Standard Syringe Research Articles

Measured depth of subcutaneous tissue on posterolateral arm of aeroallergen immunotherapy patients

Background Subcutaneous immunotherapy (SIT) injections for aeroallergens are often utilized in patients. SIT should be injected into the subcutaneous space in the mid-posterolateral upper arm. If the injections are given intramuscularly (IM), there may be an increased risk of anaphylaxis. In our allergy clinic, SIT is given with BD Safety Glide™ Allergy syringes with needle length 13mm. There is a risk of the SIT being injected IM if patients have a skin to muscle depth (STMD) less than 13mm. Methods Charts were reviewed in an allergy clinic for patients on SIT where an ultrasound of the left posterolateral arm was done to measure STMD. Baseline characteristics of the two groups of patients with STMD greater than, and less than or equal to 13mm were compared. The proportions of patients with STMD greater than 4mm, 6mm, 8mm, and 10mm were calculated. Multivariable logistic regression was performed with age, sex, BMI and race. Results Ultrasounds had been completed on 186 patients on SIT. There were 149 (80%) with STMD less than 13mm. Baseline characteristics including age, sex and BMI differed among the two groups (p < 0.05). Based on the logistic regression analysis, BMI was significantly associated with STMD. There were 168 (90%) patients with more than 4mm STMD. Conclusions With standard allergy syringes, most patients on SIT are at risk of receiving the injections IM. A needle length of 4mm would significantly decrease the risk of SIT being given IM.

Making Nasopalatine Blocks Comfortable: A Randomised Prospective Clinical Comparison of Pain Associated with the Injection Using an Insulin Syringe and a Standard Disposable 3 mL Syringe

This study was conducted to compare and evaluate the pain associated with administration of Nasopalatine blocks using a disposable insulin syringe and the conventional disposable 3 mL syringe. Forty patients requiring intraalveolar extractions of maxillary central incisors were randomly assigned to two groups of 20 patients each; one (Group A) received the nasopalatine block with a standard 3mL syringe and the other (Group B) received the block with an insulin syringe. Patients were asked to rate the pain associated with the injection on a visual analog scale (VAS) and the results were analysed using a Chi Square Test. The mean VAS score for Group A and B was 1.55 and 1 respectively. Chi Square value was calculated to be 8.603 (degree of freedom= 3, P value= 0.0351). There were no differences in the effectiveness of anesthesia between the groups. Pain associated with administration of the nasopalatine blocks may be significantly mitigated by using the Insulin syringe.

Endothelialized Microfluidics for Studying Microvascular Interactions in Hematologic Diseases

Advances in microfabrication techniques have enabled the production of inexpensive and reproducible microfluidic systems for conducting biological and biochemical experiments at the micro- and nanoscales 1,2. In addition, microfluidics have also been specifically used to quantitatively analyze hematologic and microvascular processes, because of their ability to easily control the dynamic fluidic environment and biological conditions3-6. As such, researchers have more recently used microfluidic systems to study blood cell deformability, blood cell aggregation, microvascular blood flow, and blood cell-endothelial cell interactions6-13.However, these microfluidic systems either did not include cultured endothelial cells or were larger than the sizescale relevant to microvascular pathologic processes. A microfluidic platform with cultured endothelial cells that accurately recapitulates the cellular, physical, and hemodynamic environment of the microcirculation is needed to further our understanding of the underlying biophysical pathophysiology of hematologic diseases that involve the microvasculature. Here, we report a method to create an "endothelialized" in vitro model of the microvasculature, using a simple, single mask microfabrication process in conjunction with standard endothelial cell culture techniques, to study pathologic biophysical microvascular interactions that occur in hematologic disease. This "microvasculature-on-a-chip" provides the researcher with a robust assay that tightly controls biological as well as biophysical conditions and is operated using a standard syringe pump and brightfield/fluorescence microscopy. Parameters such as microcirculatory hemodynamic conditions, endothelial cell type, blood cell type(s) and concentration(s), drug/inhibitory concentration etc., can all be easily controlled. As such, our microsystem provides a method to quantitatively investigate disease processes in which microvascular flow is impaired due to alterations in cell adhesion, aggregation, and deformability, a capability unavailable with existing assays.

