Intramuscular injections can cause damage to arteries, veins and nerves. Achieving maximum effects of medications through precise intramuscular (IM) injections must be assured and with certainty, particularly with lon...Intramuscular injections can cause damage to arteries, veins and nerves. Achieving maximum effects of medications through precise intramuscular (IM) injections must be assured and with certainty, particularly with long-acting injection drugs (LAI). The purpose of this study is to determine precision in IM LAIs of patients with schizophrenia. These evidences estimate “Distance from the Epidermis to the Under-Fascia” (DEUF) and “Distance from Epidermis to the Upper-Arm Bone” (DEB) of the deltoid muscle. Explanatory variables include body height, weight, body-mass index (BMI), deltoid-muscle circumference, fat percentage and muscle mass measured by body composition monitor. Sixty nine subjects are included based on the Diagnostic Statistical Manual of Mental Disorders (DSM-IV, 1994), and receive treatments of typical and atypical antipsychotic LAI. There are 46 males and 23 females with average age of 51.41 (Standard Deviation = 13.58) and ranging from 21 to 81 years who are all right-handed. Ultrasonographic data and those from explanatory variables are calculated using Spearman’s rank correlation coefficients. Multiple regression analysis (step-wise method/forced input method) is performed assuming DEUF or DEB as dependent variables. Significant correlations are found with highest adjusted R-square. Paired t-tests show differences in average values of actual ultrasonographic measurements assigned to DEUF or DEB, and the regression equations for accuracy. Ultrasonographic values are assigned multiple-regression equations as true values, and the calculated values are compared with those obtained by regression equations. There are no significant differences observed for either the right or left arm. The multiple regression equations for BMI and fat percentages (upper extremity estimation) of DEUF, and for BMI and injection site circumference of estimated DEB, successfully value the DEUF and DEB. By using these multiple regression equations for IM injection to the deltoid-muscle, DEUF can better ensure accurate LAI into the muscle through body monitor, DEB, and measured values of the deltoid-muscle injection site circumference.展开更多
BACKGROUND Hemorrhoids are a common anal condition and can afflict an individual at any age.Epidemiological survey results in China show that the prevalence of anorectal diseases is as high as 50.1%among which 98.08%o...BACKGROUND Hemorrhoids are a common anal condition and can afflict an individual at any age.Epidemiological survey results in China show that the prevalence of anorectal diseases is as high as 50.1%among which 98.08%of patients have hemorrhoid symptoms.AIM To assess long-term efficacy and safety of cap-assisted endoscopic sclerotherapy(CAES)with long injection needle for internal hemorrhoids.METHODS This study was retrospective.Data from patients with symptomatic internal hemorrhoids treated with CAES using endoscopic long injection needle from April 2016 to December 2019 were collected.Patients were telephoned and followed at two time points,December 2020 and 2021,to evaluate the improvements in symptoms,complications,recurrence,and satisfaction.RESULTS Two hundreds and one patients with internal hemorrhoids underwent CAES with the long needle.The first median follow-up was performed 33 mo postoperatively.Symptoms improved in 87.5%of patients after the first CAES.Efficacy did not decrease with treatment time extension.Fifty-four patients underwent colonoscopy after the first CAES treatment of which 21 underwent CAES again,and 4 underwent hemorrhoidectomy.At the first follow-up,62.7%of patients had both improved hemorrhoid grades and symptoms,and 27.4%had a significant improvement in both parameters.At the second follow-up,61.7%of the patients showed satisfactory improvement in their hemorrhoid grade and symptoms when compared with pre-surgery values.90%of patients reported CAES was painless,and 85%were satisfied/very satisfied with CAES treatment outcomes.CONCLUSION The present study based on the largest sample size reported the long-term follow-up of the treatment for internal hemorrhoid with the CAES using endoscopic long injection needle.Our findings demonstrate that CAES should be a micro-invasive endoscopic technology yields satisfactory long-term efficacy and safety.展开更多
Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer...Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.展开更多
目的系统评价棕榈酸帕利哌酮注射液与其他抗精神病药长效针剂比较治疗精神分裂症的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、PsycINFO、CNKI、SinoMed、VIP、WanFang Data数据库,搜集关于棕...目的系统评价棕榈酸帕利哌酮注射液与其他抗精神病药长效针剂比较治疗精神分裂症的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、PsycINFO、CNKI、SinoMed、VIP、WanFang Data数据库,搜集关于棕榈酸帕利哌酮注射液对比其他抗精神病药长效针剂治疗精神分裂症的随机对照试验(RCT),检索时限均从建库至2023年4月30日。由2名研究者独立筛选、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入12个RCT,包括4368例患者。Meta分析结果显示,棕榈酸帕利哌酮注射液组与利培酮长效针剂组的临床有效率差异无统计学意义(P>0.05),与其他抗精神病药长效针剂组的阳性和阴性症状量表(PANSS)总体评分改变值差异也无统计学意义(P>0.05)。与其他抗精神病药长效针剂组相比,棕榈酸帕利哌酮注射液组总退出率[RR=1.14,95%CI(1.06,1.24),P<0.01]和肌注部位异常的不良反应发生率[RR=2.08,95%CI(1.03,4.22),P=0.04]均显著增加。结论当前证据表明,与其他抗精神病药长效针剂相比,棕榈酸帕利哌酮注射液治疗精神分裂症的有效性并无明显差异,但部分不良反应发生率稍有增加。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。展开更多
