Hypodermic Research Articles

A Death Too Fast - Suxamethonium Chloride Poisoning: A Case Report

Introduction: Suxamethonium chloride (SUX) is a short acting depolarizing muscle relaxant commonly used for medical procedures to induce respiratory paralysis. The case report aims to highlight the important postmortem findings associated with SUX poisoning. Case report: A female adult health-care worker in her thirties was found dead in her bedroom at home. There were two empty ampoules of IV/IM Suxamethonium Chloride 100 mg/2 ml found next to the body. Results: The autopsy revealed an adult female with multiple needle injection marks. Gross examination of the lungs showed markedly congested lungs and froth in the airways. The liver showed foci of petechial haemorrhages and confluent haemorrhages. Other internal organs showed diffuse vascular congestion. Microscopically, significant pathological changes were seen in the lungs and kidneys with areas of pulmonary infarction and acute tubular necrosis. SUX was not detected from the toxicological analysis. Correlating the circumstantial evidence at the scene of death, autopsy and microscopic findings, the cause of death was certified as SUX poisoning. Conclusions: We wished to demonstrate the autopsy and histopathological findings associated with acute SUX poisoning culminating in death due to respiratory paralysis.

A systematic review of microneedles technology in drug delivery through a bibliometric and patent overview

The transdermal drug delivery (TDD) route has gathered considerable attention for its potential to improve therapeutic efficacy while minimizing systemic side effects. Among transdermal technologies, microneedle (MN) devices have proven to be a promising approach that combines the advantages of traditional needle injections and non-invasive topical applications. This review provides a comprehensive analysis of progress in transdermal drug delivery systems (TDDS) via MN from 2000 to 2023, integrating bibliometric analysis and patent landscape to present a multi-faceted perspective on the evolution of this technology. The study identifies key trends, challenges, and opportunities in the research, implementation, and commercialization of MN tools through a systematic examination of scientific literature and an extensive investigation of global patent databases. The study of bibliometric trends reveals the leading experts, organizations, companies, and countries contributing to this field, collaboration networks, and the thematic evolution of research topics. The patent analysis offers insights into innovative trajectories, key players, and geographical distribution of intellectual property. This review resumes the latest advancements in MN devices and provides a strategic outlook that can guide future research directions, promote partnerships, and inform stakeholders involved in the development of TDDS.

An optimized Langendorff-free method for isolation and characterization of primary adult cardiomyocytes

Isolation of adult mouse cardiomyocytes is an essential technique for advancing our understanding of cardiac physiology and pathology, and for developing therapeutic strategies to improve cardiac health. Traditionally, cardiomyocytes are isolated from adult mouse hearts using the Langendorff perfusion method in which the heart is excised, cannulated, and retrogradely perfused through the aorta. While this method is highly effective for isolating cardiomyocytes, it requires specialized equipment and technical expertise. To address the challenges of the Langendorff perfusion method, researchers have developed a Langendorff-free technique for isolating cardiomyocytes. This Langendorff-free technique involves anterograde perfusion through the coronary vasculature by clamping the aorta and intraventricular injection. This method simplifies the experimental setup by decreasing the need for specialized equipment and eliminating the need for cannulation of the heart. Here, we introduce an updated Langendorff-free method for isolating adult mice cardiomyocytes that builds on the Langendorff-free protocols developed previously. In this method, the aorta is clamped in situ, and the heart is perfused using a peristaltic pump, water bath, and an injection needle. This simplicity makes cardiomyocyte isolation more accessible for researchers who are new to cardiomyocyte isolation or are working with limited resources. In this report, we provide a step-by-step description of our optimized protocol. In addition, we present example studies of analyzing mitochondrial structural and functional characteristics in untreated isolated cardiomyocytes and cardiomyocytes treated with the acute inflammatory stimulus lipopolysaccharide (LPS).

