Appropriate Needle Lengths Determined Using Ultrasonic Echograms for Intramuscular Injections in Japanese Infants

Adjuvanted vaccines are recommended for administration through an intramuscular route. The Centers for Disease Control and Prevention (CDC) has recommended the anterolateral thigh using a 22 - 25-G 25-mm (1 inch) needle for infants, injected at a 90° into the skin surface, and using a 16 mm (5/8 inch) for newborns. Appropriate needle lengths may differ depending on racial backgrounds. In the present study, the thickness of the epidermis and lengths from the skin surface to the muscle fascia and bone were measured using ultrasonic echograms in order to determine suitable needle lengths for Japanese infants aged 2, 3, 4, 5, 6, and 12 - 15 months old. The thickness of the epidermis was 1.44 - 1.54 mm (95% CI), and the lengths from the skin surface to the muscle fascia and bone were 11.52 - 12.28 mm (95% CI), and 25.66 - 26.93 mm (95% CI), respectively, at the anterolateral thigh. At the center of the deltoid muscle, skin thickness was similar to that at the thigh, furthermore the lengths from the skin surface to the muscle fascia and bone were 8.49 - 9.10 mm (95% CI), and 17.38 - 18.31 mm (95% CI), respectively. The lengths from the skin surface to the muscle fascia and bone were 1 - 2 mm shorter in 2-month-old infants than those in older generations. Therefore, the appropriate needle length for intramuscular injections in Japanese infants was 16 mm (5/8 inch) at any age and sites, and with 25 mm (1 inch) needles at a 90° angle being associated with the risk of over-penetration.

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.

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

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

Rapid and sensitive liquid chromatography–tandem mass spectrometric method for the quantitative determination of potentially harmful substance 5,5′-oxydimethylenebis (2-furfural) in traditional Chinese medicine injections

With the rapid development and wide application of traditional Chinese medicine injection(TCMI), a number of adverse events of some TCMIs have incessantly been reported and have drawn broad attention in recent years. Establishing effective and practical analytical methods for safety evaluation and quality control of TCMI can help to improve the safety of TCMIs in clinical applications. In this study, a sensitive and rapid high-performance liquid chromatography–tandem mass spectrometry(HPLC–MS/MS)method has been developed and validated for the quantitative determination of potentially harmful substance5,5′-oxydimethylenebis(2-furfural, OMBF) in TCMI samples. Chromatographic separation was performed on a C18 reversed-phase column(150 mm × 2.1 mm, 5 μm) by gradient elution, using methanol–water containing 0.1% formic acid as mobile phase at the flow rate of 0.3 m L/min. MS/MS detection was performed on a triple quadrupole mass spectrometer with positive electrospray ionization in the multiple reaction-monitoring mode. The method was sensitive with a limit of quantification of 0.3 ng/m L and linear over the range of 0.3–30 ng/m L(r = 0.9998). Intra-and inter-day precision for analyte was o9.52% RSD withrecoveries in the range 88.0–109.67% at three concentration levels. The validated method was successfully applied to quantitatively determine the compound OMBF in TCMIs and glucose injections. Our study indicates that this method is simple, sensitive, practicable and reliable, and could be applied for safety evaluation and quality control of TCMIs and glucose injections.

Oil oxidation in the whole temperature regions during oil reservoir air injection and development methods

The oil oxidation characteristics of the whole temperature regions from 30 ℃ to 600 ℃ during oil reservoir air injection were revealed by experiments. The whole oil oxidation temperature regions were divided into four different parts: dissolving and inflation region, low temperature oxidation region, medium temperature oxidation region and high temperature oxidation region. The reaction mechanisms of different regions were explained. Based on the oil oxidation characteristics and filed tests results, light oil reservoirs air injection development methods were divided into two types: oxygen-reducing air flooding and air flooding;heavy oil reservoirs air injection in-situ combustion development methods were divided into two types: medium temperature in-situ combustion and high temperature in-situ combustion. When the reservoir temperature is lower than 120 ℃, oxygen-reducing air flooding should be used for light oil reservoir development. When the reservoir temperature is higher than 120 ℃, air flooding method should be used for light oil reservoir development. For a normal heavy oil reservoir, when the combustion front temperature is lower than 400 ℃, the development method is medium temperature in-situ combustion. For a heavy oil reservoir with high oil resin and asphalting contents, when the combustion front temperature is higher than 450 ℃, the development method at this condition is high temperature in-situ combustion. Ten years field tests of air injection carried out by PetroChina proved that air has advantages in technical, economical and gas source aspects compared with other gas agents for oilfield gas injection development. Air injection development can be used in low/super-low permeability light oil reservoirs, medium and high permeability light oil reservoirs and heavy oil reservoirs. Air is a very promising gas flooding agent.