A neutral beam injection (NBI) system has been developed and is being tested for an Experimental Advanced Superconducting Tokamak (EAST) device. The NBI system needs to be employed for an auxiliary heating and current...A neutral beam injection (NBI) system has been developed and is being tested for an Experimental Advanced Superconducting Tokamak (EAST) device. The NBI system needs to be employed for an auxiliary heating and current drive of EAST plasmas. The first long pulse ion source (LPIS-1) has been installed in the neutral beam test bed (NBTB) system, and the performance is being tested in the NBTB. The LPIS-1 consists of a magnetic bucket plasma generator with multipole cusp-fields and a set of tetrode accelerators with slit-type apertures (a transparency of 60%). The ion beam trajectories of the accelerator column are estimated for the LPIS-1, including an original structure, with the change of slit aperture distance, plasma grid shape, grid gap distance, and voltage ratio between a plasma grid and a gradient grid using the IGUN code. This kind of calculation for the ion beam trajectory may be useful for the estimation of beam extraction characteristics and the direction of accelerator upgrade or modification, prior to the experiments of ion beam extraction.展开更多
Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article wa...Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new con-firmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.展开更多
The aim of this study was to consider the characteristics of intramuscular diffusion status of risperidone and aripiprazole long acting injectable (LAI) by ultrasonography. Subjects were 40 adult subjects diagnosed wi...The aim of this study was to consider the characteristics of intramuscular diffusion status of risperidone and aripiprazole long acting injectable (LAI) by ultrasonography. Subjects were 40 adult subjects diagnosed with schizophrenia and treated with LAI [32 patients were risperidone LAI (RLAI) and 8 patients were aripiprazole LAI (ALAI)]. However, in this paper, only three cases (one RLAI case and 2 ALAI cases) were selected to illustrate the diffusion effects of both LAI. Dorsogluteal intramuscular (IM) injection sites were measured at prone position using the “double cross” method. Before LAI injection, the distance from the epidermis to the under-fascia (DEUF), and distance from the epidermis to the iliac bone (DEI) at the IM injection site were assessed by using ultrasonography: 1) the injection needle was inserted to the gluteus medius, and 2) observed the diffusion status within the muscle injected RLAI and ALAI were confirmed using the B-mode ultrasonography. Both RLAI and ALAI were depicted as high echogenicity with acoustic shadowing. It was considered that the diffusion states of LAIs by ultrasonography were important time course evaluations providing objective evidence.展开更多
In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is de...In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.展开更多
On HL-2A,two different injections(supersonic molecular beam injection(SMBI)and pellet injection(PI)) are used to mitigate edge localized mode(ELM)-filament convective transport.The changes of their characteristics are...On HL-2A,two different injections(supersonic molecular beam injection(SMBI)and pellet injection(PI)) are used to mitigate edge localized mode(ELM)-filament convective transport.The changes of their characteristics are studied in this paper.A high spatiotemporal resolution probe shows there are many similar phenomena,and the filament density amplitude and radial velocity are both suppressed.Our statistical results indicate that:the velocity suppression comes from the decrease of filament density and temperature;the transient particle and heat fluxes drop strongly;and long-range correlation along a magnetic flux surface also decreases,when the electron-ion collisionality increases significantly,which may have a role on the filament parallel current during ELM mitigation.展开更多
文摘Intramuscular injections can cause damage to arteries, veins and nerves. Achieving maximum effects of medications through precise intramuscular (IM) injections must be assured and with certainty, particularly with long-acting injection drugs (LAI). The purpose of this study is to determine precision in IM LAIs of patients with schizophrenia. These evidences estimate “Distance from the Epidermis to the Under-Fascia” (DEUF) and “Distance from Epidermis to the Upper-Arm Bone” (DEB) of the deltoid muscle. Explanatory variables include body height, weight, body-mass index (BMI), deltoid-muscle circumference, fat percentage and muscle mass measured by body composition monitor. Sixty nine subjects are included based on the Diagnostic Statistical Manual of Mental Disorders (DSM-IV, 1994), and receive treatments of typical and atypical antipsychotic LAI. There are 46 males and 23 females with average age of 51.41 (Standard Deviation = 13.58) and ranging from 21 to 81 years who are all right-handed. Ultrasonographic data and those from explanatory variables are calculated using Spearman’s rank correlation coefficients. Multiple regression analysis (step-wise method/forced input method) is performed assuming DEUF or DEB as dependent variables. Significant correlations are found with highest adjusted R-square. Paired t-tests show differences in average values of actual ultrasonographic measurements assigned to DEUF or DEB, and the regression equations for accuracy. Ultrasonographic values are assigned multiple-regression equations as true values, and the calculated values are compared with those obtained by regression equations. There are no significant differences observed for either the right or left arm. The multiple regression equations for BMI and fat percentages (upper extremity estimation) of DEUF, and for BMI and injection site circumference of estimated DEB, successfully value the DEUF and DEB. By using these multiple regression equations for IM injection to the deltoid-muscle, DEUF can better ensure accurate LAI into the muscle through body monitor, DEB, and measured values of the deltoid-muscle injection site circumference.
