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Rosacea is a chronic inflammatory skin disease, characterized by transient flushing, persistent erythema, papules, pustules and telangiectasia. The pathogenesis of rosacea is complex. Although traditional therapies have been shown to improve the symptoms, the therapeutic effect is not satisfactory. In recent years, scholars at home and abroad have proposed new therapeutic approaches to treat rosacea and advancement has been achieved in the fields of topical injection therapy, systemic therapy and physical therapy. Injections of botulinum toxin (BTX) can improve the facial erythema and flushing as well as patients quality of life. Medications such as Tranexamic Acid (TXA) and metformin originally prescribed for other disorders have shown potential therapeutic effects on rosacea. Additionally, the treatment of either neurological or psychiatric disorders or digestive diseases that are comorbid with rosacea may also alleviate rosacea. This article reviews the recent advances in the treatment of rosacea, aiming to provide new insights for the clinical treatment.

Objective To evaluate the clinical efficacy and safety of trephine combined with superficial X-ray radiation and local injection in the treatment of generalized keloids. Methods Five patients with generalized keloids treated at Dermatology Hospital of Southern Medical University from May 2020 to May 2021 were included in this study. VSS scores were compared before and after 12-month treatments with trephine combined with superficial X-ray radiation and local injection of triamcinolone acetonide. Adverse reactions were also assessed. Results After the treatment, all scar tissue became flatter and softer. The VSS scores were significantly decreased from the baseline (4.08±1.11 vs. 9.28±1.52, t=16.30, P

AbstractThe local injection of therapeutic drugs, including cells, oncolytic viruses and nucleic acids, into different organs is an administrative route used to achieve high drug exposure at the site of action. However, after local injection, material backflow and side effect reactions can occur. Hence, this study was carried out to investigate the effect of gelatin on backflow reduction in local injection. Gelatin particles (GPs) and hydrolyzed gelatin (HG) were injected into tissue models, including versatile training tissue (VTT), versatile training tissue tumor-in type (VTT-T), and broiler chicken muscles (BCM), using needle gauges between 23 G and 33 G. The backflow material fluid was collected with filter paper, and the backflow fluid rate was determined. The backflow rate was significantly reduced with 35 μm GPs (p value < .0001) at different concentrations up to 5% and with 75 μm GPs (p value < .01) up to 2% in the tissue models. The reduction in backflow with HG of different molecular weights showed that lower-molecular-weight HG required a higher-concentration dose (5% to 30%) and that higher-molecular-weight HG required a lower-concentration dose (7% to 8%). The backflow rate was significantly reduced with the gelatin-based formulation, in regard to the injection volumes, which varied from 10 μL to 100 μL with VTT or VTT-T and from 10 μL to 200 μL with BCM. The 35 μm GPs were injectable with needles of small gauges, which included 33 G, and the 75 μm GPs and HG were injectable with 27 G needles. The backflow rate was dependent on an optimal viscosity of the gelatin solutions. An optimal concentration of GPs or HG can prevent material backflow in local injection, and further studies with active drugs are necessary to investigate the applicability in tumor and organ injections.

For many years, sustained-release drug delivery systems (SRDDS) have emerged as a featured topic in the pharmaceutical field. Particularly for chronic diseases, such as osteoarthritis, there is a lot of demand for SRDDS because of the long treatment period and repetitive medication administration. Thus, we developed an injectable PLGA-F127 microsphere (MS) that is capable of the in situ conversion to an implant. The microprecipitation method for PLGA-F127 MS was established, and the physicochemical stability of the products was confirmed. The microspheres were assembled into a single mass in 37 °C aqueous conditions and showed a remarkably delayed drug release profile. First, the release started with no significant initial burst and lagged for 60 days. After that, in the next 40 days, the remaining 75% of the drugs were constantly released until day 105. We expect that our PLGA-F127 MS could be employed to extend the release period of 2 months of medication to 4 months. This could be a valuable solution for developing novel SRDDS for local injections. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical efficacy and safety of trephine combined with superficial X-ray radiation and local injection in the treatment of generalized keloids. Methods Five patients w让h generalized keloids treated at Dermatology Hospital of Southern Medical University from May 2020 to May 2021 were included in this study・ VSS scores were compared before and after 12-month treatments with trephine combined with superficial radiation and local injection of triamcinolone acetonide ・ Adverse reactions were also assessed ・ Results After the treatment, all scar tissue became flatter and softer・ The VSS scores were significantly decreased from the baseline (4. 08 土 1 ・ 11 必.9・ 28 ± 1 ・ 527 t = 16. 30, P <0. 001)・ No severe infections, severe allergy or skin ulcers were observed during the followperiod・ Conclusion Trephine combined with superficial X-ray radiation and local injection of triamcinolone acetonide is effective and safe for keloids. [ABSTRACT FROM AUTHOR]

To report a case of anaphylactic shock caused by the treatment of plantar warts with local injection of pingyangmycin and review the relevant literature. A 30-year-old male had two horny growths on the front sole for 2 months and was diagnosed with plantar wart. Patient was healthy without a history of allergy to foods or drugs. He was treated with local injection of Pingyangmycin in the interval of 3~4 weeks at our hospital in May 2021. After three treatments, the patient did not continue the treatment because of the disappearance of the lesions. In July 2022, plantar wart recurred and the patient received the injection of pingyangmycin again. However, about 5 minutes after the fifth injection, patient developed symptoms of anaphylactic shock such as blurred vision, dyspnea, and blood pressure dropping. Dexamethasone (5 mg IV) and epinephrine (0.5 mg IM) were given immediately. About 1 hour later, the symptoms were gradually relieved and his vital signs were stable.

Objective To analyze the efficacy and safety of intralesional triamcinolone acetonide in the treatment of mass granulomatous mastitis (GLM). Methods Retrospective analysis was made on 67 patients with GLM who were treated in Xijing Hospital from July 2021 to May 2022 and met the inclusion criteria. Among them, 31 patients were treated with local injection of triamcinolone acetonide, while 36 ones were treated with oral methylprednisolone. All the included patients underwent surgical treatment after their condition met the surgical criteria, and the follow-up period lasted for up to six months after surgery. The two groups were compared in improvement of symptoms and signs, treatment time, clinical effectiveness and safety, and recurrence rate. Results The effective rate of triamcinolone acetonide group and methylprednisolone group was 100%, but the clinical cure rate was significantly higher in triamcinolone acetonide group than in methylprednisolone group in stratified analysis (P<0.05). The improvement time of symptoms and signs in triamcinolone acetonide group was significantly shorter than that in methylprednisolone group (P<0.05). The incidence of side effects in triamcinolone acetonide group was also significantly reduced compared to methylprednisolone group (P<0.05). Follow-up for half a year showed no recurrence in both groups. Conclusion Compared with the traditional oral methylprednisolone group, local injection of triamcinolone acetonide in the treatment of mass granulomatous mastitis can rapidly relieve clinical symptoms and signs, shorten treatment time, and has higher efficiency and fewer side effects. Local injection of hormone combined with surgery is effective in treating mass granulomatous mastitis with low recurrence rate. [ABSTRACT FROM AUTHOR]

For many years, sustained-release drug delivery systems (SRDDS) have emerged as a featured topic in the pharmaceutical field. Particularly for chronic diseases, such as osteoarthritis, there is a lot of demand for SRDDS because of the long treatment period and repetitive medication administration. Thus, we developed an injectable PLGA-F127 microsphere (MS) that is capable of the in situ conversion to an implant. The microprecipitation method for PLGA-F127 MS was established, and the physicochemical stability of the products was confirmed. The microspheres were assembled into a single mass in 37 °C aqueous conditions and showed a remarkably delayed drug release profile. First, the release started with no significant initial burst and lagged for 60 days. After that, in the next 40 days, the remaining 75% of the drugs were constantly released until day 105. We expect that our PLGA-F127 MS could be employed to extend the release period of 2 months of medication to 4 months. This could be a valuable solution for developing novel SRDDS for local injections.

