Injection Location Research Articles

Systematic investigation and validation of peanut genetic transformation via the pollen tube injection method

Genetic transformation is a pivotal approach in plant genetic engineering. Peanut (Arachis hypogaea L.) is an important oil and cash crop, but the stable genetic transformation of peanut is still difficult and inefficient. Recently, the pollen tube injection pathway has been shown to be effective for the genetic transformation of peanut. However, the poor reproducibility of this pathway is still controversial. In this study, the appropriate time and location of injection, along with transgenic screening, were systematically investigated in the pollen tube mediated peanut genetic transformation. Our findings revealed that Agrobacterium injections could be conducted within a time window of two to three hours preceding and succeeding the blooming process. Among the various selective markers evaluated, the Basta screening emerged as the most expedient, followed closely by the DsRed visual screening. According to resistance screening and molecular identification, the average transformation efficiency was 2.6% in the heritable transgenic progenies, which was more likely affected by individual operation by style cavity injection. Furthermore, the use of synergistic FT artificially regulated the blooming of peanuts under indoor conditions, facilitating operations involving keel petal injection and ultimately enhancing the genetic transformation efficiency. Thus, our study systematically validated the feasibility of peanut genetic transformation through an optimized pollen-tube injection technique without tissue culture, potentially guiding future advancements in peanut engineering and molecular breeding programs.

Role of 3D ultrasound in the treatment of stress urinary incontinence with polyacrylamide hydrogel (Bulkamid®) - A pilot study.

Polyacrylamide hydrogel (PAHG) is a bulking agent used in treatment of stress urinary incontinence (SUI) in women. Some women experience an improvement or cure in stress urinary incontinence (SUI) symptoms lasting only a few weeks after the injection of the bulking agent. The aim of this study was to use three-dimensional ultrasound (3DUS) to describe the changes in volume, number of deposits and echogenicity of the bulking agent 3months after PAHG injection. Prospective cohort study of fourteen women with SUI or mixed primarily SUI, who underwent an injection of PAHG. The subjective outcome was evaluated with Patient Global Impression of Improvement questionnaire. 3DUS was performed in all patients immediately after injection of PAHG and again at 3months follow-up. The study found a mean 36.5% loss in bulking agent volume during the study period. A total of 53 PAHG deposits were found by ultrasound immediately after injection. At 3months follow-up 41 PAHG deposits were left. All deposits were hypoechogenic immediately after injection and only 24% of demonstrated PAHG collections had a hypoechoic echogenicity at 3months follow-up. More than 1/3 of volume of injected PAHG and 23% of deposits could not be found by 3DUS at 3months follow-up. Only 24% of PAHG injections in our patients had hypo-echoic echogenicity at 3months follow-up. Larger 3DUS studies with longer follow-up and focus on exact location of the PAHG injections are important future studies.

Computer Modeling of Bevacizumab Drug Distribution After Intravitreal Injection in Rabbit and Human Eyes.

Age-related macular degeneration (AMD) is a progressive eye disease that causes loss of central vision and has no cure. Wet AMD is the late neovascular form treated with vascular endothelial growth factor (VEGF) inhibitors. VEGF is the critical driver of wet AMD. One common off-label anti-VEGF drug used in AMD treatment is bevacizumab. Experimental efforts have been made to investigate the pharmacokinetic (PK) behavior of bevacizumab in vitreous and aqueous humor. Still, the quantitative effect of elimination routes and drug concentration in the macula are not well understood. In this work, we developed two spatial models representing rabbit and human vitreous to better understand the PK behavior of bevacizumab. This study explores different cases of drug elimination and the effects of injection location on drug concentration profiles. The models are validated by comparing them with experimental data. Our results suggest that anterior elimination is dominant for bevacizumab clearance from rabbit vitreous, whereas both anterior and posterior elimination have similar importance in drug clearance from the human vitreous. Furthermore, results indicate that drug injections closer to the posterior segment of the vitreous help maintain relevant drug concentrations for longer, improving bevacizumab duration of action in the vitreous. The rabbit and human models predict bevacizumab concentration in the vitreous and fovea, enhancing knowledge and understanding of wet AMD treatment.

