Standard Injection Technique Research Articles

The Effect of Helfer Skin Tap Technique on Pain Reduction and Hemodynamic Parameters During Tetanus Injection in Pregnant Women

Abstract Aim; The study was aimed at determining the effect of the Helfer skin tap technique on pain reduction and hemodynamic variables in pregnant women during tetanus injection. Method; It was a comparative study with a randomized control group conducted in a Family Health Center between August 2021, and March 2022. The study was conducted with 65 pregnant women who got tetanus vaccine. The tetanus vaccine was administered using the Helfer skin tap techniques to 33 of pregnant women and the standard intramuscular injection (IM) technique to 32 women. Pregnant women’s pain levels were evaluated on the Number Rating Scale after vaccination by the researcher. Similarly, the hemodynamic variables of the pregnant women were examined by the same researcher before and immediately after the vaccine administration. Results; It was determined that there was a statistically significant difference between the Helfer skin tap groups and standard application group in terms of mean pain intensity in the post-intervention (p < .01). The majority of the sample (69.7%) in the Helfer skin tap group perceived mild pain and most of the participants (46.9%) in the standard application group had moderate pain in the post-intervention. Respiratory rates of the pregnant women in the Helfer skin tap group were seen to decrease significantly after the vaccine administration (p < .01), but no change was found in the other hemodynamic variables. Helfer skin tap group heart rates were significantly lower compared with those in the standard group (p < .05), while their saturation levels were significantly higher (p < .01). Conclusion; It was concluded that the Helfer skin tap technique is an effective method to reduce pain during IM tetanus vaccine administration.

Efeito da técnica de tosse durante injeção subcutânea de heparina na intensidade da dor e satisfação individual

Objective: to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. Method: the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. Results: there was a statistically significant difference between patients’ mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. Conclusion: the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

Local Anesthetic Efficacy in Marijuana Users and Nonusers: A Pilot Study.

Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers. Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals. A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia. No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.

Analytical methods for assessing retinal cell coupling using cut-loading

Electrical coupling between retinal neurons contributes to the functional complexity of visual circuits. "Cut-loading" methods allow simultaneous assessment of cell-coupling between multiple retinal cell-types, but existing analysis methods impede direct comparison with gold standard direct dye injection techniques. In the current study, we both improved an existing method and developed two new approaches to address observed limitations. Each method of analysis was applied to cut-loaded dark-adapted Guinea pig retinae (n = 29) to assess coupling strength in the axonless horizontal cell type ('a-type', aHCs). Method 1 was an improved version of the standard protocol and described the distance of dye-diffusion (space constant). Method 2 adjusted for the geometric path of dye-transfer through cut-loaded cells and extracted the rate of dye-transfer across gap-junctions in terms of the coupling coefficient (kj). Method 3 measured the diffusion coefficient (De) perpendicular to the cut-axis. Dye transfer was measured after one of five diffusion times (1-20 mins), or with a coupling inhibitor, meclofenamic acid (MFA) (50-500μM after 20 mins diffusion). The standard protocol fits an exponential decay function to the fluorescence profile of a specified retina layer but includes non-specific background fluorescence. This was improved by measuring the fluorescence of individual cell soma and excluding from the fit non-horizontal cells located at the cut-edge (p<0.001) (Method 1). The space constant (Method 1) increased with diffusion time (p<0.01), whereas Methods 2 (p = 0.54) and 3 (p = 0.63) produced consistent results across all diffusion times. Adjusting distance by the mean cell-cell spacing within each tissue reduced the incidence of outliers across all three methods. Method 1 was less sensitive to detecting changes induced by MFA than Methods 2 (p<0.01) and 3 (p<0.01). Although the standard protocol was easily improved (Method 1), Methods 2 and 3 proved more sensitive and generalisable; allowing for detailed assessment of the tracer kinetics between different populations of gap-junction linked cell networks and direct comparison to dye-injection techniques.

