Modified unilateral periureteral injection technique in the treatment of patients with high-grade vesicoureteral reflux: A study of primary findings

Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.

Intramuscular vaccine administrations including the adoption of"Zeta-track technique"&"without aspiration slow injection technique"(ZTT&WASiT):a prospective review

Objective:To review the current literature on the practice of intramuscular injections(IMIs),focusing on immunizations.Methods:The present study comprises 2 reviews,characterized by high-quality evidence,per taining to the deployment of the slow injection technique without aspiration(referred to in this paper as the without-aspiration slow injection technique[WASi T])and combined with the Zeta-track technique(ZTT).The literature review is oriented toward the analysis of 2 features associated with IMIs techniques:safety and pain,integrating new evidence on vaccinee positioning for each muscle site and general relaxation techniques in the multi-parametric analysis.Results:The rigorous and in-depth reviews in the current study reveal the usefulness of including,among the international guidelines for via intramuscular immunizations,the adoption of WASi T only for compliant vaccinees,and in combination with all validated techniques for IMIs,and the use of ZTT limitedly if specific well-developed muscles are indicated.All the technique's limitations are exposed.Conclusions:Future research directions are presented by including the author's study designs to provide indirect evidence for the validity of the rationale of the slow injection technique using scientific methods,and for the conduction of future randomized controlled trials(RCTs)focused on revisiting the adoption of ZTT in a dynamic and integrated immunizations protocol in anterolateral thigh(ALT),ventrogluteal(VG),and also in the deltoid muscle,in the specific cases analyzed.

Construction of a model of autologous blood intracerebral hemorrhage in rats with a double injection and double needle withdrawal and the characteristics of the operative technique

BACKGROUND ： Experimental animal models of intracerebral hemorrhag （ICH） are greatly needed, so the process of establishment should be ideal in hematoma formation and easy to operate. OBJECTIVE ： To construct model of ICH in rats with double injection of autologous blood taken from the cut tail cut and double withdrawal of the needle （shortened as two-step injection model）, and compare with those induced by single and double injections. DESIGN ： A randomized controlled tria SETTING： Department of Neurology, General Hospital of Military Area Command of Chinese PLA. MATERIALS： Thirty male Wistar rats of 10 to 12 months, weighing （400±25） g, provided by the Experimental Center of Medical Animals, General Hospital of Shenyang Military Area Command of Chinese PLA, were divided randomly into 3 groups with 10 rats in each group： two-step injection group, single injection group, double injection group. METHODS ： The experiment was carried out in the Department of Neurology, General Hospital of Military Area Command of Chinese PLA from March to June in 2004. Autologous blood ICH model in rats were established as follows： In the two-step injection group, 50 μL unclotted autologous blood was taken from the rat tail cut, then injected with microsyringe into the caudate nucleus, 10 μL injected at first, paused for 2 minutes, and then the rest 40 μL injected slowly and continuously within 2 minutes. After the injection, the needle was kept immovable for about 4 minutes, withdrawn 2.0 mm, again kept immovable for about 4 minute, and then removed wholly at a slow speed. In the single injection group, 50 μL unclotted tail blood was injected slowly and continuously all within 2 minutes and the needle was slowly removed;（4） In the double injection group, 10 mL blood was injected at first, paused for 2 minutes, the rest 40 μL injected evenly within 2 minutes, and then the needle was withdrawn slowly and uninterruptedly. Neurologic findings were scored in accordance with Longa＇s five-point scale （0-4 scores, the higher the score, the severer the neurological dysfunction）. The rats were killed to remove and sections were prepared, the morphological features of hematomas were grossly observed, the maximal diameter and size of hematomas in each slice were measured with the imaging analytical system, and the volume was calculated. Meanwhile, the conveniences of the techniques were compared. MAIN OUTCOME MEASURES： The morphological features and volume of hematomas, neurologic deficit score （NDS）, and the convenience of the techniques were compared. RESULTS： All the 30 rats were involved in the analysis of results without deletion. （1） Results of the morphological observation of volume of hematoma： In the two-step injection group, hematomas located in the right caudate nucleus area regularly in circular or analogously circular shape in each slice. The formation rate of hematomas in the single injection group and double injection group were lower than those in the two-step injection group [60% （6/10）, 80% （8/10）, 100% （10/10）, P〈 0.01, 0.05]. The volume of hematomas in the single injection group and double injection group were smaller than those in the two-step injection group [（28.5±14.8）, （33.4±7.4）, （41.6±3.9） mm3, P〈 0.01, 0.05]. （2） NDS results： The NDS scores in the single injection group and double injection group were smaller than that in the two-step injection group （0.90±0.83, 1.30±0.78, 1.90±0.57, P〈 0.05）. （3）Comparison of the convenience of the techniques： The double injection method allowed generating reproducible hematomas in rats with shortcomings that it needed autologous arterial blood from femoral artery, and precision instruments such as microinfusion pump. The two-step injection injected fresh unclotting blood taken directly from the tail cut with microsyringe into the rat brain, and it has the advantages of easy operation, no influence on the activity of thrombase, shorter duration for model establishment, and higher rate of hematoma formation, which could generate ideal and economical models of ICH. The two-step injection induced hemotoma regularly in circular or analogously circular shape in each slice, but those induced by single and double injections were mostly in strip or fusiform shapes and extending along the needle tracks or into the ventricle or subarachnoid space. CONCLUSION ： The autologous blood ICH model induced by the two-step injection method is a reproducible and reliable one in regular shape, which is better than those induced by double and single injections.