Electrothermal therapy for the in vivo elimination of circulating tumor cells by using a functionalized injection needle

The elimination of circulating tumor cells (CTCs) has recently emerged as a reliable route to inhibit metastasis of cancer. Despite some progress of photodynamic therapy and photothermal therapy (PTT), their unsatisfying efficacy or difficult operation has limited their clinical application. Herein, inspired by an immersion heater, an electrothermal therapy (ETT) strategy for the elimination of CTCs in the peripheral blood was proposed by using a functionalized injection needle. CTCs can be captured by the nanostructured surface of the injection needle and then killed in the energized state due to the temperature increase caused by electrothermal conversion. ETT not only avoids the irradiation through an external light source but also controls the temperature of the needle more easily and accurately than PTT. Thus, this study proposes a more applicable strategy for the elimination of CTCs.

Does the Diffusion Profile Differ Between Botulinum Toxin Type a Formulations? Implications for the Management of Post-Stroke Spasticity.

Botulinum toxin type A is a first-line treatment for post-stroke spasticity, with selective action at nerve endings and minimal effects beyond the injection site. However, concerns about potential adverse reactions due to toxin diffusion and spread can significantly influence physicians' therapeutic decisions in managing post-stroke spasticity. Current evidence shows that while the main formulations of botulinum toxin type A have different molecular weights and sizes, they do not exhibit differing diffusion profiles. Instead, the key factors determining botulinum toxin type A diffusion and spread in post-stroke spasticity management are the dose (i.e., the actual amount of 150 kDa neurotoxin protein injected), dilution, and injection volume. Other injection-related factors, such as the needle gauge and injection speed, have also been suggested to have a secondary influence on botulinum toxin type A diffusion and spread. The needs of patients with post-stroke spasticity may vary, and depending on treatment goals, botulinum toxin type A diffusion and spread can be something to avoid or may offer therapeutic benefits by reaching a greater number of nerve terminals in the target muscle, enhancing the toxin's effect. These factors should be carefully evaluated in spasticity clinics.

Investigating Osteomyelitis as a Rare Adverse Effect of Vaccination in the Pediatric Population.

Immunization is a preventive measure of crucial importance. As with any other medication, side effects are a possibility and include the rare occurrence of severe infections, such as osteomyelitis. We report an unusual case of pediatric osteomyelitis following vaccination and provide a review of similar reports submitted to the Vaccine Adverse Event Report System (VAERS), aiming to explore the association between the vaccination procedure and the occurrence of osteomyelitis in childhood. A previously healthy infant, with no history of trauma or infection, presented with hyperpyrexia, swelling, and functional impairment in the left leg and was eventually diagnosed with osteomyelitis of the left femur. An edema was noted at the site of the injection that he received days before for immunization purposes. The infection required surgical drainage and a four-week-long intravenous antibiotic treatment, and the patient was discharged upon showing improved clinical conditions. Forty-seven reports of similar cases submitted to VAERS between 1994 and 2023 were collected, and several cases from the literature, including a case of femoral osteomyelitis in a newborn vaccinated against Hepatitis B, attributed to improper injection technique. Another case was reported in a 15-year-old girl, which aligned with six similar cases of osteomyelitis in adolescents following HPV vaccines collected from VAERS. Despite the small sample number, the findings that in 77% of cases the infection was localized in the vaccinated limb and that symptoms appeared on average 4.3 days (IQR 1.0-5.7 days) post-vaccination suggest a possible link to the injection procedure and highlight the need to adhere to recommendations regarding skin preparation and the selection of the appropriate needle length and injection site.

Hydrogel-Forming Microneedles in the Management of Dermal Disorders Through a Non-Invasive Process: A Review.