Endothelialized Microfluidics for Studying Microvascular Interactions in Hematologic Diseases

Advances in microfabrication techniques have enabled the production of inexpensive and reproducible microfluidic systems for conducting biological and biochemical experiments at the micro- and nanoscales (1,2). In addition, microfluidics have also been specifically used to quantitatively analyze hematologic and microvascular processes, because of their ability to easily control the dynamic fluidic environment and biological conditions(3-6). As such, researchers have more recently used microfluidic systems to study blood cell deformability, blood cell aggregation, microvascular blood flow, and blood cell-endothelial cell interactions(6-13).However, these microfluidic systems either did not include cultured endothelial cells or were larger than the sizescale relevant to microvascular pathologic processes. A microfluidic platform with cultured endothelial cells that accurately recapitulates the cellular, physical, and hemodynamic environment of the microcirculation is needed to further our understanding of the underlying biophysical pathophysiology of hematologic diseases that involve the microvasculature. Here, we report a method to create an "endothelialized" in vitro model of the microvasculature, using a simple, single mask microfabrication process in conjunction with standard endothelial cell culture techniques, to study pathologic biophysical microvascular interactions that occur in hematologic disease. This "microvasculature-on-a-chip" provides the researcher with a robust assay that tightly controls biological as well as biophysical conditions and is operated using a standard syringe pump and brightfield/fluorescence microscopy. Parameters such as microcirculatory hemodynamic conditions, endothelial cell type, blood cell type(s) and concentration(s), drug/inhibitory concentration etc., can all be easily controlled. As such, our microsystem provides a method to quantitatively investigate disease processes in which microvascular flow is impaired due to alterations in cell adhesion, aggregation, and deformability, a capability unavailable with existing assays.

Design and In Vitro Testing of a Pressure-Sensing Syringe for Endotracheal Tube Cuffs

Endotracheal intubation is a frequently performed procedure in the prehospital setting, intensive care unit, and for patients undergoing surgery. The endotracheal tube cuff must be inflated to a pressure that prevents air leaks without compromising tracheal mucosal blood flow. For simultaneous endotracheal tube cuff inflation and measurement, we designed and tested a novel pressure-sensing syringe in vitro. The prototype was developed using a standard 10-mL polycarbonate syringe body that houses a plunger and a silicone rubber bellows, the pressure-sensing element. Bellow feasibility was determined and modeled using finite element analysis. Repeatability testing at each pressure measurement for each bellows (pressure versus deflection) was within an average standard deviation of 0.3 cm to 1.61 cm (1%-5% error). Using an aneroid manometer for comparison, there was excellent linear correlation with a Spearman rank of 0.99 (P < 0.001), up to 30 cm H(2)O.

A Matter of Conscience

Anesthesiologists are continually engaged in selfassessment, and our specialty has been defined by its commitment to minimizing errors and ensuring the safety of all patients. Anesthesiologists were pioneers in safety and continue to be seen as leaders in improving quality of care and outcomes. This is well illustrated by the Anesthesia Patient Safety Foundation, which has led efforts in anesthesia-related safety. Notwithstanding this history, 2 related areas of potentially dangerous practice continue despite numerous previous warnings. What are these dangers? The first is the accidental administration of IV drugs into epidural or intrathecal space. The second is the even more dangerous administration of epidural drugs into the circulation via the IV catheter. With this editorial, we challenge the anesthesiology community, along with the relevant industry and regulatory agencies, to take urgent action and eliminate an unnecessary and preventable risk to our patients.

