Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures

Esophageal strictures are a problem frequently encountered by gastroenterologists. Dilation has been the customary treatment for benign esophageal strictures, and dilation techniques have advanced over the years. Depending on their characteristics and the response to treatment, esophageal strictures can be classified into two types: 1, simple (Schatzki rings, webs, peptic injury, and following sclerotherapy) - these are easily amenable to dilation, with a low recurrence rate after initial treatment; and 2, complex (caused by caustic ingestion, radiation injury, anastomotic strictures, and photodynamic therapy) - these are difficult to dilate and are associated with higher recurrence rates. Refractory strictures are those in which it is not possible to relieve the anatomic restriction successfully up to a diameter of 14 mm over five sessions at 2-weekly in- tervals, due to cicatricial luminal compromise or fibrosis; and recurrent strictures are those in which it is not possible to maintain a satisfactory luminal diameter for 4 wk once the target diameter of 14 mm has been achieved. There are no standard recommendations for the management of refractory strictures. The various techniques used include intralesional steroid injectioncombined with dilation; endoscopic incisional therapy, with or without dilation; placement of self-expanding metal stents, Polyflex stents, or biodegradable stents; self-bougienage; and endoscopic surgery. This review discusses the indications, technique, results, and complications of the use of intralesional steroid injections combined with dilation and endoscopic incisional therapy with dilation in refractory strictures.

Low-dose intralesional injection of 5-fluorouracil and triamcinolone reduces tissue resident memory T cells in chronic eczema

BACKGROUND Tissue resident memory T(TRM)cells have been reported to play a significant role in the pathogenesis and relapse of chronic eczema.AIM To compare the efficacy and safety of the intralesional injection of 5-fluorouracil(5-FU)and triamcinolone(TA)with those associated with TA alone for the treatment of chronic eczema.METHODS A total of 168 patients were randomized to 5-FU+TA or TA groups and received a one-time intralesional injection of 5-FU+TA or TA only.Biopsies were collected before and 2 wk after treatment for evaluation of histopathological changes.All patients were followed up monthly for up to 1 year.RESULTS No serious adverse event was observed in either group.Although the mean atopic dermatitis severity index scores and effective rates were comparable between the two groups after 2 wk of treatment,the relapse rate was significantly lower in the 5-FU+TA group than in the TA group.Histological examination showed significantly fewer CD8^(+)and CD103^(+)T cells but not CD4^(+)T cells in the 5-FU+TA group.CONCLUSION One-time intralesional injection of 5-FU+TA is effective and safe for chronic eczema treatment and can further reduce the retention of T_(RM) cells in the lesional skin and the relapse rate of chronic eczema.

Direct Transplant of Melanocytes from Normal Donor Area into Vitiligenous Recipient Area by Intralesional Injection of Melanocytes Using Spade Like Needle Technique

Background: Vitiligo is a common autoimmune inflammatory skin disease, where there are different surgical techniques for treatment of stable patches of vitiligo .Objective: To find non-costly, minimally invasive, simple technique by direct melanocytes transplant by spade needle technique in treatment of vitiligo. Patients and Methods: This interventional, therapeutic, comparative study was done in Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from April 2014-March 2015. Twenty patients with localized, generalized and segmental vitiligo were included. Full history and examination for each patient was done with 4 (20%) males and 16 (80%) females and their ages ranged from 9 - 40 (23.15 ± 11.44) years. Forty one patches in 20 patients treated by spade grafting technique and the donor and recipient sites were demarcated and anesthesia done by xylocaine 2% with adrenalin 1:100,000. Transplantation was started by using disposable needle gauge 18 (the sharp end of needle was cut by a scissor to make it a spade like) with medical syringe 5 ml supplied with normal saline. The micro-pieces were taken from donor site and transplanted directly, easily and rapidly into dermis of recipient site and followed by pushing normal saline and the procedure was repeated to cover all recipient sites with 5 mm distance between injection points. The surface area of the lesions was calculated and the reduction rate was estimated every month till the end of the 4th month period of the treatment. Results: Including 41 patches in 20 patients with the surface area of the patches ranged from 1.5 - 90 cm2 (13.78 ± 17.57) cm2. The mean ±SD of surface area of lesions was decreased from 13.78 ± 17.57 cm2 at baseline visit to 13.61 ± 17.48 cm2 at the second visit (after 2 weeks ) which was statistically significant (p value ≤ 0.001). The mean surface area continued to be reduced till reaching 12.20 ± 15.68 cm2 at the third visit and 12.01 ± 15.55 cm2 at the fourth visit. All were statistically significant when compared to baseline visit. There was reduction in surface area 1.1% at two weeks, 9.93%, and 12.5% at the 2nd, 4th months respectively. Conclusions: Intradermal injection of melanocytes in patients with vitiligo by spade like needle was very quick and simple non-costly technique, and gave 12.5% reduction which could be repeated at different times until satisfactory re-pigmentation of vitiligenous skin is achieved.