BACKGROUND: The use of tranexamic acid in total knee arthroplasty can reduce perioperative blood loss, but the optimal choice of tranexamic acid administration route and dose remains controversial. OBJECTIVE: To investigate the efficacy and safety of tranexamic acid in reducing perioperative blood loss in patients with total knee arthroplasty. METHODS: 261 patients undergoing total knee arthroplasty in Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital) from January 2020 to December 2021 were enrolled, including 61 males and 200 females, at the age of (68.0±7.1) years. Among them, 85 cases received intravenous infusion of tranexamic acid 1 g before skin incision and when the incision was sutured (intravenous group); 115 cases received intravenous infusion of tranexamic acid 1 g before skin incision, and 1 g of tranexamic acid was given intravenously when the incision was sutured after surgery (combined group); 61 cases did not use tranexamic acid (blank group). Blood loss of the patients was recorded; blood laboratory data of the patients were collected after surgery; postoperative complications and blood transfusion were counted. All patients were followed up to 1 month after the operation. RESULTS AND CONCLUSION: (1) Compared with the blank group, the total blood loss and invisible blood loss during the perioperative period in the intravenous group and the combined group were significantly lower (P < 0.05). There was no significant difference in the total blood loss and invisible blood loss between the intravenous group and the combined group during the perioperative period (P > 0.05). (2) There was no significant difference in intraoperative blood loss and postoperative venous thrombosis incidence among the three groups (P > 0.05). The blood transfusion rate in the intravenous group and the combined group was lower than that in the blank group (P < 0.05). (3) The hemoglobin levels of patients in the intravenous group and the combined group were higher than those in the blank group on days 1 and 3 after operation (P < 0.05). The platelet counts in the intravenous group and the combined group were higher than those in the blank group on the first day after operation (P < 0.05). The leukocyte count of the intravenous group and the combined group on the first day after operation was lower than that of the blank group (P < 0.05). The leukocyte count in the intravenous group on the first day after operation was lower than that in the combined group (P < 0.05). The erythrocyte sedimentation rate and C-reactive protein level of the intravenous group and the combined group on the first day after operation were lower than those of the blank group (P < 0.05). The erythrocyte sedimentation rate and C-reactive protein level in the intravenous group on the first day after operation were lower than those in the combined group (P < 0.05). (4) These results have suggested that intravenous injection and intra-articular injection are both effective ways of using tranexamic acid, and intravenous injection and intra-articular injection have no synergistic effect. [ABSTRACT FROM AUTHOR]

Microneedles are micron structures that provide the possibility of drug delivery, vaccination and sampling of different organs. The use of microneedles does not require special skills and training, it significantly reduces the dosage and allows the timely release of the drug. The numerous advantages of microneedles compared to other methods of drug delivery have attracted the attention of many researchers. Microneedles are made from the order of microns to millimeters using microfabrication technology using various metals, silicon and polymers. So far, various methods have been proposed for making microneedles. In this article, the conventional and widely used methods of microneedle manufacturing are presented along with their advantages and limitations in terms of the effective parameters in the selection of microneedle. Effective factors such as the type of drug, the desired mechanism for drug delivery, the dimensions and material type lead to the selection of different methods for making microneedles. Among the existing micro fabrication methods, the casting method has the ability to produce different types of microneedles, and thus has been the most popular. The casting method is simple and cheap and can be produced in high volume. Deep reactive ion etching methods make high-precision microneedles, but due to the need for advanced and expensive equipment, a skilled person, and a complex and time-consuming process, they are not capable of mass production. Meanwhile, 3D printing with fully automatic processes is a good option to choose. [ABSTRACT FROM AUTHOR]

To report a case of anaphylactic shock caused by the treatment of plantar warts with local injection of pingyangmycin and review the relevant literature. A 30-year-old male had two horny growths on the front sole for 2 months and was diagnosed with plantar wart. Patient was healthy without a history of allergy to foods or drugs. He was treated with local injection of Pingyangmycin in the interval of 3~4 weeks at our hospital in May 2021. After three treatments, the patient did not continue the treatment because of the disappearance of the lesions. In July 2022, plantar wart recurred and the patient received the injection of pingyangmycin again. However, about 5 minutes after the fifth injection, patient developed symptoms of anaphylactic shock such as blurred vision, dyspnea, and blood pressure dropping. Dexamethasone (5 mg IV) and epinephrine (0.5 mg IM) were given immediately. About 1 hour later, the symptoms were gradually relieved and his vital signs were stable. [ABSTRACT FROM AUTHOR]

Traditional drug solutions or suspensions, have been shown to treat pain in complete Freund’s adjuvant (CFA)-induced chronic inflammatory pain in rats, with or without combination with magnetic therapy. In this study, we aimed to prepare, characterize, and evaluate the therapeutic effects of microparticles containing dexamethasone for local administration and treatment of chronic inflammatory pain. The results showed the following; a) Preparation and characterization: two ratios of poly(lactic-co-glycolic acid) (PLGA)/poly(lactic acid) (PLA) were used. The prepared batches were similar in size and magnetic responsiveness. The microparticle size distribution assessed via electron microscopy suggested a homogeneous distribution and absence of aggregates. Dexamethasone release profiles (microparticles synthesized with a feed ratio of 1:4) showed a sustained release in vitro and good biocompatibility with tissues. b) Therapeutic effect: the treatment effect of dexamethasone-PLGA magnetic microspheres + magnetic therapy was substantially better than that observed for other groups on day 4, as monitored by appearance, mechanical pain threshold, and histological analysis. This type of carrier could be a suitable magnetically retainable local drug delivery system for treating chronic pain.

Background: Retroauricular injection is a local steroid hormone administration method commonly used to treat deafness or tinnitus. The acute stage of Bell's Palsy is an acute disease that requires steroid therapy. Retroauricular injection may replace oral administration of steroid hormones in the treatment of this disease as well as reduce the occurrence of adverse reactions. Methods: This study included patients with Bell's Palsy within seven days of onset. A total of 120 patients were enrolled as the study subjects and randomly divided into two groups: the experimental group and the control group. Both groups received routine acupuncture treatment and took a traditional Chinese medicine decoction corresponding with the syndrome type. Methylprednisolone sodium succinate was injected into the bone surface of retroauricula in the experimental group, and prednisone acetate was orally administered in the control group. The main outcome indicators were the House–Brackmann (HB) grade, the facial disability index (FDI), and time of postauricular pain after one month of treatment. Results: There were no significant differences in the HB grade (2.00 ± 1.06 vs. 1.88 ± 1.06, P=), FDIP (97.25 ± 6.00 vs. 97.17 ± 7.39, P=), and FDIS (0.60 ± 3.02 vs. 1.33 ± 4.27, P=) at 30 days after treatment between the two groups (P > 0.05). Postauricular pain disappeared earlier in the experimental group (3.66 ± 1.67 days) than in the control group (6.31 ± 2.34); the difference was statistically significant (P ≤ 0.001). The adverse reaction rate was lower in the experimental group (15.00%) than in the control group (21.66%). Interpretation: Although the dose of steroid hormone injected into the bone surface of retroauricula in the treatment of Bell's Palsy is lower than the administered dose of oral hormones, it has the same curative effect; however, it has a better effect regarding to the duration of postauricular pain and adverse reactions.