Nanopatch targeted delivery of both antigen and adjuvant to skin synergistically drives enhanced antibody responses

Many vaccines make use of an adjuvant to achieve stronger immune responses. Alternatively, potent immune responses have also been generated by replacing the standard needle and syringe (which places vaccine into muscle) with devices that deliver vaccine antigen to the skin's abundant immune cell population. However it is not known if the co-delivery of antigen plus adjuvant directly to thousands of skin immune cells generates a synergistic improvement of immune responses. In this paper, we investigate this idea, by testing if Nanopatch delivery of vaccine – both the antigen and the adjuvant – enhances immunogenicity, compared to intramuscular injection. As a test-case, we selected a commercial influenza vaccine as the antigen (Fluvax 2008®) and the saponin Quil-A as the adjuvant. We found, after vaccinating mice, that anti-influenza IgG antibody and haemagglutinin inhibition assay titre response induced by the Nanopatch (with delivered dose of 6.5ng of vaccine and 1.4μg of Quil-A) were equivalent to that of the conventional intramuscular injection using needle and syringe (6000ng of vaccine injected without adjuvant). Furthermore, a similar level of antigen dose sparing (up to 900 fold) – with equivalent haemagglutinin inhibition assay titre responses – was also achieved by delivering both antigen and adjuvant (1.4μg of Quil-A) to skin (using Nanopatches) instead of muscle (intramuscular injection). Collectively, the unprecedented 900 fold antigen dose sparing demonstrates the synergistic improvement to vaccines by co-delivery of both antigen and adjuvant directly to skin immune cells. Successfully extending these findings to humans with a practical delivery device – like the Nanopatch – could have a huge impact on improving vaccines.

Active silicone oil removal with a modified vacuum syringe.

At present, the number of clinical indications for the use of silicone oil (SO) has increased in intraocular surgery because of the advent of new techniques in vitreoretinal surgery, availability of better quality oils, and greater experience in its use. Consequently, the number of procedures for SO removal has increased, and support technologies for these procedures are always a concern. A simple active technique for SO removal based on a 5-mL standard syringe with an 18G cannula was developed. The oil is suctioned into the syringe by the pulling effect of a spring assembled along the axis of the piston. No abrupt change in the intraocular pressure is produced because of the oil viscosity and the reduced diameter of the cannula. A technique for SO removal that has been used successfully during the past 7 years is presented in this article. During the 7-year period, 234 SO removals were performed without any complication or device failure. Using the present method, the average time for SO removal was 4 minutes. The average extraction time with the technique is 4 minutes, which is in the range of other active techniques, and it is faster than passive methods that are performed between 8 and 9 minutes. The technique is in line with the advantages of more elaborated active methods without using complex technology. It is considered to be highly successful and easy to implement.

T Tail Configuration Of Opsite On Suction Tubing Outlet For Modified Vacuum Assisted Closure.