Experimental study on secondary air mixing along the bed height in a circulating fluidized bed with a multitracer-gas method

A multitracer-gas method was proposed to study the secondary air(SA)mixing along the bed height in a circulating fluidized bed(CFB)using carbon monoxide(CO),oxygen(O_(2)),and carbon dioxide(CO_(2))as tracer gases.Experiments were carried out on a cold CFB test rig with a cross-section of 0.42 m×0.73 m and a height of 5.50 m.The effects of superficial velocity,SA ratio,bed inventory,and particle diameter on the SA mixing were investigated.The results indicate that there are some differences in the measurement results obtained using different tracer gases,wherein the deviation between CO and CO_(2) ranges from 42%to 66%and that between O_(2) and CO_(2) ranges from 45%to 71%in the lower part of the fluidized bed.However,these differences became less pronounced as the bed height increased.Besides,the high solid concentration and fine particle diameter in the CFB may weaken the difference.The measurement results of different tracer gases show the same trends under the variation of operating parameters.Increasing superficial velocity and SA ratio and decreasing particle diameter result in better mixing of the SA.The effect of bed inventory on SA mixing is not monotonic.

Factors influencing time course of pain after depot oil intramuscular injection of testosterone undecanoate

Pain following depot intramuscular （IM） injection of oil vehicle-based drugs has been little studied. This study aimed to determine prospectively the prevalence,determinants,severity and functional consequences of pain during the week after IM injection of 1 000 mg testosterone undecanoate （TU） in a 4-mL castor oil vehicle. Androgendeficient men receiving regular T replacement therapy at an academic andrology clinic were recruited to report pain scores using a coloured visual linear analogue scale at seven times over the first day and daily for a week after a deep IM gluteal injection. The time course and covariables influencing pain scores were analysed by mixed model analysis of variance （ANOVA）. Following 168 injections in 125 men,pain was reported by 80% of men,peaking immediately after injection,reaching only moderate severity,lasting 1-2 days and returning to baseline by day 4.The pain required little analgesic use and produced minimal interference in daily activities. The time course of pain scores was reproducible in the 43 men who underwent two consecutive injections. Pain was more severe in men who had an earlier painful injection,but less severe in older and more obese men. There were negligible differences in post-injection pain experience between experienced nurses administering injections. Deep IM gluteal injection of depot TU in 4-mL castor oil is well tolerated and post-injection pain is influenced by earlier painful injection experience,as well as age and obesity.

The relationship between body mass index, thickness of subcutaneous fat, and the gluteus muscle as the intramuscular injection site

An intramuscular injection (IMI) is an injection given directly into the central area of a specific muscle. Certain medicines need to be administered by the gluteal route for these to be effective. The aim of this study was to determine the influence of body mass index (BMI), subcutaneous fat, and muscular thickness of the dorsogluteal IMI site among healthy Japanese women. There were 39 healthy female subjects who volunteered and met the criteria. Their ages ranged from 40s to 60s (50.82 ± 6.04). With the data collected using the B-mode ultrasound images of the dorsogluteal site, it was found that the distance from the epidermis to the under-fascia (DEUF) of the gluteus maximus was dissimilar between the subject’s right and left buttocks. It was found that the distance from the epidermis to the iliac bone (DEI) was significantly more on the right than on the left buttocks. In the case of an adult Japanese woman with a BMI of 21 or more, the DEUF of the gluteus medius was found to be about 30 mm, and the DEI was approximately 50 mm or more. Based on these findings, it is recommended that a needle length of 38 mm (1.5 inches) can be safely used to administer IMIs to the gluteus medius muscle to effectively and efficiently deliver medications through the IMI route.