Intralesional corticosteroid injections for infantile hemangioma

Infantile hemangiomas(IHs) are the most common benign soft-tissue tumors in infancy;about 10%–15% of them may result in various complications that require active management. The current first-line treatment for IH is oral propranolol;however, some studies recommend intralesional corticosteroid injections for small, limited, deep, or prominent tumors because of concern regarding serious systemic complications related to propranolol. This review summarizes and analyzes the current clinical studies on corticosteroid injections in IHs, discusses treatment norms, and explores future research directions.

A randomized clinical trial assessing the efficacy of single and multiple intralesional collagenase injections for treating contracted scars

Background:Scar contractions caused by trauma or burns can cause secondary physical dysfunction and disfigurement.Many minimally invasive methods for scar contraction have shown limited applicability and efficacy.This study investigated the feasibility and efficacy of intralesional collagenase injections for scar contraction treatment.Methods:Patients with contracted scars who had limited joint movement and physical disfiguration for>1 year were enrolled in this single-blind,randomized clinical trial from July 2017 to February 2018 at Shanghai Ninth People’s Hospital.Collagenase was injected into the firm-contracted scar(15 U/cm^(2))three times at 4-week intervals in the multiple treatment group and once in the single treatment group,and a placebo injection was performed in the control group.Scar length and skin texture were documented at the 4-and 12-week follow-ups.The safety of the collagenase treatment was also evaluated.Results:The contracted scar was significantly elongated after both single and multiple collagenase treatments.The results showed that,compared to a one-time treatment,repeated injections were more effective at 12 weeks,with an average improvement of 26.83(15.79%).At 12 weeks,78.9% of the patients in the multiple group and 52.9%in the single group achieved significant improvement at 12 weeks.No severe adverse events were observed.Conclusion:Intralesional collagenase injection showed promising results in improving scar contraction and provides an alternative treatment for patients.

Treatment of mouth and jaw diseases with intralesional steroid injection

Many lesions of the oral region are treated with surgical methods such as curettage and resection. Chemotherapy and radiation therapy with or without surgical intervention can be used as an adjunct in some cases. Intralesional steroid injection is a conservative procedure which is already used in various regions of the body andjoints. This technique is used also for a number of mouth and jaw lesions. Localized langerhans cell histiocytosis, central giant cell granuloma, oral submucous fibrosis, oral lichen planus, lichen sclerosus of the oral mucosa, lymphatic malformations and orofacial granulomatosis can be considered among these diseases. The purpose of this review is to investigate the effects of intralesional steroid injections in the treatment of oral diseases.

Intralesional Interstitial Injection of Bleomycin for Management of Extracranial Arteriovenous Malformations in Children

Background Despite many advances in the treatment for extracranial arteriovenous malformations(AVMs),they still result in tedious dissection and potential unacceptable complications,particularly in children.Therefore,this study aimed to investigate the efficacy and safety of intralesional interstitial injection of bleomycin for the treatment of children with AVMs.Methods A total of 10 children(6 boys and 4 girls)with AVMs were treated with serial interstitial bleomycin injections between May 2014 and January 2017.Maximum single doses of 15 U and 1 U/kg per session were administered for six sessions at a 1-month interval.Therapeutic effectiveness was evaluated and classified into four categories:complete response(CR),partial response(PR),no response,and worsening at 3 months after the last session.Further clinical follow-up outcomes were classified as improved,stable,or aggravated.Adverse events were recorded according to the Society of Interventional Radiology classification.Results All 10 children completed the sessions and follow-ups.CR occurred in 3(30%)patients,PR in 6(60%),and no response in 1(20%).Minor complications(class A)included maculopapular rash,bulla,vomiting,and hyperpigmentation,whereas no major complications occurred.Conclusion Intralesional interstitial injection of bleomycin is a feasible approach for the treatment of AVMs in children and provides safe and effective outcomes.This method may be an earlier treatment alternative in children to prevent potential destructive progression,considering the serious complications of currently available therapeutic methods.