Many modified vacuum assisted closure methods have been proposed as an alternative to original VAC which are simple and cost-effective. M Singh et al has proposed the idea of a poor man’s VAC (1-2). We would like to suggest few modifications in the methodology considering which will improve the efficiency of poor man’s VAC. The port of exit of the suction tubing from the dressing remains a potential site of leakage. For the use of non electrical suction devices it is necessary to have complete leak proof dressing. Every attempt has to be made to minimize the leak. We recommend Ttailing of suction tubing which prevents leakage significantly from our experience. INTRODUCTION Many modified vacuum assisted closure methods have been proposed as an alternative to original VAC which are simple and cost-effective. M Singh et al has proposed the idea of a poor man’s VAC (1-2). We would like to suggest few modifications in the methodology considering which will improve the efficiency of poor man’s VAC. The port of exit of the suction tubing from the dressing remains a potential site of leakage. For the use of non electrical suction devices it is necessary to have complete leak proof dressing. Every attempt has to be made to minimize the leak. We recommend Ttailing of suction tubing which prevents leakage significantly from our experience. METHODOLOGY The opsite is applied in such a manner that the tubing is lifted one to two inches beyond the edge of the wound by the assistant, and the opsite is adhered to the whole circumference of the tubing and opposing beneath the suction tubing by the applicant in a key hole fashion creating an air tight seal towards the periphery. The “wings” of the opsite is adhered to the skin surface. Now the cross section appears a T shape (Figure 1 ). When this procedure is not performed there is always a chance of peritubal leak from the triangular dead space area tracking along the tubing into the wound especially when the opsite is streched. This procedure prevents the leakage and the efficiency of modified VAC remains same for varying size of tubing. This process is similar to creation of witzel tube for feeding jejunostomy. Figure 1 Figure 1. (T tail configuration in different views ) ADVANTAGES Avoids tunneling through the tissue as much as possible preventing the tissue damage and risk of spread of infection. Change of tubing easily, frequently with every change of dressing Avoiding pain and discomfort to the patient T Tail Configuration Of Opsite On Suction Tubing Outlet For Modified Vacuum Assisted Closure. 2 of 3 Avoids unnecessary usage of adhesive plasters in attempt to sealing the leak. It is easy, comfortable, cost-effective and decreases frequent monitoring for leakage. Patients are relatively ambulant when the negative suction can be maintained through using 50 cc syringes and romovac Though the leakage chances are more in regions involving ankle, groin, axilla, and uneven surfaces , pedal suction device with calibrated vacuum gauge can maintain for a longer period than usual. Figure 2 Figure 2: Measurement of negative pressure with suction gauge with syringe type, romovac and mucus sucker. The 50 cc syringe piston is held in position with a 20 cc syringe piston. A standard 50cc syringe is able to create a maximum amount of 450 mm hg pressure. A standard romovac drain is able to create a negative pressure of 75 mm hg pressure and a mucus sucker produces a vacuum of similar amount. We have used infant feeding tube, ryle’s tube and suction catheters as suction tubing’s with good efficacy and these materials are readily available in government hospitals. Figure 3 Figure 3: Wound healing after application of modified VAC with pedal suction. It is beyond doubt the results are gratifying with poor man’s VAC, we totally agree with the results. With the Ttailing the performance can be more enhanced in low resource setting. Wounds of extensive surface area is are the limiting factor for poor man’s VAC as there are multiple sites of leakage, hence may require a motorized suction device or central vacuum for maintaining the vacuum depending on the resource setting. Vacuum dressing has to be done with great caution or avoided in peripheral vascular disease (3). Further studies regarding the microbial clearance rate, wound contraction time, bed occupancy, patient’s compliance are required to formulate guidelines and standardize poor man’s VAC. Simpler Low cost vacuum devices like these need to be encouraged, educated and improved with modifications which are user as well as patient friendly.

Stability of refrigerated cord blood gas samples

Accurate records of cord blood gas samples may be important but analysis of samples may be delayed post delivery due to logistical constraints. Cord blood gas samples are stable within...

Standardisation of neonatal prescribing in the east of england

BackgroundThe East of England (EoE) perinatal networks have 18 neonatal units including three network neonatal intensive care units. Different units historically have used different drug infusion policies. For transferred babies...

A passive integrated transponder tag implanted by a new alternative surgical method: effects on the oriental weather loach (Misgurnus anguillicaudatus) and application in a small irrigation system

We validated the effects of a passive integrated transponder (PIT) tagging process on the oriental weather loach Misgurnus anguillicaudatus. Laboratory experiments were conducted to assess the effects of PIT tagging on fish survival, growth, wound healing, and tag omission. Two tagging protocols, standard syringe injection versus insertion through a small hole pierced by a fine needle-shaped awl, were compared using a 12.5 × 2.07 mm2 tag. A control group was also included. In comparison with the awl technique, syringe injection heightened the mortality of the loach and delayed healing of the wound caused by tag insertion. No effects of either PIT tagging method were detected on the growth of surviving loach. We also field-tested similarly tagged populations within a river-based irrigation system of Sado Island, Japan. Two different sized tags (long, 12.5 × 2.07 mm2; short, 8.5 × 2.12 mm2) were compared by using antenna loggers which detected fish movement through gates and automatically logged tagged fish’s tag IDs and timestamps. By comparing logged data and actual fish collection surveys both below and above the gates, 77% and 30% of actual loach movements were confirmed to have been successfully logged for the long and short tags, respectively. The awl insertion technique with the longer tag is therefore recommended for use in similar studies of smaller fish species.