Background. Carpal tunnel syndrome is the most common compression mononeuropathy. The choice of the preferred conservative treatment method is still relevant, especially for the patients with the moderate severity of the disease. Objective: to perform a comparative study of the effectiveness of local injection therapy and wrist splinting in idiopathic moderate carpal tunnel syndrome; to assess the duration of the clinical effect in the follow‑up period to 6 months. Materials and methods. The study included 105 cases of moderate idiopathic carpal tunnel syndrome. Patients were randomized to 2 groups depending on the treatment method: the main group (n = 54) received 1 or 2 ultrasound‑guided injections with glucocorticosteroid (betamethasone 5 mg + 2 mg/1.0 ml) and lidocaine 2 % 1.0 ml into the carpal canal; the control group (n = 51) was assigned wrist splinting at night for 1 month. The primary criterion for therapy effectiveness was evaluation by clinical scales (SSS, FSS, LANSS, Visual Analogue Scale) after 1 month from the treatment initiation. A secondary criterion for the therapy effectiveness was the assessment of changes in electrophysiological and neurosonographic parameters.Results. The scores for SSS, FSS, LANSS and Visual Analogue Scale were significantly lower at 1 month in the injection therapy group than in the splinting group (p

Traditional drug solutions or suspensions, have been shown to treat pain in complete Freund's adjuvant (CFA)-induced chronic inflammatory pain in rats, with or without combination with magnetic therapy. In this study, we aimed to prepare, characterize, and evaluate the therapeutic effects of microparticles containing dexamethasone for local administration and treatment of chronic inflammatory pain. The results showed the following; a) Preparation and characterization: two ratios of poly(lactic-co-glycolic acid) (PLGA)/poly(lactic acid) (PLA) were used. The prepared batches were similar in size and magnetic responsiveness. The microparticle size distribution assessed via electron microscopy suggested a homogeneous distribution and absence of aggregates. Dexamethasone release profiles (microparticles synthesized with a feed ratio of 1:4) showed a sustained release in vitro and good biocompatibility with tissues. b) Therapeutic effect: the treatment effect of dexamethasone-PLGA magnetic microspheres + magnetic therapy was substantially better than that observed for other groups on day 4, as monitored by appearance, mechanical pain threshold, and histological analysis. This type of carrier could be a suitable magnetically retainable local drug delivery system for treating chronic pain. [ABSTRACT FROM AUTHOR]

Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate. [ABSTRACT FROM AUTHOR]

Background/Aims Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding. Methods We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.

Background: In a previous paper, we have demonstrated that: (1) local injection of corticosteroids for carpal tunnel syndrome (CTS) is as effective as decompressive surgery, at 1-year follow-up; and (2) surgery has an additional benefit in the 2-year follow-up. In this study, we assess the long-term outcomes of both therapies in an observational extension of the patients originally enrolled in our randomized clinical trial. Methods: Patients were included in an open, randomized clinical trial, comparing injections versus surgery in CTS. After the end of the clinical trial, patients received the treatment prescribed by their general practitioner or specialist. Therapeutic failure was defined as the need of any new therapeutic intervention on the involved wrist. Comparison between groups was made using Cox multiple regression analysis. Estimation of the accumulated incidence of new therapeutic failure was made considering the withdrawal as a competitive risk (Gooley's test). Results: Of 163 randomized wrists at the beginning of the study, only 148 were available at the final follow-up. The mean follow-up was 6.3 and the median was 5.9 years. In the long-term follow-up, the accumulated incidence of therapeutic failure in the surgery group was 11.6% versus 41.8% in the injection group. The Cox multiple regression analysis showed a risk of failure associated with injection group of 4.5 (95% confidence interval [CI], 2.1-9.8; P <.0001). Conclusions: In long-term follow-up, surgery seems more effective than local corticosteroid injections in primary CTS. Nonetheless, about 58% of the patients in the injection group will not need further therapeutic interventions during the follow-up. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a widespread disease of synovial joints, the treatment of which determines a significant number of tactical and strategic directions. Currently, there is experience in the local use of so-called synovial fluid (SF) prostheses, which are viscoelastic substances that improve the cushioning properties of the native intra-articular environment. The overwhelming majority of viscoelastic additives are represented by hyaluronic acid (HA) derivatives, a natural component of SF, whose biological role consists in maintaining the rheological properties of fluid and the presence of anti-inflammatory, anti-nociceptive and chondro-protective properties. In the development of HA drugs, the main goals are the sustained and controlled release of therapeutic doses of the drug, taking into account the choice of carrier, drug molecule and target articular tissue. Assessing the quality and physiological feasibility of introducing a particular viscoelastic drug into the joint involves determining the so-called crossover frequency - the point of intersection of the viscosity modulus G’ and the elastic modulus G” (G’/G”), which reflects changes in the viscoelastic properties of the SF with increasing load frequency when transitioning from walking to running. Physiological range of frequencies out of the majority of investigated medical products corresponds to a single one, among which there are also variants of domestic production. Numerous studies of local application of some HA drugs in patients with OA confirm their effectiveness and safety, in particular, reduction of pain syndrome, reduction of the need for nonsteroidal anti-inflammatory drugs, improvement of the quality of life. However, unfortunately, most HA drugs available on the market have not undergone full-fledged clinical trials, so there is a need to study the comparative effectiveness of drugs of this group approved for use and determine their place in the treatment of OA with different variants of the course.

Hui Ma,1,2 Ping Kuen Lam,3 Wing Sum Siu,1,2 Cindy See Wai Tong,3 Kin Ki Yan Lo,3 Chi Man Koon,1,2 Xiao Xiao Wu,1,2 Xiang Li,1,2 Wen Cheng,1,2 Wai Ting Shum,1,2 Ping Chung Leung1,2 1Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region of China; 2State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region of China; 3Chow Tai Fook-Cheng Yu Tung Surgical Stem Cell Research Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region of ChinaCorrespondence: Ping Chung LeungInstitute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region of ChinaTel +85222528868Email pingcleung@cuhk.edu.hkIntroduction: The biological role of mesenchymal stem cells (MSCs) in wound healing has been demonstrated. However, there were limited studies on the healing effect of secretome which consists of many biological factors secreted by MSCs. In this study, we aimed to compare the therapeutic effects of secretome with MSCs on facilitating wound healing.Methods: Green fluorescent protein labelled adipose-derived MSCs (GFP-ADMSCs) or secretome was injected in the full-thickness skin excision model on SD rats. The wound healing process was evaluated by calculating the healing rate and the histological examinations on skin biopsy. The cell viability, proliferation and mobility of the rat dermal fibroblasts were compared after different treatments. The inflammatory response in macrophages was indicated by the level of nitric oxide (NO) and inflammatory cytokines through NO assay and ELISA.Results: On day 5 and day 14, both MSCs and secretome accelerated the wound healing, secretome further enhanced the process. GFP-MSCs were detected 10 days after transplantation. The level of IL-6 and TNF-α in blood was reduced after MSCs and secretome treatments. The expressions of VEGF and PCNA were increased after treatment, higher intensity of VEGF was observed in secretome-injected tissue. The concentrations of total protein and VEGF in secretome were 2.2 ± 0.5 mg/mL and 882.0 ± 72.7 pg/mL, respectively. The cell viability and proliferation of FR were promoted significantly after the treatment. The scratch test showed that secretome accelerated the wound healing speed. Secretome reduced the metabolism of macrophages remarkably, but it did not decrease the level of macrophage-secreted NO. The expression of the pro-inflammatory cytokines (IL-6, MCP-1 and TNF-α) was downregulated significantly.Conclusion: Our study indicated both MSCs and MSCs-derived secretome enhanced the wound healing process in early phase. Secretome further promoted the healing effects through promoting the fibroblast proliferation and migration and suppressing the inflammatory response.Keywords: MSCs, secretome, wound healing, local injection, skin

Pyriform sinus fistula (PSF) is a rare congenital branchial anomaly that commonly found in children. It can result in recurrent cervical infection or acute suppurative thyroiditis (AST). Confirming the fistula tract is the key point for the diagnosis of PSF. Ultrasound plays an important role in the diagnosis of PSF and its complications. We examine a case of AST secondary to PSF by ultrasonography, and successfully demonstrate its fistula through local injection of ultrasound contrast agent into the thyroid abscess cavity. This is the first report that confirms a fistula tract through local injection of ultrasound contrast agent, and it can serve as an accurate modality for the fistula detection of PSF.

