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Background: Minimizing air aspiration by carefully filling blood gas syringes is crucial to prevent air contamination from causing undesirable variations in gasses and other molecules. While some previous studies investigated this aspect, these are now outdated and only analyzed a limited number of blood gas parameters. Thus, we investigated the effects air contamination in the syringe using a modern blood gas analyzer. Methods: We sampled venous blood from 17 laboratory workers (mean age: 46±11 years; 10 women), filling two consecutive blood gas syringes. The first was filled exactly to its nominal volume (i.e., 1.0 mL), while the second was filled with 0.8 mL of blood and 0.2 mL of ambient air. Blood gas analysis was performed in each syringe using an identical analyzer. Results: In the syringe with the air bubble, we found statistically significant increase in pH (0.1%), pO2 (10.8%), SO2 (11.2%), total hemoglobin (3.0%), and hematocrit (2.7%), while values of pCO2 (-4.8%), sodium (-0.5%), and ionized calcium (-1.3%) were significantly reduced. With exception of pH, all these changes exceeded the performance specifications. Potassium, chloride, glucose, lactate, COHb and MetHb values remained unchanged. Conclusions: These findings confirm that air bubbles must be removed as soon as possible after sampling from blood gas syringes to prevent artifactual test results and misleading clinical judgment and inappropriate treatment. When blood gas syringes are received in the laboratory with air bubbles inside, the most vulnerable parameters (i.e., pO2, SO2, pCO2, sodium, ionized calcium, hematocrit and hemoglobin) should be suppressed. [ABSTRACT FROM AUTHOR]

Introduction: Anti-vascular endothelial growth factor (VEGF) agents have been the standard treatment for retinal diseases for almost two decades. These treatments are administered via intravitreal injection using single-use vials or prefilled syringes (PFS). In this systematic review, we evaluate health care resource use and clinical outcomes and experiences with PFS for intravitreal injection of anti-VEGF treatments. Methods: MEDLINE, EMBASE, and The Cochrane Library were searched from January 1, 2015 to February 8, 2024 to identify literature reporting outcomes regarding procedural efficiency, health care resource use, patient and clinician experiences, and safety for currently approved anti-VEGFs (ranibizumab, aflibercept, brolucizumab) administered using PFS. Comparators were vial-based injections of the same anti-VEGFs. Results: A total of 36 publications met the criteria for inclusion in the systematic literature review; the majority were non-randomized studies, with a small number of reviews, case series, survey studies, and opinion articles. Publications reported that preparation times were significantly shorter for PFS (40.3–57.9 s) versus vials (ranibizumab, 62.8–98.0 s; aflibercept, 71.9–79.5 s), with no differences in product stability between PFS and vials. Clinicians expressed a preference for PFS and thought PFS were faster, easier to use, and had increased safety versus vials. Publications consistently reported significantly lower rates of endophthalmitis per injection with PFS versus vials (ranibizumab PFS, 0–0.02%; aflibercept PFS, 0.01–0.02%; ranibizumab vial, 0.02–0.05%; aflibercept vial, 0.02–0.06%). Four publications reported increased rates of transient vision loss after aflibercept PFS injection versus vial-based injection. No publications reported outcomes regarding health care resource use or patient experiences. Conclusion: The available literature supports the increased procedural efficiency of PFS versus vial-based intravitreal injection of anti-VEGFs. PFS are positively perceived by clinicians and have a safety benefit in the form of a decreased risk of endophthalmitis versus vials. Plain Language Summary: Anti-vascular endothelial growth factor (VEGF) drugs, given by injection into the eye, are commonly used to treat diseases that affect the back of the eye (the retina). Anti-VEGF drugs are provided in small containers (vials) or in syringes that are already filled with the drug (prefilled syringes). When someone is treated with an anti-VEGF drug from a vial, the drug must first be taken from the vial using a needle and syringe, and then injected. When someone is treated with an anti-VEGF drug from a prefilled syringe, the drug is injected directly from the prefilled syringe, i.e., there are fewer steps involved when a prefilled syringe is used. We searched the medical literature to see if there were differences in clinical outcomes and experiences between prefilled syringes and vials when used to inject anti-VEGF drugs. Clinicians spent about 50% less time getting ready for injections when prefilled syringes were used than when vials were used. Clinicians also preferred to use prefilled syringes than vials for injecting anti-VEGF drugs. Clinicians reported that prefilled syringes were easier to use, faster, and safer than vials. Patients who were given injections from prefilled syringes had a lower rate of infection of the inside of the eye (endophthalmitis) than patients who were given injections from vials. These results indicate that using prefilled syringes for injecting drugs into the eye can improve efficiency at ophthalmology clinics and improve safety for patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of contamination of venous blood with a lipid-containing solution on parameters measured by a modern blood gas analyzer. We collected venous blood from 17 healthcare workers (46 ± 11 years; 53 % women) into three blood gas syringes containing 0 , 5 and 10 % lipid-containing solution. Blood gas analysis was performed within 15 min from sample collection on GEM Premier 5000, while triglycerides and serum indices were assays on Roche COBAS C702. Triglycerides concentration increased from 1.0 ± 0.3 mmol/L in the uncontaminated blood gas syringe, to 39.4 ± 7.8 and 65.3 ± 14.4 mmol/L (both p<0.001) in syringes with 5 and 10 % final lipid contamination. The lipemic and hemolysis indices increased accordingly. Statistically significant variation was noted for all analytes except hematocrit and COHb in the syringe with 5 % lipids, while only COHb did not vary in the syringe with 10 % lipids. Significant increases were observed from 5 % lipid contamination for pO2, SO2 and lactate, while the values of pH, pCO2, sodium, potassium, chloride, ionized calcium, glucose, hematocrit (10 % contamination), hemoglobin and MetHB decreased. All these changes except lactate and CoHb exceeded their relative performance specifications. Artifactual hyperlipidemia caused by contamination with exogenous lipids can have a clinically significant impact on blood gas analysis. Manufacturers of blood gas analyzers must be persuaded to develop new instruments equipped with serum indices. [ABSTRACT FROM AUTHOR]

While many sources of contamination in chemical and biological laboratories are well understood and known, some are less so. To quantify the magnitude of the potential contamination of solutions by zinc in common laboratory syringes, a study was conducted on solutions stored in rubber-containing syringes in which the rubber was catalyzed by zinc. This study identified specific factors contributing to contamination from laboratory syringes, including the syringe brand, time, solution type, and pH. Two common syringe brands, Covidien and BD, were tested, and three time durations, 0 days, 1 day, and 14 days, were examined. The solutions tested included sucrose and tartaric acid, representing both covalent and ionic species. Additionally, this study employed a pH range of 2 to 13 to further explore zinc contamination across a wide range of conditions and factors. The zinc concentration from the syringes was measured using inductively coupled plasma mass spectrometry (ICP-MS). The results, which ranged from less than 20 to over 600 μg L−1, revealed increased zinc concentration at both extreme pH values, while remaining lower but measurable at neutral pH levels. Zinc contamination is important to study because its contamination in laboratory syringes could interfere with the detection of other elements, further skew laboratory data, unexpectedly catalyze reactions, and lead to inconsistencies in experimental conditions. This study further emphasizes the broader significance of understanding pollutants within laboratory settings. The findings highlight the intricate dynamics of zinc contamination, stressing the need for the control of environmental factors and the broad dissemination of lesser-known sources. Recognizing the potential impact of contaminants like zinc is crucial, as it not only influences analytical accuracy, but also mirrors the wider concern of pollutants compromising scientific integrity in diverse experimental conditions. [ABSTRACT FROM AUTHOR]

While many sources of contamination in chemical and biological laboratories are well understood and known, some are less so. To quantify the magnitude of the potential contamination of solutions by zinc in common laboratory syringes, a study was conducted on solutions stored in rubber-containing syringes in which the rubber was catalyzed by zinc. This study identified specific factors contributing to contamination from laboratory syringes, including the syringe brand, time, solution type, and pH. Two common syringe brands, Covidien and BD, were tested, and three time durations, 0 days, 1 day, and 14 days, were examined. The solutions tested included sucrose and tartaric acid, representing both covalent and ionic species. Additionally, this study employed a pH range of 2 to 13 to further explore zinc contamination across a wide range of conditions and factors. The zinc concentration from the syringes was measured using inductively coupled plasma mass spectrometry (ICP-MS). The results, which ranged from less than 20 to over 600 μg L−1, revealed increased zinc concentration at both extreme pH values, while remaining lower but measurable at neutral pH levels. Zinc contamination is important to study because its contamination in laboratory syringes could interfere with the detection of other elements, further skew laboratory data, unexpectedly catalyze reactions, and lead to inconsistencies in experimental conditions. This study further emphasizes the broader significance of understanding pollutants within laboratory settings. The findings highlight the intricate dynamics of zinc contamination, stressing the need for the control of environmental factors and the broad dissemination of lesser-known sources. Recognizing the potential impact of contaminants like zinc is crucial, as it not only influences analytical accuracy, but also mirrors the wider concern of pollutants compromising scientific integrity in diverse experimental conditions.