Syringe micro vibrator (SMV) a new device being introduced in dentistry to alleviate pain and anxiety of intraoral injections, and a comparative study with a similar device

BackgroundNeurologically, it is proven that stimulation of larger diameter fibers - e.g. using appropriate coldness, warmth, rubbing, pressure or vibration- can close the neural "gate" so that the central perception of itch and pain is reduced. This fact is based upon "Gate-control" theory of Melzack and Wall.Presentation of the hypothesisSyringe Micro Vibrator is a new design being introduced for the first time in the field of Dentistry. This device is a promising breakthrough in pain and anxiety management and may deliver solution for clinicians plagued with patient pain phobia. It has an off-set rotating micro vibration creator with ultra high frequency and ultra low altitude that can be easily placed on any standard dental syringe and some disposable syringes. This device was registered as an invention in dentistry and received Iran National Patent number of 63765.Testing the hypothesisBy creating micro vibration, this device would be effective in reducing the pain and anxiety confronted with most types of intraoral injections as palatal, mandibular block, intraligamental and local infiltration. From the aspect of the patient pain management, this device contributes both physiologically (based on Gate Control Theory of pain) and psychologically (based on the device function as will be explained by dentist to the patient as a modern pain reducing technology). From the aspect of clinician, SMV motor provides vibrations with ultra high frequency to alleviate pain, but since it has ultra low vibration altitude, it has no adverse effect on the clinician dexterity and accuracy during injection and it does not interfere with pin point localization of injection site.Implications of the hypothesisUpon mounting on a conventional dental anesthesia injection syringe, SMV is switched on and the clinician then uses normal injection technique to administer the anesthetic. This device is not only a useful accessory device for ordinary patients, but also more useful for pediatric patients and those who have a phobia of intraoral injection or pain.

Assessment of self-injection experience in patients with rheumatoid arthritis: psychometric validation of the Self-Injection Assessment Questionnaire (SIAQ)

BackgroundSubcutaneous self-injection of medication has benefits for the patient and healthcare system, but there are barriers such as dexterity problems and injection anxiety that can prevent self-injection being used effectively. An accurate method of evaluating patients' experiences with self-injection would enable assessment of their success in giving self-injections and the likelihood of them adhering to a self-injection regimen. The aim of this study was to develop a questionnaire to measure overall patient experience with subcutaneous self-injection (the Self-Injection Assessment Questionnaire [SIAQ]), and to investigate its psychometric properties.MethodsThe construct validity and reliability of the SIAQ were tested in patients with rheumatoid arthritis who volunteered to inject certolizumab pegol using a standard syringe during an open-label multinational extension trial of the long-term safety and efficacy of this drug. The SIAQ PRE module was self-completed before the first self-injection, and the POST module was self-completed following each of three fortnightly self-injections.ResultsNinety-seven patients completed the SIAQ. All items correlated well with their respective domains in confirmatory factor analysis. As predicted, compared with other participants, patients with very low scores (less than 3 out of 10) in PRE causal domains (Feelings about injections and Self-confidence) were significantly less satisfied with their first self-injection, as were patients with a very low score in any POST causal domain (Self-confidence, Feelings about injections, Injection-site reactions and Ease of use), demonstrating known-groups validity. Causal domain scores generally correlated most strongly with the Satisfaction with self-injection domain, supporting convergent validity. The SIAQ demonstrated internal consistency and reproducibility; Cronbach's α and the test-retest coefficient were > 0.70 for all domains. Sensitivity and responsiveness were also shown, where measurable. Each language version showed structural validity.ConclusionThe SIAQ was demonstrated to be a valid, reliable tool in patients with rheumatoid arthritis.