Refractory lipoatrophy treated with autologous whole blood injection:A case report

BACKGROUND Intramuscular corticosteroid injection may cause adverse effects such as dermal and/or subcutaneous atrophy,alopecia,hypopigmentation,and hyperpigmentation.Although cutaneous atrophy can spontaneously resolve,several treatment options have been suggested for this condition.CASE SUMMARY In this paper,we report a case of corticosteroid injection induced lipoatrophy treated with autologous whole blood(AWB)injection,as the condition had been unresponsive to fractional laser therapy.A 29-year-old female patient visited the dermatology clinic complaining of skin depression on her right buttock area,which had appeared six months earlier.There had been only subtle improvement at the margins after fractional CO_(2) laser treatment;therefore,after obtaining informed consent from the patient,AWB treatment was initiated.One month after the first AWB injection,the size and depth of the lesion had noticeably improved,and a slight improvement was also observed in discoloration.CONCLUSION Close observation is the initial treatment of choice for steroid induced skin atrophy;however,for patients in need of immediate cosmetic improvement,AWB injection may be a safe and cost-effective alternative.

Generation of transgenic chicken through ovarian injection

Background : Traditional DNA microinjection methods used in mammals are difficult to apply to avian species due to their unique reproductive characteristics. Genetic manipulation in chickens, particularly involving immature follicles within living ovaries, has not been extensively explored. This study seeks to establish an efficient method for generating transgenic chickens through ovarian injection, potentially bypassing the challenges associated with primordial germ cell (PGC) manipulation and fertilized egg microinjection. Methods : Hens were anesthetized and underwent a surgical procedure to access the ovary for DNA injection into immature follicles. The study used liposomes to deliver GFP- expressing plasmids at various dosages. After injection, hens recovered, and their eggs were fertilized through artificial insemination. Results : Transgenic chickens were successfully generated in one generation without needing G0 founders. The injection of 20 μg plasmid yielded the highest transgenic efficiency at 12.1%. GFP- positive embryos were confirmed through microscopy, and successful transgene expression was validated at the tissue level using immunostain- ing. TERT and GFP elements introduced in the G1 generation resulted in 4.1% positive transgene rates, as confirmed by PCR and Southern blotting. Conclusion : This ovarian injection method offers a promising alternative for avian ge- netic manipulation, bypassing complex PGC procedures and enabling direct genera- tion of G1 transgenic chickens. This technique simplifies the transgenic process for chickens and has the potential to be adapted for other avian species, especially those without established PGCs culture systems.

Clinical observation on prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation

BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.

Effect of different injection strategies considering intravenous injection on combination therapy of magnetic hyperthermia and thermosensitive liposomes

The combination therapy of magnetic hyperthermia and thermosensitive liposomes(TSL)is an emerging and effective cancer treatment method.The heat generation of magnetic nanoparticles(MNPs)due to an external alternating magnetic field can not only directly damage tumor cells,but also serves as a triggering factor for the release of doxorubicin from TSL.The aim of this study is to investigate the effects in the degree of tumor cell damage of two proposed injection strategies that consider intravenous administration.Since both MNPs and TSL enter the tumor region intravenously,this study establishes a biological geometric model based on an experiment-based vascular distribution.Furthermore,this study derives the flow velocity of interstitial fluid after coupling the pressure distribution inside blood vessels and the pressure distribution of interstitial fluid,which then provides the convective velocity for the calculation of subsequent nanoparticle concentration.Different injection strategies for the proposed approach are evaluated by drug delivery result,temperature distribution,and tumor cell damage.Simulation results demonstrate that the proposed delayed injection strategy after optimization can not only result in a wider distribution for MNPs and TSL due to the sufficient diffusion time,but also improves the distribution of the temperature and drug concentration fields for the overall efficacy of combination therapy.

Numerical Simulation of Asphaltene Precipitation and Deposition during Natural Gas and CO_(2) Injection

Asphaltene deposition is a significant problem during gas injection processes,as it can block the porous medium,the wellbore,and the involved facilities,significantly impacting reservoir productivity and ultimate oil recovery.Only a few studies have investigated the numerical modeling of this potential effect in porous media.This study focuses on asphaltene deposition due to natural gas and CO_(2) injection.Predictions of the effect of gas injection on asphaltene deposition behavior have been made using a 3D numerical simulation model.The results indicate that the injection of natural gas exacerbates asphaltene deposition,leading to a significant reduction in permeability near the injection well and throughout the reservoir.This reduction in permeability strongly affects the ability of gas toflow through the reservoir,resulting in an improvement of the displacement front.The displacement effi-ciency of the injection gas process increases by up to 1.40%when gas is injected at 5500 psi,compared to the scenario where the asphaltene model is not considered.CO_(2) injection leads to a miscible process with crude oil,extracting light and intermediate components,which intensifies asphaltene precipitation and increases the viscosity of the remaining crude oil,ultimately reducing the recovery rate.