While several studies have shown that insulin pens are more convenient and accurate than conventional administration with syringes and vials (syringes/vials), there is a frequent need for low-dose insulin injections administered by nurses using syringes/vials in hospital settings, particularly for critically ill patients. However, there is a lack of research investigating factors related to the accuracy of low-dose insulin administration using syringes/vials, particularly in hospital settings. We therefore performed a cross-sectional study to assess the accuracy of low-dose insulin administration by registered nurses using syringes/vials and to determine whether time of day, years of experience and adherence to proper injection procedures (vertical insertion/drawing and air bubble checking) affected the accuracy. The participants were 33 registered nurses working in the diabetes ward, and a total of 198 trials were analyzed. Using syringes/vials, the median errors converted to insulin units were found to be 0.6 units for the 2- and 6-unit target doses, and 0.7 units for the 10-unit target dose. In cases with the largest error, errors for the 2-, 6-, and 10-unit target doses were observed to be 2.3, 4.0, and 3.3 units, respectively. In our study, time of day, years of experience and vertical insertion/drawing did not correlate with errors, but errors were significant in the participants who did not check for air bubbles. Nurses can make non-negligible dosage errors when administering low-dose insulin using syringes/vials, and this is particularly likely when air bubble checks are missed. [ABSTRACT FROM AUTHOR]

Ulf Müller-Ladner,1 Christopher J Edwards,2 Andreas Erkens3 1Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany; 2Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK; 3Aurum Research GmbH, Lauf a.d., Pegnitz, GermanyCorrespondence: Ulf Müller-Ladner, Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Benekestrasse 2-8, D-61231 Bad Nauheim, Germany, Fax +49 6032-996 2104, Email u.mueller-ladner@kerckhoff-klinik.dePurpose: Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. A new MTX pen with modernized button-free autoinjection technology was developed as a successor to a button-activated pen (metoject®/metex® PEN). To assess the needs of users and the relevance of features of the new MTX autoinjector an international online survey was performed.Methods: A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations and information about features of the new MTX autoinjector.Results: In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories “dosing/administration” and “ease of use”. The first impression of the new MTX autoinjector was positive in 82% of physicians, 87% of nurses, and 76% of patients, respectively. The four most important features of the new MTX autoinjector were 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 chips of a total of 100 chips), small injection volume (9.7 to 11.7 chips), 10 different doses for dose flexibility (8.0 to 13.2 chips), and short injection time below 5 seconds (8.5 to 11.1 chips).Conclusion: Arguments for the use of MTX pens as opposed to PFS predominantly refer to dosing/administration and ease of use. The new button-free MTX autoinjector combines a number of advantageous features identified by the international survey.Plain Language Summary: Subcutaneous injection of methotrexate (MTX) is an option to treat patients with specific inflammatory diseases. A new MTX autoinjector with button-free activation of the injection and no need to build a skin fold was developed to address some of the reasons for non-adherence. The importance of specific needs of users as well as the relevance of features of the new MTX autoinjector are unknown. Therefore, a structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Illustrations and information about features of the new MTX autoinjector were distributed to the participants. The results of the study show that arguments for the use of MTX pens as opposed to prefilled syringes predominantly affect the categories dosing/administration and ease of use followed by safety/side effects. In addition, the study identified four main advantageous features of the new MTX autoinjector, ie simplicity due to the 2-step button-free autoinjector mechanism, the small injection volume, 10 different doses for dose flexibility, and the short injection time below 5 seconds.Keywords: autoinjector, methotrexate, pen, psoriasis, rheumatoid arthritis, syringe

Abstract Intravitreal injections are a common procedure in ophthalmology, often using syringes coated with silicone to aid piston movement and needles coated with silicone oil to facilitate penetration of the sclera. Pegcetacoplan and avacincaptad pegol, recently approved for clinical use by the US Food and Drug Administration, have higher viscosity and seem more susceptible to entrap air bubbles compared to anti-VEGF drugs. It is plausible that both anti-complement drugs could be associated with a higher likelihood of introducing silicone oil in the vitreous because of higher viscosity, with potentially higher friction at the inner surface of syringe barrel, in the vicinity of silicone oil. In addition to this, undesirable agitation might be inadvertently promoted by some retina specialists to remove air bubbles from the drug solution. In conclusion, recent reports of silicone oil droplets in the vitreous of patients receiving pegcetacoplan injection might be related to both its viscosity and to agitation of the syringe to remove air bubbles. Since avacincaptad pegol also is viscous, though with different pH, syringe and filter needle, we might expect similar reports for this agent soon. We also recommend further studies be carried not only to clarify the current matter but also the potential association between the combination of agitation, silicone oil and inflammation or any immune response.

Serial synchrotron crystallography (SSX) helps to determine the room-temperature structure of macromolecules with minimal radiation damage. Pink-beam X-ray provides more photon flux than a monochromatic beam, which can increase the diffraction intensity of crystal samples and reduce the issue of partial reflection measurement compared with a monochromatic beam. The demonstration of pink-beam SSX at the 1C beamline at the Pohang Light Source II (PLS-II) was previously reported. The Bragg peaks observed in SSX diffraction data using a pink-beam exhibited a slightly stretched shape, unlike that from a monochromatic beam. Therefore, it is necessary to develop an indexing algorithm that can efficiently process the Bragg peak generated by pink-beam SSX. Therefore, the collected pink-beam SSX diffraction data can be tentatively used to develop an indexing program for Bragg peaks generated using the pink-beam. In this study, detailed information on the diffraction data of pink-beam SSX at PLS-II was reported to access the raw data and process the information.

The employment of advanced analytical techniques and instrumentation enables the tracing of volatile organic compounds (VOCs) in vestigial concentrations (ppbv-pptv range) for several emerging applications, such as the research of disease biomarkers in exhaled air, the detection of metabolites in several biological processes, and the detection of pollutants for air quality control. In this scope, the storage of gaseous samples is crucial for preserving the integrity and stability of the collected set of analytes. This study aims to assess the suitability of three commercially available syringes as air containers (AC) that are commonly used for the collection, storage, isolation, and transportation of samples: glass syringes with glass plungers (AC1), and two plastic syringes, one with plastic plungers (AC2), and one with rubbered plungers (AC3). For this purpose, 99 air samples with different times of storage (from 10 min to 24 h) were analyzed using a Gas Chromatography—Ion Mobility Spectrometry device and the degradation of the samples was properly assessed by comparing the changes in the VOCs' emission profiles. The quality of the method was assured by via the measurement of the blank's spectra before each experimental run, as well as by the consecutive measurement of the three replicates for each sample. A statistical analysis of the changes in the VOCs' emission patterns was performed using principal component analysis (PCA). The results, with a total explained variance of 93.61%, indicate that AC3 is the most suitable option for the long-term storage of air samples. Thus, AC3 containers demonstrated a higher capacity to preserve the stability and integrity of the analytes compared to AC1 and AC2. The findings of the short-term effects analysis, up to 1 h, confirm the suitability of all analyzed syringe-based containers for sample-transferring purposes in onsite analysis. [ABSTRACT FROM AUTHOR]

Introduction. Needle and syringe programs (NSP) reduce syringe sharing and HIV transmission among people who inject drugs (PWID). However, their effectiveness relies on sufficient individual and population level coverage. In Tijuana, Mexico, the Global Fund (GF) supported NSP during 10/2011-12/2013, but withdrew funds at the end of 2013 following Mexico’s re-classification as an upper-middle income country. Objective. We tested the hypothesis of higher NSP access and lower receptive syringe sharing among PWID in Tijuana during the GF support period compared to pre-GF initiation and post-GF withdrawal. Method. We used data from an ongoing cohort study of PWID in Tijuana (03/2011-10/2015) to implement a segmented regression analysis investigating changes in the self-reported probability of NSP access, reported difficulty in finding sterile syringes and receptive syringe sharing before GF initiation and after GF discontinuation. Results. We found a large significant increase in the probability of NSP access (+.07) and decrease in receptive syringe sharing (-.23) right after GF initiation, which continued over the GF period. Subsequently, we found a significant decline in NSP access (-.05) and an increase in receptive syringe sharing (+.02) right after post-GF withdrawal, which continued thereafter. Discussion and conclusion. We demonstrated significant temporal changes in NSP access and receptive syringe sharing among PWID in Tijuana after GF initiation and withdrawal consistent with our hypothesis. Coordinated efforts with local authorities are needed to sustain major coverage NSP in settings receiving GF or external aid to guarantee continuity of harm reduction services and prevent reinside in risk behaviors associated with HIV transmission.