The Fat Trap: A Simple Method for Harvesting Large Amounts of Adipose Tissue during Liposuction

Sir: Autologous fat grafting is a technique that is increasingly used in plastic and reconstructive surgery. When large amounts of adipose tissue are needed, such as for breast reconstruction, syringe aspiration can be tedious and time consuming. We describe here an original and simple technique for harvesting large volumes of adipose tissue. We use an 800-ml sterile drainage bottle connected on one end to the liposuction cannula (4 or 6 mm) and on the other end to the aspirating device, as shown in Figure 1.Fig. 1.: The fat trap with an 800-cc drainage bottle.The adipose tissue is collected in the drainage bottle, which serves as a “fat trap.” Once liposuction is finished, the fatty tissue is transferred into 10-ml syringes. Centrifugation of the sample is performed as described in Coleman's technique.1 Reinjection is achieved using 3-ml syringes. We used this technique in more than 200 cases of autologous fat grafting after breast reconstruction with implants or flaps. The mean volume of fat harvested was 400 cc (range, 200 to 1000 cc) and the mean volume of fat reinjected was 150 cc (range, 40 to 470 cc). We have been using this fat trap for more than 3 years for breast reconstruction. With a median follow-up of 12 months, we did not notice any increase in fat resorption compared with the standard syringe fat-harvesting technique. However, there are still controversies regarding the best way to harvest and reinject adipocytes. For Pu et al., although liposuction does not damage the histologic structure of the fatty tissue, it reduces the viability and cellular function of adipocytes.2 Conversely, for Sommer and Sattler, adipocytes survive equally well after liposuction or needle aspiration.3 Adanali et al. stated that liposuction does not damage fat samples if the vacuum used is lower than 700 mmHg.4 Moreover, Park et al. have shown that even if liposuction causes more initial damage to the fatty tissue, it allows better long-term viability because of increased cell proliferation.5 Although the Coleman technique is suitable when small volumes of fat tissue are needed (e.g., for facial rejuvenation), liposuction using our fat trap allows for the harvesting of important amounts of fatty tissue and reduces the duration of surgery. This is particularly interesting when important volumes have to be reconstructed using adipocytes. Furthermore, our technique is simple and does not require a specific device because 800-ml drainage bottles can be found in every surgical unit. Liposuction using the fat trap is a simple technique that is helpful when large amounts of adipose tissue are needed in reconstructive surgery. A prospective evaluation of our autologous fat grafting cases is currently ongoing and will allow us to compare the fat-resorption rate of this technique to that of the Coleman technique. DISCLOSURE The authors have no conflicts of interest to disclose. Tarik Ihrai, M.D. Krishna B. Clough, M.D. Claude Nos, M.D. Isabelle Sarfati, M.D. Paris Breast Center Paris, France

A Global Health Partnership's Use of Time-Limited Support to Catalyze Health Practice Change: The Case of GAVI's Injection Safety Support

This paper presents the findings of a study to assess the effectiveness and sustainability of a GAVI (Global Alliance of Vaccines and Immunization) sponsored, time-limited Injection Safety (INS) support. The support came in two forms: 1) in-kind, in the form of AD syringes and safety boxes, and 2) in cash, for those countries that already had a secure, multi-year source of AD syringes and safety boxes, but proposed to use INS support to strengthen their injection safety activities. In total, GAVI gave INS support for a three-year period to 58 countries: 46 with commodities and 12 with cash support. To identify variables that might be associated with financial sustainability, frequencies and cross-tabulations were run against various programmatic and socio-economic variables in the 58 countries. All but two of the 46 commodity-recipient countries were able to replace and sustain the use of AD syringes and safety boxes after the end of their GAVI INS support despite the fact that standard disposable syringes are less costly than ADs (10–15 percent differential). In addition, all 12 cash-recipient countries continued to use AD syringes and safety boxes in their immunization programs in the years following GAVI INS assistance. At the same time, countries were often not prepared for the increased waste management requirements associated with the use of the syringes, suggesting the importance of anticipating challenges with the introduction of new technologies. The sustained use of AD syringes in countries receiving injection safety support from GAVI, in a majority of cases through government financing, following the completion of three years of time-limited support, represents an early indication of how GHPs can contribute to improved health outcomes in immunization safety in the world's poorest countries in a sustainable way.

