoms of 23.5 months. Baseline VAS pain and ASES scores were comparable between groups. While mean VAS pain scores improved in both groups at 3 months after treatment, pain scores were superior with ATI at 6 months (p=0.01). Mean ASES scores in the ATI group were superior to the CS group at 3 months (p=0.026) and 6 months (p=0.012). Seven participants in the CS group withdrew prior to 12 months due to lack of improvement. At 12 months, mean VAS pain in the ATI group was 1.6 ± 1.3. The improvements in mean ASES scores in the ATI group at 6 and 12 months were greater than the MCID (12.0 points). At 12 months, 95% of ATI participants had an ASES score > the PASS (patient acceptable symptom state).This is the first level one study using ATI to treat interstitial supraspinatus tear. ATI results in a significant reduction in pain and improvement in shoulder function.

Ultrasound-Guided Treatment of Meralgia Paresthetica: With or Without Corticosteroid? A Double-Blinded, Randomized Controlled Study.

Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested.

Comparison of steroid injection vs platelet rich plasma injection in the treatment of de-quervain tenosynovitis

Introduction: De Quervains disease is a chronic inflammation of tendons of abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) as they pass through 1st dorsal extensor compartment of wrist. Aim of the study is to compare the functional outcome between PRP (Platelet rich plasma) vs Steroid injections in the management of this pathology. Methods: This was a prospective study of 30 patients with de quervains tenosynovitis and study conducted between September 2021 to November 2021 for a period of 3 months follow up done. The present study included 30 patients of both sexes, different age groups associated with co-morbidities divided into two groups. Group I received CS injection, and group II received PRP injection. Results: The average age of patients in Category I was 37 years and in category II was 37 years. A statistical difference was seen in VAS on comparing the baseline evaluation with the results after 1 month of injection administration. It was found that there was more depletion in VAS score in Category I (2.33%) after one month of injection whereas Category II showed an initial low depletion rate after one month (2.86%) followed by a steady decline rate after 3 months. A similar difference was reflected on using the Quick DASH score in which Category I projected a greater improvement after one month of injection use whereas Category II projected a steady improvement rate after 3 months of injection use. Conclusion: PRP for De Quervains tenosynovitis can be used as a 2nd line of management instead of steroid as PRP has better functional outcome and lesser complications as compared to steroid therapy.

Intra-Articular Injection of Platelet-Rich Plasma Is More Effective than Hyaluronic Acid or Steroid Injection in the Treatment of Mild to Moderate Knee Osteoarthritis: A Prospective, Randomized, Triple-Parallel Clinical Trial.

Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections.

Comparisons between lysis and lavage, intra-articular steroid injections, and three-point subsynovial steroid injections using operative single-cannula arthroscopy — A retrospective analysis

The aim of this study is to compare the effectiveness of intra-articular and three-point sub-synovial steroid injections.In this retrospective Cohort study an OSCA lysis and lavage, intra-articular and threepoint sub-synovial steroid injections were performed and the maximal interincisinal opening (MIO), pain using 10- point visual analog scale (VAS) and quality of life (QOL) were measured one week before the procedure and 1, 3, 6, 12 months, and 2 and 3years after surgery.Sixty-five patients suffering from internal derangement refractory to conservative treatment charts were reviewed. successfully lowered pain (p value = 0.0012), and improved mouth opening (p value = 0.023), and quality of life (QoL) (p value = 0.003) for up to 6 months after surgery. OSCA with intra-articular CS injections effectively lowered pain (p value = 0.0025), and improved mouth opening (p value = 0.03) and QoL (p value = 0.004) for 12 months. In comparison, OSCA with sub-synovial steroid injections was significantly effective in lowering pain (p value = 0.000002), improving mouth opening (p value = 0.000004), and QoL (p value p = 0.000006) for the duration of the 36-month follow-up period within the limitations of the study it seems that the OSCA technique with site-specific, sub-synovial CS injections should be the preferred treatment approach when the priority is long-term success concerning pain relief, increased mouth opening and improved quality of life in Wilkes II-IV patients.