Permanent Magnet Temperature Estimation for PMSMs Using Virtual Position-offset Injection

This paper proposes a virtual position-offset injection based permanent magnet temperature estimation approach for permanent magnet synchronous machines(PMSMs). The concept of virtual position-offset injection is mathematically transforming the machine model to a virtual frame with a position-offset. The virtual frame temperature estimation model is derived to calculate the permanent magnet temperature(PMT) directly from the measurements with computation efficiency. The estimation model involves a combined inductance term, which can simplify the establishment of saturation compensation model with less measurements. Moreover, resistance and inverter distorted terms are cancelled in the estimation model, which can improve the robustness to the winding temperature rise and inverter distortion. The proposed approach can achieve simplified computation in temperature estimation and reduced memory usage in saturation compensation. While existing model-based approaches could be affected by either the need of resistance and inverter information or complex saturation compensation. Experiments are conducted on the test machine to verify the proposed approach under various operating conditions.

Cross-upgrading of biomass hydrothermal carbonization and pyrolysis for high quality blast furnace injection fuel production:Physicochemical characteristics and gasification kinetics analysis

The paper proposes a biomass cross-upgrading process that combines hydrothermal carbonization and pyrolysis to produce high-quality blast furnace injection fuel.The results showed that after upgrading,the volatile content of biochar ranged from 16.19%to 45.35%,and the alkali metal content,ash content,and specific surface area were significantly reduced.The optimal route for biochar pro-duction is hydrothermal carbonization-pyrolysis(P-HC),resulting in biochar with a higher calorific value,C=C structure,and increased graphitization degree.The apparent activation energy(E)of the sample ranges from 199.1 to 324.8 kJ/mol,with P-HC having an E of 277.8 kJ/mol,lower than that of raw biomass,primary biochar,and anthracite.This makes P-HC more suitable for blast furnace injection fuel.Additionally,the paper proposes a path for P-HC injection in blast furnaces and calculates potential environmental benefits.P-HC of-fers the highest potential for carbon emission reduction,capable of reducing emissions by 96.04 kg/t when replacing 40wt%coal injec-tion.

Horizontal well spacing optimization and gas injection simulation for the ultra-low-permeability Yongjin reservoir

Optimal spacing for vertical wells can be effectively predicted with several published methods,but methods suitable for assessing the proper horizontal well spacing are rare.This work proposes a method for calculating the optimal horizontal well spacing for an ultra-low permeability reservoir e the Yongjin reservoir in the Juggar Basin,northwestern China.The result shows that a spacing of 640m is the most economical for the development of the reservoir.To better develop the reservoir,simulation approaches are used and a new model is built based on the calculated well spacing.Since the reservoir has an ultralow permeability,gas injection is regarded as the preferred enhanced oil recovery(EOR)method.Injection of different gases including carbon dioxide,methane,nitrogen and mixed gas are modelled.The results show that carbon dioxide injection is the most efficient and economical for the development of the reservoir.However,if the reservoir produces enough methane,reinjecting methane is even better than injecting carbon dioxide.

Numerical analysis of hydraulic fracture propagation in deep shale reservoir with different injection strategies

Deep shale reservoirs are characterized by elevated breakdown pressures,diminished fracture complexity,and reduced modified volumes compared to medium and shallow reservoirs.Therefore,it is urgent to investigate particular injection strategies that can optimize breakdown pressure and fracturing efficiency to address the increasing demands for deep shale reservoir stimulation.In this study,the efficiency of various stimulation strategies,including multi-cluster simultaneous fracturing,modified alternating fracturing,alternating shut-in fracturing,and cyclic alternating fracturing,was evaluated.Subsequently,the sensitivity of factors such as the cycle index,shut-in time,cluster spacing,and horizontal permeability was investigated.Additionally,the flow distribution effect within the wellbore was discussed.The results indicate that relative to multi-cluster simultaneous fracturing,modified alternating fracturing exhibits reduced susceptibility to the stress shadow effect,which results in earlier breakdown,extended hydraulic fracture lengths,and more consistent propagation despite an increase in breakdown pressure.The alternating shut-in fracturing benefits the increase of fracture length,which is closely related to the shut-in time.Furthermore,cyclic alternating fracturing markedly lowers breakdown pressure and contributes to uniform fracture propagation,in which the cycle count plays an important role.Modified alternating fracturing demonstrates insensitivity to variations in cluster spacing,whereas horizontal permeability is a critical factor affecting fracture length.The wellbore effect restrains the accumulation of pressure and flow near the perforation,delaying the initiation of hydraulic fractures.The simulation results can provide valuable numerical insights for optimizing injection strategies for deep shale hydraulic fracturing.