Targeted, Needle‐Free Vaccinations in Skin using Multilayered, Densely‐Packed Dissolving Microprojection Arrays

Targeting of vaccines to abundant immune cell populations within our outer thin skin layers using miniaturized devices-much thinner than a needle and syringe, could improve the efficacy of vaccines (and other immunotherapies). To meet this goal, a densely packed dissolving microprojection array (dissolving Nanopatch) is designed, achieving functional miniaturization by 1) formulating small microneedles (two orders of magnitude smaller than a standard needle and syringe) and 2) multiple layering of the payload within microprojections with tight tolerances (of the order of a micrometer). The formulation method is suitable to many vaccines because it is without harsh or complex chemical processes, and it is performed at low temperatures and at a neutral pH. When the formulated dNPs are applied to skin, consistent and robust penetration is achieved, rapidly targeting the skin strata of interest (<5 min; significantly faster than larger dissolving microneedles that have been previously reported). Resultant diffusion is significantly enhanced within the dermis compared with the epidermis. Using two different antigens (ovalbumin and a commercial trivalent influenza vaccine [Fluvax2008]), the administration of these dissolving patches generate robust systemic immune responses in a mouse model. To the authors' knowledge, this is the first report of successful vaccination with any form of dissolving microneedles. The patches made by this method therefore have the potential for pain-free, needle-free, and effective vaccination in humans.

Influence of a Passive Sonic Irrigation System on the Elimination of Bacteria from Root Canal Systems: A Clinical Study

Introduction The present investigation evaluated the ability of a new passive sonic irrigation (sonic group) system (EndoActivator) to eliminate cultivable bacteria from root canals in vivo and compared it with that of standard syringe irrigation (control group). Methods Data were obtained by using bacteriologic sampling of root canals treated by endodontic residents. Sampling results from 1 session of treatment were then compared with results obtained after intervisit calcium hydroxide disinfection and a second session of treatment. Results There was no significant difference in the ability of sonic group and control group to eliminate cultivable bacteria from root canals ( P > .05). A second session and intervisit calcium hydroxide disinfection were able to eliminate cultivable bacteria from significantly more teeth than a single session of treatment ( P < .05). Conclusions These in vivo results strengthen the case for a multi-visit approach to the treatment of apical periodontitis.

The role of bulk modulus in epidural placement

Figure 4 4) Constant force on the plunger that automatically depresses when the epidural needle enters the epidural space eliminates the subjective “feel” required with standard LOR syringes. 5) Air Vs Saline: As no subjective feel is required, technically saline is as good as air. Thus by avoiding air complications related to it like, patchy block, risk of venous air embolism can be avoided. 6) Cost effective: by replacing regular syringe instead of LOR syringe cost can reduced.

Electroporation: A promising method for the nonviral delivery of DNA vaccines in humans?

The without a doubt major obstacle for making DNA vaccines a commercial success is delivery. If delivery cannot be made simple, cheap and effective, DNA vaccines may not become a viable option for human use. Numerous clinical trials have confirmed that a standard needle and syringe simply do not do the job, i.e., delivering the DNA payload inside the cell. Having recognized this shortcoming, investigators have developed several new approaches for DNA vaccine delivery. In particular, new types of delivery devices, originally intended for in vitro use, have been applied for in vivo delivery. These include particle bombardment or biolistic delivery, and in vivo electroporation (EP). Importantly, both techniques seem to overcome the size barrier, meaning that they work in both mice and larger animals. In vivo EP has the key features of improved DNA uptake, increased antigen expression and a local inflammation. These factors are essential to make DNA vaccines effective in a larger host. Early data from clinical trials with DNA vaccines delivered by in vivo EP are cautiously promising. Thus, we may be entering a new era of DNA vaccination where we start to see clinical effects in humans; however, these may also be accompanied by side effects, as the vaccines become more effective.