Effect of injection location on mixing characteristics with pylon downstream of cavity

Scramjet propulsion holds promise for high-speed travel and reusable satellite launches, but fuel combustion at supersonic speeds presents a challenge. Limited retention time hinders proper air-fuel mixing. While placing a pylon upstream improves mixing, its impact downstream remains unexplored. This study investigates the effects of different fuel injection locations within the cavity on mixing performance. Numerical simulations with the Improved Delayed Detached-Eddy Simulation (IDDES) turbulence model are used to examine various injection locations. The study found that placing the pylon downstream significantly altered flow patterns. This led to the formation of additional vortices and better mixing downstream and within the cavity. The penetration height is also augmented due to the presence of a pylon. Different injection locations varied in mixing efficiency, penetration height, and total pressure loss, with normal-flow injection close to the cavity's aft showing better overall mixing performance. Dynamic Mode Decomposition (DMD) analysis provided insights into mixing improvement mechanisms, highlighting the effect of injection strategies on flow dynamics and relation with pressure spectra. DMD modes showed distinct dominant frequencies for each injection case, influencing lateral mass and momentum exchange within the cavity and affecting shock interactions. The findings underscore the significance of judiciously selecting injection positions, accounting for mixing efficiency, penetration height, and total pressure loss.

A Single-Dose Study to Evaluate the Relative Bioavailability, Safety, and Tolerability of Monthly Extended-Release Buprenorphine at Alternative Injection Locations in Adult Participants with Opioid Use Disorder.

Buprenorphine extended-release monthly formulation (BUP-XR, SUBLOCADE®) is approved for treatment of moderate-to-severe opioid use disorder (OUD) following subcutaneous injection in the abdomen. This open-label pharmacokinetic study assessed three alternative injection locations (upper arm, thigh, buttocks) to offer additional flexibility considering the chronic nature of the disease and patient preferences. Following stabilization on 12/3 mg/day of sublingual buprenorphine/naloxone for ≥ 7 days, participants with moderate-to-severe OUD were randomized to receive a single 300-mg BUP-XR injection in the upper arm, thigh, buttocks, or abdomen (reference). Serial blood samples were taken to measure buprenorphine plasma concentrations over 28 days and assess buprenorphine relative bioavailability. Safety evaluations included treatment-emergent adverse events and assessments of injection site pain, tenderness, erythema, induration, and swelling. A total of 88 participants received a single subcutaneous injection of 300-mg BUP-XR in the upper arm (N = 21), thigh (N = 23), buttocks (N = 22), or abdomen (N = 22); 81/88 (92%) completed the study. Buprenorphine plasma exposure (area under the plasma concentration-time curve over 28 days) was comparable across injection site groups with mean buprenorphine plasma concentrations sustained at approximately 2 ng/mL (therapeutic target concentration) or above. Buprenorphine maximum plasma concentration (Cmax) was approximately 39% and 52% higher after injection in the upper arm and thigh, respectively, versus the abdomen, while comparable between buttocks and abdomen. Higher Cmax values were not associated with an increased incidence of adverse events. Safety and injection site tolerability were comparable across injection groups. These pharmacokinetic and safety findings support BUP-XR injection into the upper arm, thigh, and buttocks. Clinicaltrials.gov: NCT05704543.

Experimental study on the drag reduction of underwater vehicles by drag-reducing agents injection

Underwater vehicles consume much energy to overcome flow resistance; therefore, reducing drag is essential to enhancing its performance. This paper proposes a drag reduction method for underwater vehicles by injecting drag-reducing agents into the turbulent boundary layer of the underwater vehicles and experimentally evaluates its performance based on the scaled suboff model. To this end, the unique injection structure and location are carefully designed to ensure the adherence of the drag-reducing solution on the wall. The polyethyleneoxide (PEO) and ceytltrimethyl ammonium chloride (CTAC) solutions are chosen as the drag-reducing agents. The effects of concentrations, flow rates, and mainstream Reynolds numbers (Re) on the drag reduction performance are investigated by measuring the total drag resistance of the scaled suboff model under different conditions. The results demonstrate that this heterogeneous drag-reducing solution injection strategy performs well in terms of drag reduction for the suboff model. The specially designed injection structure can uniformly distribute the drag-reducing solution to the near-wall region of the suboff model. Under certain conditions, both PEO and CTAC solutions can significantly reduce the total drag resistance and have an optimal concentration at different Re. At their optimal concentrations, the drag reduction of the total resistance can achieve about 59.38% and 48.31% for PEO and CTAC solutions, respectively, at Re = 2.7 × 104. However, with the current design, the drag reduction decreases with the increase of Re due to the difficulty of the drag-reducing agent wrapping around the suboff model effectively. Further work is still necessary to improve the design and the location of the injection structure so that it can adapt to high-Re cases.

