Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

AIM:To assess the clinical efficacy and safety of combining panretinal photocoagulation(PRP)with intravitreal conbercept(IVC)injections for patients with high-risk proliferative diabetic retinopathy(HR-PDR)complicated by mild or moderate vitreous hemorrhage(VH),with or without diabetic macular edema(DME).METHODS:Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study.Upon establishing the patient’s diagnosis,an initial IVC was performed,followed by prompt administration of PRP.In cases who significant bleeding persisted and impeded the laser operation,IVC was sustained before supplementing with PRP.Following the completion of PRP,patients were meticulously monitored for a minimum of six months.Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography(FFA)results.Therapeutic effect and the incidence of adverse events were observed.RESULTS:Out of 42 patients(74 eyes),29 were male and 13 were female,with a mean age of 59.17±12.74y(33-84y).The diabetic history was between 1wk and 26y,and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y.The affected eye received 2.59±1.87(1-10)IVC injections and underwent 5.5±1.02(4-8)sessions of PRP.Of these,68 eyes received PRP following 1 IVC injection,5 eyes after 2 IVC injections,and 1 eye after 3 IVC injections.Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment,with resolution of DME in 51 eyes 3-48wk after initial treatment.A newly developed epiretinal membrane was noted in one eye.Visual acuity significantly improved in 25 eyes.No complications such as glaucoma,retinal detachment,or endophthalmitis were reported.CONCLUSION:The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.

Comparative study of boron and neon injections on divertor heat fluxes using SOLPS-ITER simulations

Based on the EAST equilibrium,the effects of boron(B)and neon(Ne)injected at different locations on the target heat load,and the distributions of B and Ne particles were investigated by transport code SOLPS-ITER.It was found that the B injection was more sensitive to the injection location for heat flux control than impurity Ne.The high electron and ion densities near the inner target in the discharge with impurity B injected from over X-point(R1)led to plasma detachment only at the inner target,and the localized B ions in the cases with injection from outer target location(R2)and upstream location(R3)led to far-SOL detachment at the outer target,but not at the inner target.In contrast,for Ne,the spatial distributions of Ne ions and electrons were found to be similar in all the cases at the three injection locations,and the detached plasma was achieved at the inner target and the electron temperature was reduced at the outer target.For locations R2 and R3,impurity B showed a more pronounced effect on the heat flux at the far-SOL of the outer target.Further analysis indicated that Ne atoms came mainly from the recycling sources,whereas B atoms came mainly from injection,and that their distinct atomic distributions resulted from the difference in the ionization threshold and ionization mean free path.In addition,the radiation proportion of B in the divertor region was larger than that of Ne when the total radiation power was similar,which suggests that B has less influence on the core region.

Background diseases and the number of previous intravitreal aflibercept injections on immediate intraocular pressure increase and vitreous reflux rate in phakic eyes

●AIM:To evaluate the effect of background diseases and number of previous intravitreal aflibercept injections(IVAIs)on immediate intraocular pressure(IOP)increase and vitreous reflux(VR)rate and to evaluate the correlation of both age and axial length with immediate IOP increase and VR rate.●METHODS:This study included 105 patients with cystoid macular edema secondary to retinal vein occlusion,35 patients with diabetic macular edema,69 patients with neovascular age-related macular degeneration(nAMD),and 12 patients with myopic choroidal neovascularization,which underwent first-time IVAI.The correlation of immediate IOP increase and VR rates with the four background diseases was investigated.Moreover,the correlation of age with immediate IOP increase and VR rate as well as correlation of axial length with immediate IOP increase and VR rate were evaluated.Further,54 patients with nAMD were treated with IVAI>10 times(multiple IVAIs).Moreover,the correlation of immediate IOP increase and VR rates with first-time and multiple IVAIs in nAMD was determined.●RESULTS:The immediate IOP increase(P=0.16)and VR rates(P=0.50)were almost similar among the four background diseases.The immediate postinjection IOP and age,VR rate and age,immediate postinjection IOP and axial length,or VR rate and axial length were not correlated in the four background diseases.The immediate IOP increase(P=0.66)and VR rates(P=0.28)did not significantly differ between first-time and multiple IVAIs in nAMD.●CONCLUSION:Background diseases and number of previous IVAIs have no effect on immediate IOP increase and VR rate.Further,age and axial length have no correlation on immediate IOP increase and VR rate.