Comparison of Gluteal Muscle Intramuscular Injection Sites of Japanese Healthy Subjects: Considerations for Optimal Insertion of Injection Needle Length

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.

Comparison of in-vial exhaust method versus conventional exhaust method in the injection of COVID-19 vaccine

Objective:The objective of the study was to compare the application effects of in-vial exhaust method and conventional exhaust method in the process of coronavirus disease 2019 vaccine injection.Materials and Methods:Using convenient sampling method,102 vaccines were selected as experiment group during the process of vaccine injection,and the in-vial exhaust method was used.One hundred and five vaccines were selected as the control group and the conventional exhaust method was adopted.The incidence of vaccine solution spillage and exhausting time in the two groups during exhaust were observed.Results:The incidence of solution spillage in the experiment group was lower than that in the control group(0 vs.6.67%,P<0.05).The exhausting time of the experiment group was shorter than that of the control group([15.12±4.43]s vs.[22.74±6.53]s,P<0.05).Conclusion:Implementing the in-vial exhaust method in the vaccine injection can effectively reduce the incidence of solution spillage,reduce nucleic acid contamination,and ensure that the vaccine is injected at the prescribed dose.Moreover,the operation is simple and easy,which improves the nurse’s vaccination efficiency,and has a higher promotion and application value.

In Vivo Kinetics and Biodistribution of a Hantaan Virus DNA Vaccine after Intramuscular Injection in Mice

To study the kinetics in vivo of a Hantaan virus DNA vaccine, we constructed a fusion DNA vaccine, pEGFP/S, by cloning the S segment of Hantavirus into the vector, pEGFP-C1, which encodes Green fluorescent protein EGFP. In this report, we provide evidence that pEGFP/S was distributed and persistently expressed for more than 60 days in several organs after inoculation. Our findings suggest that the persistent immune responses induced by a Hantaan virus DNA vaccine are likely due to the plasmid pEGFP/S deposited in vivo, which acts as a booster immunization.

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new con-firmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

Simulation of Non-isothermal Injection Molding for a Non-Newtonian Fluid by Level Set Method

A non-isothermal injection molding process for a non-Newtonian viscous pseudoplastic fluid is simulated.A conservative interface capturing technique and the flow field solving method are coupled to perform a dynamic simulation.The validity of the numerical method is verified by a benchmark problem.The melt interface evolution versus time is captured and the physical quantities such as temperature,velocity and pressure at each time step are obtained with corresponding analysis.A"frozen skin"layer with the thickness increasing versus time during the injection process is found.The fact that the"frozen skin"layer can be reduced by increasing the injection velocity is numerically verified.The fountain flow phenomenon near the melt interface is also captured.Moreover,comparisons with the non-isothermal Newtonian case show that the curvatures of the interface arcs and the pressure contours near the horizontal mid-line of the cavity for the non-Newtonian pseudoplastic case is larger than that for the Newtonian case.The velocity profiles are different at different positions for the non-Newtonian pseudoplastic case,while in the case of Newtonian flow the velocity profiles are parabolic and almost the same at different positions.

Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.

Density Limits with Different Fuelling Methods in the HL-2A Tokamak

Density limits with different fuelling methods have been compared in HL-2A, i.e. direct gas puffing and supersonic molecular beam injection （SMBI） from outer midplane, and divertor gas fuelling. The maximum densities for low current discharges are 3.4×10^19 m-3, 4.3×10^19 m-3 and 4.7×10^19 m-3 for the 3 kinds of fuelling methods. The corresponding density ratios to Green- wald density limit are 0.9, 1.1, 1.2, respectively. The behavior of density limit disruption is analyzed as well.