文摘BACKGROUND Hemorrhoids are a common anal condition and can afflict an individual at any age.Epidemiological survey results in China show that the prevalence of anorectal diseases is as high as 50.1%among which 98.08%of patients have hemorrhoid symptoms.AIM To assess long-term efficacy and safety of cap-assisted endoscopic sclerotherapy(CAES)with long injection needle for internal hemorrhoids.METHODS This study was retrospective.Data from patients with symptomatic internal hemorrhoids treated with CAES using endoscopic long injection needle from April 2016 to December 2019 were collected.Patients were telephoned and followed at two time points,December 2020 and 2021,to evaluate the improvements in symptoms,complications,recurrence,and satisfaction.RESULTS Two hundreds and one patients with internal hemorrhoids underwent CAES with the long needle.The first median follow-up was performed 33 mo postoperatively.Symptoms improved in 87.5%of patients after the first CAES.Efficacy did not decrease with treatment time extension.Fifty-four patients underwent colonoscopy after the first CAES treatment of which 21 underwent CAES again,and 4 underwent hemorrhoidectomy.At the first follow-up,62.7%of patients had both improved hemorrhoid grades and symptoms,and 27.4%had a significant improvement in both parameters.At the second follow-up,61.7%of the patients showed satisfactory improvement in their hemorrhoid grade and symptoms when compared with pre-surgery values.90%of patients reported CAES was painless,and 85%were satisfied/very satisfied with CAES treatment outcomes.CONCLUSION The present study based on the largest sample size reported the long-term follow-up of the treatment for internal hemorrhoid with the CAES using endoscopic long injection needle.Our findings demonstrate that CAES should be a micro-invasive endoscopic technology yields satisfactory long-term efficacy and safety.
文摘Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.
文摘A neutral beam injection (NBI) system has been developed and is being tested for an Experimental Advanced Superconducting Tokamak (EAST) device. The NBI system needs to be employed for an auxiliary heating and current drive of EAST plasmas. The first long pulse ion source (LPIS-1) has been installed in the neutral beam test bed (NBTB) system, and the performance is being tested in the NBTB. The LPIS-1 consists of a magnetic bucket plasma generator with multipole cusp-fields and a set of tetrode accelerators with slit-type apertures (a transparency of 60%). The ion beam trajectories of the accelerator column are estimated for the LPIS-1, including an original structure, with the change of slit aperture distance, plasma grid shape, grid gap distance, and voltage ratio between a plasma grid and a gradient grid using the IGUN code. This kind of calculation for the ion beam trajectory may be useful for the estimation of beam extraction characteristics and the direction of accelerator upgrade or modification, prior to the experiments of ion beam extraction.
文摘Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new con-firmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.
文摘The aim of this study was to consider the characteristics of intramuscular diffusion status of risperidone and aripiprazole long acting injectable (LAI) by ultrasonography. Subjects were 40 adult subjects diagnosed with schizophrenia and treated with LAI [32 patients were risperidone LAI (RLAI) and 8 patients were aripiprazole LAI (ALAI)]. However, in this paper, only three cases (one RLAI case and 2 ALAI cases) were selected to illustrate the diffusion effects of both LAI. Dorsogluteal intramuscular (IM) injection sites were measured at prone position using the “double cross” method. Before LAI injection, the distance from the epidermis to the under-fascia (DEUF), and distance from the epidermis to the iliac bone (DEI) at the IM injection site were assessed by using ultrasonography: 1) the injection needle was inserted to the gluteus medius, and 2) observed the diffusion status within the muscle injected RLAI and ALAI were confirmed using the B-mode ultrasonography. Both RLAI and ALAI were depicted as high echogenicity with acoustic shadowing. It was considered that the diffusion states of LAIs by ultrasonography were important time course evaluations providing objective evidence.
文摘In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.
基金supported by National Natural Science Foundation of China(Nos.11075046,10975049,11375054,11275060)the National Magnetic Confinement Fusion Science Program of China(Nos.2013GB112008,2013GB107000,2013GB104002,2014GB107000,2014GB108000)the China-Korean Joint Research Program(No.2012DFG02230)
文摘On HL-2A,two different injections(supersonic molecular beam injection(SMBI)and pellet injection(PI)) are used to mitigate edge localized mode(ELM)-filament convective transport.The changes of their characteristics are studied in this paper.A high spatiotemporal resolution probe shows there are many similar phenomena,and the filament density amplitude and radial velocity are both suppressed.Our statistical results indicate that:the velocity suppression comes from the decrease of filament density and temperature;the transient particle and heat fluxes drop strongly;and long-range correlation along a magnetic flux surface also decreases,when the electron-ion collisionality increases significantly,which may have a role on the filament parallel current during ELM mitigation.