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 CO2 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.

Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.

Possible link between long-term and short-term water injections and earthquakes in salt mine and shale gas site in Changning,south Sichuan Basin, China

Late at night on 17 June 2019,a magnitude 6.0 earthquake struck Shuanghe Town and its surrounding area in Changning County,Sichuan,China,becoming the largest earthquake recorded within the southern Sichuan Basin.A series of earthquakes with magnitudes up to 5.6 occurred during a short period after the mainshock,and we thus refer to these earthquakes as the Changning M6 earthquake sequence(or swarm).The mainshock was located very close to a salt mine,into which for^3 decades fresh water had been extensively injected through several wells at a depth of 2.7–3 km.It was also near(within^15 km)the epicenter of the 18 December 2018 M5.7 Xingwen earthquake,which is thought to have been induced by shale gas hydraulic fracturing(HF),prompting questions about the possible involvement of industrial activities in the M6 sequence.Following previous studies,this paper focuses on the relationship between injection and seismicity in the Shuanghe salt field and its adjacent Shangluo shale gas block.Except for a period of serious water loss after the start of cross-well injection in 2005–2006,the frequency of earthquakes shows a slightly increasing tendency.Overall,there is a good correlation between the event rate in the Shuanghe area and the loss of injected water.More than 400 M≥3 earthquakes,including 40 M≥4 and 5 M≥5 events,had been observed by the end of August 2019.Meanwhile,in the Shangluo area,seismicity has increased during drilling and HF operations(mostly in vertical wells)since about 2009,and dramatically since the end of 2014,coincident with the start of systematic HF in the area.The event rate shows a progressively increasing background with some fluctuations,paralleling the increase in HF operations.More than 700 M≥3 earthquakes,including 10 M≥4 and 3 M≥5 in spatially and temporally clustered seismic events,are correlated closely with active fracturing platforms.Well-resolved centroid moment tensor results for M≥4 earthquakes were shown to occur at very shallow depths around shale formations with active HF,in agreement with some of the clusters,which occurred within the coverage area of temporary or new permanent monitoring stations and thus have been precisely located.After the Xingwen M5.7 earthquake,seismic activity in the salt well area increased significantly.The Xingwen earthquake may have created a unidirectional rupture to the NNW,with an end point close to the NW-trending fault of the Shuanghe earthquake.Thus,a fault in the Changning anticline might have terminated the fault rupture of the Xingwen earthquake,possibly giving the Xingwen earthquake a role in promoting the Changning M6 event.

Intraarticular injections(corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis

Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeling,degeneration of ligaments and menisci,and hypertrophy of the joint capsule take parts in the pathogenesis.Pain is the hallmark symptom of OA,but the extent to which structural pathology in OA contributes to the pain experience is still not well known.For the knee OA,intraarticular(IA)injection(corticosteroids,viscosupplements,blood-derived products)is preferred as the last nonoperative modality,if the other conservative treatment modalities are ineffective.IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA.IA hyaluronic acid(HA)injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk.But for HA injections,the costeffectiveness is an important concern that patients must be informed about the efficacy of these preparations.Although more high-quality evidence is needed,recent studies indicate that IA platelet rich plasma injections are promising for relieving pain,improving knee function and quality of life,especially in younger patients,and in mild OA cases.The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction.But,there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.

Effect of individualized therapy for AIDS patients with cytomegalovirus retinitis in intravitreal ganciclovir injections

The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome(AIDS) patients with cytomegalovirus retinitis(CMVR) was investigated. A total of 32 eyes in 23 AIDS patients diagnosed as CMVR from 2017 to 2018 were included in the retrospective study. All patients underwent induction therapy by using intravenous drip of the anticytomegalovirus(CMV) agent ganciclovir(5 mg/kg q12 h) combined with intravitreal ganciclovir injection(3 mg/time, 2 times/wk). The visual acuity, fundus photographs, lesion location, and number of intravitreal injections were observed preoperatively and postoperatively. Totally 14 eyes were cured during induction therapy. The number of injections [4.13(2 to 6)] in CMVR patients with peripherally fundus lesions were significantly lower than those with central lesions (4.89(2 to 6))The individualized therapy of intravitreal ganciclovir injections for AIDS patients with CMVR can effectively reduce the numbers of intravitreal injections.