Abstract Background Noninfectious endophthalmitis may be misdiagnosed, leading to serious clinical implications. So far, its causative factors remain unknown. Therefore, this study assessed the role of silicone oil and syringe agitation in the development of inflammation after intravitreal injection of aflibercept. Methods A randomized, double-blind, controlled clinical trial included subjects with an indication of intravitreal antiangiogenic therapy prior to vitrectomy for proliferative diabetic retinopathy. Aflibercept was injected 48 h before surgery. The control group received the injection without agitation, while the intervention group was injected with a previously agitated syringe by flicking with either a siliconized or silicone oil-free syringe. The primary endpoint was the presence of anterior chamber reaction (ACR) at 48 h. Aqueous samples were collected and underwent cytometric bead array analysis for quantification of interleukins and chemokines. Results Forty-one individuals were included (21 in the agitation group and 20 in the no-agitation group). None of the included eyes showed baseline signs of AC cells, hyperemia or pain complaint, while 10% of control group and 80% of agitation group showed AC cells 48 h after injection of aflibercept with SR syringe. There were no differences in the mean variations of all cytokines and chemokines by agitation status. However, there was a marginally significant increase between the mean variations of IP-10 (p = 0.057) and IL-8 (p = 0.058) in the siliconized one. Conclusion This clinical trial discloses a potential role of agitation and siliconized syringes in the development of inflammation after an intravitreal injection of aflibercept. These findings have important clinical implications for all healthcare practitioners who perform intravitreal injections. Trial Registration: Brazilian Registry of Clinical Trials, RBR-95ddhp. Registered 12 May 2019, http://www.ensaiosclinicos.gov.br/rg/RBR-95ddhp/

This study describes the results of a mold filling simulation analysis of a medical syringe performed during the thermoplastic injection molding process, which was performed using a computational Fluid Dynamic Simulation (CFD) with the Volume of Fluid Method (VOF). ANSYS Fluent was used for analysis and data collection. Medical grade polypropylene (PP) is considered in this study. The studies consider physical parameters (such as inlet position and syringe thickness) of the injection molding process. The outlet vent must be placed as far away from the inlet as possible to root out entrapped air and allow the molten PP to occupy the mold cavity. The findings revealed that syringe thicknesses ranging from 0.75 mm to 1.00 mm resulted in increased flow velocity, shorter filling time, and faster flow front advancement. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided hydrostatic reduction (UGHR) is a well accepted and widely used method of paediatric intussusception reduction, with the saline drip technique being the most commonly employed. Aims and Objectives: In this study we aimed to assess the outcomes of a novel technique of UGHR. Materials and Methods: Data was obtained from a 15 year retrospective chart review of paediatric intussusceptions. Following resuscitation, UGHR was performed for uncomplicated intussusceptions using a 50cc syringe to infuse saline into the colon. It was performed in the ultrasound suite without sedation and time taken was monitored. A maximum of 3 attempts were done to achieve reduction. Results: UGHR was attempted in 66 of 93 intussusceptions. The commonest type of intussusception was ileo-colic(91%) and the commonest symptom was vomiting(70%). Surgery was performed only when there was shock, peritonitis or repeated failed reductions. The median time taken for reduction was 4.9 minutes. The overall success rate was 83% with 89% of these requiring only a single attempt. There were no deaths or procedure related complications. Conclusions: The syringe technique for intussusception reduction is a safe, effective, and time-saving technique. Additionally, it offers the advantages of simplicity and rapidity of reduction and in experienced hands may not require pressure monitoring

Supply of autodisable (AD) syringes has been a key component of global COVID-19 vaccination campaigns, and it is critical to maintaining safe injection practices for routine immunization as well as pandemic response. AD syringe production increased significantly in response to demand, but distribution challenges have included the need to coordinate syringes to meet the specific delivery requirements of various COVID-19 vaccines, shipping bottlenecks, and syringe export restrictions. Stockpiling syringes, ensuring standardization of future vaccine dose volumes, and geographical diversification of syringe production would improve syringe logistics in the future. Balancing syringe supply and demand and stabilizing the market over the long term is essential to ensure that the world is prepared for possible new variants of COVID-19 or a new global outbreak. This will require concerted action on the part of public, nonprofit, and private partners.

Purpose: The intravitreal injection volume is known to vary with plunger alignment and the speed of injection. We investigated the role that syringe stopper deformation plays in allowing excess volumes to be injected into the eye and the potential for the vitreous humor to become incarcerated when excess force is released within the eye. Design: Experimental study. Methods: Aflibercept prefilled syringes (PFSs), ranibizumab PFSs, and 1-ml tuberculin (TB) syringes were subjected to increasing injection force to assess the extent to which each design allowed for excess volumes to be expelled after the stopper reached the bottom of the syringe barrel (i.e., after the 50-μl dose was expelled). Main Outcome Measures: Additional volume expelled with stopper deformation. Results: Syringe stoppers are capable of deformation into the dead space when additional force is applied. This allows for progressively greater medication doses to be administered. At an additional force of 3.92 N after the syringe stopper came in contact with the bottom of the syringe barrel, the aflibercept PFSs, ranibizumab PFSs, and 1-ml TB syringes dispensed an additional 17.2%, 11.4%, and 0.8% higher volume than the intended volume of 50 μl, respectively. Upon release of this force, a proportional volume was observed to be drawn back into the needle. Conclusions: The intravitreal injection volume varies with the force applied to fully depressed syringes because of syringe stopper deformation. We advise that performing forceful intravitreal injections be avoided to prevent excessive dosing of medication. We also caution that pressure applied to the plunger during intravitreal injections not be released while the needle is in the vitreous cavity to guard against vitreous incarceration, which could lead to retinal tear formation or detachment.

Background. At present, intraocular drops of silicone oil, which is a lubricant for disposable syringes used for intravitreal injections, are being actively studied. Among the undesirable effects of their presence are patient’s complaints of visual discomfort associated with floating opacities, as well as a potential connection with episodes of intraocular inflammation and increased intraocular pressure.The aim: to assess the prevalence of silicone oil droplets in the vitreous in patients treated with multiple intravitreal injections.Materials and methods. A single-center retrospective cohort study was carried out. Inclusion criterion: treatment with multiple (at least 5) intravitreal injections of drug solutions performed according to registered indications. The study group consisted of 86 eyes of 85 patients (56 women, 29 men; age – from 36 to 89 y.o., average – 71.7 y.o.), who received an average of 13.2 injections of solutions of various drugs.Results. Drops of silicone oil were detected by biomicroscopy in 57 eyes (66.28 %) and by ultrasonography in 76 (88.37 %). The coincidence of the results of applying the methods was recorded in 73.26 % of observations. Seven (8.1 %) patients had characteristic complaints. Four patients (4.7 %) had a history of aseptic vitreitis. The hypothesis was confirmed that the possibility of silicone oil droplets getting into the vitreous increases with the number of intravitreal injections. A similar relationship was established in relation to the possibility of the appearance of characteristic complaints in patients due to the presence of drops and episodes of aseptic vitreitis.Conclusion. The release of drops of silicone oil from syringes during intravitreal injections is an urgent problem that requires further study. In the Russian Federation, the situation is aggravated by the lack of prefilled syringes with drugs approved for administration into the eye cavity, as well as the lack of syringe models designed for use in ophthalmology.

The employment of advanced analytical techniques and instrumentation enables the tracing of volatile organic compounds (VOCs) in vestigial concentrations (ppbv-pptv range) for several emerging applications, such as the research of disease biomarkers in exhaled air, the detection of metabolites in several biological processes, and the detection of pollutants for air quality control. In this scope, the storage of gaseous samples is crucial for preserving the integrity and stability of the collected set of analytes. This study aims to assess the suitability of three commercially available syringes as air containers (AC) that are commonly used for the collection, storage, isolation, and transportation of samples: glass syringes with glass plungers (AC1), and two plastic syringes, one with plastic plungers (AC2), and one with rubbered plungers (AC3). For this purpose, 99 air samples with different times of storage (from 10 min to 24 h) were analyzed using a Gas Chromatography—Ion Mobility Spectrometry device and the degradation of the samples was properly assessed by comparing the changes in the VOCs’ emission profiles. The quality of the method was assured by via the measurement of the blank’s spectra before each experimental run, as well as by the consecutive measurement of the three replicates for each sample. A statistical analysis of the changes in the VOCs’ emission patterns was performed using principal component analysis (PCA). The results, with a total explained variance of 93.61%, indicate that AC3 is the most suitable option for the long-term storage of air samples. Thus, AC3 containers demonstrated a higher capacity to preserve the stability and integrity of the analytes compared to AC1 and AC2. The findings of the short-term effects analysis, up to 1 h, confirm the suitability of all analyzed syringe-based containers for sample-transferring purposes in onsite analysis.