Microneedle (MN) technology has emerged as a promising approach for delivering therapeutic agents to the skin, offering significant potential in treating various dermal conditions. Among these technologies, hydrogel-forming microneedles (HFMNs) represent a transformative advancement in the management of dermal diseases through non-invasive drug delivery. These innovative devices consist of micrometer-sized needles made of native or crosslinked hydrophilic polymers, capable of penetrating the stratum corneum without damaging underlying tissues. Upon insertion, HFMNs rapidly absorb interstitial fluid, swelling to form a hydrogel conduit that enables the efficient transport of therapeutic agents directly into the dermal microcirculation. The non-invasive nature of HFMNs enhances patient compliance by eliminating the pain and discomfort associated with traditional hypodermic needles. This technology allows for the delivery of a wide range of drugs, including macromolecules and biomacromolecules, which are often difficult to administer dermally due to their size and polarity. Moreover, HFMNs provide controlled and regulated release profiles, enabling sustained therapeutic effects while minimizing systemic side effects. Additionally, HFMNs can be used for both drug delivery and real-time interstitial fluid monitoring, offering valuable insights into disease states and treatment responses. This dual functionality positions HFMNs as a versatile dermatology tool capable of effectively addressing various dermal complications. This review explores the potential use of polymeric biomaterials in HFMN fabrication and their application in treating major dermal disorders, such as acne, psoriasis, and other skin conditions. Furthermore, the review highlights the non-invasive nature of MN-based treatments, underscoring their potential to reduce patient discomfort and improve treatment adherence, as supported by the recent literature.

New Dosage Form of Insulin: Review Article

Many patients with advanced type 2 diabetes mellitus (T2DM) and all patients with T1DM require insulin to keep blood glucose levels in the target range. The most common route of insulin administration is subcutaneous insulin injections. There are many ways to deliver insulin subcutaneously, such as vials and syringes, insulin pens, and insulin pumps. Though subcutaneous insulin delivery is the standard route of insulin administration, it is associated with injection pain, needle phobia, lipodystrophy, noncompliance, and peripheral hyperinsulinemia. Therefore, the need exists to deliver insulin in a minimally invasive or noninvasive way and in the most physiological way. Inhaled insulin was the first approved noninvasive and alternative way to deliver glucose, but it has been withdrawn from the market. Researchers are exploring technologies to enable noninvasive insulin delivery. Some of the routes for insulin administration that are under investigation are oral, buccal, nasal, peritoneal, and transdermal. This article has focused on different possible routes of insulin administration, their advantages and limitations, and the possible scope of the new drug development.

Engineering the Functional Expansion of Microneedles.

Microneedles (MNs), composed of an array of micro-sized needles and a supporting base, have transcended their initial use to replace hypodermic needles in drug delivery and fluid collection, advancing toward multifunctional platforms. In this review, four major areas are summarized in interdisciplinary engineering approaches combined with MNs technology. First, electronics engineering, the most extensively researched field, enables applications in biomonitoring, electrical stimulation, and closed-loop theranostics through the generation, transmission, and transformation of electrical signals. Second, in electromagnetic engineering, the responsiveness of electromagnetic induction offers prospects for remote and programmable therapeutic applications. Third, photonic engineering endows MNs with novel functionalities, such as waveguiding and photonic manipulation to enhance optical therapeutic capabilities and facilitate the visualization of disease progression and treatment processes. Lastly, it reviewed the role of mechanical engineering in conferring shape adaptability and programmable motion features necessary for various MNs applications. This review focuses on the functionalities that emerge from the intersection of MNs with complementary engineering technologies, aiming to inspire further research and innovation in microneedle technology for biomedical applications.

Fabrication of a Polyglycolic Acid Porous Microneedle Array Patch Using the Nonsolvent Induced Phase Separation Method for Body Fluid Extraction