Developing PDE-constrained optimal control of multicomponent contamination flows in porous media

This paper develops a robust and efficient PDE-constrained optimal control model for multicomponent pollutions in porous media, which takes into account nonlinear multi-component contamination flows of groundwater. The objective of the pollution optimal control is to identify the optimal injection rates from the top part boundary of domain, which can minimize the least squares error between the concentrations that are simulated and the allowable observed concentrations at observation sites, combining with the affection of costs associated with reducing emissions at injection locations. To discrete the constrained governing system of nonlinear multi-component flows, the splitting improved upwind finite difference scheme is developed for multicomponent PDEs system involving nonlinear chemical reactions of multicomponent pollutants and the pollutant injected rates on the upper part boundary. We employ the differential evolution (DE) optimization algorithm to solve the optimization. We numerically demonstrate the effectiveness of our model by analyzing the flow simulation on a simple geometric aquifer and identifying the optimal injection rates by minimizing the concentration derivation and the abatement costs. We also investigate the simulation of the contamination flow in a more realistic-shaped aquifer, which further validates our model's robustness and efficacy. The developed PDE-constrained control model and algorithm can be applied to applications of groundwater pollution control.

Numerical study of magnetic nanoparticles injection into a brain tumor considering the effects of injection volume and location on the termination of cancerous cells.

Lately, magnetic nanoparticle (MNP) hyperthermia gained much attention because of its therapeutic efficiency. It is challenging to predict all the treatment parameters during the actual therapeutic environment. Hence, the numerical approaches can be utilized to optimize various parameters of interest. In the present research, MNP hyperthermia on a cancerous tumor placed inside the human brain is investigated numerically using a realistically shaped model for the head layers and the tumor. Applying the boundary conditions, a steady-state Pennes's bioheat transfer equation is solved using the finite element method scheme. The effects of MNP injection volume and location on tumor thermal distribution are examined and discussed in detail. The total volume of the brain tumor is 5990 mm3. Three different volumes of injection per point, namely, 0.6, 1.2, and 3 μl, as well as several injection points, are performed. It is observed that choosing a higher number of MNP injection points affects the temperature distribution in terms of uniformity. In contrast, an accurate injection volume provides lower temperatures for the treatment of cancerous tissue. Moreover, it is concluded that interfaces between the different layers of the anatomically correct brain model play a critical role in thermal therapy. Based on the obtained results, it is concluded that the optimal condition for MNP hyperthermia of a cancerous tumor with a volume of 5990 mm3 is the total injection volume of 80 μl through 20 different points all over the brain tumor considering an injection volume of 4 μl for each point.

Adverse events after chemodenervation with onabotulinum neurotoxin A in children with hypertonia and sialorrhea.

To identify the incidence and type of adverse events reported after chemodenervation with onabotulinum neurotoxin A (BoNT-A) in children with hypertonia and sialorrhea and compare adverse events in the on-label or off-label use of BoNT-A with regard to dose, patient's age, and location of the injection. Using a retrospective chart review, we studied BoNT-A injections occurring from January 2017 to December 2020 in patients at a pediatric hospital. The electronic health record was examined to identify adverse events reported within 2 months of the injection. Data included the patient's age, sex, race, and ethnicity, as well as the type of toxin injected, the dose, the location of injection, and the patient's weight. We analyzed 1733 procedures. Adverse events were infrequent (2.5%) and not serious, most commonly reported as pain or discomfort. All adverse events were temporary and there were no deaths. We did not observe a meaningful difference in the frequency of adverse events for injections that exceeded the 2022 US Food and Drug Administration (FDA)-approved maximum dose compared to injections that were within the FDA-approved dose range. The likelihood of adverse events did not increase with higher doses of BoNT-A. More adverse events were reported for injection into the salivary glands (4.37%) than into the extremities (2.26%). Higher doses of injected BoNT-A in a pediatric population may be safe. Further work is needed to investigate the relationship between dose and efficacy.