Background: Noninfectious endophthalmitis may be misdiagnosed, leading to serious clinical implications. So far, its causative factors remain unknown. Therefore, this study assessed the role of silicone oil and syringe agitation in the development of inflammation after intravitreal injection of aflibercept. Methods: A randomized, double-blind, controlled clinical trial included subjects with an indication of intravitreal antiangiogenic therapy prior to vitrectomy for proliferative diabetic retinopathy. Aflibercept was injected 48 h before surgery. The control group received the injection without agitation, while the intervention group was injected with a previously agitated syringe by flicking with either a siliconized or silicone oil-free syringe. The primary endpoint was the presence of anterior chamber reaction (ACR) at 48 h. Aqueous samples were collected and underwent cytometric bead array analysis for quantification of interleukins and chemokines. Results: Forty-one individuals were included (21 in the agitation group and 20 in the no-agitation group). None of the included eyes showed baseline signs of AC cells, hyperemia or pain complaint, while 10% of control group and 80% of agitation group showed AC cells 48 h after injection of aflibercept with SR syringe. There were no differences in the mean variations of all cytokines and chemokines by agitation status. However, there was a marginally significant increase between the mean variations of IP-10 (p = 0.057) and IL-8 (p = 0.058) in the siliconized one. Conclusion: This clinical trial discloses a potential role of agitation and siliconized syringes in the development of inflammation after an intravitreal injection of aflibercept. These findings have important clinical implications for all healthcare practitioners who perform intravitreal injections. Trial Registration: Brazilian Registry of Clinical Trials, RBR-95ddhp. Registered 12 May 2019, http://www.ensaiosclinicos.gov.br/rg/RBR-95ddhp/ [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the accuracy and precision of different syringe designs for intravitreal injection of anti-VEGF agents.MethodsVolume output was measured from three syringe designs-1) 1.0 mL tuberculin syringe, 2) 1.0 mL syringe with low dead space plunger, and 3) 0.5 mL low-volume syringe-to deliver 50 µL of bevacizumab, ranibizumab, or aflibercept, each repeated four times by three different physicians for 108 total simulated injections. Volume output was calculated from difference in syringe weight before and after expelling the drug. Accuracy was determined by mean absolute percentage error (MAPE), and precision was measured by coefficient of variation (CV).ResultsVolume output from all three syringes was significantly different from 50 µL, with mean volumes of 58.0 ± 5.7 µL for the tuberculin syringe, 58.0 ± 4.0 µL for the low dead space syringe, and 55.5 ± 5.1 µL for the low-volume syringe (p < 0.00001 for all). The low-volume syringe was the most accurate (MAPE = 12.8 ± 7.8% vs. 17.3 ± 9.3% or 15.9 ± 8.1%), and the low dead space syringe was the most reproducible (CV = 0.068 vs. 0.091 or 0.097). There was no significant difference in volume output between different anti-VEGF agents.ConclusionsIntravitreal injections of anti-VEGF agents using a 1.0 mL tuberculin syringe demonstrate poor accuracy and precision. A lower capacity syringe may improve accuracy, while a low dead space plunger may improve precision.

Purpose: To describe cases of significant vision loss after intravitreal aflibercept administration using prefilled syringes (PFS) and to study the relationships among syringe design, injection speed, and injection force. Design: Retrospective case series and experimental study. Participants: Twelve patients who received intravitreal aflibercept via PFS. Methods: All retina specialists (n = 13) at Oregon Health & Science University and the Veterans Affairs Portland Medical Center were queried in December 2020 to report episodes of significant vision loss after aflibercept PFS use. Chart review was completed for all affected patients. Using a commercially available force measuring system, injection force was measured for aflibercept PFS, ranibizumab PFS, and a tuberculin syringe at various injection speeds. Main Outcome Measures: Number of significant vision loss episodes after aflibercept PFS use and average injection force (Newtons) at various injection speeds across different syringes. Results: Ten specialists (76.9%) reported a perceived increase in vision loss after injection with aflibercept PFS. Sixteen events of light perception or worse vision were reported immediate after aflibercept PFS use. Chart review was available for 12 of these events. The indication for aflibercept was exudative age-related macular degeneration (n = 8), diabetic macular edema (n = 3), and central serous chorioretinopathy (n = 1). The median age of affected patients was 71 years (range, 49–94 years). Two patients were being treated for glaucoma (n = 1) or ocular hypertension (n = 1); 1 patient was a glaucoma suspect. Anterior chamber paracentesis was performed in 4 patients to normalize intraocular pressure (IOP) promptly. Laboratory experiments demonstrated that higher injection speeds were associated with higher injection forces for all syringe types. Injection forces were consistently greater with aflibercept PFS than with the ranibizumab PFS or tuberculin syringe (P < 0.0001). Conclusions: Retina specialists at our institutions have noted numerous cases of severe transient vision loss with aflibercept PFS use. The average injection force may be greater with the aflibercept PFS when compared with other intravitreal anti–vascular endothelial growth factor (VEGF) options. Additional clinical studies are needed to understand better how syringe design and fluid dynamics may contribute to vision loss after injection.

Abstract Background To evaluate the efficacy and outcomes of one-way surgical technique for the treatment of vitreous hemorrhage post vitrectomy on proliferative diabetic retinopathy (PDR) patients. Methods This retrospective case series include 47 PDR patients who had vitrectomy with balanced saline solution tamponade and have developed vitreous hemorrhage without significant absorption. The one-way air-fluid exchange procedure which involves the application of a 0.22-μm pore size filter to exchange about 4.5–5.5 ml of fluid with a 10 ml syringe was performed on 47 patients (47 eyes). Post procedure, additional treatments were administered when needed. Best corrected visual acuity (BCVA), occurrence of intra-procedural and post-procedural complications were recorded and analyzed. Results A total of 47 eyes of 47 PDR patients with a mean age of 50.8 ± 12.0 years were reviewed. Because of vitreous hemorrhage or tractional retinal detachment of PDR, all 47 eyes underwent vitrectomy with balanced saline solution tamponade prior to the exchange procedure. Four patients (8.51%) and 43 patients (91.5%) were diagnosed with type 1 diabetes mellitus (T1DM), or type 2 diabetes mellitus (T2DM), respectively. All 47 eyes were given the one-way air-fluid exchange procedure in the treatment room. Forty-two cases (89.4%) needed the air-fluid exchange procedure only once, 4 cases (8.51%) underwent the procedure twice, and 1 case (2.13%) was given the procedure three times, followed by additional retinal photocoagulation and one intravitreal injection of Conbercept. In addition to the procedure, no further treatment was needed for 5 eyes (10.6%) while additional retinal laser treatment was provided for 41 eyes (87.2%). The BCVA at the final follow-up was significantly improved from the initial acuity baseline in all cases. No complications were observed during the follow-ups. Conclusion This one-way air-fluid exchange procedure can effectively exchange the vitreous hemorrhage and improve visual acuity of PDR patients who develop vitreous rehemorrhage post vitrectomy without obvious complications.

Background: Ultrasound-guided hydrostatic reduction (UGHR) is a well accepted and widely used method of paediatric intussusception reduction, with the saline drip technique being the most commonly employed. Aims and Objectives: In this study we aimed to assess the outcomes of a novel technique of UGHR. Materials and Methods: Data was obtained from a 15 year retrospective chart review of paediatric intussusceptions. Following resuscitation, UGHR was performed for uncomplicated intussusceptions using a 50cc syringe to infuse saline into the colon. It was performed in the ultrasound suite without sedation and time taken was monitored. A maximum of 3 attempts were done to achieve reduction. Results: UGHR was attempted in 66 of 93 intussusceptions. The commonest type of intussusception was ileo-colic(91%) and the commonest symptom was vomiting(70%). Surgery was performed only when there was shock, peritonitis or repeated failed reductions. The median time taken for reduction was 4.9 minutes. The overall success rate was 83% with 89% of these requiring only a single attempt. There were no deaths or procedure related complications. Conclusions: The syringe technique for intussusception reduction is a safe, effective, and time-saving technique. Additionally, it offers the advantages of simplicity and rapidity of reduction and in experienced hands may not require pressure monitoring [ABSTRACT FROM AUTHOR]

