Research progress of needle-free injection technology / 药学学报

Needle-free injection technology (NFIT) refers to the drug delivery systems in which drugs are propelled as high-speed jet streams using any of the pressure source to penetrate the skin to the required depth. NFIT is a promising drug delivery system as it enables the injection of liquids, powders, and depot/projectiles, and has the advantages of preventing needle stick accidents, improving drug bioavailability, eliminating needle-phobia, increasing vaccine immunity, simplifying operations and is convenient for patients to use. NFIT and its research background, the structure and classification of needle-free jet injectors (NFJI), drugs that can be delivered using NFJI and the factors affecting the injection effect are comprehensively reviewed in this paper. The limitations and potential development directions are summarized to provide a theoretical basis for the application and development of NFIT.

Study on Testing Methods of Pen-injector's Dosing Accuracy / 中国医疗器械杂志

OBJECTIVE@#An accuracy test method is proposed to reduce the amount of reagents used in the test and reduce the cost of spot checks and self-tests.@*METHODS@#According to the requirements of dose accuracy test in standard atmospheric conditions in ISO 11608-1:2014, dose accuracy test is carried out for the same batch of reusable pen injector samples by using the test method proposed in this paper and the test method in relevant foreign research, and the data measured by the two methods are processed.@*RESULTS@#After experimental testing and analysis, the data measured by the two methods did not exceed the dose accuracy limit specified in the ISO standard. There was no significant difference between the two methods when the dose of 60 U and 30 U were tested, but there was significant difference when the dose of 1 U was tested.@*CONCLUSIONS@#Both methods can be used to evaluate dose accuracy, however, the method proposed in this paper can reduce the usage of drugs by 2/3, so it can reduce cost of supervised test.

A prospective study of contrast preservation using ultra-low contrast delivery technique versus standard automated contrast injector system in coronary procedures

Background We aimed to assess the decrease in contrast media volume (CMV) with ultra-low contrast delivery technique (ULCD) developed at our institution versus the usual automated contrast injector system (ACIS) contrast delivery in coronary procedures. Methods We analyzed the amount of contrast given in the consecutive 204 patients of the operators who use ULCD technique versus consecutive 200 patients of the other operators who use ACIS without ULCD technique for coronary angiograms and/or percutaneous coronary interventions (PCIs) from May 2017 to July 2018 at our center. We calculated the mean CMV between these groups. Results We observed a significant reduction in mean CMV with ULCD technique versus standard ACIS, respectively: angiogram 24.8 ± 15.8 mL (n = 194) vs 42.3 ± 25.1 mL (n = 200) (p < 0.0001); PCI 23.5 ± 19.7 mL (n = 52) vs 48.2 ± 30.8 mL (n = 16) (p < 0.0070); angiogram with ad hoc PCI 53.4 ± 32.1 mL (n = 23) vs 89.7 ± 35.6 mL (n = 16) (p < 0.0024); and overall angiogram and PCI 27.4 ± 20.5 mL (n = 204) vs 44.9 ± 28.0 mL (n = 181) (p < 0.0001). Conclusion Our study showed a highly significant reduction in CMV using ULCD technique compared to standard ACIS contrast delivery in coronary invasive procedures. Even in the standard ACIS arm, CMV was significantly lower than values reported in literature, possibly due to operators' bias toward contrast preservation.

Therapeutic effect and imaging study of directional bone cement guide for the treatment of thoracolumbar vertebral compression fractures / 中国骨伤