Power System State Estimation Solution With Zero Injection Constraints Using Modified Newton Method and Fast Decoupled Method in Polar Coordinate

如何保证零注入节点的注入功率在状态估计结果中严格为0是电力系统状态估计研究中的重要问题。在直角坐标下,由于零注入约束为线性约束,可使用修正牛顿法来有效地解决这一问题。因此,借鉴直角坐标下修正牛顿法的思路,提出了极坐标下的修正牛顿法和修正快速解耦估计。这些方法的计算流程与传统的极坐标下的牛顿法和快速解耦估计非常相似,计算速度与大权重法相当,同时能够保证零注入约束严格满足。仿真结果验证了所得结论。

New approach to develop a 3D non-isothermal computational framework for injection molding process based on level set method

The simulation of three-dimensional(3D) non-isothermal, non-Newtonian fluid filling process is an extremely difficult task and remains a challenging problem, which includes polymer melt flow with free surface coupled with transient heat transfer. This paper presents a full 3D non-isothermal two-phase flow model to predict the complex flow in melt filling process, where the Cross-WLF model is applied to characterize the rheological behavior of polymer melt. The governing equations are solved using finite volume method with SIMPLEC algorithm on collocated grids and the melt front is accurately captured by a high resolution level set method. A domain extension technique is adopted to deal with the complex cavities, which greatly reduces the computational burden. To verify the validity of the developed 3D approach, the melts filling processes in two thin rectangular cavities(one of them with a cylindrical insert) are simulated. The predicted melt front interfaces are in good agreement with the experiment and commercial software prediction. For a case with a rather complex cavity, the dynamic filling process in a hemispherical shell is successfully simulated. All of the numerical results show that the developed numerical procedure can provide a reasonable prediction for injection molding process.

Determination of Level of Knowledge on Modern Methods of Family Planning among Women of Reproductive Age (18 - 49 Years) at Mathare North Health Center in Nairobi County, Kenya

Introduction: Modern family planning methods (MFPM) prevent unwanted pregnancies, reduce fertility rate, and increase the interval between pregnancies. They prevent pregnancy by preventing fertilization or implantation of the fertilized ovum. MFPM include tubal ligation (TL), vasectomy, oral contraceptive pills, the intrauterine contraceptive device (IUCD), depot injections, sub-dermal implants, and male and female condoms. Objective: To determine the level of knowledge of modern family planning methods (MFPM) among women of reproductive age (18 - 49 years) at the Mathari North Health Center in Nairobi County, Kenya. Methods: The study conducted among women of reproductive age at Mathare North Health Center in Nairobi was a cross-sectional descriptive survey between March 2016 and November 2018. It provided both qualitative and quantitative data. The sample size comprised of 274 women of reproductive age, i.e. (18 - 49 years) attending antenatal and postnatal clinics at the facility. Those excluded were women below 18 years of age, as they could not give consent according to Kenyan Laws. The data were collected using an interviewer-administered structured questionnaire, which consisted of socio-demographic and characteristics, knowledge of modern family planning methods and distance from the facility. Likert scale was used to ensure that data was tabulated on daily basis and subjected to statistical manipulation using Statistical Package for Social Sciences (SPSS). Results: The four leading MFPM in use in order of acceptability were injectables, implants, intrauterine contraceptive device and pills in that order. 91% of respondents were aware or had heard about modern family planning methods. Level of education of mother and father were the two variables that influenced the uptake of MFPM with p-values of 0.0260 and 0.025, respectively. The study further found that knowledge of MFPM had a significant influence on their assimilation and utilization. All secondary variables considered in the research exhibit a substantial relationship concerning the use of MFPM. Conclusion: Communities around Mathari North Health Center need to be given information;education and counselling on MFPM to enable them make an informed decision and choice on their preferred method of family planning.

A fast explicit finite difference method for determination of wellhead injection pressure

A fast explicit finite difference method (FEFDM),derived from the differential equations of one-dimensional steady pipe flow,was presented for calculation of wellhead injection pressure.Recalculation with a traditional numerical method of the same equations corroborates well the reliability and rate of FEFDM.Moreover,a flow rate estimate method was developed for the project whose injection rate has not been clearly determined.A wellhead pressure regime determined by this method was successfully applied to the trial injection operations in Shihezi formation of Shenhua CCS Project,which is a good practice verification of FEFDM.At last,this method was used to evaluate the effect of friction and acceleration terms on the flow equation on the wellhead pressure.The result shows that for deep wellbore,the friction term can be omitted when flow rate is low and in a wide range of velocity the acceleration term can always be deleted.It is also shown that with flow rate increasing,the friction term can no longer be neglected.