A novel vortex-assisted dispersive liquid–liquid microextraction method based on deep eutectic solvent (VA–DLLME–DES) completed in syringe has been established to extract 12 quinolones from honey. This method is an improvement of traditional DLLME. In this work, the green DES prepared with heptanoic acid and thymol was used for extractant rather than traditional organic extraction solvent. Without centrifugation, the phases were separated in the way of removing aqueous phase by pushing the syringe and extractant phase was collected for ultra performance liquid chromatography-mass spectrometry (UPLC–MS) analysis. The stability of DES and some experimental parameters (type, molar ratios and volume of extraction solvent, type and volume of dispersant, vortex time and effect of pH and NaCl) were evaluated. In the range of 2–100 ng/mL, the proposed method showed good linearities (r2 ranged from 0.996 to 0.999). The extraction recoveries were obtained in the range of 75.01%–117.05% and relative standard deviations were less than 13.83% for inter- (n = 6) and intra-day (n = 3) precisions. The limits of detection and quantification were 3 ng g−1 and 10 ng g−1, respectively. The developed method with the advantages of simple operation, short extraction time and less consumption organic solvent provides a technical idea for green, simple and time-saving sample preparation methods. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to quantify the amount of silicone oil (SO) released across a variety of syringe and needle models routinely used for intravitreal injection. Methods: The release of SO was assessed in eight models of syringes, two of which were reported to be 'SO‐free', and eleven models of needles with unknown SO content. To evaluate SO release within the context of anti‐VEGF therapeutics, syringes were evaluated using aflibercept, bevacizumab, buffer, ziv‐aflibercept and formulation buffer. All syringe tests were performed with or without agitation by flicking for syringes. Needles were evaluated without agitation only. Samples were fluorescently labelled to identify SO, and triplicate measurements were collected using imaging flow cytometry. Results: Seven out of 8 syringe models showed a statistically significant increase in the SO particle count after agitation. The two SO‐free syringe models (HSW Norm‐Ject, Daikyo Crystal Zenith) released the least SO particles, with or without agitation, whereas the BD Ultra‐Fine and Saldanha‐Rodrigues syringes released the most. More SO was released when the syringes were prefilled with formulation buffer than with ziv‐aflibercept. Syringes filled with aflibercept and bevacizumab had intermediate levels. Agitation increased the release of SO into each of the drug solutions. Silicone oil (SO) was detected in all needles. Conclusions: Agitation of the syringe by flicking leads to a substantial increase in the number of SO particles. Silicone oil (SO)‐free syringes had the best performance, but physicians must also be aware that needles are siliconized and also contribute to the injection of SO into the vitreous. [ABSTRACT FROM AUTHOR]

Objective: To describe ocular hypertension cases after using a new aflibercept prefilled syringe and to assess the main characteristics of these eyes and their possible association with intraocular pressure (IOP) changes., Methods: Case series. We reported all the cases of ocular hypertension following aflibercept prefilled syringes (PFS) treatment in our department between April 2021 and December 2023., Results: A total of 4183 eyes were treated with aflibercept PSF. Thirteen transitory IOP elevations were observed immediately after injection (0.3%). Two eyes had an IOP between 30-35 mmHg, five eyes had an IOP between 36-55 mmHg and three eyes had an IOP > 56 mmHg. The mean IOP was 45.5 mmHg±11.33. Only six eyes needed anterior chamber paracentesis (37.5%). The other patients were treated conservatively (ocular massage and/or IOP-lowering drops). The mean IOP after treatment was 15.71 mmHg±7.20. Visual acuity improved after treatment in all the patients., Discussion: Compared with other injectors, reports have indicated a higher incidence of moderate and severe IOP spikes with aflibercept PSF. The European Medicine Agency (EMA) has associated this significant increase with incorrect syringe handling, leading to higher injection volumes. Although plunger misalignment seems to play a role in the IOP spikes, some other characteristics of this new injector could play a role. Factors such as syringe diameter, plunger alignment, and injection force may contribute to this issue. The reason some authors found no significant differences in IOP elevation after IVI, with aflibercept PFS, could be due to variations in patient characteristics, which may also play an important role in post-IVI pressure changes., Conclusions: Intraocular pressure spikes after aflibercept PFS can be explained by injector characteristics. The PFS of aflibercept has a domed plunger. Incorrect alignment between the base of the plunger and the black dosing line could cause an increase in the injected volume. Furthermore, the wider syringe diameter of aflibercept PFS could imply a larger injection force, increasing the risk of IOP elevation. Patient characteristics, such as previous VPP, axial length, or glaucoma history, may also play a role. Further studies are required to develop an ideal intravitreal syringe., Competing Interests: The authors state no conflict of interest., (© 2024 The Authors.)

Objective To evaluate two different feeding methods for Yinzhihuang oral liquid in the treatment of neonatal jaundice. Methods Totally 200 neonatal jaundice cases requiring oral administration of Yinzhihuang oral liquid were randomly divided into the control group and the observation group, with 100 cases in each group. The disposable 5ml syringe was used to feed neonates with Yinzhihuang oral liquid in the control group, and the disposable pacifier was used as an auxiliary feeding device in the observation group. The adverse reactions to oral administration and length of time spent in medication were recorded. Results The incidences of choking cough, vomiting and overflowing drug liquid in the observation group were lower than those in the control group (P＜0. 05), and length of time spent in medication was shorter in the observation group were lower than that in the control group (P＜0. 05). Conclusion In the treatment of neonatal jaundice, the combined use of disposable pacifier and disposable syringe is effective to reduce the risk of choking cough, vomiting and overflowing drug liquid, and shorten the length of time spent in oral medication. (目的 对比两种不同喂药方法在茵栀黄口服液治疗新生儿黄疸中的应用效果。方法 选取入住新生儿科的200例需要口服茵栀黄的黄疸患儿, 随机分为2组, 对照组(n=100)采用一次性5 mL注射器喂药, 观察组(n=100)采用一次性奶嘴辅助一次性注射器喂药。对比2组黄疸患儿的反应、喂药时间等方面的差异。结果 观察组黄疸患儿呛咳、呕吐、溢药等不良反应发生率低于对照组, 喂药所需时间较对照组少, 差异有统计学意义(P＜0. 05)。结论 茵栀黄口服液治疗新生儿黄疸中, 采用一次性奶嘴辅助一次性注射器能有效降低新生儿呛咳、呕吐、溢药的发生风险, 缩短口服给药所需时间。)

Background: Syringes are commonly used in pharmacy compounding for the measurement of small volumes, especially in the preparation of sterile products for injection and infusion. However, there are no current official guidelines for the proper use of syringes in measuring small volumes. Objective: The purpose of this project was to determine the accuracy and precision of commercially available syringes in measuring small volumes during sterile product preparation to make recommendations for syringe size selection. Methods: To assess precision and accuracy of syringes, 3 separate investigators measured 5%, 10%, or 20% (n = 30 each) of the volume of a 1-, 3-, 5-, 10-, or 20-mL syringe with an attached 18G, 1½" needle by drawing sterile water for injection from a vial. Delivered volumes were measured gravimetrically using an electronic balance and converted to volume using the specific gravity of water (1.0). Accuracy is represented as the mean and standard deviation, while precision is represented as percent relative standard deviation. Differences were assessed using a 1-way analysis of variance with Bonferroni adjustments and significance set at P <.05. Results: Precision and accuracy were highly variable and often significantly (P <.05) different compared to the theoretical volume delivered both within and between investigators. An increased likelihood of unacceptable error (>5%) was observed when less than 20% of the labeled capacity of a syringe was measured. Mean percent error ranged from 1.4% to 18.6%, despite manufacturer specification of ±5% accuracy, suggesting proper technique as a major factor in small-volume measurements. Conclusion: In addition to proper, validated training of syringe users, we recommend that users measure no less than 20% of the indicated volume of the syringe while choosing syringes as close as possible to the desired measurement. When possible, very small volumes should be diluted to meet the minimum volume of the smallest syringe available. Implementation of these recommendations will improve accurate dosing and, ultimately, patient safety. [ABSTRACT FROM AUTHOR]

Abstract Objective To assess the number of eyes with silicone oil in the vitreous after intravitreal injection. Methods This cross-sectional, comparative study was divided into 2 groups: (1) treatment—eyes subjected to antiangiogenic therapy; (2) control—no history of intravitreal injection. Subjects were assessed regarding age, gender, clinical diagnosis, lens status, visual acuity and number of previous intravitreal injections. All eyes underwent a meticulous slit-lamp and ultrasound examination for the identification of silicone oil. ImageJ software was used to quantify the index of silicone oil (IOS) by ultrasonography. Results Sixty-seven eyes (30 controls, 37 treated) were included. Slit-lamp examination found silicone oil droplets in 25 out of 37 (67.57%) treated eyes and in none of the control group. Ultrasonography identified silicone oil in 28 out of 37 (75.68%) treated eyes and in 1 out of 30 (3.33%) controls. An observed agreement of 85.07% and a Cohen’s Kappa coefficient of 69.10% (p