OBJECTIVE@#To evaluate the therapeutic effects and bone cement distribution of unilateral percutaneous kyphoplasty (PKP) with oriented bone cement injector for thoracolumbar osteoporotic vertebral compression fractures (OVCFs).@*METHODS@#The clinical data of 211 patients (211 vertebrae) with thoracolumbar osteoporotic compression fractures underwent PKP between July 2016 to July 2018 were retrospectively analyzed. All punctures were performed unilaterally:102 patients in observation group used oriented bone cement injector including 30 males and 72 females with an average age of (68.4±8.9)years old; 109 patients in regular group used traditional bone cement injector including 32 males and 77 females with an average age of (70.4±9.2) years old. The two groups were compared in terms of duration of operation, cement volume, visual analogue scale(VAS), Oswestry Disability Index(ODI), distribution of bone cement, bone cement leakage and Cobb angle modified rate.@*RESULTS@#There were no significant difference in gender, age and fracture vertebra between the two groups(>0.05). No significant difference was found between two groups in duration of operation, cement volume, VAS, ODI and Cobb angle(>0.05). In observation group, 10 cases occurred cement leakages, with leakage rate of 9.80%; and in regular group, 11 cases occurred cement leakage, with leakage rate of 10.09%. There was no significant difference in the cement leakage rate between two groups(>0.05). In observation group, proportion rate of I-IV degree in cement distribution was 60.78%, 19.61%, 9.80%, 9.80%, respectively; while 39.45%, 22.93%, 22.93%, 14.68% in regular group. The I degree of cement cross-filling rate was better in observation group than in regular group(0.05). From T10 to L₅, I degree bone cement distribution rate of both groups showed decline trend. The I degree cement cross-filling rate in L₁-L₅ was 50% in observation group and 30.23% in regular group(<0.05).@*CONCLUSIONS@#Oriented bone cement injector can control the direction of bone cement dispersion and achieve effective distribution of bilateral bone cement using unilateral puncture and satisfactory surgical results. It is feasible and effective for unilateral PKP treatment of OVCFs.

Administration of the adrenaline auto-injector at the nursery/kindergarten/school in Western Japan

BACKGROUND: In view of the increasing prevalence of food allergies, there has been an associated increase in frequency of situations requiring an emergency response for anaphylaxis at the home, childcare facilities and educational institutions. OBJECTIVE: To clarify the situation of adrenaline auto-injector administration in nursery/kindergarten/school, we carried out a questionnaire survey on pediatric physicians in Western Japan. METHODS: In 2015, self-reported questionnaires were mailed to 421 physicians who are members of the West Japan Research Society Pediatric Clinical Allergy and Shikoku Research Society Pediatric Clinical Allergy. RESULTS: The response rate was 44% (185 physicians) where 160 physicians had a prescription registration for the adrenaline auto-injector. In the past year, 1,330 patients were prescribed the adrenaline auto-injector where 83 patients (6% of the prescribed patients) actually administered the adrenaline auto-injector, of which 14 patients (17% of the administered patients) self-administered the adrenaline auto-injector. “Guardians” at the nursery/kindergarten and elementary school were found to have administered the adrenaline auto-injector the most. Among 117 adrenaline auto-injector prescription-registered physicians, 79% had experienced nonadministration of adrenaline auto-injector at nursery/kindergarten/school when anaphylaxis has occurred. The most frequent reason cited for not administering the adrenaline auto-injector was “hesitation about the timing of administration.” CONCLUSION: If the adrenaline auto-injector was administered after the guardian arrived at the nursery/kindergarten/school, it may lead to delayed treatment of anaphylaxis in which symptoms develop in minutes. Education and cooperation among physicians and nursery/kindergarten/school staff will reduce the number of children suffering unfortunate outcomes due to anaphylaxis.

Influences of sterile injector on infusion precision of syringe pump / 医疗卫生装备

To explore the influences of the sterile injectors with different sources while the same capacity on the infusion precision of the syringe pump. With six injects with two brands were selected as the subjects and an electronic pump for measuring, flow test was carried out with the brands marked on the pump or not. There was significant difference between the flows from the syringe pumps marked with the injector brands and those without the mark of the brands. The sterile injector has to be set before using the syringe pump.

Evaluation of efficacy of intralesional glucocorticoid injection with a needle-free injector for the treatment of keloid / 中华皮肤科杂志

Objective To compare the efficacy of intralesional glucocorticoid injection with a needle-free injector versus an ordinary injector for the treatment of keloid. Methods A total of 60 patients with keloid were enrolled and randomly divided into two groups by using a random number table to receive intralesional injection of compound betamethasone with a needle-free injector(n=31)or an ordinary injector(n=29). The injection was given at a dose of 0.2 ml/cm3 once every 3 weeks for 3 sessions. Parameters for therapeutic efficacy were assessed, adverse reactions were recorded, and clinical pictures were taken before and after each treatment. Statistical analysis was carried out by the Mann-Whitney U test and chi-square test with the SPSS 19.0 software. Results Compared with the ordinary injector group, the needle-free injector group showed significantly different injection time during the first and second treatment (U=299.000, 773.500, respectively, both P=0.000), as well as duration of pain after the first injection(U=730.000, P=0.003). After three sessions of treatment, there was a significant difference in the volume, height, hardness of keloid, scores for pain, itching and appearance, and number of injection points between the needle-free injector group and ordinary injector group (U=295.000, 336.500, 264.000, 464.000, 451.500, 308.000, 233.500, P=0.001, 0.007, 0.000, 0.041, 0.043, 0.003, 0.001, respectively). No significant differences were observed in the incidence of adverse reactions between the two groups(all P>0.05). Moreover, the interval for lesion recurrence was significantly shorter in the needle-free injector group(11.8 days, 95%CI:10.96-12.6 days)than in the ordinary injector group(21.2 days, 95%CI:13.96-28.45 days). Conclusion Compared with the ordinary injector, the needle-free injector shows better efficiency for the treatment of keloid with decreased difficulty in injection and improved compliance in patients.