Development of a Controlled Injection Method Using Support Templates for the Production of Chemobrionic Materials.

Chemobrionics is a research field about the well-known self-organized inorganic structures. Numerous research works have focused on controlling their growth pattern and characteristic features. In the present study, a controlled injection method is proposed to produce more regular self-assembled chemobrionics compared to the standard direct injection technique. This method involves the injection of a metal salt solution into an agarose support template filled with an anionic solution. The obtained structures were studied by scanning electron microscopy, X-ray microtomography, X-ray photoelectron spectroscopy, Raman spectroscopy, Fourier-transform IR spectroscopy, and thermogravimetric analysis. Despite the complex mechanism and chemistry underlying the self-organization phenomena, the controlled injection method enabled the generation of regular standard chemobrionic structures with high experimental reproducibility. It provided the extraction of tubular structures from the reaction vessel without breakage, thus allowing comprehensive characterization. Furthermore, the morphological, chemical, and thermal features of these structures were highly correlated with the standard chemobrionics obtained in the direct injection method. The proposed controlled injection method holds great promise for understanding and controlling the properties of chemobrionics and related structures.

Impulse Noise Removal Using Soft-computing

Image restoration has become a powerful domain now a days. In numerous real life applications Image restoration is important field because where image quality matters it existed like astronomical imaging, defense application, medical imaging and security systems. In real life applications normally image quality disturbed due to image acquisition problems like satellite system images cannot get statically as source and object both moving so noise occurring. Image restoration process involves to deal with that corrupted image. Degradation model used to train filtering techniques for both detection and removal of noise phase. This degeneration is usually the result of excess scar or noise. Standard impulse noise injection techniques are used for standard images. Early noise removal techniques perform better for simple kind of noise but have some deficiencies somewhere in sense of detection or removal process, so our focus is on soft computing techniques non classic algorithmic approach and using (ANN) artificial neural networks. These Fuzzy rules-based techniques performs better than traditional filtering techniques in sense of edge preservation.

The Significance of Repeated Education in Correcting Insulin Injection Techniques and Improving Glycemic Control

Background: The success of insulin therapy in achieving glycemic control highly relies on proper insulin injection practices. Proper insulin injection technique is crucial for optimizing the efficacy of insulin therapy. Therefore, it becomes imperative to train people with diabetes on standard insulin injection techniques. In some clinic settings, the education about the technique of injection may be delivered only once, and there is possibility that the patients can still commit mistakes while administering insulin. Ensuring proper insulin injection practices can help improve hemoglobin A1c (HbA1c) and achieve good glycemic control. Aim and Objective: This study aimed to assess the significance of wrong insulin injection techniques on poor glycemic control, and the impact of brief education sessions in inculcating proper insulin injection practices among patients with Type 2 diabetes mellitus (T2DM) was assessed in a real-world diabetes care setting. Methods: A retrospective analysis was conducted for the past 2 years among T2DM patients who exhibited improper injection techniques despite attending a 15-min training session. They were asked to fill in a questionnaire as well as their injection sites were examined. They were again made to attend the session and followed up for the succeeding 6 months to understand the underlying benefits of such training episodes. Results: Among people with T2DM, 126 individuals were identified with wrong injection practices. The mean HbA1c was 10.42% ± 2.33%, mean fasting blood glucose 199.60 ± 82.46 mg/dL, and mean postprandial blood glucose 236.70 ± 96.11 mg/dL. The participants' average number of insulin shots a day was 2.85 ± 1.11. The site of injection was incorrect in 20.17% of the patients; in 35.65%, the procedure of injecting was incorrect; and 11.97% did not follow injection site rotation. 18.80% of the patients presented with lipodystrophy or lipoatrophy. Conclusion: Improvement of insulin injection technique requires the involvement of all the key stakeholders in insulin therapy, these being diabetes educators and/or nurses, physicians, patients, and needle/device manufacturers. However, there is a need for clear guidance for diabetes educators and other health-care professionals so that they can, in turn, educate their patients to successfully self-manage their insulin therapy.

Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers.

BACKGROUNDImage-guided radiotherapy (IGRT) has significantly improved the precision in which radiotherapy is delivered in cancer treatment. Typically, IGRT uses bony landmarks and key anatomical structures to locate the tumor. Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue. The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied. However, placement requires expertise and specialized endoscopic ultrasound equipment. This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT.AIMTo assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients.METHODSA retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne, Australia was conducted. Up to four liquid fiducials were inserted per patient, each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil (Lipiodol; Aspen Pharmacare) and n-butyl 2-cyanoacrylate (Histoacryl®; B. Braun). A 23-gauge injector (Cook Medical) was used for the injection. All procedures were performed by or under the supervision of a gastroenterologist. Liquid fiducial-based IGRT (LF-IGRT) consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy. Patients received standard-IGRT (S-IGRT) if fiducial visibility was insufficient, consisting of bone match as a surrogate for tumor position. Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments. RESULTS52 patients were referred for liquid fiducial placement within the study period. A total of 51 patients underwent liquid fiducial implantation. Of these a total of 31 patients received radiotherapy. Among these, the median age was 77.4 years with a range between 57.5 and 88.8, and 64.5% were male. Twenty-seven out of the 31 patients were able to have LF-IGRT while four had S-IGRT. There were no complications after endoscopic implantation of liquid fiducials in our cohort. The cohort overall survival (OS) post-radiotherapy was 19 mo (range 0 to 87 mo). Whilst the progression-free survival (PFS) post-radiotherapy was 13 mo (range 0 to 74 mo). For those treated with curative intent, the median OS was 22.0 mo (range 0 to 87 mo) with a PFS median of 14.0 mo (range 0 to 74 mo). Grade 3 complication rate post-radiotherapy was 29%.CONCLUSIONLF-IGRT is feasible in 87.1% of patients undergoing liquid fiducial placement through standard gastroscopy injection technique. Our cohort has an overall survival of 19 mo and PFS of 13 mo. Further studies are warranted to determine the long-term outcomes of liquid-fiducial based IGRT.

Injection Cryolipolysis: First-in-human Study

Background:Injection cryolipolysis using an ice slurry has been hypothesized to be a novel method of reducing fat. The present first-in-human pilot study aims to investigate the feasibility, safety, and tolerability of ice slurry injection into human subcutaneous fat.Methods:Preabdominoplasty subjects were recruited. Baseline measurements and serial follow-up visits following a single ice slurry injection procedure into tissue to be excised during abdominoplasty were performed. Melted ice slurry injection was used as control. Feasibility using standard injection techniques was assessed. Thermal imaging was used to determine cooling efficacy. Safety was assessed by adverse event monitoring. Tolerability was assessed by subject-reported pain score. Histology and ultrasound were monitored for structural changes associated with cryolipolysis.Results:A single injection of ice slurry was feasible and sufficient to cool adipose below the target temperature (10C). There were no serious adverse events. The most common adverse events were bruising and erythema. The mean pain score for ice slurry-injected sites was 1.9/10 and 1.3/10 in control injection sites. Evidence of cryolipolysis was observed on ultrasound and tissue histology in ice slurry-injected sites.Conclusions:Ice slurry injections are feasible, with an observed safety and tolerability profile comparable to topical cryolipolysis. The ice slurry can cool tissue to induce cryolipolysis, as observed by thermal imaging, ultrasound, and tissue histology, and is selective for ice-injected sites. No significant changes were observed in control sites. The ice slurry may be a promising candidate to enable more precise, effective, and customizable aesthetic fat reduction that warrants further investigation.

Impact of Anxiety Levels and Sleep Patterns on Perceived Pain During Intravitreal Bevacizumab Injections.