ABSTRACTTraditional blood sampling is essential for early diagnosis and subsequent analysis, but the methods using hypodermic needles are painful and burdensome. Recently, a minimally invasive approach utilizing porous microneedles has been developed and various porous microneedle array patches (MAPs) composed of biodegradable polymers have been investigated. To address issues about low mechanical strength and liquid absorption with porous MAPs, we used polyglycolic acid (PGA) as it is a biodegradable and hydrophilic polymer with high mechanical properties. In this study, we established a nonsolvent‐induced phase separation (NIPS) method for the fabrication of PGA porous MAPs, as the porous MAPs can be fabricated by simply immersing the molds injected with PGA‐hexafluoro‐2‐propanol (HFIP) solution in nonsolvents. We achieved the maximum liquid absorption rate of 16 ± 8.2 × 10−2 µL/min per one microneedle using the PGA porous MAPs fabricated by using ethanol as nonsolvent and PGA concentration of 10% (w/w). Our study provides a comprehensive understanding of porous MAPs fabricated using PGA material as well as its characteristics regarding the structural and mechanical properties of PGA MAPs, with potential as a diagnostic device to substitute conventional hypodermic needles for interstitial fluid (ISF) sampling and diagnosis.

Desenvolvimento de um dispositivo de fixação para aplicações de injeção com seringa em pacientes diabéticos

Hypodermic needles are widely used in both medicine and dentistry, which makes their study crucial. Understanding the pain perception caused by the insertion of these needles is particularly important for patients who fear or are phobic about seeing or feeling that they penetrate their skin. Our previous research focused on the impact of various needle characteristics on pain sensation during hypodermic injections and identified ways to reduce discomfort and injection-related phobia. We hypothesized that reducing the force required for needle penetration could minimize tissue trauma, and therefore, the pain experienced. That previous study investigated how factors such as cannula diameter, surface roughness, penetration depth, lubrication, and angle of the needle's bevel tip influence pain perception during injections, employing an artificial tissue model to gauge the effort needed for penetration. The findings indicated that needles with larger bevel angles required more penetration force, which correlated with increased pain perception among patients. In the presente study we further examined the wear and burr formation on repeatedly used needles using a profile projector and Scanning Electron Microscopy (SEM), which can hinder penetration and cause tissue damage. Additionally, we explored mechanical methods to prevent needles intended for subcutaneous injections from inadvertently penetrating muscle tissue. We developed a device to simplify the process of administering and self-administering injections, enhancing safety, comfort, and reducing the pain experienced by patients. This approach not only addresses the technical aspects of needle design but also considers the psychological impacts on patients, potentially improving therapeutic outcomes

Evaluation of dental students' learning curve in intraligamentary anesthesia using different syringe systems: A prospective crossover study.

This prospective crossover preclinical trial aimed to evaluate the learning curve of dental students in successfully administering intraligamentary anesthesia (ILA) using three different syringe systems. Dental students performed ILA using three devices in two separate sessions, each targeting mandibular and/or maxillary premolars. The devices included two manual systems (pistol-type and lever-based) and one computer-controlled local anesthetic delivery system (CCLAD). The primary research parameter was the success rate of anesthesia, defined as the percentage of successful ILA administrations confirmed by a negative response to a cold test. Secondary parameters included pain experienced during needle penetration and injection, students' self-reported levels of mental tension and handling of the syringes, and any potential side effects. A total of 110 students performed ILA on 599 teeth during the study period. When comparing the CCLAD system to the manual syringes, the CCLAD system exhibited a significantly higher overall success rate in the first session (92.5% vs. 77.4%; p<0.001), potentially due to its precise control of anesthetic flow and pressure, which likely facilitated more effective anesthetic delivery. However, when examining the individual manual techniques, no significant difference was found between the pistol-type manual and the CCLAD system (p=0.66). All techniques' success rate increased from the first to the second session (80.4% vs. 86.9%; p=0.0357). Additionally, penetration pain demonstrated a significant decrease across all techniques (p<0.01). Notably, students' anxiety levels decreased, and self-assurance increased significantly over the sessions. Undesired reversible side effects were documented in 10.9% of cases. These findings suggest that repeated practice of ILA, particularly with different syringe systems, enhances anesthetic success and psychological readiness for patient interaction. Additional training sessions may further improve proficiency.

Recent Innovations and Future Perspectives in Transferosomes for Transdermal Drug Delivery in Therapeutic and Pharmacological Applications.