Transscleral Fixation of Intraocular Lenses Using Modified Injector

PURPOSE: To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector. METHODS: We have modified and used the Sapphire unfolder injector system (Allergan(R), USA). This involved, cutting a slit longitudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o'clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o'clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o'clock) is tied to the haptic on the opposite side and inserted. RESULTS: The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly. CONCLUSIONS: This technique is an effective procedure for minimizing entangled thread and corneal astigmatism.

Scleral fixation of one piece intraocular lens by injector implantation.

Aim of Study: With an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fi xation through small clear corneal incision. Materials and Methods: Case report and literature review. Results: This procedure has been performed in eight aphakic eyes with four diff erent types of IOLs. Good centration was achieved with minimal technical eff ort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up. Conclusion: We managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fl uid leakage and consecutive hypotony can be minimized.

Auto-injector:a supporting approach of emergency medicine for the first-aid / 国际药学研究杂志

Auto-injector, a spring-driven drug-device based combination production that automatically injects the drug into the skin via a pre-filled syringe or cartridge, allows minimally trained individuals to self-inject potentially life-saving medication when e-mergency medical care may be absent or remote, and thus has been becoming a supporting approach of emergency medicine for the first-aid. The auto-injector was developed originally by the United State of America, and experienced the three outstanding states in-cluding syrettes, single chamber auto-injectors and dual chamber auto-injectors from the battlefield to the civilianization. The current auto-injector devices have five different types named as ACE (AtroPen), ComboPen, Binaject, Soluject and Truject, respectively. The applied drugs to the systems for military use have atropine, pralidoxime chloride, obidoxime, diazepam and morphine sulfate. The oth-er drugs for emergency medical use such as epinephrine, lidocaine hydrochloride and sumatriptan have been also applied to. All of the auto-injector based combination production have been twined with a simulator in order to conduct a training schedule before use. Importantly, the needle hidden or the device-status notification technique after injection has been becoming a trend in the technology advances of the auto-injectors.

Auto-injector: A supporting approach of emergency medicine for the first-aid / 国际药学研究杂志

Auto-injector, a spring-driven drug-device based combination production that automatically injects the drug into the skin via a pre-filled syringe or cartridge, allows minimally trained individuals to self-inject potentially life-saving medication when emergency medical care may be absent or remote, and thus has been becoming a supporting approach of emergency medicine for the first-aid. The auto-injector was developed originally by the United State of America, and experienced the three outstanding states including syrettes, single chamber auto-injectors and dual chamber auto-injectors from the battlefield to the civilianization. The current auto-injector devices have five different types named as ACE (AtroPen), ComboPen, Binaject, Soluject and Truject, respectively. The applied drugs to the systems for military use have atropine, pralidoxime chloride, obidoxime, diazepam and morphine sulfate. The other drugs for emergency medical use such as epinephrine, lidocaine hydrochloride and sumatriptan have been also applied to. All of the auto-injector based combination production have been twined with a simulator in order to conduct a training schedule before use. Importantly, the needle hidden or the device-status notification technique after injection has been becoming a trend in the technology advances of the auto-injectors.

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

PURPOSE: To investigate effects of a new push-through insertion method for donor lenticules using an injector system on endothelial viability ex vivo and in a clinical case series of endothelial keratoplasty. METHODS: An ex vivo delivery model was used with porcine corneoscleral rims. We compared the endothelial viability in a new push-through insertion method using the Visian Implantable Collamer Lens (ICL) injector versus that of standard forceps-assisted insertion for lenticule delivery. Twenty porcine corneal lenticules were divided into four groups by insertion method and wound size. Vital dye staining was performed and devitalized areas were semi-quantitatively assessed by digital imaging. In the clinical case series, Descemet's stripping endothelial keratoplasty (DSEK) using the push-through method was performed in seven patients and endothelial outcome was determined six months postoperatively. RESULTS: Mean devitalized areas for the push-through method were significantly lower than for forceps-assisted insertion through 3.2 mm incision (23.99 +/- 2.17% vs. 50.48 +/- 5.07%, p = 0.009) in the ex vivo model. Average endothelial cell counts of donor tissues of patients who underwent DSEK were 26.4% lower six months postoperatively. CONCLUSIONS: Push-through delivery of donor lenticules using the Visian ICL injector system appears to be less harmful to endothelial cells than conventional forceps-assisted delivery.