Background: Recently, there was a series of clinical studies focusing on local injection of platelet-rich plasma (PRP) for treatment of patients with carpal tunnel syndrome (CTS). However, the safety and efficacy of PRP in these CTS patients remains controversial. Therefore, we performed a systematic review to compare PRP with other conservative treatments in treatment of CTS patients. Methods: We systematically searched from electronic databases (Cochrane, PubMed, Web of Science, and EMBASE) up to 10 December 2021. The data of clinical results were extracted and analyzed by RevMan Manager 5.4. Results: Finally, eight randomized controlled studies, involving 220 CTS patients undergoing local injection of PRP were enrolled in this systematic review. All enrolled trials were considered to be of high quality. In the short-term efficacy, the PRP group was significantly lower in symptom severity scale (SSS) compared with the control group (MD = −2.00; 95% CI, −3.15 to −0.85; p = 0.0007; I2 = 0%). In the mid-term efficacy, the PRP group was significantly effective than the control group in the visual analogue scale (MD = −0.63; 95% CI, −1.22 to −0.04; p = 0.04; I2 = 61%), SSS (MD = −3.56; 95% CI, −4.93 to −2.18; p < 0.00001; I2 = 0%), functional status scale (MD = −2.29; 95% CI, −3.03 to −1.56; p < 0.00001; I2 = 45%), sensory peak latency (MD = −0.39; 95% CI, −0.58 to −0.19; p = 0.0001; I2 = 0%) and cross-sectional area of median nerve (MD = -0.20; 95% CI, −0.31 to −0.10; p = 0.0002; I2 = 0%). In the mid-long-term efficacy, the PRP group was only significantly lower in SSS compared with the control group (MD = −2.71; 95% CI, −4.33 to −1.10; p = 0.001; I2 = 38%). Conclusion: Local PRP injection is more effective than other conservative treatments in terms of mid-term efficacy in relieving pain, improving wrist function and symptoms, reducing MN swelling, and partially improving electrophysiological indicators. However, the long-term adverse side and consensus on standardization of PRP in CTS patients still need further large-scale trials. [ABSTRACT FROM AUTHOR]

Background: Postauricular injection as a local therapy has been confirmed to be effective for inner ear diseases. However, the mechanism for the drugs entering the inner ears remains unknown. This study aims to compare the distribution of dexamethasone by intramuscular injection with that by postauricular injection, and explore the pathway of the drugs entering the inner ears. Methods: An in vivo optical imaging system was used to conduct a time course observation to compare the distribution of dexamethasone by intramuscular injection with that by postauricular injection in male guinea pigs. The drug availability in the tympanic mucosa, tympanum, endolymphatic sac, and cochlea was observed by a confocal laser scanning microscope. Results: The local fluorescent intensity by postauricular injection was significantly higher in the inner ears, and lower in partial peripheral organs, than that by the intramuscular injection. The drug metabolism by postauricular injection exhibited an obviously sustained release effect in the inner ears. Drugs by postauricular injection might enter the endolymphatic sac through the posterior auricular artery and occipital artery, as well as the connections of the mastoid emissary vein, sigmoid sinus and endolymphatic sac. Conclusion: More drugs concentrated in the inner ear for longer therapeutic time and less systemic delivery implied more effective and less risk of side effects through postauricular injection than intramuscular injection safer for the treatment of inner ear diseases. [ABSTRACT FROM AUTHOR]

Abstract Glioblastoma (GBM) is the most common and malignant Grade IV primary craniocerebral tumor caused by glial cell carcinogenesis with an extremely poor median survival of 12–18 months. The current standard treatments for GBM, including surgical resection followed by chemotherapy and radiotherapy, fail to substantially prolong survival outcomes. Adeno-associated virus (AAV)-mediated gene therapy has recently attracted considerable interest because of its relatively low cytotoxicity, poor immunogenicity, broad tissue tropism, and long-term stable transgene expression. Furthermore, a range of gene therapy trials using AAV as vehicles are being investigated to thwart deadly GBM in mice models. At present, AAV is delivered to the brain by local injection, intracerebroventricular (ICV) injection, or systematic injection to treat experimental GBM mice model. In this review, we summarized the experimental trials of AAV-based gene therapy as GBM treatment and compared the advantages and disadvantages of different AAV injection approaches. We systematically introduced the prospect of the systematic injection of AAV as an approach for AAV-based gene therapy for GBM.

Background: Recently, there was a series of clinical studies focusing on local injection of platelet-rich plasma (PRP) for treatment of patients with carpal tunnel syndrome (CTS). However, the safety and efficacy of PRP in these CTS patients remains controversial. Therefore, we performed a systematic review to compare PRP with other conservative treatments in treatment of CTS patients.Methods: We systematically searched from electronic databases (Cochrane, PubMed, Web of Science, and EMBASE) up to 10 December 2021. The data of clinical results were extracted and analyzed by RevMan Manager 5.4.Results: Finally, eight randomized controlled studies, involving 220 CTS patients undergoing local injection of PRP were enrolled in this systematic review. All enrolled trials were considered to be of high quality. In the short-term efficacy, the PRP group was significantly lower in symptom severity scale (SSS) compared with the control group (MD = −2.00; 95% CI, −3.15 to −0.85; p = 0.0007; I2 = 0%). In the mid-term efficacy, the PRP group was significantly effective than the control group in the visual analogue scale (MD = −0.63; 95% CI, −1.22 to −0.04; p = 0.04; I2 = 61%), SSS (MD = −3.56; 95% CI, −4.93 to −2.18; p < 0.00001; I2 = 0%), functional status scale (MD = −2.29; 95% CI, −3.03 to −1.56; p < 0.00001; I2 = 45%), sensory peak latency (MD = −0.39; 95% CI, −0.58 to −0.19; p = 0.0001; I2 = 0%) and cross-sectional area of median nerve (MD = -0.20; 95% CI, −0.31 to −0.10; p = 0.0002; I2 = 0%). In the mid-long-term efficacy, the PRP group was only significantly lower in SSS compared with the control group (MD = −2.71; 95% CI, −4.33 to −1.10; p = 0.001; I2 = 38%).Conclusion: Local PRP injection is more effective than other conservative treatments in terms of mid-term efficacy in relieving pain, improving wrist function and symptoms, reducing MN swelling, and partially improving electrophysiological indicators. However, the long-term adverse side and consensus on standardization of PRP in CTS patients still need further large-scale trials.