A Probabilistic Trust Model and Control Algorithm to Protect 6G Networks against Malicious Data Injection Attacks in Edge Computing Environments

Future 6G communications are envisioned to enable a large catalogue of pioneering applications.These will range from networked Cyber-Physical Systems to edge computing devices,establishing real-time feedback control loops critical for managing Industry 5.0 deployments,digital agriculture systems,and essential infrastructures.The provision of extensive machine-type communications through 6G will render many of these innovative systems autonomous and unsupervised.While full automation will enhance industrial efficiency significantly,it concurrently introduces new cyber risks and vulnerabilities.In particular,unattended systems are highly susceptible to trust issues:malicious nodes and false information can be easily introduced into control loops.Additionally,Denialof-Service attacks can be executed by inundating the network with valueless noise.Current anomaly detection schemes require the entire transformation of the control software to integrate new steps and can only mitigate anomalies that conform to predefined mathematical models.Solutions based on an exhaustive data collection to detect anomalies are precise but extremely slow.Standard models,with their limited understanding of mobile networks,can achieve precision rates no higher than 75%.Therefore,more general and transversal protection mechanisms are needed to detect malicious behaviors transparently.This paper introduces a probabilistic trust model and control algorithm designed to address this gap.The model determines the probability of any node to be trustworthy.Communication channels are pruned for those nodes whose probability is below a given threshold.The trust control algorithmcomprises three primary phases,which feed themodel with three different probabilities,which are weighted and combined.Initially,anomalous nodes are identified using Gaussian mixture models and clustering technologies.Next,traffic patterns are studied using digital Bessel functions and the functional scalar product.Finally,the information coherence and content are analyzed.The noise content and abnormal information sequences are detected using a Volterra filter and a bank of Finite Impulse Response filters.An experimental validation based on simulation tools and environments was carried out.Results show the proposed solution can successfully detect up to 92%of malicious data injection attacks.

Shenqi Fuzheng injection alleviates chemotherapy-induced cachexia by restoring glucocorticoid signaling in hypothalamus

Chemotherapy-induced cachexia(CIC)is a debilitating condition characterized by weight loss,muscle atrophy,and anorexia[1].While peripheral mechanisms of cachexia have been extensively studied,the involvement of the central nervous system(CNS)in CIC is often overlooked.Chemotherapeutic drugs cause stress responses and inflammation,which may impact the hypothalamus and disrupt systemic energy and neuroendocrine functions.Understanding hypothalamic roles in regulating these processes can provide insights into CIC's mechanisms and aid in developing novel therapies.

Personalized laparoscopic radical resection of gallbladder cancer by staining of the liver draining area through ICG injection into the cholecystic artery

Gallbladder cancer(GBC)is a common malignant tumor often diagnosed in advanced stages.Surgery is among the most important treatments for GBC.Radical resection of GBC involves removal of the gallbladder and the gallbladder bed[liver segments(S)4b and 5],and hepatoduodenal ligament regional lymphadenectomy.The main GBC metastasis modes are blood and lymph node metastases.The scope of resection/wedge resection or regular S4b and S5 hepatectomy for blood metastasis is a matter of debate.A variety of hepatectomy methods have been proposed for T2 stage GBC,but no consensus has been reached regarding the scope of radical resection.Currently,the liver resection range is determined by branches of the portal vein.S4b and S5 hepatectomy is determined according to the liver portal vein branch perfusion area,but the rationale for liver resection for GBC is to eliminate potential metastasis from the cystic vein reflux area to the liver.In the case described herein,we used a novel technique and theoretical framework to conduct laparoscopic radical resection of gallbladder cancer(LRRGC)facilitated by staining of the liver draining area with an indocyanine green(ICG)injection into the cholecystic artery.

Does HSP27 injection induce glaucoma damage in mice?

In a further aging society,excellent eyesight is an integral part of overall well-being and quality of life.Preserving good vision is crucial to maintaining mobility,independence,and mental health.There can be several reasons for visual impairment in elderly people,these include age-related macular degeneration,the leading cause of vision loss among older adults,cataract,glaucoma,diabetic retinopathy,retinal detachment,and others.