There have been several non-invasive administrations that have emerged recently to replace conventional needle injections. With its minimal rejection rate, remarkable ease of administration, and remarkable patient comfort and perseverance, the transdermal drug delivery system (TDDS) is the most attractive of them all. The skincare industry, which includes cosmetics, may also find use for TDDS in addition to the pharmaceutical industry. As this strategy mainly entails local drug administration, it can prevent untargeted drug delivery to tissues not intended for the treatment and buildup of localized drug concentrations. Transdermal delivery is hampered by a number of physicochemical characteristics of the skin, which have led to a great deal of research into ways to get over these barriers. The majority of transdermal medicines that have proved effective do so by using smaller lipophilic compounds, which have a molecular weight of a few 100 Daltons. Transferosomes have proven to be an effective method for transdermal distribution of a range of therapies, including hydrophilic actives, bigger molecules, peptides, proteins, and nucleic acids, in order to get around the medications' size and lipophilicity limits. Because of their flexible form and increased surface hydrophilicity, transferosomes are essential for the delivery of medicines and other solutes through and into the skin by exploiting hydration gradients a source of energy. As a result, the medication is released into the skin layers under regulated conditions and has improved overall penetration. In this section we outline the development of transferosomes from liposomes and solid lipid nanoparticles, as well as their subsequent advancements as commercially available dosage forms, physical-chemical characteristics, and cutaneous kinetics.

Acupoint catgut embedding advantage in treating gastro-oesophageal reflux disease (ACE-GERD): study protocol for a randomised controlled trial

BackgroundGastro-oesophageal reflux disease (GERD) is a highly prevalent disorder worldwide and developing effective treatment strategies for GERD is a clinical priority. GERD is associated with anxiety and depression. Several approaches...

Standardisation of microencapsulation protocol for chilled preservation of Malabari buck spermatozoa

The present study was conducted to standardise the protocol for microencapsulation of buck spermatozoa for its chilled preservation. Semen ejaculates collected from Malabari bucks of age two to three years, weighing 42 to 46 Kg and maintained under uniform managemental conditions were utilised. Sodium alginate of concentrations 0.5, 0.75 and 1.5 per cent with varying gauge sized hypodermic needles of 18G, 20G and 23G were used. The distance between the tip of the needle and the upper meniscus of BaCl2 solution was adjusted to varied distance like ≥ 7 cm, 3.5 to 5 cm, ≤ 2cm. This resulted in capsule sizes of 1 mm, 2 mm, 3 mm, 4 mm, 4.5 mm, 6 mm and 7 mm. Different shape of capsules like globular, plate like, irregular, tear-drop and oval were obtained and the capsule stability varied from 35 to 75 per cent. Capsule parameters were assessed at 0 h, 24 h, 48 h, 72 h and 96 h of chilled preservation in EYC extender at ratio of (1:2). The results of the present study cited that 1.5 per cent sodium alginate concentration, with 23G sized hypodermic needle and distance of 3.5 cm were ideal to acquire uniform spherical shaped stable capsule of size 1.90 ± 0.03 and stability of 75 per cent Keywords: Microencapsulation, chilled preservation, buck spermatozoa, Malabari

Strategies for transportation of peptides across the skin for treatment of multiple diseases.

An established view in genetic engineering dictates an increase in the discovery of therapeutic peptides to enable the treatment of multiple diseases. The use of hypodermic needle for delivery of proteins and peptides occurs due to the hydrophilic nature, sensitivity toward proteolytic enzymes and high molecular weight. The non-invasive nature of the transdermal delivery technique offers multiple advantages over the invasive route to release drugs directly into the systemic circulation to enhance bioavailability, better patient compliance, reduced toxicity and local irritability. The transdermal route seems highly desirable from the pharmaco-therapeutic and patient compliance point of view, however, the lipophilic barrier of skin restricts the application. The use of several techniques like electrical methods (iontophoresis, sonophoresis etc.), chemical penetration enhancers (e.g. protease inhibitors, penetration enhancers, etc.) and nanocarriers (dendrimers, lipid nanocapsules, etc.) are utilized to improve the passage of drug molecules across the biomembranes. Additionally, such clinical interventions facilitate the physicochemical characteristics of peptides, to enable effective preservation, conveyance and release of therapeutic agents. Moreover, strategies ensure the attainment of the intended targets and enhance treatment outcomes for multiple diseases. This review article focuses on the techniques of peptide transportation across the skin to advance the delivery approaches and therapeutic efficiency.