A First-Passage Model of Intravitreal Drug Delivery and Residence Time-Influence of Ocular Geometry, Individual Variability, and Injection Location.

Standard of care for various retinal diseases involves recurrent intravitreal injections. This motivates mathematical modeling efforts to identify influential factors for ocular drug residence time, aiming to minimize administration frequency. We sought to describe the vitreal diffusion of therapeutics in nonclinical species frequently used during drug development assessments. In human eyes, we investigated the impact of variability in vitreous cavity size and eccentricity, and in injection location, on drug disposition. Using a first-passage time approach, we modeled the transport-controlled distribution of two standard therapeutic protein formats (Fab and IgG) and elimination through anterior and posterior pathways. Anatomical three-dimensional geometries of mouse, rat, rabbit, cynomolgus monkey, and human eyes were constructed using ocular images and biometry datasets. A scaling relationship was derived for comparison with experimental ocular half-lives. Model simulations revealed a dependence of residence time on ocular size and injection location. Delivery to the posterior vitreous resulted in increased vitreal half-life and retinal permeation. Interindividual variability in human eyes had a significant influence on residence time (half-life range of 5-7days), showing a strong correlation to axial length and vitreal volume. Anterior exit was the predominant route of drug elimination. Contribution of the posterior pathway displayed a 3% difference between protein formats but varied between species (10%-30%). The modeling results suggest that experimental variability in ocular half-life is partially attributed to anatomical differences and injection site location. Simulations further suggest a potential role of the posterior pathway permeability in determining species differences in ocular pharmacokinetics.

Investigating combustion efficiency and NOx emission reduction in fluidized bed ammonia-coal co-firing

Ammonia, a carbon-free fuel, can significantly reduce CO2 emissions when co-fired with coal in power plants. Fluidized bed combustion, known for its excellent gas-solid mixing and low NOx emissions, is a promising method for ammonia-coal co-firing. However, challenges remain in optimizing ammonia injection and controlling nitrogen oxide emissions. This study investigates these aspects using a lab-scale fluidized bed reactor with flexible ammonia injection points. Key variables, such as ammonia co-firing ratios, injection location, temperature, and outlet oxygen concentration, are examined. The results show that with ammonia injection ratios up to 70 %, NO and N2O emissions slightly increase, while ammonia escape is maintained below 5 ppm. Air staging effectively controls NOx emissions, and higher temperatures promote N2O decomposition, but increase NOx levels. Ammonia injection does not raise unburned carbon content. Rate of production and sensitivity analyses highlight the role of OH radicals in ammonia conversion and identify the critical reactions affecting NO generation. This study highlights the feasibility of fluidized bed ammonia-coal co-firing technology.

Numerical study on ammonia injection location of ammonia and low-rank coal cofiring in 1000 MWe ultra super critical carolina-type boiler

Global CO2 emissions from coal-fired power plants necessitate innovative solutions to reduce their environmental footprint. Ammonia cofiring has emerged as a promising solution for reducing CO2 emissions in these plants. The ammonia injection optimization is analyzed using computational fluid dynamics simulations in a 1000 MW Ultra Super Critical Coal Fired Power Plant, comparing four injection sites at a 20 % thermal energy cofiring ratio. Results indicated the bottom burner as the most effective location, achieving the lowest NOx emissions (102.20 mg/Nm3) compared to traditional coal-firing (131.78 mg/Nm3). A sensitivity analysis favored bottom and mid burner injections over equal distribution, leading to further investigations into varying injection locations and cofiring ratios (5%–60 %). Increased cofiring ratios decreased gross power output by 3.6 MW per percentage increase in cofiring, alongside shifts in flue gas properties and a complex NOx emission trend. Initially, NOx emissions decreased, with a 0.784 up to 20 % cofiring, but dramatically increased beyond, reaching a ratio of 3.744 at 60 % cofiring. This study reveals critical insights into emission management and highlights the need for improved derating strategies to mitigate acid corrosion risks, marking a significant step towards environmentally sustainable coal power generation.