Performance of supersonic model combustors with staged injections of supercritical aviation kerosene

Supersonic model combustors using two-stage injections of supercritical kerosene were experimentally investigated in both Mach 2.5 and 3.0 model combustors with stagnation temperatures of approximately 1,750 K. Supercritical kerosene of approximately 760 K was prepared and injected in the overall equivalence ratio range of 0.5-1.46. Two pairs of integrated injector/flameholder cavity modules in tandem were used to facilitate fuel-air mixing and stable combustion. For single-stage fuel injection at an upstream location, it was found that the boundary layer separation could propagate into the isolator with increasing fuel equivalence ratio due to excessive local heat release, which in turns changed the entry airflow conditions. Moving the fuel injection to a further downstream location could alleviate the problem, while it would result in a decrease in combustion efficiency due to shorter fuel residence time. With two-stage fuel injections the overall combustor performance was shown to be improved and kerosene injections at fuel rich conditions could be reached without the upstream propagation of the boundary layer separation into the isolator. Furthermore, effects of the entry Mach number and pilot hydrogen on combustion performance were also studied.

Meta-analysis of neostigmine injections given at the Zusanli （ST 36） acupoint in thetreatment of postpartum urinary retention

Objective： We aimed to determine the effect of neostigmine injections given at the Zusanli （ST 36） acupoint whentreating postpartum urinary retention. Methods： We conducted a systematic review to identify randomized controlledtrials （RCTs） involving neostigmine injections given at the Zusanli （ST 36） acupoint for treating postpartum urinaryretention. We searched the Cochrane Library, Pubmed, Web of Science, Chinese National Knowledge Infrastructure, VipDatabase, and Chinese Biomedical Literature Database from the creation of the database to December 30, 2016. Bias riskassessment was performed using Revman 5.3 software from Cochrane based on the criteria set out in the CochraneHandbook for Systematic Reviews of Interventions, version 5.1.0. Results： Thirteen studies were included with 627participants in the treatment group and 584 participants in the control group. （1） Overall response rate： neostigmineinjections given at the Zusanli （ST 36） acupoint have a better curative effect than injections given in muscle, odds ratio（OR） = 8.74, 95% confidence interval （CI） [5.83, 13.10], Z = 10.49 （P 〈 0.001）; （2） Comparison of effects at differentdosages： （i） 0.5 mg of neostigmine Zusanli （ST 36） acupoint injection group has better effect than 1 mg of neostigmineintramuscular injection group, OR = 15.84, 95% CI [5.74, 43.72],Z = 5.34 （P 〈 0.001）, （ii） 0.5 mg of neostigmineinjection given at the Zusanli acupoint has a better curative effect than 0.5 mg of neostigmine injection given in muscle ,OR = 7.30, 95% CI [3.47, 15.34], Z = 5.24 （P 〈 0.001）; （iii） 1 mg of neostigmine injection at the Zusanli （ST 36）acupoint has better efficacy than 1 mg of neostigmine injection in muscle, OR = 7.76, 95% CI [4.46, 13.52], Z = 7.25 （P〈 0.001）. Conclusion： Neostigmine injections at the Zusanli （ST 36） acupoint have beneficial effects in treatingpostpartum urinary retention. However, the low quality of the studies included in the meta-analysis raises questions overthe reliability of the results. Further studies are still needed.

Neuroprotective effects of ultrasound-guided nerve growth factor injections after sciatic nerve injury

Nerve growth factor（NGF） plays an important role in promoting neuroregeneration after peripheral nerve injury. However, its effects are limited by its short half-life; it is therefore important to identify an effective mode of administration. High-frequency ultrasound（HFU） is increasingly used in the clinic for high-resolution visualization of tissues, and has been proposed as a method for identifying and evaluating peripheral nerve damage after injury. In addition, HFU is widely used for guiding needle placement when administering drugs to a specific site. We hypothesized that HFU guiding would optimize the neuroprotective effects of NGF on sciatic nerve injury in the rabbit. We performed behavioral, ultrasound, electrophysiological, histological, and immunohistochemical evaluation of HFU-guided NGF injections administered immediately after injury, or 14 days later, and compared this mode of administration with intramuscular NGF injections. Across all assessments, HFU-guided NGF injections gave consistently better outcomes than intramuscular NGF injections administered immediately or 14 days after injury, with immediate treatment also yielding better structural and functional results than when the treatment was delayed by 14 days. Our findings indicate that NGF should be administered as early as possible after peripheral nerve injury, and highlight the striking neuroprotective effects of HFU-guided NGF injections on peripheral nerve injury compared with intramuscular administration.