BackgroundPostauricular injection as a local therapy has been confirmed to be effective for inner ear diseases. However, the mechanism for the drugs entering the inner ears remains unknown. This study aims to compare the distribution of dexamethasone by intramuscular injection with that by postauricular injection, and explore the pathway of the drugs entering the inner ears.MethodsAn in vivo optical imaging system was used to conduct a time course observation to compare the distribution of dexamethasone by intramuscular injection with that by postauricular injection in male guinea pigs. The drug availability in the tympanic mucosa, tympanum, endolymphatic sac, and cochlea was observed by a confocal laser scanning microscope.ResultsThe local fluorescent intensity by postauricular injection was significantly higher in the inner ears, and lower in partial peripheral organs, than that by the intramuscular injection. The drug metabolism by postauricular injection exhibited an obviously sustained release effect in the inner ears. Drugs by postauricular injection might enter the endolymphatic sac through the posterior auricular artery and occipital artery, as well as the connections of the mastoid emissary vein, sigmoid sinus and endolymphatic sac.ConclusionMore drugs concentrated in the inner ear for longer therapeutic time and less systemic delivery implied more effective and less risk of side effects through postauricular injection than intramuscular injection safer for the treatment of inner ear diseases.

The local injection of therapeutic drugs, including cells, oncolytic viruses and nucleic acids, into different organs is an administrative route used to achieve high drug exposure at the site of action. However, after local injection, material backflow and side effect reactions can occur. Hence, this study was carried out to investigate the effect of gelatin on backflow reduction in local injection. Gelatin particles (GPs) and hydrolyzed gelatin (HG) were injected into tissue models, including versatile training tissue (VTT), versatile training tissue tumor-in type (VTT-T), and broiler chicken muscles (BCM), using needle gauges between 23 G and 33 G. The backflow material fluid was collected with filter paper, and the backflow fluid rate was determined. The backflow rate was significantly reduced with 35 μm GPs ( p value < .0001) at different concentrations up to 5% and with 75 μm GPs ( p value < .01) up to 2% in the tissue models. The reduction in backflow with HG of different molecular weights showed that lower-molecular-weight HG required a higher-concentration dose (5% to 30%) and that higher-molecular-weight HG required a lower-concentration dose (7% to 8%). The backflow rate was significantly reduced with the gelatin-based formulation, in regard to the injection volumes, which varied from 10 μL to 100 μL with VTT or VTT-T and from 10 μL to 200 μL with BCM. The 35 μm GPs were injectable with needles of small gauges, which included 33 G, and the 75 μm GPs and HG were injectable with 27 G needles. The backflow rate was dependent on an optimal viscosity of the gelatin solutions. An optimal concentration of GPs or HG can prevent material backflow in local injection, and further studies with active drugs are necessary to investigate the applicability in tumor and organ injections.

Abstract Background At present, patients with ocular myasthenia gravis (OMG) are typically treated with systemic drugs. We investigated the use of dexamethasone injected in the peribulbar region or extraocular muscle to treat patients with OMG. Methods Patients with OMG were given dexamethasone via peribulbar injection or direct injection into the main paralyzed extraocular muscles, once a week, for 4–6 weeks. The severity of diplopia, blepharoptosis, eye position, and eye movement were evaluated before and after treatment. The duration of follow-up time was ≥6 months. Results Among the 14 patients with OMG who received this treatment, mean age was 38.7 ± 29.7 years. After treatment, symptoms were relieved in 12 patients (85.7%), 1 patient (7.1%) had partial response to treatment, and 1 patient (7.1%) had no response. Two patients (14.2%) experienced symptom recurrence during the follow-up period. Conclusions Dexamethasone peribulbar or extraocular muscle injection is effective in the treatment of patients with OMG and may replace systemic drug therapy. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038863 , October 7, 2020.Retrospectively registered.

Background & aim: Pain is the most important complaint of children after tonsillectomy. Thus, poor relief will lead to complications. Therefore, the aim of the present study was to determine and compare the effect of topical injection of bupivacaine with lidocaine-epinephrine combination on pain after tonsillectomy. Methods: The present paper was a double-blind controlled clinical trial study. The statistical population consisted of 87 children aged 4-10 years who were candidates for tonsillectomy. All patients in all 3 groups underwent general anesthesia in the same way and the knife surgery method was the same in all patients. 5 minutes before the incision, 2 cc in the first group and 2 cc in the second group in the children in the bed and around the tonsils were injected locally and no intervention was performed in the control group. Pain intensity in children 2, 4, 6 and 8 hours after surgery was assessed using the Wang Baker pain scale. The collected data were analyzed using descriptive and analytical statistical tests (95% confidence interval and significance level (p 0.05). There was a statistically significant difference between the pain intensity range of children in the two intervention groups and children in the control group at all measurement times (2, 4, 6 and 8 hours after surgery) (p=0.001). Conclusion: Topical injection of bupivacaine and lidocaine-epinephrine combination around the tonsils reduced the severity of pain in children after tonsillectomy, however no difference was seen in the effect of topical bupivacaine injection with lidocaine-epinephrine combination on postoperative pain relief after surgery not observed except at 2 and 4 hours after surgery. Topical injection of bupivacaine and lidocaine-epinephrine combination was safe at the injected concentration and no side effects were observed.

Abstract Peripheral neuropathy is a common neurodegenerative disease, with vastness of inducers and causalities. The acquired form peripheral neuropathy can be caused by traumatic injuries caused by nerve lacerations or compressions. Such injuries are usually followed by Wallerian degeneration, and inflammatory reaction. We present a case of a 33-year-old female with a chronic loss of the ulnar nerve function for 8 years after traumatic laceration. After that, she regained the functions of ulnar nerve after nerve stimulation by peri-ulnar nerve injection of methylprednisolone and lidocaine. The theory behind using steroids is related to the fact that the immune system could induce a secondary injury that interferes with the recovery. Many studies have shown effectiveness in using steroids alone or when combined with other substances on nerve regeneration in animal models. We believe that this is the first report of nerve recovery using local steroidal injections after a traumatic injury.

PurposeTo evaluate the clinical effects and outcomes of local intra-gestational sac methotrexate injection followed by dilation and curettage for treatment of cesarean scar pregnancies (CSP).MethodThis prospective non-randomized study was conducted on patients diagnosed with CSP between 2018 and 2020 at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Patients were categorized into two groups according to the treatments, i.e., local intra-gestational sac methotrexate injection followed by dilation and curettage (group A), and uterine artery embolization in combination with dilation and curettage (group B). The choices of treatment reflect the patients' decision after they thoroughly understood the benefits and risks of the two therapies. Clinical data were then collected and compared between these two alternatives.ResultsSeventy-seven patients with CSP were enrolled in the study. Of this total, 41 vs. 36 were respectively categorized into group A and group B. Similar success rates were observed between these two groups (92.7 vs. 97.2%; RR = 27.362, 95% CI: 0.496–1.51E3, p = 0.106). However, the overall occurrence of complications in group A was significant lower when compared with group B (17.1 vs. 52.8%; RR = 0.236, 95% CI: 0.077–0.728, p = 0.012). Lower abdominal pain (unrelated to infection) and intrauterine adhesions were the two primary complications exhibited in group B of the present study, with rates of 38.9 and 22.2% respectively.ConclusionsLocal intra-gestational sac methotrexate injection followed by dilation and curettage is an effective and safe treatment for CSP that also drastically reduces the risks of complications. Further multiple center randomized trials with large series are warranted to confirm these findings.