Multimodal Pilot Evaluation of a Hyaluronic Acid Infraorbital Filler Using Precise, Multipositional, 3-Dimensional Imaging Quantification, Patient-Reported Outcomes, and Anatomic Cadaveric Assessments.

Despite the high demand of filler in the infraorbital area, there remains debate on injection practices, precise anatomical placement, and hyaluronic acid (HA) filler behavior. We aimed to contribute to the clinical and anatomic understanding of infraorbital HA injection through a prospective patient injection study in combination with a cadaveric analysis. Patients were injected with Volbella XC (JUVÉDERM, Allergan Aesthetics, an AbbVie Company, Irvine, CA) into the tear trough region by a single experienced aesthetic plastic surgeon. Over a 90-day period, precise undereye volumetric measurements using 3-dimensional photogrammetry (VECTRA-M3, Canfield Scientific, Inc., Fairfield, NJ) and patient-reported outcomes (PROs; FACE-Q) were collected and analyzed relative to 2 pretreatment severity scales. Juvéderm Vycross (Allergan Aesthetics, an AbbVie Company, Irvine, CA) and Restylane NASHA (Galderma, Lausanne, Switzerland) products were injected into the infraorbital and malar region in 6 cephalus specimens and evaluated with regards to the anatomic injection location with and without common clinical physical manipulations. Eleven patients participated with a 100% retention rate. Infraorbital HA volume maintenance was 70% to 81% at 30 days and 50% to 70% at 90 days. Significant improvement was noted in the eyes, overall facial appearance, and cheekbones (P < .05) with FACE-Q outcomes, irrespective of pretreatment severity. In the cadaver examination, we observed differences in the anatomic locations occupied by Juvéderm and Restylane products as well as in behavior after physical manipulation between gel types. Volbella XC effectively augments undereye volume to diminish infraorbital hollowing as measured over a 90-day period with significantly improved PROs. Enhanced knowledge of the behavior of Volbella XC and other HA fillers in this sensitive anatomic region will lead to improved patient outcomes.

Numerical simulation of co-firing LRC and ammonia in Pangkalan Susu 3 & 4 coal-fired steam power plant (CFSPP) capacity 210 megawatts

The effort to reduce CO2 and NOx emissions plays a crucial role in mitigating climate change, improving air quality, complying with environmental regulations, and promoting clean technology innovation. Ammonia, as an emission-free fuel, shows significant potential as a co-firing agent with Coal in coal-fired steam power plants (CFSPP). Previous studies have demonstrated promising results in emission reduction through ammonia co-firing. This research presents a numerical analysis based on Computational Fluid Dynamics (CFD) to investigate the co-firing of ammonia with low-calorific Coal (LRC) in the CFSPP Pangkalan Susu Units 3 and 4, with a capacity of 210 MW. The study employs fluid flow modelling and chemical reaction analysis using the Discrete Phase Model (DPM) to provide accurate predictions of temperature distribution and pollutant concentrations in pulverized coal boilers. Cofiring simulations were conducted with ammonia additions of 5 % and 15 % on a calorific basis. Injection experiments from each burner (A-D) were performed to identify the optimal injection location. The simulation results indicate changes in combustion characteristics, particularly in temperature distribution. The main finding reveals a temperature decrease when ammonia is added as a co-firing material, attributed to the higher H2O content, which leads to increased moisture losses. In terms of efficiency, co-firing showed a decline compared to the baseline combustion of 100 % LRC coal due to the more significant moisture losses. The highest reduction in CO2 emissions was observed when 15 % ammonia was injected from burner B in case #6, with a mass fraction value of 0.171 at the boiler outlet. Similarly, the most significant reduction in NOx emissions occurred with a 15 % ammonia co-firing from burner B, yielding a mass fraction value of 8.81E-04 at the boiler outlet. This co-firing technology is expected to enhance decarbonization efforts and optimize the use of renewable energy in the future.