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

PURPOSE: To investigate effects of a new push-through insertion method for donor lenticules using an injector system on endothelial viability ex vivo and in a clinical case series of endothelial keratoplasty. METHODS: An ex vivo delivery model was used with porcine corneoscleral rims. We compared the endothelial viability in a new push-through insertion method using the Visian Implantable Collamer Lens (ICL) injector versus that of standard forceps-assisted insertion for lenticule delivery. Twenty porcine corneal lenticules were divided into four groups by insertion method and wound size. Vital dye staining was performed and devitalized areas were semi-quantitatively assessed by digital imaging. In the clinical case series, Descemet's stripping endothelial keratoplasty (DSEK) using the push-through method was performed in seven patients and endothelial outcome was determined six months postoperatively. RESULTS: Mean devitalized areas for the push-through method were significantly lower than for forceps-assisted insertion through 3.2 mm incision (23.99 +/- 2.17% vs. 50.48 +/- 5.07%, p = 0.009) in the ex vivo model. Average endothelial cell counts of donor tissues of patients who underwent DSEK were 26.4% lower six months postoperatively. CONCLUSIONS: Push-through delivery of donor lenticules using the Visian ICL injector system appears to be less harmful to endothelial cells than conventional forceps-assisted delivery.

Determinación de cobre, magnesio y zinc en leucocitos mononucleares mediante espectrometría de absorción atómica con llama / Determination of copper, magnesium and zinc in mononuclear leukocytes by flame atomic absorption spectrometry

En este trabajo se evaluó un nuevo microinyector de inyección en flujo para la determinación de Cu, Mg y Zn en células mononucleares de la sangre. Este dispositivo permitió analizar muestras en el orden de microlitros mediante espectrometría de absorción atómica con llama, es fácil de construir y adaptar al inyector convencional del espectrofotómetro de absorción atómica. En la determinación de Cu, Mg y Zn se obtuvieron límites de detección de 106, 65 y 37 µg L-1,respectivamente. En las pruebas de recuperación de estos elementos en leucocitos mononucleares se encontraron porcentajes de recuperación entre 98 y 110%.

In this paper we evaluated a new micro-flow injector for the determination of the concentrations of Cu, Mg and Zn in mononuclear blood cells. This device analyzed sample volumes in the order of microliters by flame atomic absorption spectrometry; it is inexpensive, and easy to build and to adapt to the conventional injector of the atomic absorption spectrophotometer. Detection limits of 106, 65 and 37 µg L-1 for Cu, Mg and Zn were obtained, respectively. The percentages of recovery tests were found between 98 and 110%.

A Case of Needleless Jet Injector Induced Bilateral Chorioretinal Injury

PURPOSE: To report a case of bilateral chorioretinal injury by needleless jet injector misuse. CASE SUMMARY: In a dermatology department, the patient was diagnosed as having total alopecia and was scheduled to be injected on her eyelash by needleless jet injector for treatment but inexpert doctor injected on the eyelid, not eyelash, by mistake. She then suddenly complained of blurred vision and a floater just after that procedure and was referred to the ophthalmology department. Bilateral vitreous hemorrhage and preretinal hemorrhage were seen during indirect ophthalmoscopic examination and bilateral prophylactic argon laser photocoagulation was done around the suspicious tear site. Then bilateral vitreous hemorrhage and preretinal hemorrhage were absorbed and we found a partial retinal rupture lesion and choroidal rupture lesion in the right eye and a retinal injury lesion in the lefteye. Therefore we observed the lesions of both eyes continuously without further treatment. Her clinical symptoms improved. CONCLUSIONS: Needleless jet injector has many advantages, especially less pain and injury than a normal needle injector and is usually used in clinic as preoperative local anesthesia and steroid injection in many medical fields. In this case, the needleless injector was accidentally misused inducing both direct and indirect choroidal rupture and retinal injury. In general, while a needleless jet injector is used in ophthalmology department, we have to use it with the greatest care.