Impact of medical adhesives on persistent fluid extravasation at needle injection sites in patients with severe edema: a randomized controlled trial.

To investigate the efficacy of medical glue in halting fluid extravasation at needle insertion sites in patients with severe edema. Sixty patients with severe edema were recruited between June 2022 and June 2023 and randomly allocated into either the control group or the experimental group, with 30 cases in each. In the experimental group, after intramuscular injection, medical glue was administered at the needle insertion site, and covered with gauze dressing upon curing, and subsequently subjected to pressure bandaging. Patients were instructed to limit their activity. Meanwhile, the control group received conventional nursing procedures involving pressure bandaging and activity restriction. The effectiveness of nursing interventions in halting exudation, duration of hospitalization, duration of exudation, nursing expenses, skin complications (infection, rash, abrasion, abnormal sensation, etc.), and patient satisfaction with nursing care were monitored. Comparison between the two groups revealed statistically significant differences in several aspects: the success rate of halting exudation, duration of exudation, total skin complication rate, and overall satisfaction [83.3% vs. 20.0%, (2.20 ± 2.76) days vs. (7.33 ± 3.28) days, 6.67% vs. 33.33%, 80.00% vs. 36.67%, P < 0.05]. However, there were no statistically significant differences in hospitalization time and nursing expenses [(14.50 ± 5.17) days vs. (14.00 ± 3.95) days, (537.53 ± 264.19) yuan vs. (661.97 ± 305.55) yuan, P > 0.05]. Medical glue demonstrates effectiveness in halting fluid extravasation at needle insertion sites among patients experiencing severe edema. Additionally, it reduces the duration of exudation, diminishes skin complications resulting from exudation, and significantly enhances patient satisfaction with nursing care. Given these benefits, its clinical adoption and application are highly recommended.

PETAL – LIKE OTOPLASTY IN THE TREATMENT OF PROTRUDING EARS

Introduction. Approximately 5% of humanity suffers from inborn protruding ears, and usually this condition causes marked psychosomatic disorders. Despite years of experience gained in aesthetic surgery, optimal technique of otoplasty is yet to be elaborated. The Aim of the Research. To develop a method of surgical correction of congenital bulging ears in order to optimize the immediate and long-term results of otoplasty. Material and methods. We have analysed the outcomes of 120 patients operated for congenital protruding ears at Lviv City Cosmetologic Hospital between 2020 and 2023. Distance between mastoid process and the concha exceeding 20 mm, and auriculo-cephalic angle over 30° were used as objective criteria of protruding ears. Surgical improvement of tall concha and increased auriculo-cephalic angle were identified as key vectors in elaboration of the original otoplasty technique. Results of the Research. With local anaesthesia, an S-shaped incision is made to the depth of perichondrium of posterior surface of the cartilage of the ear. Once subcutaneous dissection is completed, preoperative markup is transferred with injection needles from anterior surface to posterior surface of the conchal cartilage. A full depth arch-shaped incision of conchal cartilage is made. Perichondrium and skin of anterior surface of the concha are mobilized with a raspatory, from the chondral «petal» to the margin of external meatus. Basis of the chondral «petal» is dissected by 2/3 of its depth along the vertical axis between the pedicle of the helix, and the antitragus. In order to reliably fix the auricula, the cartilage is stitched to the mastoid process with three mattress sutures on the ventral surface of the «petal». Finally, excessive skin is carefully resected, and the wound is closed with continuous suture, with dead space elimination for hematoma prevention. Our technique has the following significant advantages: Unique conchal cartilage is kept entirely, therefore it can be used as auto-transplant in the future. The technique does not significantly affect the rheology of auricula. With this technique correction and modification of antihelical curve and radius is possible; if necessary, width of auricula can be corrected, and auricular height to width ratio can be modified. The proposed «petal» technique significantly reduces the rate of postoperative complications, such as recurrent protruding ears. Postoperatively, the size of external meatus is not reduced, hence no hearing deterioration. The outcomes of the technique we have developed were assessed 6 months after otoplasty as good, satisfactory and unsatisfactory. Good outcome: preservation of symmetry and anatomical «standard» of both auriculas, no recurrence throughout follow-up, and no impairment of sensation in the external ear. Satisfactory outcome: anatomical «standard» of the organ is preserved, with permissible error of up to 3 mm in the symmetrical points on the right and left auriculas, not requiring additional correction. Conclusions. 98 (81,3%) patients operated by the proposed «petal» technique assessed their otoplasty outcome as good, 17 (14,3%) of patients assessed the outcome of surgery as satisfactory. 5 (4,3%) patients were not satisfied with the outcome of surgery. These patients were operated during the early period of development of the technique.