Assessment of the impact of greenhouse rainwater harvesting managed aquifer recharge on the groundwater system in the southern Jeju Island, South Korea: Implication from a numerical modeling approach

Managed aquifer recharge (MAR) is increasingly being adopted worldwide to mitigate groundwater depletion and ensure the sustainability of water resources. Rainwater harvesting (RWH)-MAR can augment aquifer storage and reduce flood damage in rural areas with dense greenhouse facilities. This study has assessed the feasibility of greenhouse RWH-MAR in Namwon agricultural areas in the southern part of Jeju Island, South Korea, by considering the injection rate and location of MAR using a numerical model. The model results showed that groundwater level increases were directly related to the infiltration rate, although spatial differences in head rise were observed owing to the spatial variability of hydraulic conductivity. In addition, installing the RWH-MAR in highland areas (>100 masl) enhanced the water level rise when compared to the expected values, indicating that a higher hydraulic gradient and thick unsaturated zone facilitated more effective MAR outcomes than in lowland areas. To optimize the contribution of source water to the agricultural water demand, placing the RWH-MAR near the pumping well improved the availability of injected rainwater to agricultural wells. This study highlights the importance of designing RWH-MAR schemes considering MAR objectives and the topographic and hydrogeological characteristics of the site.

Secure smart grid implementation with automatic data integrity attack location prediction and exalted energy theft detection

Smart grid systems use digital communication technology to efficiently monitor and manage electricity distribution. However, there is a need for improve the robustness of smart grid systems. Hence a novel “Secure Smart Grid Implementation with Automatic Data Integrity Attack Location Prediction and Exalted Energy Theft Detection” has been proposed. Current detection methods are not good at identifying data integrity attacks. So a novel Automatic Deterministic Attack Location Prediction Model detects data integrity attacks using a Stacked Watermarking BiGRU-based Deep Deterministic Q network, extracting system matrix and state time series variation. Moreover, Energy theft detection algorithms, which are intended to detect dishonest clients, provide erroneous findings because of linear interpolation processes and randomised near misses, which ignore important data points. Thus a novel Exalted Energy Theft Detector with Secure Encoding is introduced where Amortized Multicode GAN method secures smart grids by detecting energy theft and preventing firmware code modifications, utilising fractional multi-level quantum encoding to identify injection locations. As a result, the proposed model has an accuracy of 97.1%, recall of 96.25%, error rate is 1.36%, F1-score is 96.20%, sensitivity is 96.10%, specificity is 96.10%, MAPE is 0.48%, MSE is 0.0001 and RMSE is 0.017.

The Effects of OnabotulinumtoxinA on Anxiety: A Systematic Review and Quantitative Analysis

Background: Psychopathological symptoms can exacerbate or induce cutaneous disorders. The side effect profile of psychiatric medications may reduce compliance in patients with primarily dermatologic complaints. OnabotulinumtoxinA injections are a common dermatologic intervention that recently demonstrated efficacy in reducing depressive symptoms. This systematic review investigates the anxiolytic effects of onabotulinumtoxinA in patients with comorbid anxiety. Methods: Following PRISMA guidelines, databases including APA PsycInfo, Embase, and PubMed were searched using MeSH terms related to onabotulinumtoxinA and anxiety. English-language primary research that examined the effects of onabotulinumtoxinA on anxiety was selected. Data regarding study design, participant demographics, indications, dosage, and anxiety scores were analyzed. Results: From 677 citations, 32 studies involving 41 patient groups met the criteria for inclusion in this review. The average population was 46 ± 14 years old and female (70 ± 24%). The most common indications for onabotulinumtoxinA included pain (46.3%) and chronic migraines/headaches (34.1%) with a mean dose of (251 ± 368 U). The severity of anxiety was assessed with validated scales in 94% and 81% of patients pre- and post-injection, respectively. At 4 ± 5 months post-onabotulinumtoxinA, 63% of patient groups revealed significant reductions in anxiety. Transient pain and muscle stiffness were the most common side effects, reported in 41.5% of groups. Conclusion: OnabotulinumtoxinA is a promising anxiolytic with a mild side effect profile. Further research will be needed to detail its efficacy relative to specific dermatologic indications, injection locations, and lasting effects.

KECORT Study: An International e-Delphi Study on the Treatment of KEloids Using Intralesional CORTicosteroids in Clinical Practice.