To evaluate the impact of anxiety and sleep patterns on intravitreal injection pain. This prospective, noninterventional study surveyed patients scheduled for intravitreal injection by two retinal surgeons. A standard intravitreal injection technique was used. Patients filled out pre-procedure General Anxiety Disorder-7 (GAD-7) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Post-procedural pain was assessed with a visual analogue scale. Quality and hours of sleep and anxiety levels were correlated with perceived intravitreal injection pain. A total of 140 patients met inclusion criteria. Mean ± standard deviation scores were 4.9 ± 5.6 for the GAD-7, 6.3 ± 4.1 for the PSQI, and 3.69 ± 2.64 for intravitreal injection pain. Anxiety correlated with intravitreal injection pain (rho = 0.25; P = .003). Previous night's sleep (rho = -0.16; P = .057) and poor sleep quality (rho = 0.14; P = .11) were weakly correlated. Regression analysis revealed anxiety was the only significant predictor of intravitreal injection pain. A 1-point increase in anxiety predicted a 0.10-point increase in intravitreal injection pain (B = 0.10, P = .032). Anxiety level was the best predictor of perceived pain. This has implications for pre-procedural anxiety screening. [Ophthalmic Surgery Lasers Imaging Retina. 2021;52:498-504.].

A Cadaveric Study of Dye Spreading: Determining the Ideal Injection Pattern for Masseter Hypertrophy.

Masseter hypertrophy is the main cause of an asymmetrical and squared lower facial contour in the Asian community. Botulinum toxin injection technique is crucial to treat this condition. To improve injection techniques for masseter hypertrophy by elucidating the distribution of the injections within the masseter. Thirty masseter muscles were divided into 6 groups of 5 muscles each. Each group received one 0.2- or 0.3-mL injection at Point A, B, or C according to a three-point technique. Muscle dimensions and dye of the primary and secondary dye spreading were measured. The average muscle length, width, and thickness were 69.87, 33.50, and 11.23 mm, respectively. The average primary longitudinal and horizontal spreading was 36.56 and 15.60 mm, respectively. No statistically significant difference was found between 0.2- and 0.3-mL injections at each point. The three-point technique best fits in the safe zone and should be the standard injection technique for masseter hypertrophy. Injection at Points B and C may create secondary spreading that affect the risorius muscle and the parotid gland which are the cause of asymmetrical smiling and xerostomia, respectively. The dosage should be adjusted according to the muscle volume and not only the thickness.

Conjunctival flora growth in intravitreal injection settings

Purpose: To study the conjunctival flora in patients undergoing repeated intravitreal injections. Methods: Prospective observational study. Patients undergoing intravitreal injections were randomized into two groups: 1) preparation with povidone-iodine 5% alone, or 2) preparation with povidone-iodine 5% with Maxitrol eye drops. Our standard injection technique included topical anesthesia, a solid bladed lid speculum, and commercially prepared topical povidone-iodine 5% applied for 2 minutes. Cultures were obtained from the conjunctival cul-de-sac on routine office visits prior to any preparation and immediately after injection. Results: A total of 110 Eyes of 86 patients were enrolled in the study. Fifty-five were irrigated with povidone-iodine 5% only, and 55 were irrigated with a combination of povidone-iodine 5% and Maxitrol drops. Compared with the povidone-iodine only group, the Maxitrol and povidone-iodine group did not lead to a statistically significant reduction in patients with positive cultures after injection, (p=0.19). The most common organism cultured was coagulase-negative staphylococcus; however, Enterococcus, Pseudomonas, Staphylococcus aureus, and Bacillus were also cultured. Thirtyseven percent of organisms were resistant to 4th generation quinolones. No cases of endophthalmitis were recognized. Of the positive cultures, 33% were resistant to over 4 antibiotics tested. Conclusion: In this routine clinical setting, conjunctival antisepsis was difficult to achieve despite the use of topical povidone-iodine with or without Maxitrol. No infectious complications were recognized.