The Effect of Premedication using a Jet-injector in Pediatric Patients / 대한마취과학회지

BACKGROUND: This study was designed to evaluate the efficacy and safety of midazolam premedication administered by a jet-injector in pediatric patients. METHODS: Children undergoing outpatient surgery were randomized into three groups: intravenous induction with thiopental sodium (control group, n = 20), oral midazolam premedication (PO-med group, n = 20) or midazolam premedication using a jet-injector (Jet-med group, n = 20). In the PO-med and Jet-med group patients, anesthetic induction was performed by sevoflurane inhalation and an intravenous catheter (IVC) was inserted after the children had been anesthetized by sevoflurane inhalation. For the control group patients, an IVC was placed in the preoperative holding area. Agitation scores were recorded in the preoperative holding area and recovery room. Anesthesia times and the views of the medical staff concerning the technique benefits were also noted. Patients and parents were interviewed on the following day. RESULTS: Maximum agitation scores in the preoperative holding area and during separation with parents were significantly lower in the PO-med and Jet-med groups. The induction time was significantly longer in the PO-med and Jet-med groups. No statistically significant differences were found for the recovery characteristics. Though interviews with patients and parents produced similar results for patients in each group, the medical staff satisfaction levels were significantly higher for patients in the PO-med and Jet-med groups. CONCLUSIONS: The findings of this study suggest that the application of the jet-injector for midazolam premedication may be clinically useful in children who do not have an IVC. The use of the jet-injector could be a substitute for the oral route for midazolam administration.

Scleral Fixation of Foldable Intraocular Lenses Using Injector

PURPOSE: To introduce the method of scleral fixation, using Mport(TM) (Bausch & Lomb) injector and silicone three-piece foldable IOL (Silens 6, Bausch & Lomb). METHODS: The study was conducted for five cases of aphakia requiring secondary implantation of IOL. The partial-thickness scleral flaps were made on 2 and 8 o' clock site. A double-armed 10-0 polypropylene suture and 26G needle were inserted through each sclera. Surgical and 26G needle were conjoined and passed out through 2 o' clock site sclera. The clear corneal incision was made on 10 o' clock site through which a suture was pulled out and cut. The end of suture which originated from 8 o' clock site was passed through the injector and tied to the leading haptic of IOL, then inserted. The other end of suture was tied to the following haptic and complete the insertion of IOL with forceps. RESULTS: Time taken for the above procedure was within 20 minutes and postoperatively induced astigmatism was less than 1.5 diopters. No specific complication was noticed. CONCLUSIONS: This technique may be an effective and substitute procedure for that have been used for reasons of less astigmatism, and stable chamber maintenance during procedure.

Airway Management of a Pediatric Patient with Interarytenoid Adhesion : A case report

Interarytenoid adhesion is a rare complication associated with endotracheal intubation. The vocal cord is fixed to arytenoid cartilage and the movement of vocal cord is limited. Its clinical symptoms are dyspnea and hoarseness, so sometimes it is mistaken for bilateral vocal cord palsy because of its clinical features. We have experienced unanticipated failed intubation followed by hypoxia in interarytenoid adhesion who was scheduled for emergency tracheotomy due to bilateral vocal cord palsy. After failure of cricothyroidotomy, patient was successfully ventilated with jet injector and tracheotomy was done without complication.

Using the high pressure injector in the contrast CT scanning for children / 中国实用护理杂志

Objective To study the characters of using the high pressure injector in the contrast CT scanning for children. Methods Summarized the nursing measures of 407 children who had accepted the contrast CT scanning. Results There were 369 children have obtained perfect effects of CT scanning, 35 children have obtained general effects and there were 2 children failure. Conclusion The method of using high pressure injector in the contrast CT scanning for children is convenient, safety and effective.

The problems of using high pressure injector in the 16-detector-row CT / 中国实用护理杂志

Objective To discuss the problems of using high pressure injector in the 16-detector-row CT. Methods Reviewed and analyzed the courses of using high pressure injector in the 16-detector-row CT for 799 patients. Results 774 patients obtained successful infusion,contrast medium hydrops were occurred in 20 patients,2 patients were infusion failure and 3 patients were redid for misoperation. Conclusion Master the details of operating high pressure injector can alleviate the pain of patients,and then obtain the satisfactory effect.