BACKGROUND: Total knee arthroplasty can produce a lot of blood loss and severe pain. How to effectively reduce blood loss and pain after total knee arthroplasty has become an urgent problem for joint surgeons. OBJECTIVE: To observe the effects of intravenous tranexamic acid combined with periarticular multipoint injection of tranexamic acid cocktail on blood loss and pain after total knee arthroplasty. METHODS: Totally 90 patients who underwent primary unilateral total knee arthroplasty admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from June 2018 to May 2019 were selected and randomly divided into three groups (n=30) according to the envelope method. Patients in the group A were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of 50 mL normal saline before the implantation of prosthesis. Patients in the group B were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of 50 mL cocktail (0.3 mL epinaphrine, 10 mL ropivacaine, 0.5 mL morphine, 39.2 mL normal saline) before the implantation. Patients in the group C were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of cocktail complex tranexamic acid (1 g:10 mL), a total of 50 mL, before the implantation. Total blood loss, drainage volume, hidden blood loss, maximum hemoglobin decline, transfusion rate and transfusion volume, visual analogue scale at rest and activity at 1, 3, 7, and 14 days after surgery, and incidence of deep vein thrombosis and other adverse events were compared among the three groups. RESULTS AND CONCLUSION: (1) In terms of blood loss, total blood loss, recessive blood loss, drainage volume and postoperative maximum hemoglobin decline in group C were all lower than those in the other two groups, with statistically significant differences (P < 0.05). It was worth mentioning that the drainage volume of group B was lower than that of group A, with statistically significant difference (P < 0.05). (2) For postoperative analgesia, visual analogue scale scores of group B and group C at rest on day 1, 3 and 7 were significantly lower than those of group A (P < 0.05), and the difference between group B and group C was not statistically significant (P > 0.05). Visual analogue scale scores at rest at 14 days after surgery showed no statistically significant difference among the three groups (P=0.898). During the activity, visual analogue scale scores of group B and group C at 1 and 3 days after surgery were significantly lower than group A (P < 0.05), but there was no statistically significant difference between group B and group C (P > 0.05). There was no statistically significant difference in visual analogue scale scores of the three groups at 7 and 14 days after surgery (P > 0.05). (3) There was no significant difference in blood transfusion rate and volume among the three groups (P > 0.05). (4) No deep vein thrombosis or other adverse events occurred in the three groups. (5) The results show that intraoperative intravenous tranexamic acid combined with periarticular multipoint infiltration injection of tranexamic acid cocktail can effectively reduce the blood loss, with effective early analgesia, and the analgesia effect is better when the patient is resting after the operation. There is no increased risk of deep vein thrombosis and other adverse events when the proposed therapy is applied to the patients [ABSTRACT FROM AUTHOR]

Shouyi Wu,1 Yajun Lian,1 Haifeng Zhang,1 Yuan Chen,1 Chuanjie Wu,2 Shuang Li,1 Yake Zheng,1 Yuhan Wang,1 Wenchao Cheng,1 Zhi Huang11Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China; 2Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of ChinaBackground: Some studies have indicated that a local injection of Botulinum Toxin Type A (BTX-A) is a promising therapy for trigeminal neuralgia (TN). However, BTX-A treatment is still ineffective for approximately 10–43% of patients. We therefore investigated which factors are associated with the therapeutic effect in BTX-A treatment of medically refractory, classical TN.Methods: We performed a retrospective cohort study with a total of 104 patients who were receiving BTX-A injection for medically refractory classical TN between August 2013 and October 2016. A VAS score, pain attack frequency per day as well as patients’ overall response to treatment and side effects were evaluated in 104 patients with TN who were receiving BTX-A.Results: A total of 87 patients reported successful results; 41 stated that their pain was completely controlled while 46 reported adequate pain relief, totaling 83.7%. Our study suggests that treatment success was higher in patients 50 or older (OR=3.66, 95% CI: 1.231–10.885). Univariate and multivariate analyses demonstrated that the patient’s age was independently associated with treatment outcome (OR=1.72, 95% CI: 1.063–2.282), with ≥50 years being a significant predictor of pain relief (P=0.020 and P=0.033, respectively). Seventeen patients (16.3%) reported mild side effects.Conclusion: A local injection of BTX-A may be a safe and efficient treatment for classical TN which lasts for several months. BTX-A is a novel strategy which is particularly worth trying for particularly middle-aged and elderly patients who cannot tolerate drug side effects and may be afraid of serious complications from microvascular decompression.Keywords: trigeminal neuralgia, Botulinum Toxin Type A, age, local injection, therapeutic effect

Abstract Background Local anesthesia is an important skill and a prerequisite for most dental treatments. However, the step from theory to application on the patient is huge for the novice. Hence, a mannequin training model course was developed and implemented into the existing local anesthesia curriculum in undergraduate dental students. It was the aim of this study to evaluate the relation between training-model and real-life anesthesia performance and to measure whether a gain in skill on the model translates to the actual patient situation. Methods Thirty-six third-year students (14 males, 22 females, age 24 years±2.98) attended the four-day course comprising each 4 h of lectures and practical training. The student cohort gave subjective ratings about the didactical components of the course after attendance by using the TRIL questionnaire (TRIL-mod; University of Trier). At the end of the course the performance of each student in administering an inferior alveolar nerve (IAN) block on the training model as well as on a fellow dental student was investigated using a standardized checklist. To evaluate the successful performance, the in vivo IAN-block was assessed using subjective patient-feeling, the sharp-blunt test and an objective pain- and thermal sensitivity tester (PATH). Results The course was rated with an average score of 5.25 ± 0.44 (range 1–6; 6 = best). On the training model, 69.4% of the students successfully performed an IAN-block. The in vivo assessment, objectified by the PATH test, showed a successful anesthesia in 36.9% of the cases. The assessment of local anesthesia by using the sharp blunt test and the subjective patient feeling significantly correlated with these findings (k = 0.453–0.751, p

Relapsed diffuse large B-cell lymphoma (DLBCL) is a disease with a poor prognosis. Recent clinical trials results showed chimeric antigen receptor (CAR) T cell therapy has a promising role in treating relapsed DLBCL. Unfortunately, patients with extranodal lesions respond poorly to CAR-T cells administered intravenously. Herein, we evaluated the efficacy and safety of a new treatment strategy of CAR-T cells, combining intravenous infusion with local injection of CAR-T cells, in a relapsed DLBCL patient with extranodal lesions. The patient achieved durable remission and without severe adverse effects after CAR-T cells treatment. During the follow-up period of one year, the patient remained in good condition. In conclusion, combining intravenous injection with a local injection for CAR-T cell is a feasible strategy for relapsed DLBCL patients with extranodal lesions.

Relapsed diffuse large B-cell lymphoma (DLBCL) is a disease with a poor prognosis. Recent clinical trials results showed chimeric antigen receptor (CAR) T cell therapy has a promising role in treating relapsed DLBCL. Unfortunately, patients with extranodal lesions respond poorly to CAR-T cells administered intravenously. Herein, we evaluated the efficacy and safety of a new treatment strategy of CAR-T cells, combining intravenous infusion with local injection of CAR-T cells, in a relapsed DLBCL patient with extranodal lesions. The patient achieved durable remission and without severe adverse effects after CAR-T cells treatment. During the follow-up period of one year, the patient remained in good condition. In conclusion, combining intravenous injection with a local injection for CAR-T cell is a feasible strategy for relapsed DLBCL patients with extranodal lesions. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) is the most common and malignant Grade IV primary craniocerebral tumor caused by glial cell carcinogenesis with an extremely poor median survival of 12–18 months. The current standard treatments for GBM, including surgical resection followed by chemotherapy and radiotherapy, fail to substantially prolong survival outcomes. Adeno-associated virus (AAV)-mediated gene therapy has recently attracted considerable interest because of its relatively low cytotoxicity, poor immunogenicity, broad tissue tropism, and long-term stable transgene expression. Furthermore, a range of gene therapy trials using AAV as vehicles are being investigated to thwart deadly GBM in mice models. At present, AAV is delivered to the brain by local injection, intracerebroventricular (ICV) injection, or systematic injection to treat experimental GBM mice model. In this review, we summarized the experimental trials of AAV-based gene therapy as GBM treatment and compared the advantages and disadvantages of different AAV injection approaches. We systematically introduced the prospect of the systematic injection of AAV as an approach for AAV-based gene therapy for GBM. [ABSTRACT FROM AUTHOR]