A New Medical Device for Improved Rotation of Insulin Injections in Type 1 Diabetes Mellitus: A Proof-of-Concept Study.

Lipohypertrophy (LH) is caused by repetitively injecting insulin into the same location. This can lead to unpredictable insulin absorption and increased glucose variability (GV). A new medical device, ROTO Track, automatically guides the user to rotate abdominal insulin injections to avoid LH lesions. This study aimed to test whether the medical device could reduce the number of insulin injections in the same subcutaneous area as compared with non-aided standard insulin injection techniques. In this proof-of-concept cross-over study, baseline data about injection site in the abdominal region were collected blinded for 1 week with a nonguiding version of the device and compared to 1 and 12 weeks of device guidance in 35 people with type 1 diabetes. The device registered time and location of abdominal injections. The primary endpoint was a "rotation score." Secondary endpoints included number and size of LH, GV, and hemoglobin A1c. The rotation score improved significantly from a baseline mean of 40.2% to 49.9% after 1 week (confidence interval: 2.2-17.2%, P = .012) and improved further after 12 weeks to 52.2% (P < .001). After 12 weeks, LH was reduced both in median size from 9.2 (range: [0.9-29.4]) cm2 to 5.4 (range: [0.0- 26.8]) cm2 (P = .041) and mean count from 1.4 (range: [1-2]) to 1.1 (range: [0-2], P = .039) and the coefficient of variation of interstitial glucose was reduced from 38.6 to 35.1 (P = .009). This proof-of-concept study indicates that the device improves rotation of insulin injections, and reduces LH and GV.

Systemic Sentinel Lymph Node Detection Using Fluorescence Imaging After Indocyanine Green Intravenous Injection in Colorectal Cancer: Protocol for a Feasibility Study.

BackgroundNodal staging is a major concern in colorectal cancer as it is an important prognostic factor. Several techniques that could potentially improve patient treatment and prognosis have been developed to increase the accuracy of nodal staging. Sentinel lymph node detection has been shown to accurately reflect nodal status in various tumors and has become the standard procedure in nodal staging of breast cancer and melanoma. However, in colorectal cancer, sentinel lymph node detection techniques are still controversial as the sensitivity reported in the literature varies from one study to another. Recently, indocyanine green fluorescence–guided surgery has been reported to be a useful technique for detection of macroscopic and microscopic metastatic deposits in lymph nodes after intravenous administration of indocyanine green dye. However, no studies have focused on the potential role of sentinel lymph node detection after systemic administration of indocyanine green dye, so-called systemic sentinel lymph nodes, or on the correspondence between the identification of the sentinel lymph node by standard local injection techniques and the detection of fluorescent lymph nodes with this new approach.ObjectiveThe aim of this protocol is to validate the concept of sentinel lymph nodes identified by fluorescence imaging after intravenous injection of indocyanine green dye and to compare the sentinel lymph nodes identified by fluorescence imaging with sentinel lymph nodes detected by the standard blue dye technique.MethodsThis study (SeLyNoFI; Sentinel Lymph Nodes Fluorescence Imaging) is a diagnostic, single-arm, open-label feasibility study, including patients with colorectal adenocarcinoma with or without metastatic disease who are admitted for elective colorectal resection of the primary tumor. This study evaluates the feasibility of a new approach for improving the accuracy of nodal staging using fluorescence imaging after intravenous administration of indocyanine green dye. Sensitivity, positive predictive value, and accuracy of the classical blue dye technique and of the investigatory fluorescence imaging technique will be calculated. Translational research will be proposed, if applicable.ResultsAs of June 2020, this study has been registered. Submission for ethical review is planned for September 2020.ConclusionsThe potential correlation between the two different approaches to detect sentinel lymph nodes offers new strategies for improving the accuracy of nodal staging in colorectal cancer. This new concept of the systemic sentinel lymph node and a greater understanding of the interactions between systemic sentinel lymph nodes and standard sentinel lymph nodes may provide important information regarding the underlying mechanism of primary tumor lymphatic drainage. The enhanced permeability and retention effect can also play a role in the fluorescence of systemic sentinel lymph nodes, especially if these lymph nodes are inflamed. In this case, we can even imagine that this new technique will highlight more instances of lymph node–positive colorectal cancer.International Registered Report Identifier (IRRID)PRR1-10.2196/17976