Effect of different lens status on intraocular pressure elevation in patients treated with anti-vascular endothelial growth factor injections

AIM: To assess the effect of lens status on sustained intraocular pressure(IOP) elevation in patients treated intravitreally with anti-vascular endothelial growth factor(VEGF) agents. METHODS: Data were retrospectively collected for all patients treated with intravitreal injections of anti-VEGF medication at a tertiary medical center in July 2015. Findings were analyzed by lens status during 6 months' follow-up. The main outcome measure was a sustained increase in IOP(≥21 mm Hg or change of ≥6 mm Hg from baseline on ≥2 consecutive visits, or addition of a new IOPlowering medication during follow-up). RESULTS: A total of 119 eyes of 100 patients met the study criteria: 40 phakic, 40 pseudophakic, and 39 pseudophakic after Nd:YAG capsulotomy. The rate of sustained IOP elevation was significantly higher in the postcapsulotomy group(23.1%) than in the phakic/pseudophakic groups(8.1%;P=0.032), with no statistically significant differences among the 3 groups in mean number of injections, either total(P=0.82) or by type of anti-VEGF mediation(bevacizumab: P=0.19;ranibizumab: P=0.13), or mean follow-up time(P=0.70). CONCLUSION: Nd:YAG capsulotomy appears to be a risk factor for sustained IOP elevation in patients receiving intravitreal anti-VEGF injections. This finding has important implications given the growing use of anti-VEGF treatment and the irreversible effects of elevated IOP.

Effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections

AIMTo evaluate the effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections.

Reagent-free determination of amikacin content in amikacin sulfate injections by FTIR derivative spectroscopy in a continuous flow system

The quantitative estimation of amikacin （AMK） in AMK sulfate injection samples is reported using FTIR-derivative spectrometric method in a continuous flow system. Fourier transform of mid-IR spectra were recorded without any sample pretreatment. A good linear calibration （r40.999, %RSDo 2.0） in the range of 7.7-77.0 mg/mL was found. The results showed a good correlation with the manufacturer＇s and overall they all fell within acceptable limits of most pharmacopoeial monographs on AMK sulfate.

Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction

Aim： To assess the behavior of patients with diabetes mellitus （DM） and erectile dysfunction （ED） during 10 consecutive years of treatment with self-injection of vasoactive drugs. Methods： Thirty-eight diabetic men, including 12 with type Ⅰ and 26 with type Ⅱ diabetes, were followed up regularly for 10 years after they began self-injecting for severe ED. Real time rigidity assessment was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for approximately 30 min. Patients were followed up every two months, and doses were increased only when the treatment response was not satisfactory. Results： The number of injections used per year by the patients was reduced each year （mean numbers： 50 in the first year and 22.5 in the 10th） and treatment shifted towards stronger therapeutic modalities （mixtures of vasoactive drugs instead of prostaglandin E1 alone）. Type Ⅰ diabetic men were standardized to a level of treatment as early as 5 years after the initiation of treatment. That level was finally reached by type Ⅱ patients after another 4-5 years. Conclusion： Treatment with self-injections of vasoactive drugs in diabetic men with severe El） is a safe and effective alternative in the long term. Diabetic men of both types show the same preferences in quality and quantity of treatment after 10 years. The key point for maintenance in treatment is the adjustment of the therapeutic method and dosage to optimal levels for satisfactory erections. （Asian J Androl 2006 Mar; 8： 219-224）

Comparison of hot-hole injections in ultrashort channel LDD nMOSFETs with ultrathin oxide under an alternating stress