Objective: To explore the early effectiveness and influence on cartilage of local injection of multimodal drug cocktail (MDC) during anterior cruciate ligament reconstruction (ACLR)., Methods: Between February 2022 and August 2023, patients undergone arthroscopic ACLR using autologous hamstring tendons were selected as the study subjects. Among them, 90 patients met the selection criteria and were randomly divided into 3 groups ( n =30) according to the different injection drugs after ligament reconstruction. There was no significant difference in baseline data such as gender, age, body mass index, surgical side, disease duration, preoperative thigh circumference, and preoperative levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), IL-1, matrix metalloproteinase 3 (MMP-3), MMP-13, and aggrecan (ACAN) in synovial fluid between groups ( P >0.05). After the ligament reconstruction during operation, corresponding MDC (consisting of ropivacaine, tranexamic acid, and betamethasone in group A, and ropivacaine, betamethasone, and saline in group B) or saline (group C) were injected into the joint and tendon site, respectively. The length of hospital stay, postoperative tramadol injection volume, incidence of complications, degree of knee joint swelling and range of motion, visual analogue scale (VAS) score, International Knee Documentation Committee (IKDC) score, Lyshlom score, and Hospital for Special Surgery (HSS) score were recorded and compared between groups. The T2 * values in different cartilage regions were detected by MRI examination and the levels of TNF-α, IL-6, IL-1, MMP-3, MMP-13, and ACAN in synovial fluid were detected by ELISA method., Results: The patients in group A, B, and C were followed up (12.53±3.24), (13.14±2.87), and (12.82±3.32) months, respectively. All incisions healed by first intention. Compared with group C, group A and group B had shorter length of hospital stay, less tramadol injection volume, and lower incidence of complications, showing significant differences ( P <0.05); there was no significant difference between group A and group B ( P >0.05). The degree of knee swelling in group A was significantly less than that in group B and group C ( P <0.05), but there was no significant difference between group B and group C ( P >0.05). At 3, 6, 12, 24, and 48 hours after operation, VAS scores of group A and group B were significantly lower than those of group C ( P <0.05); at 72 hours after operation, there was no significant difference among the three groups ( P >0.05). At 3 days, 14 days, and 1 month after operation, the range of motion of knee joint in group A were significantly better than those in group C ( P <0.05), and there was no significant difference between the other groups ( P >0.05). At 1 month after operation, the IKDC score of group A and group B was significantly higher than that of group C ( P <0.05); there was no significant difference among the three groups at other time points ( P >0.05). There was no significant difference in Lyshlom score and HSS score among the three groups at each time point ( P >0.05). At 14 days after operation, the levels of IL-1 and IL-6 in the synovial fluid in groups A and B were significantly lower than those in group C ( P <0.05). There was no significant difference in the levels of TNF-α, MMP-3, MMP-13, and ACAN between groups A and B ( P >0.05). At 1 month after operation, there was no significant difference in the above indicators among the three groups ( P >0.05). At 3, 6, and 12 months after operation, there was no significant difference in the T2 * values of different cartilage regions among the three groups ( P >0.05)., Conclusion: Injecting MDC (ropivacaine, tranexamic acid, betamethasone) into the joint and tendon site during ACLR can achieve good early effectiveness without significant impact on cartilage.

Osteosarcoma (OS) is a serious primary bone malignant tumor that can easily affect children and adolescents. Chemotherapy is one of the important and feasible clinical treatment strategies for the treatment of OS at present, which is severely limited due to insufficient retention time, poor penetration ability, and serious side effects of current anti-tumor drug preparations. In this work, a novel injectable thermo-sensitive hydrogel (mPEG45–PLV19) loaded with methotrexate and alendronate, and the sustained release at the tumor site synergistically inhibited the progression of OS. The mPEG45–PLV19 shows excellent physical and chemical properties. Compared with other treatment groups, the in vivo treatment of gel+ methotrexate + alendronate effectively inhibited the growth of tumor. More importantly, it significantly reduced bone destruction and lung metastasis caused by OS. Therefore, this injectable thermo-sensitive hydrogel drug delivery system has broad prospects for OS chemotherapy.

Carpal tunnel syndrome is the most frequent entrapment neuropathy. We performed a literature review of application of local corticosteroid injections. The main aim of the review is to outline the issues concerning indications for the treatment, efficiency and safety of the procedure, and the effect’s duration. Different techniques and different types of corticosteroids, outcomes of the local injections in comparsion with surgical treatment are discussed.

Purpose: To assess the safety and efficacy of local intra-gestational sac methotrexate injection followed by dilation and curettage (D&C) in treating cesarean scar pregnancies (CSP).Method: Medical records of CSP patients treated with local intra-gestational sac methotrexate injection followed by dilation and curettage were analyzed at the Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, China.Results: Thirty-one patients were included in this study. The mean gestational age, sac diameter and thickness of the uterine scar were 49.6 ± 7.7 days, 1.8 ± 0.6 cm and 0.30 ± 0.15 cm, respectively. The median pretreatment serum β-human chorionic gonadotropin (β-HCG) level was 40,887 mIU/mL, with the 25th and 75th percentiles at 19,852 and 74,552, respectively. The median blood loss during D&C was 20 mL with the 25th and 75th percentiles at 10 mL and 50 mL. Following D&C, a Foley's balloon catheter compression was implanted in 26 (83.9%) patients due to active uterine bleeding. All patients had a β-HCG regression time of ≤ 4 weeks after D&C. While 30 patients (96.8%) had a uterine recovery time of ≤ 4 weeks, and 29 patients (93.5%) had resumption of menstruation of less than 6 weeks. Three patients (9.7%) had complications. One of them suffered from massive vaginal bleeding and underwent s blood transfusion. There were no other complications, such as pelvic infection and uterine rupture during the procedures. And no patient was converted to surgical resection or uterine artery embolization. Overall, 30 patients (96.8%) were treated successfully.Conclusion: Local intra-gestational sac methotrexate injection followed by D&C with the aid of a Foley's balloon catheter compression appears to be a safe and effective treatment for CSP. Further randomized controlled trials are suggested to confirm these findings. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy is a common neurodegenerative disease, with vastness of inducers and causalities. The acquired form peripheral neuropathy can be caused by traumatic injuries caused by nerve lacerations or compressions. Such injuries are usually followed by Wallerian degeneration, and inflammatory reaction. We present a case of a 33-year-old female with a chronic loss of the ulnar nerve function for 8 years after traumatic laceration. After that, she regained the functions of ulnar nerve after nerve stimulation by peri-ulnar nerve injection of methylprednisolone and lidocaine. The theory behind using steroids is related to the fact that the immune system could induce a secondary injury that interferes with the recovery. Many studies have shown effectiveness in using steroids alone or when combined with other substances on nerve regeneration in animal models. We believe that this is the first report of nerve recovery using local steroidal injections after a traumatic injury. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies have shown that the increase of bone resorption in osteoclasts over-activates transforming growth factor beta 1 (TG F-β1 ), and uncouples bone resorption and bone formation, ultimately leading to a hardened phenotype of the subchondral bone in an animal model of osteoarthritis. Progression of osteoarthritis can be attenuated by inhibiting TGF-β1 signaling pathway. OBJECTIVE: To detect whether osteoarthritis progression can be delayed by the local injection of halofuginone in Beagle models of osteoarthritis. METHODS: Eighteen male Beagle dogs were randomized into a sham (control) group, a model (osteoarthritis) group, or a treatment (halofuginone) group. Animal models of osteoarthritis were made by anterior cruciate ligament transaction in the latter two groups. Animals in the treatment group were given local injection of halofuginone (37.8 ng) into the subchondral bone. Serum levels of type II collagen C-terminal peptide (CTX-11) and type X collagen α1 chain (COL10A1) were measured at 4, 8, 12, and 16 weeks after modeling. The Beagle dogs were sacrificed at the 16th week after surgery, and the alterations of microarchitecture of the subchondral bone were detected by micro-CT. Articular cartilage degeneration was graded using safranin 0 and fast green staining combined with the Osteoarthritis Research Society International (OARSl)-modified Manking criteria. lmmunostaining analyses were conducted to detect the expression levels of TGF-β1 and matrix metalloproteinase 13. The study protocol was approved by the Animal Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University, with the approval No. IACUC20160304-07. RESULTS AND CONCLUSION: The COL1OA1 level in the model group was higher than that in the control group and the treatment group at 8 and 12 weeks after modeling (P < 0.01 ). The levels of CTX-11 in the model group were higher than that in the control group and the treatment group at 8, 12, and 16 weeks after modeling (P < 0.05). Micro-CT examination showed that compared with the control and treatment groups, the bone volume fraction of the subchondral bone was increased in the model group, while the subchondral bone trabecular separation and the trabecular model factor were decreased significantly (all P < 0.05). The OARSI-modified Manking score was significantly higher in the model group than in the control group and the treatment group (both P < 0.01 ). lmmunohistochemistry results showed that the expression levels of matrix metalloproteinase 13 and TGF-β1 in the model group were significantly higher than those in the control group and the treatment group (all P < 0.01 ). No significant differences in the above-mentioned indexes were found between the control group and the treatment group (all P > 0.05). Overall, local injection of halofuginon attenuates anterior cruciate ligament transection-induced osteoarthritis by inhibiting abnormally elevated TGF-β1 in the subchondral bone and blocking abnormal bone remodeling. Therefore, local injection of halofuginon may be a new therapeutic alternative for osteoarthritis. [ABSTRACT FROM AUTHOR]