Abstract Background Reuse of injection devices to give healthcare injections decreased from 39.8 to 5.5% between 2000 and 2010, but trends since 2011 have not been described. We reviewed results of Demographic and Health Surveys (DHS) to describe injection practices worldwide from 2011 to 2015. Methods We searched the DHS Internet site for data published on injection practices conducted in countries from 2011 to 2015, extracted information on frequency (number of healthcare injections per person in the last 12 months) and safety (proportion of syringes and needles taken from a new, unopened package). We compared gender groups and WHO regions in terms of frequency and safety. For countries with data available, we compared injection practices 2004–2010 and 2011–2015. Results Since 2011, 40 of 92 countries (43%) that conducted DHS surveys reported on injection practices. On average, the frequency of injection was 1.64 per person per year (from 3.84 in WHO Eastern Mediterranean region to 1.18 in WHO African region). Among those, 96.1% of injections reportedly used new injection devices (from 90.2% in the WHO Eastern Mediterranean region to 98.8% in the WHO Western Pacific region). On average, women received more injections per year (1.85) than men (1.41). Among 16 (40%) countries with data in 2004–2010 and 2011–2015, 69% improved in terms of safety. The annual number of unsafe injections reduced in 81% of countries. In Pakistan, the number of unsafe injections was the highest and did not decrease between 2006 and 2012. Conclusions Injection practices have continued to improve in most countries worldwide, although the Eastern Mediterranean region in particular still faces unsafe practices that are not improving. Further efforts are needed to eliminate unsafe injection practices in health care settings, including through the use of reuse-prevention devices. Despite some limitations, DHS is an easily available method to measure progress over time.

Abstract Background Epinephrine is a lifesaving medication in the treatment of anaphylaxis. Epinephrine auto-injectors are the preferred method of epinephrine administration, but are not universally available or affordable. Little is known about the effects on epinephrine when it is drawn up in advance and stored as prefilled syringes. Objective To study the stability and sterility of epinephrine when stored in syringes. Methods We searched Embase, Medline, and Web of Science in June 2016 for all studies of epinephrine stored in syringes in concentrations between 0.1 and 1 mg/mL that measured epinephrine stability and/or sterility over time, regardless of date published or language. Results Three studies were included, one testing two concentrations of epinephrine. Only one study tested epinephrine 1 mg/mL, the concentration clinically relevant for intramuscular use during anaphylaxis. Neither this study nor the one study testing 0.7 mg/mL epinephrine found significant degradation after 56 and 90 days, respectively. One of the two studies testing epinephrine at a concentration of 0.1 mg/mL found significant degradation by 14 days; the other found no degradation up to 168 days. Two studies tested for bacterial growth, with none detected after 28 and 90 days, respectively. One study tested for fungal growth, with none detected after 90 days. Conclusions Limited evidence suggests that syringes filled with 1 mg/mL epinephrine are stable and sterile for 90 days. More research is needed testing the duration of stability and sterility of prefilled syringes with the 1 mg/mL concentration most commonly used in anaphylaxis, testing more extensively in different storage conditions and across a wider range of marketed syringe brands.

Abstract Background Intravitreal silicone oil droplets have been found in the vitreous. The aim of this study is to compare the rates of silicone oil released by different brands of commonly used syringes for intravitreal injection after agitation by flicking. Methods Three models of two brands of syringes were analyzed for their rates of silicone oil release: Saldanha Rodrigues (SR) 1 mL insulin syringe (SR, Brazil, syringe 1), Becton–Dickinson (BD) Plastipak 1 mL insulin syringe (Brazil, syringe 2), and BD Safety-Glide 1 mL insulin syringe (USA, syringe 3). All syringes were tested under four different conditions: positive control (fluid with addition of silicone oil) without agitation (group 1, n = 5); positive control with agitation (group 2, n = 3); fluid only without agitation (group 3, n = 5); and fluid only with agitation (group 4, n = 5). Masked graders performed all analyses using light microscopy. Results All syringes (1, 2, and 3) released silicone oil droplets in the positive control group regardless of the agitation status (groups 1 and 2). When no oil was added and the syringes were not agitated, only syringe 1 released silicone oil droplets (40% of samples). After agitation, syringes 1 and 3 released silicone oil droplets in all samples. Quantitative analysis showed a significantly (P = 0.011; 11.2 ± 2.9 vs. 0.6 ± 0.9, respectively) higher mean number of silicone oil droplets released by syringe 1 after agitation compared to no agitation. Syringe 1 also had significantly (P = 0.002, 11.2 ± 2.9 vs. 0.0 ± 0.0 vs. 2.2 ± 0.8, respectively) more droplets than syringes 2 and 3 after agitation. Conclusions Syringes commonly used for intravitreal injections frequently release silicone oil droplets when agitated by flicking, especially the SR insulin ones. We recommend that they not be agitated at the time of intravitreal injection and that the manufacturers consider producing syringes adapted for intraocular use.

Marilyn S Kwolek,1 Jon E Block2 1Private Practice, Danville, CA 94526, USA; 2Independent Clinical Consultant, San Francisco, CA 94115, USA Background: Although freehand injection of botulinum toxin remains the status quo, it is an inaccurate technique for delivering precise amounts of neurotoxin at multiple injection sites with expediency. We developed an inexpensive, ergonomic, single-use, disposable exostructure device that rapidly converts a standard syringe into a highly accurate injection instrument. Materials and methods: Based on the results of two independent injectors, we determined the comparative delivery dose accuracy, precision, and amount of product waste associated with a standard syringe using the freehand injection technique vs a prototype injection assist device. Fifteen experienced injectors were also surveyed regarding their satisfaction using the device in a controlled research setting. Results: The average percentage difference from the expected dose value was 10% or 0.0025 mL). Accuracy estimates were also superior with the device over freehand for 2- and 4-unit doses. Precision estimates favored the device for all comparisons and all dosing regimens. The magnitude of variability around the average difference ranged from 2.2 to 5.4 times worse for the freehand method compared to the device. The overall percentage of product waste was substantial with the freehand method (>10%) compared to the device (4.3%) (P=0.04) for 1-unit injections. The percentage of injections showing measurable product waste was also significantly lower with the device (78% vs 25%, P=0.01). Fourteen of 15 (93%) injectors surveyed would use the device in daily practice if it were included complimentary with the neurotoxin. Conclusion: The injection assist device offered superior accuracy and precision compared to the freehand method across the entire injection regimen. The ancillary finding of a significant reduction in product waste with the device was particularly notable. Keywords: neurotoxin, injection, syringe, accuracy

Background: Many diabetic dogs and cats require small doses of insulin that must be administered accurately. Objectives: To compare the accuracy and precision of insulin syringes and pen‐injectors. Animals None. Methods: To determine how accurately and precisely insulin doses are delivered, 0.5, 1, 2, 4, 8, and 16 U doses were dispensed 25 times from 5 SoloSTARs, 5 FlexPens, 5 KwikPens, 5 JuniorSTARs, 5 VetPens 0.5‐8 U, 5 VetPens 1‐16 U, and by 5 veterinarians using 30 U/0.3 mL and 40 U/mL insulin syringes. Each dose was weighed, using a precision balance, and the intended and delivered doses were compared. Results: All pen‐injectors delivered less insulin than the intended dose, underdosage being inversely proportional to insulin dose. The differences between the intended and the delivered dose were not significant using JuniorSTAR and VetPen 0.5‐8 U at insulin doses of 0.5, 1, 2, and 4 U, using the 30 U/0.3 mL insulin syringe at the 4 U dose and using the 40 U/mL insulin syringe at the 4, 8, and 16 U doses. With all the devices, precision increased with increasing doses of insulin. The coefficient of variation was <8% for all 6 pen‐injectors. Conversely, using 30 U/0.3 mL and 40 U/mL syringes at an insulin dosage of 0.5 U the coefficients of variation were 12.08% and 9.39%, respectively. Conclusions and Clinical Importance: JuniorSTAR and VetPen 0.5‐8 U were more accurate than the other devices when delivering ≤2 U doses, while the delivery of 8 and 16 U doses was more accurate using 40 U/mL syringes. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy and outcomes of one-way surgical technique for the treatment of vitreous hemorrhage post vitrectomy on proliferative diabetic retinopathy (PDR) patients.Methods: This retrospective case series include 47 PDR patients who had vitrectomy with balanced saline solution tamponade and have developed vitreous hemorrhage without significant absorption. The one-way air-fluid exchange procedure which involves the application of a 0.22-μm pore size filter to exchange about 4.5-5.5 ml of fluid with a 10 ml syringe was performed on 47 patients (47 eyes). Post procedure, additional treatments were administered when needed. Best corrected visual acuity (BCVA), occurrence of intra-procedural and post-procedural complications were recorded and analyzed.Results: A total of 47 eyes of 47 PDR patients with a mean age of 50.8 ± 12.0 years were reviewed. Because of vitreous hemorrhage or tractional retinal detachment of PDR, all 47 eyes underwent vitrectomy with balanced saline solution tamponade prior to the exchange procedure. Four patients (8.51%) and 43 patients (91.5%) were diagnosed with type 1 diabetes mellitus (T1DM), or type 2 diabetes mellitus (T2DM), respectively. All 47 eyes were given the one-way air-fluid exchange procedure in the treatment room. Forty-two cases (89.4%) needed the air-fluid exchange procedure only once, 4 cases (8.51%) underwent the procedure twice, and 1 case (2.13%) was given the procedure three times, followed by additional retinal photocoagulation and one intravitreal injection of Conbercept. In addition to the procedure, no further treatment was needed for 5 eyes (10.6%) while additional retinal laser treatment was provided for 41 eyes (87.2%). The BCVA at the final follow-up was significantly improved from the initial acuity baseline in all cases. No complications were observed during the follow-ups.Conclusion: This one-way air-fluid exchange procedure can effectively exchange the vitreous hemorrhage and improve visual acuity of PDR patients who develop vitreous rehemorrhage post vitrectomy without obvious complications. [ABSTRACT FROM AUTHOR]