1002-P: The ROTO Track Device Improves Rotation of Insulin Injections in T1DM: A Proof-of-Concept Study

Lipohypertrophy (LH), a common side effect of insulin therapy, is caused by repetitively injecting insulin into the same location. When insulin is injected into LH lesions, the absorption of insulin may be erratic and unpredictable, which can lead to unexpected hyperglycemia and hypoglycemia and increased blood glucose variability. To improve injection techniques and avoid LH, a new medical device, ROTO Track® which automatically guides the person with diabetes to rotate the abdominal insulin injections was tested. The hypothesis is that the device can reduce the number of insulin injections in the same subcutaneous area as compared with non-aided standard insulin injection techniques in people with T1DM. Methods: In this proof-of-concept cross-over study, baseline data about injection site in the abdominal region was collected blinded for one week with a non-guiding version of the device and compared to 12 weeks of device guidance in 35 people with T1DM. The device registered injection time and location on the abdomen. Based on this a "rotation score", the primary endpoint, was calculated. Secondary end points included number and size of LH, glycemic variability and HbA1c. LH sizes were documented by drawing on a wound care grid after palpation of the skin. Interstitial glucose was measured with a continuous glucose monitor and the coefficient of variation, CV was calculated. Results: The rotation score improved significantly from a baseline mean of 40.2% to 49.9% after one week (CI: 2.2% - 17.2%, p=0.012) and improved further after 12 weeks to 52.2% (p&amp;lt;0.001). After 12 weeks, LH was reduced both in mean size from 11.9 (+/- 9.5) cm2 to 8.2 (+/- 9.7) cm2 (p=0.041) and numbers (p=0.039) and the CV of interstitial glucose was reduced from 38.6 to 35.1 (p=0.009). There were no changes in mean interstitial glucose, HbA1c or hypoglycemic events after 12 weeks. Conclusion: This proof-of-concept study indicates that the device is safe, improves rotation, reduces LH and reduces glycemic variability. Disclosure C.K. Klarskov: None. Y.H. Hamid: None. R.T. Tjalk-Bøggild: Board Member; Self; ROTO Health ApS. Employee; Self; ROTO Health ApS. L. Tarnow: None. P.L. Kristensen: None. Funding Innovation Fund Denmark (8063-00049B); Nordic Healthcare Technology

Abstract P4-02-02: Low-cost fluorescein guided sentinel lymph node biopsy as an alternative to radio-pharmaceutical guided SLNB -Results of a prospective, comparative validation study