Intralesional corticosteroid administration (ICA) is a first-line keloid treatment. However, it faces significant variability in current clinical and scientific practice, which hinders comparability of treatment results. The aim of the study was to reach consensus on different aspects of ICA using hypodermic needles in keloids among an international group of dermatologists and plastic surgeons specialized in keloid treatment to provide consensus-based clinical treatment recommendations for all physicians treating keloids. The keloid expert panel of 12 dermatologists and 11 plastic surgeons rated 30 statements. Two online e-Delphi rounds were held, both with a response rate of 100%. Fifteen (65%) keloid experts participated in the final consensus meetings. Consensus was defined as ≥ 75% of the participants choosing agree or strongly agree on a 7-point Likert scale. Consensus was reached on treatment goals, indication for ICA, triamcinolone acetonide (TAC) 40 mg/mL as the preferred corticosteroid administered at a maximum of 80 mg per month and at intervals of 4 weeks, minimizing pain during ICA, the use of 1 mL syringes and 25 or 27 Gauge needles, blanching as endpoint of successful infiltration, caution of not injecting subcutaneously, and the option of making multiple passes in very firm keloids prior to infiltration. Consensus could not be reached on TAC dosing, methods of prior local anesthesia, and location of injection. This e-Delphi study provides important clinical treatment recommendations on essential aspects of ICA in keloids. By implementing these recommendations, uniformity of ICA in keloid treatment will increase and better treatment results may be achieved.

Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade after Approval: A Single-Blind Study to Evaluate the Reduction in Pain in OnabotulinumtoxinA Detrusor Injection Using Different Injection Needles.

Overactive bladder (OAB) has a significant impact on the quality of life; thus, it requires treatment that can be adhered to over a long period without undue side effects. The current treatment which uses an anticholinergic or β-3 agonist may fail to improve symptoms and has side effects, leading to high discontinuation rates. OnabotulinumtoxinA (OnabotA) detrusor injection has been approved for idiopathic OAB as a second-line treatment with good effectiveness and tolerability. This study used a visual analog scale (VAS) to assess the impact of the type of needle used for OnabotA detrusor injections under local anesthesia on the pain levels after each injection. This study included 68 female patients. We used three different needles with thicknesses ranging from 22 to 27 gauge, lengths between 4 and 5 mm, and different cuts. The sensation of pain was rated at each standardized injection location. Regardless of the needle used, the patients' perceptions of pain at the beginning of the procedure were rated as being less than the subsequent injections. Most pain sensations were rated as low to moderate. The mean pain sensation on the VAS was 2.5 ± 0.3 overall, i.e., for all patients and needles used. Statistically significant differences in pain sensation were rated only at some locations of the bladder (on the back wall and the right side of the bladder). The single needles averaged the following pain scores: 2.8 ± 0.3 for needle A (20 G, 4 mm), 2.1 ± 0.3 for needle B (27 G, 5 mm), and 2.6 ± 0.4 for needle C (20 G, 4 mm, sharp cut 15°). The 27-gauge needle caused significantly less pain, and it had no negative impact due to its length, which was 1 mm longer than the other needles. Thus, the needle thickness was a decisive factor in the patients' perceptions of pain.

Numerical investigation on secondary injection and thrust vector control in a planar double divergent nozzle

In this work, the performance of secondary injection thrust vector control of an altitude adaptive planar double divergent supersonic nozzle is numerically investigated. The compressible turbulent flow is solved using the kT−kL−ω transition-sensitive eddy-viscosity model. An analytical model to predict the separation distance and penetration height due to secondary fluid injection is developed based on the blunt-body theory, and it shows good agreement with the numerical estimation. The computational results indicate that injection pressure, injector location and injection angle significantly impact the thrust vector control performance. The core flow is disrupted by the momentum injection from the secondary fluid, causing the flow field structure to become asymmetrical. The wall pressure imbalance between the upper and lower nozzle increases as the secondary jet pressure elevates. Further, the thrust vectoring amplification factor is improved when the injector is placed downstream near the outlet since the shock reflection is circumvented. Indeed, that resulted in the generation of a large lateral thrust force. Most importantly, for a high injector slot angle, the primary downstream vortex disappears, and a strong secondary upstream vortex is generated, which shifts the primary upstream vortex opposite to the core flow, subsequently the shock separation is advanced. In addition, a secondary injector fitted near the exit with high inclination angles and injection pressure generated a lateral thrust of 20%.