Osteosarcoma (OS) is a serious primary bone malignant tumor that can easily affect children and adolescents. Chemotherapy is one of the important and feasible clinical treatment strategies for the treatment of OS at present, which is severely limited due to insufficient retention time, poor penetration ability, and serious side effects of current anti-tumor drug preparations. In this work, a novel injectable thermo-sensitive hydrogel (mPEG45–PLV19) loaded with methotrexate and alendronate, and the sustained release at the tumor site synergistically inhibited the progression of OS. The mPEG45–PLV19 shows excellent physical and chemical properties. Compared with other treatment groups, the in vivo treatment of gel+ methotrexate + alendronate effectively inhibited the growth of tumor. More importantly, it significantly reduced bone destruction and lung metastasis caused by OS. Therefore, this injectable thermo-sensitive hydrogel drug delivery system has broad prospects for OS chemotherapy. [ABSTRACT FROM AUTHOR]

platelet-rich-plasma is increasingly used in tennis elbow. This study show the clinical outcomes of a single PRP injection .our study was done between Dec. 2015 and Oct. 2016, platelet-rich- plasma was administrated to thirty patients. All subjects underwent prospective clinical evaluation, including visual analog scale (VAS) for pain for six month follow up .most of the patient (VAS) significantly improve from (p > 0.05) after injection with platelet-rich -plasma .so as the result show the PRP injections in tennis elbow showed better improvement in outcomes . [ABSTRACT FROM AUTHOR]

Objective. To evaluate the potential immediate analgesic effect of addition of 5% dextrose water (D5W) during local steroid injection for treatment of plantar fasciitis (PF). Methods. In this single blind study, 122 patients with PF were randomly assigned to receive either 40 mg triamcinolone acetonide/1ml + 0.5ml. lidocaine 2% (group A: 61 patients; 73 heels) or 40mg triamcinolone acetonide/1ml+0.5ml. lidocaine2%+ 0.5ml. buffered D5W (group B: 61 patients; 69 heels) as a local injection using the medial approach. Visual analogue scale (VAS 0-10) was used to assess the degree of pain intensity during the injection. Results. The mean for age was 42.56 years in group A and 43.39 years in group B (P = 0.86), the female to male ratio was 2.8-1 in both groups and the mean for BMI was 31.49 in group A and 30.86 in group B (P=0.51). A significant difference in VAS was observed; the mean was 8.26±2.00 in group A and 4.25±2.05 in group B (P <0.0001) with a confidence interval (95% CI) of 7.78 -8.74 for group A and 3.76 - 4.72 for group B. Conclusions. The addition of 0.5 ml. D5W can decrease the pain associated with local steroid injection for treatment of PF. [ABSTRACT FROM AUTHOR]

Objectives To evaluate surgical and biochemical outcomes of local methylene blue [total thyroidectomy (TT)-MB] injection during subcapsular thyroidectomy in preservation of parathyroid glands (PTGs). Patients and methods The study include 88 patients divided into two groups. The study group (GP) included 44 patients assigned to TT-MB and control GP included 44 patients who underwent conventional total thyroidectomy. All patients underwent clinical and radiological workup and estimation of serum parathyroid hormone (PTH) and serum total and ionized calcium. Operative procedure entails injection of 1–3 ml MB (0.8 mg/ml) in thyroid subcapsular layer, and the procedure was repeated till completion of thyroidectomy. Study outcomes The study outcomes included frequency of PTG localization, frequency and extent of hypoparathyroidism (HPT) as judged by estimated serum PTH on first and sixth postoperative day (POD1 and POD6) in relation to preoperative level, and the frequency and extent of disturbed serum calcium levels. The outcomes in the cases with TT-MB were compared with the outcomes of the control group patients, who had TT without the use of MB. Results Dissection was easy in 38 (86.36%) cases and more difficult in six (13.63%) cases. One study and five control patients had HPT on POD6, and no study patient but two control patients continued experiencing HPT, with significant difference in favor of study group. Conclusion Subcapsular MB injection during subcapsular thyroidectomy facilitates safe thyroid dissection sparing PTG with easy successful dissection rate of 86.36%. Despite decreased serum PTH, its extent was minimal, and only one patient developed transient HPT. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of local injection of receptor activator of nuclear factor kappa B ligand (RANKL) on experimental tooth movement and subsequent alveolar bone remodelling in mice. Materials and Methods: Sixty mice were randomised to receive daily local RANKL or phosphate‐buffered saline injections in the buccal premaxillary bone for 14 of 21 days of incisor movement, followed by a 21‐day retention period. Five mice from each group were euthanised on days 0, 3, 7, 14, 21 and 42, and specimens were prepared for haematoxylin and eosin, tartrate‐resistant acid phosphatase and immunohistochemical staining. Five mice from each group were subjected to serial microcomputed tomography until day 42 for tooth movement and bone volume quantification. Results: The experimental group showed significantly greater tooth movement and bone volume reduction on days 14 and 21; an increased osteoclast number on days 3, 7, 14 and 21; and no difference on day 42. Higher RANKL expression was observed on days 7 and 14, with remarkable alkaline phosphatase activity. No significant systemic changes were observed. Conclusion: Local RANKL injection leads to increased osteoclastic activity and facilitates tooth movement, followed by subsequent alveolar bone formation; this implies a reversible transitional acceleration of bone resorption. [ABSTRACT FROM AUTHOR]