Effect of Alternate Bearing Phenomenon and Boron Foliar Application on Nitrogen-15 Uptake,Translocation and Distribution in Mango Tree(cv.Zebda)

The objectives of this investigation are to study nitrogen uptake,translocation,accumulation and distribution in mango tree organs using labeled nitrogen(^(15)N)and to understand the mechanism of boron action in increasing fruit yield in the off-year.A field experiment was conducted using fifteen-year-old mango trees(cv.Zebda)grown at Al Malak Valley Farm,El-Sharkeya Governorate-Egypt.Treatments included the application of(^(15)NH4)2SO4,“in the on-year”,at a rate of 50 g nitrogen/tree through the stem injection technique.While boron was sprayed on the same trees“in the off-year”at the following rates:0.0(control),250 and 500 mg·L^(-1).The authors hypothesize that boron and nitrogen act synergistically to increase mango fruit yield in the off-year.Results indicated that the highest ^(15)N uptake and accumulation in the on and off-years was observed in the upper(young leaves).When boron was applied at 250 mg·L^(-1),in the off-year,the upper(young leaves)recorded the highest ^(15)N uptake and accumulation(%^(15)Ndff=13.93)relative to the other two leaf categories and those of the on-year.In the on-year fruit accumulated higher ^(15)N than leaf or bud.In the off-year,bud exhibited the highest ^(15)N accumulation without boron application,while leaves exhibited the highest ^(15)N with boron application.The highest%^(15)Ndff in all tree organs was observed at 250 mg·L^(-1) boron rate.Boron increased nitrogen uptake,translocation and accumulation in mango tree organs.A synergistic relationship was observed between boron and nitrogen which led to an increase in fruit yield in the off-year.

Injection and Extraction Techniques in Circular Accelerators

Injection and extraction are usually the key systems in circular accelerators.They play important roles in transferring the beam from one stage acceleration to the other or to experimental stations.It is also in the injection and extraction regions where beam losses happen mostly.Due to the tight space and to reduce the perturbation to the circulating orbit,the devices are usually designed to meet special requirements such as compactness,small stray field,fast rise time or fall time,etc.Usual injection and extraction devices include septum magnets,kicker magnets, electrostatic deflectors,slow bump magnets and strippers.In spite of different accelerators and specification for the injection and extraction devices,many techniques are shared in the design and manufacturing.This paper gives a general review on the techniques employed in the major circular accelerators in China.

Effect of structured education program on physiological and psychosocial outcomes in type 2 diabetes patients:A randomized controlled trial

Objective:This study was conducted to compare the effect of structured education program versus traditional diabetes education on insulin injection technique as well as physiologically and psychosocially related outcomes in adults with Type 2 diabetes.Materials and Methods:This study was a randomized controlled trial.Totally,71 Type 2 diabetes patients of using the insulin pen were enrolled and randomly divided into the intervention group(n=36)and the control group(n=35)according to random number table method.Patients in the intervention group received structured education program,while patients in the control group received traditional diabetes education.The levels of glycosylated hemoglobin(HbA1c),blood glucose,and lipids were monitored before and 3 months after intervention,and the insulin injection techniques,diabetes distress,and diabetes self-management skills between groups were assessed after 3 months.Results:Finally,65 participants(intervention group:n=33,control group:n=32)finished the study.After the intervention,HbA1c was lower(7.42±0.80 vs.8.35±1.40,P=0.002),fasting blood glucose(FBG)was lower(7.27±1.06 vs.9.40±3.16,P<0.001),and postprandial blood glucose(PBG)was lower(10.33±2.20 vs.12.77±4.94,P=0.012)in the intervention group than in the control group.No statistically significance was identified between the two groups in scores of Diabetes Distress Scale and summary of diabetes self-care activities.Conclusion:Patients with Type 2 diabetes received structured education program,with greater improvements achieved in HbA1c,FBG,PBG,and measures about insulin injection techniques compared to the traditional education group,but there was no significant difference in diabetes distress or self-management behavior between groups.