Cromolyn Sodium differentially regulates human mast cell and mouse leukocyte responses to control allergic inflammation

BackgroundCromolyn Sodium (CS) has been used in the past as an anti-allergy drug owing to its mast cell (MC) stabilizing properties that impair histamine release. However, additional mechanisms for its clinical actions are likely and might help to identify new roles for MCs and leukocytes in regulating inflammation. Here, using human cord blood-derived MCs (CBMCs), mouse bone marrow-derived MCs (BMMCs) and eosinophils (BMEos), and in vivo mouse models of allergic inflammation (AI), additional actions of CS on MCs were determined. MethodsThe in vitro effects of CS on IgE-activated human and mouse MCs were assessed by measuring the levels of pro-inflammatory (tryptase, LTC4, IL-8, CD48) and pro-resolution effectors (IL-10, CD300a, Annexin A1) before and after CS treatment. The in vivo effects of daily CS injections on parameters of inflammation were assessed using mouse models of allergic peritonitis (AP) (Ovalbumin/Alum- or Ovalbumin/S. aureus enterotoxin B) and allergic airways inflammation (AAI) (house dust mite (HDM)). ResultsIn vitro, CS did not affect pro-inflammatory effectors but significantly increased the anti-inflammatory/pro-resolution CD300a levels and IL-10 release from IgE-activated CBMCs. BMMCs were not affected by CS. In vivo, CS injections decreased total cell and Eos numbers in the peritoneal cavity in the AP models and bronchoalveolar lavage and lungs in the AAI model. CS reduced EPX release from PAF-activated BMEos in vitro, possibly explaining the in vivo findings. ConclusionTogether, these results demonstrate immunomodulatory actions for CS in AI that are broader than only MC stabilization.

Overview of diagnostics on a small-scale RF source for fusion (ROBIN) and the one planned for the diagnostic beam for ITER.

India is responsible for the supply of diagnostic neutral beam systems for ITER to diagnose its helium ash during the deuterium-tritium plasma phase using the charge exchange recombination spectroscopy technique. Considering the many first of its kind in terms of technologies and beam development aspects, ITER Indian domestic agency has adopted a strategy of developing the technology and beam experimentation in parallel. On the beam development front three test beds, namely, the ROBIN (Rf Operated Beam source in India for Negative ion research), the TWIN (TWo rf driver-based Indigenously built Negative ion source), and the INTF (INdian Test Facility) are presently in their various phases of operation, optimization, and setting up at IPR, respectively. Experiments related to plasma production, beam production, and acceleration up to 30keV in volume and surface mode have been performed on ROBIN. The maximum negative hydrogen ion current density to a tune of 27 mA/cm2 is obtained in the surface mode with Cs injection. Optimal source performance requires optimal surface conditions, minimum impurities, careful characterization of the plasma, cesium feed and its redistribution, and optimal wall temperatures of the surfaces of the plasma box and the plasma grid. A combination of probe, optical, vacuum, laser based, electrical, and calorimetric diagnostic measurements enables such a control. At ROBIN, the above diagnostics are being used regularly. The operational and diagnostic experiences on ROBIN shall provide the desired experience and database for operations of TWIN and INTF in the coming years. A large number of conventional and advanced diagnostic techniques are used for plasma and beam characterization. These diagnostics are suitable not only to detect and understand the plasma but also for studies related to impurity evolution. The temporal evolution of impurities significantly impacts the plasma and beam properties. The studies help in establishing correlations between physical parameters and operational parameters to optimize the source performance ensuring adequate safety and investment protection. This paper will present a brief overview of various diagnostics implemented, lessons learned, and the results obtained from ROBIN. In addition, an outline of the diagnostics planned for INTF based on the experience and understandings developed during the present experiments on ROBIN and TWIN and considering the requirements of large systems shall be discussed.

Measurements of work function and surface conditions in cesiated negative ion sources.

Negative hydrogen (H-) ion sources are operated with Cs injection to reduce coextracted electron current. Injected Cs atoms adhere on the surface of the electrode with extraction holes and increase the local density of H- ions. The surface work function of the extraction electrode is the key parameter determining electron transfer from the electrode to hydrogen atom leaving the surface. Thus, the work functions of the target surfaces for obtaining fundamental process data were measured with the work function diode, Kelvin probe, and photoelectric method. The measurement of the work function of the extraction electrode accompanies difficulties as probe insertion blocks the plasma flow and photoelectric signals are small. Attempts made to monitor the surface conditions for realizing better ion source operations are summarized.

Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective, randomized, double-blinded study

PurposeThe purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment. Material and methodsThe study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points. ResultsIn the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones). ConclusionInitial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.