Background: Tandem mass spectrometry becomes a common and important test in newborn screening, but potential contamination of the equipment has largely been ignored.Methods: The source of contamination through Biosan quality control samples was examined prospectively, and further confirmed by retrospective analysis of patient samples.Results: We found that the source of contamination came from a syringe in the Biosan quality control samples. Furthermore, we found that a large number of indicators in the patient sample were interfered by syringe contamination in our center, and also in two other newborn screening centers, but the affected indicators were different in different screening centers.Conclusion: Syringe contamination will affect the detection of patient samples by tandem mass spectrometry and should be monitored carefully and immediately.

Objective: The off-label use in clinical practice of non-approved syringes for intravitreal drug administration has resulted in the detection of silicone oil drops in the vitreous of some patients. This situation derives from the lack of approved syringes for intraocular use in the Spanish market. The aim of this work is to review the use of syringes for intraocular administration, as well as to search for alternatives that meet the legal requirements for these unmet needs., Method: A systematic review was performed following the PRISMA 2020 guidelines by searching PubMed with the descriptors: (silicone) AND (syringes) AND ((intraocular) OR (intravitreal)) and filtering all existing publications from January 2006 to December 2023, including all those articles dealing with silicone oil release in intravitreal injections and analysing the possible consequences., Results: Sixty-eight results were found, 23 of which were excluded because they did not deal with the subject under study, leaving a total of 45 articles for the systematic review. These were classified according to the conclusions obtained in 4 groups: the adverse reactions produced by silicone; the administration technique; the physicochemical aspects of silicone release; and the characteristics of the medical device. After reviewing the current manufacturers and technical data sheets of commercialised syringes, the existing syringes for this use have been collected, finding 2 that will probably be commercialised in Spain at the beginning of 2024: Zero Residual™ 0.2 ml SiO-free and VitreJect® Ophthalmic., Conclusions: From the results obtained, it can be interpreted that the use of syringes and needles with silicone for intravitreal use is a concern for health professionals due to the implications and consequences that may arise in patients, the most important being adverse reactions, so it is necessary to have silicone-free syringes on the market that are specific for intraocular use. Safety and legality in the use of intraocular syringes and needles is essential to guarantee ocular integrity and patient health., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The off-label use in clinical practice of non-approved syringes for intravitreal drug administration has resulted in the detection of silicone oil drops in the vitreous of some patients. This situation derives from the lack of approved syringes for intraocular use in the Spanish market. The aim of this work is to review the use of syringes for intraocular administration, as well as to search for alternatives that meet the legal requirements for these unmet needs., Method: A systematic review was performed following the PRISMA 2020 Guidelines by searching PubMed with the descriptors: "silicone" AND "syringes" AND ("intraocular" OR "intravitreal") and filtering all existing publications from January 2006 to December 2023, including all those articles dealing with silicone oil release in intravitreal injections and analysing the possible consequences., Results: Sixty-eight results were found, 23 of which were excluded because they did not deal with the subject under study, leaving a total of 45 articles for the systematic review. These were classified according to the conclusions obtained in 4 groups: the adverse reactions produced by silicone, the administration technique, the physicochemical aspects of silicone release, and the characteristics of the medical device. After reviewing the current manufacturers and technical data sheets of commercialized syringes, the existing syringes for this use have been collected, finding two that will probably be commercialized in Spain at the beginning of 2024: Zero Residual™ 0.2 ml SiO-free and VitreJect® Ophthalmic., Conclusions: From the results obtained, it can be interpreted that the use of syringes and needles with silicone for intravitreal use is a concern for health professionals due to the implications and consequences that may arise in patients, the most important being adverse reactions, so it is necessary to have silicone-free syringes on the market that are specific for intraocular use. Safety and legality in the use of intraocular syringes and needles is essential to guarantee ocular integrity and patient health., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Abstract Friction is a genuine issue in the use of many medical devices involving rubbery materials such as plungers in medical syringes. This paper presents a new direction for the reduction of friction in medical syringes based on surface texturing of the rubber plunger. The specimens were prepared by casting poly(vinylsiloxane) (PVS) rubber into a pre-fabricated negative template obtained by 3D printing. Friction tests were performed on a home-made test-rig. It was clearly shown that friction resistance can be considerably manipulated when using textured plungers.

Séverine Vermeire,1 François D’heygere,2 Antoine Nakad,3 Denis Franchimont,4 Fernand Fontaine,5 Edouard Louis,6 Philippe Van Hootegem,7 Olivier Dewit,8 Guy Lambrecht,9 Beatrijs Strubbe,10 Filip Baert11 1Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium; 2Department of Gastroenterology, AZ Groeninge, Kortrijk, Belgium; 3Department of Gastroenterology, CHWAPI, Tournai, Belgium; 4Department of Gastroenterology, Erasme Hospital, Brussels, Belgium; 5Department of Gastroenterology, CHC St Joseph, Liège, Belgium; 6Department of Gastroenterology, University Hospital CHU Sart Tilman, Liège, Belgium; 7Department of Gastroenterology, AZ St Lucas, Brugge, Belgium; 8Department of Gastroenterology, UCL St Luc, Brussels, Belgium; 9Department of Gastroenterology, AZ Damiaan, Oostende, Belgium; 10Department of Gastroenterology, OLV Hospital, Aalst, Belgium; 11Department of Gastroenterology, AZ Delta, Roeselare-Menen, Belgium Purpose: Simponi® (golimumab, MSD) is a fully human monoclonal antibody against tumor necrosis factor alpha administered subcutaneously using an autoinjector or a prefilled syringe. This study examined preference for administration of golimumab by autoinjector or prefilled syringe in patients with moderate-to-severe ulcerative colitis (UC). Patients and methods: This was a multicenter, open-label, randomized crossover trial (EudraCT no 2014-000656-29). Patients with moderate-to-severe UC were randomized 1:1 to receive 2 subcutaneous injections of 50 mg golimumab with the autoinjector followed by 2 injections of 50 mg with the prefilled syringe or the same 4 injections administered in the opposite order. Patients assessed preference, ease of use, and discomfort immediately after the injections and 2 weeks later. Results: Ninety-one patients were included (median age=42.7 years [range, 19.7–93.7]; 58% male). The autoinjector was preferred by 76.9% of patients immediately after injections and by 71.4% 2 weeks later. The autoinjector was more often considered extremely easy or easy to use (94.5%) than the prefilled syringe (73.6%). Moderate discomfort or worse was reported by more patients when using the prefilled syringe (20.9%) than when using the autoinjector (5.5%), and severe discomfort or discomfort preventing injection of future doses was reported by 8.8% for the prefilled syringe but not at all when using the autoinjector. A favorable or extremely favorable overall impression was reported by 89.0% for the autoinjector and 72.5% for the prefilled syringe. Conclusion: Most patients with moderate-to-severe UC preferred to self-administer golimumab with the autoinjector over a prefilled syringe. Keywords: autoinjector, adherence, anti-TNF, subcutaneous injection, treatment, self-injection

Vancomycin is increasingly administrated by continuous infusion. But the treatment of patient in intensive care need restricted volume to prevent fluid overload. The aim of the study was to evaluate the physical and chemical stability of solutions of a high concentration of vancomycin hydrochloride in 5 % glucose or 0.9 % NaCl.