Abstract Introduction: Sentinel lymph node biopsy (SLNB) is the current standard of care for surgical staging of clinically N0 axilla in breast cancer (BC) patients. The current gold standard technique for SLNB utilizes a radiopharmaceutical (R) and a blue dye (B) in combination (RB). However, in the developing countries, the limited availability and high costs of radiopharmaceutical and gamma probe are major barriers in performing SLNB. Fluorescein (F) is a commonly available, inexpensive and safe lymphophilic dye commonly used for retinal angiography. When injected, it is trapped selectively by lymphatics and rapidly transported to, and concentrated in the lymph nodes, which can be detected as bright fluorescent structures under blue light. Its use can obviate the need for radiopharmaceutical and gamma probe. In this comparative validation study, we used this novel dye and an inexpensive hand-held blue LED light as the method for SLNB, and assessed the SLN identification rate (SLN-IR) &amp; false negative rate (FNR) of SLNB using fluorescein and its combination with blue dye, with those of the gold standard (RB). Methods: After obtaining approval from IEC, in this prospective, comparative validation SLNB study, 40 cN0 early BC patients treated were recruited, starting March 2018. After getting due consent from the patients, SLNB was performed using 99mTc-Sulphur-colloid(and gamma probe), methylene blue &amp; fluorescein (and blue LED light), using the standard injection techniques and timings for R and B. One ml Inj Fluorescein 4%, diluted in 4 ml of saline was injected peri-tumoral and sub-areolar (half and half) just before axillary incision. ALND was performed irrespective of SLNB histology, and the SLN-IR and FNR obtained with various methods compared. Results: All in all, SLNs could be identified in 39 (97.5%) patients using one or the other dye. The SLN-IRs using the investigational dye- fluorescein (F) alone (92.5%), or in combination with methylene blue (FB combination, 92.5%) were identical, and comparable with the gold standard RB combination (SLN-IR 92.5%). However the SLN-IR using radiotracer (R) alone (87.5%), and blue dye alone (72.5%) were significantly inferior compared to the investigational F or FB combination, or the conventional gold standard RB combination. The SLN FNRs were 0% using Radiotracer alone, RB combination, Fluorescein alone and FB combination, while it was 50% using methylene blue dye (B) alone. Conclusions: Results of this novel prospective, comparative validation SLNB study suggest that SLN identification rates and false negative rates using the novel inexpensive fluorescein dye and an LED blue light, used alone or in combination with methylene blue, are comparable to those achieved by using the current gold standard combination of radio-colloid and methylene blue. By replacing the radio-colloid with fluorescein, and gamma probe with LED blue light, we could perform SLNB with similar efficacy and accuracy, but at a fraction of the cost by obviating the use of expensive radio-pharmaceutical and the gamma probe. This low-cost innovation has the potential to be helpful in implementation of cost-effective SLNB across developing world. Citation Format: Gaurav Agarwal, VC Ramya, Sabaretnam Mayilvahanan, Gyan Chand, Anjali Mishra, Amit Agarwal, Saroj K Mishra, Sanjay Gambhir, Vinita Agrawal, Narendra Krishnani, Punita Lal. Low-cost fluorescein guided sentinel lymph node biopsy as an alternative to radio-pharmaceutical guided SLNB -Results of a prospective, comparative validation study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-02.

Self-Sensing via Flux Injection With Rapid Servo Dynamics Including a Smooth Transition to Back-EMF Tracking Self-Sensing

Self-sensing control at zero and low speed has been widely implemented and studied by many researchers. This technique is based on injecting a high-frequency voltage or current into the motor to estimate the motor position and speed from the measured motor quantities like current or voltage. Tracking the motor back-EMF or flux signal has been used to control motors during medium- and high-speed operations. This article proposes a high-frequency flux injection (HFFI) based self-sensing using deadbeat-direct torque and flux control to control permanent magnet servo motor at zero and low speed with ideally zero torque ripple, unlike the standard current or voltage injection techniques. The HFFI is combined with a back EMF self-sensing technique to control the motor during medium- and high-speed operations. This article also proposes a method for a smooth transition between these two methods. The proposed controller is used to control different types of slightly salient servo motors during dynamic servo operations.

A modified technique for intralesional injection of collagenase Clostridium histolyticum for Peyronie's disease results in reduced procedural morbidity using a standardized hematoma classification rubric.