The behaviours of three types of hot-hole injections in ultrashort channel lightly doped drain （LDD） nMOSFETs with ultrathin oxide under an alternating stress have been compared. The three types of hot-hole injections, i.e. low gate voltage hot hole injection （LGVHHI）, gate-induced drain leakage induced hot-hole injection （GIDLIHHI） and substrate hot-hole injection （SHHI）, have different influences on the devices damaged already by the previous hot electron injection （HEI） because of the different locations of trapping holes and interface states induced by the three types of injections, i.e. three types of stresses. Experimental results show that GIDLIHHI and LGVHHI cannot recover the degradation of electron trapping, but SHHI can. Although SHHI can recover the device＇s performance, the recovery is slight and reaches saturation quickly, which is suggested here to be attributed to the fact that trapped holes are too few and the equilibrium is reached between the trapping and releasing of holes which can be set up quickly in the ultrathin oxide.

Emamectin benzoate 9.7%SL as a new formulation for a trunkinjections against pine wood nematode,Bursaphelenchus xylophilus

In this study,we investigated the preventive effects of emamectin benzoate 9.7%SL,which was newly developed to reduce the injection volume and number of injection holes required to protect against pine wood nematode.None of the Pinus thunbergii trees injected with emamectin benzoate 9.7%SL at 0.3 mL/cm diameter at breast height(DBH)died within 2 years of inoculation with pine wood nematodes.Emamectin benzoate 9.7%SL injected at 0.6 mL/cm DBH resulted in no tree mortality for 3 years.Mean residue of emamectin benzoate 9.7%SL in pine twigs injected with 0.3 mL/cm DBH was 0.490μg/g at 1 year after injection and 0.303μg/g after 2 years.These residues values are greater than 0.031μg/g,previously determined IC95 value for emamectin benzoate against the pine wood nematode.Our field experiment and residue analysis showed that emamectin benzoate 9.7%SL could be a substitute agent for emamectin benzoate 2.15%EC,which is widely used to prevent pine wood nematode in the field and that injection volume and number of injection holes can be greatly educed using this new formulation,which will reduce injury to the cambium,interruption of water movement,and infection of inoculation wounds by wood-decay or blue stain fungi.

When traditional ground support techniques aren’t enough–Chemical injections can solve complex problems

Broken and jointed ground is extremely hazardous and requires unique stabilization techniques to protect workers and critical entries.Bolting techniques,even the most advanced pre-load to create roof compression,can leave large gaps of unconfined and separated roof.This roof can also be susceptible to water inflows which only exacerbate the support problem.These types of conditions existed on long-term development main entry accessing several future longwall panels.The geotechnical assessment identified well defined jointing systems that also permitted water to flow between the roof separations,which"lubricated"the roof material and minimized any frictional advantages.Chemical injections of polyurethane materials,Minova Carbopur WS,was placed beyond the bolted horizon to move the water to the rib lines and reinforce the fractured and broken roof.The injection materials permitted the effective use of bolting patterns and helped ensure long-term stability of critical entries.The paper describes the evaluation techniques,design patterns,basis for chemical selection and application,and results and recommendations.

Accuracy of shoulder joint injections with ultrasound guidance:Confirmed by magnetic resonance arthrography

BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used;however, they pose a risk of radiation exposure and are expensive and timeconsuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures.AIM To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography(MRA).METHODS The study included 179 shoulders of patients with recurrent anterior instability(150 patients;103 and 76 right and left shoulders, respectively;160 males and 19 females;average age = 20.5 years;age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 m L lidocaine(1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation(T2)-weighted images of axial planes and classified the intraarticular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage;minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs;and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen’s kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman’s rank correlation coefficient.RESULTS Of the 179 injections, 163 shoulders(91.0%) had no leakage, 10 shoulders(5.6%) had minor leakage, and six shoulders(3.4%) had major leakage. In total, 173 shoulders(96.6%) were intraarticularly injected;thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, indicating consistency in the evaluations by both examiners. Regression analysis of the inaccurate injection rate for assessingtechnical learning showed a logarithmic curve with a downward trend(R;= 0.887, P < 0.001). Three(50%) of the six inaccurate injections classified into “major leakage” were observed in the first 30 injections, indicating that the accurate injection showed a leaning effect.CONCLUSION Ultrasound-guided intra-articular glenohumeral injections using a posterior approach had high accuracy;however, injection accuracy depends on clinical experience.

Chinese Association for the Study of Pain:Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China(2020 edition)

Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.