Impact of Syringe and Needle Reuse on the Clinical Outcomes of Patients With Type 2 Diabetes: A 12-Week Randomized Clinical Trial.

To evaluate the clinical and laboratory outcomes of patients with type 2 diabetes by comparing the no reuse or reuse of syringes and needles for insulin injection. Adults with type 2 diabetes who had reused syringes and needles at least three times were randomly instructed either to not reuse or to reuse insulin syringes and needles five times. The primary outcomes assessed were glycemic control, pain scores, and skin complications (ecchymosis, lipohypertrophy, nodules, infection) at baseline and 4, 8, and 12 weeks after the intervention. Secondary outcomes included treatment adherence, quality of life, microbiological contamination of syringes and needles, needle quality, and insulin injection technique. Among the 71 participants (mean ± SD age 59.7 ± 8.8 years), 59% were women with a median duration of diabetes of 18 years (interquartile range 10-25 years) and a mean BMI of 31.7 ± 6.7 kg/m2. The group that reused syringes and needles experienced an increase in lipohypertrophy/nodules (0.16 ± 0.08, P = 0.040) but did not experience worsening pain or glycemic control, even when the syringes and needles were inserted into the skin with great effort. There was no difference in the total number of skin complications, quality of life, or microbiological contamination. Both groups improved treatment adherence, with a greater increase in the reuse group. The reuse of syringes and needles is associated with a modest increase in lipohypertrophy/nodules but does not have a short-term impact on glycemic control in patients with type 2 diabetes.

Temperature-sensitive injectable chitosan-based hydrogel for endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is an effective treatment for polyps and early gastrointestinal cancers, but requires a high level of operator skill. Injecting submucosal materials (SIM) helps create a fluid cushion between the mucosal and muscular layers, making the procedure easier and reducing associated risks. However, SIMs commonly used in current clinical practice tend to spread quickly and fail to provide long-lasting submucosal fluid cushions (SFC). Thus, there is a critical need for a material that is easy to inject while also maintaining a durable barrier. We prepared succinylated hydroxybutyl chitosan (HBC-SA) by adding succinic anhydride (SA) to hydroxybutyl chitosan (HBC). The hydrogel had excellent temperature-sensitive properties and was able to be injected via an endoscopic injection needle even after gel formation. In vitro and in vivo studies showed that it has satisfactory biocompatibility. Functional experiments showed that the submucosal lifting properties of this hydrogel were significantly better than that of normal saline (NS) and sodium hyaluronate (SH), two commonly used clinical materials. In addition, the hydrogel possessed excellent hemostatic properties. Based on these results, HBC-SA is a promising candidate for submucosal injection during ESD.