Early clinical trials of injectable collagenase Clostridium histolyticum (CCh) for Peyronie's disease (PD) demonstrated safety and efficacy. Since then, modified injection protocols have been proposed. Adverse events-such as bruising, swelling, hematoma, and corporal rupture-exceed 50% in many studies, but lack of standardization of hematoma severity limits conclusions about the relative safety of protocols. We propose a modification of the standard injection technique that aims to decrease the rates of adverse events. We further describe a hematoma classification rubric that may standardize safety assessment. A modified injection procedure, termed the "fan" technique, was employed in the treatment of PD. All men receiving CCh from January 2016 through January 2019 at a single institution were included in an institutional review board (IRB) approved database. Treatment outcomes and adverse events were retrospectively assessed. A three-tiered hematoma classification rubric was devised to standardize reporting of hematoma, which was defined as concurrent bruising and swelling at the site of injection without loss of erection. Using the fan technique, 152 patients received 1323 injections. Eight hematomas (5.3% of all patients, 0.6% of all injections) were observed. The number of grade I, grade II, and grade III hematomas were 3, 2, and 3, respectively. Bruising or swelling not meeting the definition of hematoma was seen in 54.6% and 27.0% of patients, respectively. There were zero corporal ruptures. A modified injection technique results in reduced procedural morbidity. A hematoma classification system provides clarity and standardization to the assessment of safety in PD treatment. Further clinical studies with control arms are required to verify these findings.

Evaluation of physician volumetric accuracy during hyaluronic acid gel injections: An observational, proof-of-concept study.

Findings indicate that standard injection techniques for hyaluronic acid (HA) soft tissue fillers result in considerable variations in the applied boluses. Furthermore, despite the knowledge that the varying biophysical properties of HA fillers (eg, G', cohesivity, viscoelasticity) can affect their ease of injection, the impact of device attributes on an injector's volumetric accuracy is currently unknown. (a) Evaluate the ability of aesthetic physicians to accurately inject a specific amount of HA filler; (b) investigate the effect of physician experience on injection accuracy; and (c) investigate the impact of different HA gel properties on an injector's performance. Thirteen physicians with aesthetic experience were recruited. Subjects were blindfolded and asked to deposit 0.2cc of four HA fillers under two conditions: (a) onto a scale and (b) into a porcine membrane. The amount of gel deposited/injected was then measured. An accurate injection was defined as 0.2cc±15%. Subjects were rarely able to dispense accurate amounts of injectate (42/208 injections or 20.19%) and often underestimated their injection quantities. Variations in the accuracy distributions between groups were observed. An injector's experience, the conditions under which injections were performed and the product choice were all variables found to affect the accuracy distributions. The findings of this study provide evidence that the use of visual and/or audible stimuli is necessary for dispensing accurate volumes. This has clinical implications for treatment efficacy and patient satisfaction during free hand injections. To ensure more accurate and reproducible results, the investigators propose a possible modification to the standard injection technique.

Accuracy comparisons of intra-articular knee injection between the new modified anterolateral Approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion

BackgroundIntra-articular knee injection with steroid or various other agents have been used to control the local inflammation and relieve pain in the osteoarthritis knee. To achieve the maximal potential therapeutic worth and decrease the complications from the inaccurate knee injection, these medications should be delivered directly into the intra-articular space. Injection technique is one of the most important factors for accuracy of knee injection. Therefore, this study was aimed to propose the new modified anterolateral injection technique for higher accuracy of knee injection in symptomatic osteoarthritis knee without effusion. Material and methodsPatients with symptomatic osteoarthritis without effusion were included prospectively from May 2014 to May 2015 and randomized into 2 groups for knee injection: Modified anterolateral (MAL), Standard superolateral (SL). Knee injection was performed by one experienced orthopaedic. Accuracy of injection was test by mini air-arthrography technique. The pain from injection were evaluated by visual analog scale (VAS). Result132 knees were included, 66 knees were modified anterolateral group same as superolateral group. The modified anterolateral injection was significantly yield the higher accuracy rate than the standard superolateral injection (89% vs 58%, P < 0.05). The pain visual analog scale was not significantly different between the modified anterolateral and standard superolateral injection technique (2.61 vs 2.65, P = 0.917) No adverse events were occurred. ConclusionThe new modified anterolateral injection yields the higher pooled accuracy rate. From the accuracy and the advantage of the new modified anterolateral injection, this is the preferred injection technique for the symptomatic osteoarthritis without knee effusion.