Ultrasound, Fluoroscopic-Guided Caudal, Lumbar Epidural Steroid Injections and Blinding Paraspinal Lumbosacral Steroid Injections in Patients with Low Back Pain with Radiculopathy

Background and Aims: Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. Patients and Methods: This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. Results: In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). Conclusion: US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.

A Structured Method of Teaching Epidural Block reduces the incidence of accidental dural puncture in inexperienced trainees.

Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.

Unique method for removal of knotted lumbar epidural catheter: A case report

BACKGROUND Combined spinal-epidural(CSE)anesthesia is the preferred anesthesia method for cesarean delivery.The use of an epidural catheter is essential for administering additional drugs intraoperatively and managing postoperative pain.However,the insertion of epidural catheters is associated with various complications,such as total spinal anesthesia,symptoms indicative of spinal nerve root irritation,and challenges in epidural catheter removal.CASE SUMMARY We present a case report of a challenging epidural catheter removal due to knotting.The lumbar computed tomography scan results revealed that the catheter formed a tight knot in the epidural space.We used a novel extubation method and successfully removed the catheter.CONCLUSION The operator can use opposite forces to"spiral"apart the spinal joints by positioning the patient's body in a specific position.The findings indicate that,when combined with imaging examination results,this method is effective for the removal of epidural catheters.

Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

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.

Safety and effectiveness of electromyography-induced rehabilitation treatment after epidural electrical stimulation for spinal cord injury:study protocol for a prospective,randomized,controlled trial

Epidural electrical stimulation is a new treatment method for spinal cord injury(SCI).Its efficacy and safety have previously been reported.Rehabilitation treatment after epidural electrical stimulation is important to ensure and improve the postoperative efficacy of epidural electrical stimulation in patients with SCI.Considering that electromyography(EMG)-induced rehabilitation treatment can accurately match the muscle contraction of patients with SCI,we designed a study protocol for a prospective,randomized controlled trial.In this trial,on the premise of adjusting the spinal cord electrical stimulator to obtain the maximum EMG signal of the target muscle,patients with SCI receiving epidural electrical stimulation will undergo EMG-induced rehabilitation treatment.Recovery of muscle strength of key muscles,quality of life,safety and therapeutic effects will be monitored.Twenty patients with SCI who are scheduled to undergo epidural electrical stimulation in Shanghai Ruijin Rehabilitation Hospital will be randomly divided into two groups with 10 patients per group.The control group will receive conventional rehabilitation treatment.The EMG-induced rehabilitation group will receive EMG-induced rehabilitation treatment of the target muscles of the upper and lower limbs based on conventional rehabilitation treatment.After rehabilitation treatment,follow up for all patients will occur at 2 weeks and 1,3 and 6 months.The primary outcome measure of this trial will be evaluation of target muscle recovery using the Manual Muscle Testing grading scale.Secondary outcome measures will include modified Barthel Index scores,integrated EMG values,the visual analogue scale,Spinal Cord Independence Measure scores,and modified Ashworth scale scores.The safety indicator will be the incidence of adverse events.This trial will collect data regarding the therapeutic effects of EMG-induced rehabilitation in patients with SCI receiving epidural electrical stimulation for 6 months after rehabilitation treatment.Findings from this trial will help develop rehabilitation methods in patients with SCI after epidural electrical stimulation.This study protocol was approved by Ethics Committee of Shanghai Ruijin Rehabilitation Hospital(Approval No.RKIRB2022-12)on February 15,2022 and was registered with Chinese Clinical Trial Registry(registration number:ChiCTR2200061674;date:June 30,2022).Study protocol version:1.0.

Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

Spinal epidural abscesses (SEA) are considerably rare and tend to present over two to five vertebral segments. Occasionally, there will be two or more noncontiguous areas of pyogenic collections [1]. Minimal cases have been reported to span the entire vertebral column;a meta-analysis estimates that 1% of all SEA are holospinal [2]. The triad of presenting symptoms includes fever, back pain (often midline), and neurologic defects [1] [2] [3]. Early detection is identified as a critical aspect of improved outcomes. Cases that do not present in this manner or with other masking symptoms can lead to delayed diagnosis, thus delaying treatment. In the event of cord compression, the occurrence of neurologic defects increases. Time from the onset of clinical manifestations to the operating room is crucial in reversing symptoms [2]. This article seeks to review a case of a 65-year-old male that presented to the emergency department (ED) due to a falling second to weakness and thigh pain. On presentation, he was also noted to have rhabdomyolysis causing acute kidney injury (AKI) with tubular necrosis. The patient was admitted to the hospital with a complex history of progressive leg weakness, pain in the lower back, incontinence, and elevated white blood cell count. Days into the admission, a magnetic resonance imaging (MRI) study was performed, which revealed a continuous posterior SEA from C4 to S2 with anterior mass effect causing spinal cord compression. Emergency neurosurgery was scheduled for laminectomies in the cervical, thoracic and lumbar spine to drain the abscess. Evaluation of this complex medical course, surgical approach to drainage of an incessant spinal column abscess, and sustained neurologic defects will be discussed.

Successful remimazolam sedation-epidural block in an older patient with severe chronic obstructive pulmonary disease:A case report

BACKGROUND Chronic obstructive pulmonary disease(COPD)is associated with high morbidity and mortality rates worldwide.Older patients have a degenerative cardiopulmonary function,weak compensatory capacity,and poor surgical tolerance.Therefore,the mode of anesthesia must be optimized.Remimazolam is a new ultrashort-acting benzodiazepine with a rapid onset of action,rapid metabolism,and mild effects on pulmonary circulation.Remimazolam sedation combined with an epidural block has not been reported in hypertensive older adults with severe COPD and inguinal mass resection.CASE SUMMARY We report the case of a 73-year-old man with hypertension and severe COPD,who underwent resection of an enlarged inguinal mass that he had noticed more than 7 mo before presentation.The patient presented with a“right inguinal mass”and was recommended to undergo an enlarged inguinal mass resection.Surgery was relatively challenging,due to the large mass(13 cm×8 cm×7 cm),hard texture,and poor mobility.Considering the advanced age of the patient,gradeⅢhypertension,and severe COPD,we administered remimazolam combined with an epidural block for anesthesia to ensure perioperative safety and careful consideration.The anesthetic effect was precise;the procedure was performed smoothly without any complications,and the patient was successfully anesthetized.However,anesthetic management in such cases has not yet been reported by previous studies.CONCLUSION Remimazolam sedation combined with an epidural block is safe and effective in older patients with hypertension and severe COPD.

Eye Movement Modeling Examples as a Teaching Tool for Epidural Block

Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.

Is It Safe to Perform an Autologous Epidural Blood Patch on Patients with Underlying Spinal Stenosis or Lumbar Disc Disease? Case Report and Literature Review

The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with underlying spinal pathology. We present a case of a patient with known severe lumbar spinal stenosis with compressive radiculopathy who received a successful epidural blood patch without worsening her underlying neurologic symptoms. Epidural blood patches can be safely performed in this patient population. However, the anesthesiologist should be aware of the risk of potentially worsening preexisting neurological deficits. Thus, we advise caution prior to placing an epidural blood patch on these patients. The risks and benefits of the procedure should be carefully weighed and considered. It is important to have a thorough discussion with the patient regarding the risks of an epidural blood patch prior to performing the procedure.