Characterization of Al_2O_3 /GaN/AlGaN/GaN metalinsulator-semiconductor high electron mobility transistors with different gate recess depths

In this paper, in order to solve the interface-trap issue and enhance the transconductance induced by high-k dielectric in metal-insulator-semiconductor （MIS） high electron mobility transistors （HEMTs）, we demonstrate better performances of recessed-gate A1203 MIS-HEMTs which are fabricated by Fluorine-based Si3N4 etching and chlorine- based A1CaN etching with three etching times （15 s, 17 s and 19 s）. The gate leakage current of MIS-HEMT is about three orders of magnitude lower than that of A1GaN/CaN HEMT. Through the recessed-gate etching, the transconductanee increases effectively. When the recessed-gate depth is 1.02 nm, the best interface performance with Tit----（0.20--1.59） p^s and Dit ：（0.55-1.08）x 1012 cm-2.eV- 1 can be obtained. After chlorine-based etching, the interface trap density reduces considerably without generating any new type of trap. The accumulated chlorine ions and the N vacancies in the AIGaN surface caused by the plasma etching can degrade the breakdown and the high frequency performances of devices. By comparing the characteristics of recessed-gate MIS-HEMTs with different etching times, it is found that a low power chlorine-based plasma etching for a short time （15 s in this paper） can enhance the performances of MIS-HEMTs effectively.

RESEARCH & DESIGN OF 60 kW SOFT-SWITCHING PLASMA CONVERTER

A novel 60 kW plasma converter with full range soft-switch by utilizing magnetizing inductance, leakage inductance and distributed inductance is introduced. The current injection phase-shifting technique is introduced into the research of soft-switching plasma converter successfully. The magnetic bias of transformer and the protection of switching parts are solved. The tests state that the power supply has excellent characteristics and higher efficiency and can meet the demand of large power plasma process well.

Combined Common Femoral Artery Endarterectomy with Superficial Femoral Artery Stenting Plus Shuxuening Injection(舒血宁注射液) Infusion for Chronic Lower Extremity Ischemia:3-Year Results

Objective： To investigate the efficacy and safety of combined common femoral artery （CFA） endarterectomy with superficial femoral artery （SFA） stenting plus Shuxuening Injection （舒血宁注射液） infusion in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities. Methods： From March 2006 to March 2011, 104 lower limbs in 96 patients with multilevel peripheral arterial steno-occlusive disease, involving SFA as well as CFA and deep femoral artery （DFA） orifice, were treated by combined surgical with endovascular therapy, such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein. Before the end of the operation, 20 mL of Shuxuening Injection was infused through the catheter located in the treated artery. Technical and hemodynamic success, as well as primary and primary-assisted patency, was determined according to the Society for Vascular Surgery Guidelines. During follow-up, clinical status assessment, ankle-brachial index （ABI） test, and duplex Doppler ultrasound were administered every 6 months, and computed tomography angiography or magnetic resonance angiography was performed at 12, 24, and 36 months after discharge. Results： All patients underwent successful combined CFA endarterectomy with SFA stenting treatment. The average ABI after the combination treatment increased from pretreatment of 0.32 ± 0.21 to 0.82±0.24 （P〈0.01）. No perioperative death and major limb amputations occurred. The mean duration of follow-up for 104 limbs from 96 patients was 1,180 days （range, 196-2,064 days）. During follow-up, 5 patients died due to myocardial infarction, cerebral infarction, or pneumonia, and 5 patients were lost to follow-up. There were 21 cases （21.4%） of restenosis, with 15 that occurred in-stent and 6 near the dJstal end of the stent. A total of 18 （18.3%） reinterventions were performed, including 6 balloon angioplasty, 8 restenting procedures, 2 bypass surgeries, and 2 major limb amputations： The primary patency rates were 92.2%, 76.8%, and 61.3% at 12, 24, and 36 months, respectively, while the primary-assisted patency rates were 94.4%, 83.2%, and 75.6% at 12, 24, and 36 months, respectively. Conclusion： The combined CFA endarterectomy with SFA stenting plus Shuxuening Injection infusion appears to offer a safe, less invasive, and effective treatment option to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease.

Effective generation of optical quadruple frequency millimeter-wave based on fiber laser using injection rational harmonic mode-locked technique

A method to generate the optical quadruple frequency millimeter-wave with high power efficiency is pro- posed and demonstrated based on the combination of the injection 2nd-order rational harmonic mode- locked fiber ring laser technique and the fiber grating notch filter. In this approach, the fiber Bragg grating notch filter is inserted into the laser cavity to prevent the undesired optical carrier, so that the pump power can be converted to 2nd-order harmonic wave more efficiently. In our experiment, the power efficiency of optical quadruple frequency millimeter-wave （40 GHz） generation is ten folds of that of our previous method based only on the rational harmonic mode-locked technique.