Significance of platelet rich plasma (PRP) and Corticosteroid injection in management of Adhesive capsulitis of shoulder

Background: The frozen shoulder is very common problem in India and usually could occur as idiopathic or trivial injury. Management modality is usually conservative and physiotherapy because of self-limiting nature of disease. Role of corticosteroid injection are usually effective for short period time but newer Orthobiologic agent like PRP injection are equally effective and minimal and no side effect. Material and method: In our study, total 50 patients were taken of adhesive capsulitis in period October 2018 to February 2020 and divided into groups randomly and PRP injection and corticosteroid injection was given and clinical outcome was recorded. Result: In our study, female are more affected then male, usually occur in age 40 to 60-year age group. The final outcome at 3 month post injection 20% patients with excellent, 48% with good and 32% with poor outcome with PRP injection group and for CS injection group this was found as 16% excellent, 36% good and 48% poor outcome. Conclusion: We concluded PRP and MPS showed efficacy and strong evidence in support significant effect of PRP, where steroid contraindicated or refused by patient in the treatment of frozen shoulder. However, inj. Methylprednisolone has sudden onset of action because of anti-inflammatory action with respect to inj. PRP, so has better result at 1 week follow up post injection but in long term (at 3 months follow up) inj. PRP has better effect in compared to injection MPS.

The cost-effectiveness of different approaches to exercise and corticosteroid injection for subacromial pain (impingement) syndrome.

To determine whether physiotherapist-led exercise intervention and US-guided subacromial CS injection is cost-effective when compared with standard advice and exercise leaflet and unguided injection in patients with subacromial pain (impingement) syndrome. An incremental cost-utility analysis using patient responses to the five-level EuroQoL-5D (EQ-5D-5L) questionnaire was undertaken from a healthcare perspective alongside a 2 × 2 factorial randomized trial with 256 participants over a 12-month follow-up period. Uncertainty was explored through the use of cost-effectiveness acceptability curves. The cost-utility analysis indicated that physiotherapist-led exercise was associated with an incremental cost of £155.99 (95% CI 69.02, 241.93) and 0.031 (95% CI -0.01, 0.07) additional quality-adjusted life-years (QALYs), an incremental cost-effectiveness ratio (ICER) of £5031 per QALY gained and an 85% chance of being cost-effective at a threshold of £20000 per QALY gained compared with the advice and exercise leaflet. US-guided injection was associated with an incremental cost of £15.89 (95% CI -59.36, 109.86) and 0.024 (95% CI -0.02, 0.07) additional QALYs, an ICER of £662 per QALY gained and a 83% chance of being cost-effective at a threshold of £20000 per QALY gained compared with unguided injection. Physiotherapist-led exercise was cost-effective compared with the advice and exercise leaflet, and US-guided injection was cost-effective when compared with unguided injection. ISRCTN, http://www.isrctn.com, ISRCTN42399123.

Comparison of the Effectiveness of Ultrasound-Guided Prolotherapy in Supraspinatus Tendon with Ultrasound-Guided Corticosteroid Injection of Subacromial Subdeltoid Bursa in Rotator Cuff-Related Shoulder Pain: A Clinical Trial Study.

Background:Shoulder pain is the third most common type of musculoskeletal disorder and rotator cuff (RC) tendinopathy is the most frequent diagnosis. Ultrasound is the most preferable guidance tool for diagnostic and interventional purposes. The aim of this study is to compare the effectiveness of the prolotherapy injection with corticosteroid injection in patients with RC dysfunction.Materials and Methods:Thirty to sixty-five-year-old patients with chronic RC disease were divided into two groups. Ultrasound-guided dextrose prolotherapy of supraspinatus tendon was done for one group and ultrasound-guided corticosteroid injection in the subacromial bursa was done for the other groups. Visual analog scale (VAS) and Shoulder Pain and Disability Index (SPADI) were evaluated for both groups at baseline, 3 and 12 weeks after injections.Results:Thirty-three patients were included in the result. Both the groups showed significant improvement in VAS and SPADI scores in 3 and 12 weeks after injections compared with preinjection times with no difference between two groups neither in 3 weeks nor in 12 weeks after injections.Conclusion:Both ultrasound-guided dextrose prolotherapy and CS injections are effective in the management of RC-related shoulder pain in both short-term and long-term with neither being superior to the other. Therefore, prolotherapy may be a safe alternative therapy instead of corticosteroid injection due to lack of its side effects.

First results of negative ion extraction with Cs for CRAFT prototype negative beam source

In order to understand the physics and pre-study the engineering issues for radio frequency (RF) negative beam source, a prototype source with a single driver and three-electrode accelerator was developed. Recently, the beam source was tested on the RF source test facility with RF plasma generation, negative ion production and extraction. A magnetic filter system and a Cs injection system were employed to enhance the negative ion production. As a result, a long pulse of 105 s negative ion beam with current density of 153 A m−2 was repeatedly extracted successfully. The source pressure is 0.6 Pa and the ratio of co-extracted electron and negative ion current is around 0.3. The details of design and experimental results of beam source were shown in this letter.