Substance P promotes epidural fibrosis via induction of type 2 macrophages

In response to spinal surgery,neurons secrete a large amount of substance P into the epidural area.Substance P is involved in macrophage differentiation and fibrotic disease.However,the specific roles and mechanisms of substance P in epidural fibrosis remain unclear.In this study,we established a mouse model of L1–L3 laminectomy and found that dorsal root ganglion neurons and the macrophages infiltrating into the wound area released sphingolipids.In vitro experiments revealed that type 1 macrophages secreted substance P,which promoted differentiation of type 1 macrophages towards a type 2 phenotype.High-throughput mRNA-seq analysis revealed that the sphingolipid metabolic pathway may be involved in the regulation of type 2 macrophages by substance P.Specifically,sphingomyelin synthase 2,a component of the sphingolipid metabolic pathway,promoted M2 differentiation in substance P-treated macrophages,while treating the macrophages with LY93,a sphingomyelin synthase 2 inhibitor,suppressed M2 differentiation.In addition,substance P promoted the formation of neutrophil extracellular traps,which further boosted M2 differentiation.Blocking substance P with the neurokinin receptor 1 inhibitor RP67580 decreased the number of M2 macrophages in the wound area after spinal surgery and alleviated epidural fibrosis,as evidenced by decreased fibronectin,α-smooth muscle actin,and collagen I in the scar tissue.These results demonstrated that substance P promotes M2 macrophage differentiation in epidural fibrosis via sphingomyelin synthase 2 and neutrophil extracellular traps.These findings provide a novel strategy for the treatment of epidural fibrosis.

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.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation:A case report

BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.

Epidural Blood Patches Performed with Miethke Sensor Reservoir for Continuous Intracranial Pressure Monitoring

An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.

Injections Attacks Efficient and Secure Techniques Based on Bidirectional Long Short Time Memory Model

E-commerce,online ticketing,online banking,and other web-based applications that handle sensitive data,such as passwords,payment information,and financial information,are widely used.Various web developers may have varying levels of understanding when it comes to securing an online application.Structured Query language SQL injection and cross-site scripting are the two vulnerabilities defined by the OpenWeb Application Security Project(OWASP)for its 2017 Top Ten List Cross Site Scripting(XSS).An attacker can exploit these two flaws and launch malicious web-based actions as a result of these flaws.Many published articles focused on these attacks’binary classification.This article described a novel deep-learning approach for detecting SQL injection and XSS attacks.The datasets for SQL injection and XSS payloads are combined into a single dataset.The dataset is labeledmanually into three labels,each representing a kind of attack.This work implements some pre-processing algorithms,including Porter stemming,one-hot encoding,and the word-embedding method to convert a word’s text into a vector.Our model used bidirectional long short-term memory(BiLSTM)to extract features automatically,train,and test the payload dataset.The payloads were classified into three types by BiLSTM:XSS,SQL injection attacks,and normal.The outcomes demonstrated excellent performance in classifying payloads into XSS attacks,injection attacks,and non-malicious payloads.BiLSTM’s high performance was demonstrated by its accuracy of 99.26%.

Iridociliary Body Metastasis of Atypical Carcinoid: Case Management with Intravitreal Anti-Vascular Endothelial Growth Factor Injections

We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.

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.

Comparison of different noble gas injections by massive gas injection on plasma disruption mitigation on Experimental Advanced Superconducting Tokamak

Massive gas injection(MGI)is a traditional plasma disruption mitigation method.This method directly injected massive gas into the pre-disruption plasma and had been developed on the Experimental Advanced Superconducting Tokamak(EAST).Different noble gas injection experiments,including He,Ne,and Ar,were performed to compare the mitigation effect of plasma disruption by evaluating the key parameters such as flight time,pre-thermal quench(pre-TQ),and current quench(CQ).The flight time was shorter for low atomic number(Z)gas,and the decrease in flight time by increasing the amount of gas was insignificant.However,both pre-TQ and CQ durations decreased considerably with the increase in gas injection amount.The effect of atomic mass on pre-TQ and CQ durations showed the opposite trend.The observed trend could help in controlling CQ duration in a reasonable area.Moreover,the analysis of radiation distribution with different impurity injections indicated that low Z impurity could reduce the asymmetry of radiation,which is valuable in mitigating plasma disruption.These results provided essential data support for plasma disruption mitigation on EAST and future fusion devices.