Peer W Kämmerer, Monika Daubländer Department of Oral, Maxillofacial and Facial Plastic Surgery, University Medical Centre Mainz, Mainz, GermanyWe read the article by Al-Shayyab1 with great interest, though we think that there is a methodical bias. Usage of standard dental syringes with 27-gauge needles is not recommended for periodontal ligament (PDL) injections as they are very unlikely to achieve the correct pressure needed for successful single tooth anesthesia. In accordance with this, specialized syringes with short 30-gauge needles are commonly used all over the literature.2 The author addresses this in the “Discussion” section and writes that “a standard conventional dental syringe was used in the present study, not a special PDL syringe, since the former is readily available in the clinic and proves equally successful when a standard 27-gauge short needle was used,” citing Malamed from 1982 (a time during which the modern PDL syringes were not developed yet3) and Madan et al who write that “intraligamentary injection technique is equally effective when a standard 27-gauge needle is used”.4 The second assumption refers to the needle only, not the syringe. In addition, this needle issue is not proven by any reference or study. Therefore, one might come to the conclusion that PDL was not carried out correctly. Also, the authors did not evaluate pulp or tissue anesthesia and started the extraction procedure after a latency period of 5 minutes in all cases. In accordance with this, the success rates of the PDL injection cannot be given, but would be of interest.View the original paper by Al-Shayyab and colleagues.

Grégoire Jacques Noël Cozon,1 Pierre Clerson,2 Annaïk Dokhan,3 Yann Fardini,2 Taylor Pindi Sala,4 Jean-Charles Crave4 1Department of Clinical Immunology and Rheumatology, Edouard Herriot Hospital, Lyon, France; 2Soladis Clinical Studies, Roubaix, France; 3KPL, Paris, France; 4Octapharma France, Boulogne, France Purpose: Patients with primary immunodeficiency (PID) often receive immunoglobulin replacement therapy (IgRT). Physicians and patients have the choice between various methods of administration. For subcutaneous immunoglobulin infusions, patients may use an automated pump (P) or push the plunger of a syringe (rapid push [RP]). P infusions are performed once a week and last around 1 hour. RP decreases the duration of administration, but requires more frequent infusions.Patients and methods: Eight out of 30 patients (coming from a single center) who had participated in the cross-over, randomized, open-label trial comparing P and RP participated in a focus group or underwent in-depth interviews. Patients had a long history of home-based subcutaneous immunoglobulin using P. The trial suggested that RP had slightly greater interference on daily life than P, but similar efficacy and better cost-effectiveness. When asked about the delivery method they had preferred, around one-third of patients pointed out RP rather than P. In-depth interviews may reveal unforeseen reasons for patients’ preferences. Results: Interviews underlined the complexity of the relationship that the patients maintain with their disease and IgRT. Even if they recognized the genetic nature of the disease and claimed PID was a part of them, patients tried not to be overwhelmed by the disease. IgRT by P was well integrated in patients’ routine. By contrast, RP too frequently reminded the patients of their disease. In addition, some patients pointed out the difficulty of pushing the plunger due to the viscosity of the product. Coming back too frequently, RP was not perceived as time saving over a week. Long-lasting use of P could partly explain patients’ reasonable reluctance to change to RP.Conclusion: In-depth interviews of PID patients highlighted unforeseen reasons for patients’ preference that the physician needs to explore during the shared medical decision-making process. Keywords: in-depth interviews, primary immunodeficiency, patients’ expectations, preference, immunoglobulins, immunoglobulins replacement therapy, pump, rapid push, syringe

Background: Fear of a dental child is most commonly associated with dentist attire and usage of syringe. The objective of the study was to evaluate the preference of dentist's attire and kind of syringe (conventional or camouflage) among different age groups of children. Materials and Methods: In this cross-sectional study A total of 750 children aged 4–14 years were included in the study. All the participants were subdivided into five major groups according to their age, i.e., 4–5 years, 6–7 years, 8–9 years, 10–11 years, and 12–14 years. A set of six photographs which included dentists in white-colored apron, pink-colored apron, green-colored apron, blue-colored apron, and gown with cartoon character and dentists without apron (formal attire) along with: (a) camouflage syringe and (b) conventional syringe were provided to every child and was asked to give his/her preference looking at the six set of pictures. The preference of each child was thus recorded. Children's anxiety level during injections and dentist attire was assessed and recorded using two anxiety scales, i.e. the Modified Child Dental Anxiety Scale faces version and Facial Image Scale.SPSS statistical software and Chi-square test were used. (P < 0.05). Results: A majority of 35.3% participants in the 4–5-years age group preferred aprons with cartoon character, while 65.3% in the 12–14-years age group selected white apron as the preferred choice. Regarding preference of the syringe type, it was observed that 82% of the younger age preferred camouflage syringe and 75% of the older age preferred conventional syringe. On comparison of both the scales, no significant differences were found. About 82% children in the older age group were reported to be nonanxious with white attire and only 14% were anxious with the conventional syringe type. Conclusion: Younger children have a greater preference of colorful attire of dentist and camouflage syringe over the conventional one when compared to older children.

Vitiligo is a common skin disorder of our country. Many of the patients are refractory to medical treatment. Dermato-Surgery is very rewarding in these cases. Thus proper selection of technique will play a major role in achieving good therapeutic and end cosmetic results. Suction blister technique is convenient and cost effective, less time consuming, pure epidermal graft, excellent colour match, pigment spread from the graft to surrounding area- upto 46% and maximum pigmentation within 3-4 months happens without any scar. Suction Blister Technique: The in vivo separation of epidermis from rest of the skin by production of a suction blister using 50 ml syringe as a vacuum creating device instead of the expensive and cumbersome vacuum devices as the time taken for the blister formation is the same. The advantage in this method we needn't inject intradermal saline into the blisters as blisters formed are appropriate and chances of improper blisters are very rare.

In this paper, we describe a new non-damaging internal tissue sampling method for preserved collection of teleostean specimens. It was tested on freshwater pipefish, as external tissue sampling is made difficult by the lack of scales, the lack of pelvic fins, the atrophy of pectoral and anal fins. The internal tissue is detached by scratching the inside of the urogenital papilla with a fine metallic probe. 95% ethanol is injected using a fine syringe, and then sucked back into the syringe with the detached tissue. This protocol has been tested on 6 specimens from 5 species of pipefish. For each specimen DNA was extracted from the internal tissue, a caudal fin clip, and when possible, eggs sampled from the male brooding pouch. Partial Cytochrome c oxydase I (COI) was amplified and sequenced. For each specimen, the 582 bp long sequences obtained from the internal tissue, the fin clip and the eggs were identical. These results validate this non-damaging internal tissue sampling method, which leaves absolutely no trace on the specimen. Although this method was developed on pipefish, it could be applied to other teleostean, even precious museum collection specimens such as type specimens. The aim of this paper, using the example of freshwater pipefish, is to present this method, which aims at preserving precious collection specimens while still valorising them. [ABSTRACT FROM AUTHOR]

Background: Syringe infusion pumps are used for the precise continuous administration of intravenous drugs. Their compliance and mechanical deficiencies have been found to cause considerable start-up delays, flow irregularities during vertical displacement, as well extensive delays of occlusion alarms at low infusion rates. The aim of this study was to evaluate the performance of several modern syringe infusion pumps at low infusion rates and the impact on drug concentration.Methods: Seven currently marketed syringe infusion pump assemblies were assessed in an in vitro study during start-up, vertical displacement manoeuvres, and infusion line occlusion at a set flow rate of 1 ml h-1. The measured data were used as input for a pharmacokinetic simulation modelling plasma concentration during a standard neonatal continuous epinephrine infusion.Results: The mean time from starting the infusion pump to steady-state flow varied from 89 to 1622 s. The zero-drug delivery time after lowering the pump ranged from 145 to 335 s. In all assemblies tested, occlusion alarm delays and measured flow irregularities during vertical displacement manoeuvres resulted in relevant deviations in plasma epinephrine concentration (>25%) as calculated by the pharmacokinetic simulation model.Conclusion: Problems with the performance of syringe infusion pump assemblies can have considerable impact on plasma drug concentration when highly concentrated short-acting cardiovascular drugs are administered at low flow rates. The problems, which affected all assemblies tested, are mainly related to the functional principle of syringe infusion pumps and will only partially be solved by incremental improvements of existing equipment. [ABSTRACT FROM AUTHOR]

In this study, a new liquid-phase microextraction method termed sieve-conducted two-syringe-based pressurized liquid-phase microextraction (SCTS-PLPME) was developed as a preconcentration tool for indium. Here, two syringes were connected to each other by an apparatus to produce an environment subject to pressure. The pressure created between the two syringes by simultaneous movements of the syringe plungers (to and fro) generated an efficient dispersion and this eliminated the need for dispersive solvents. Determination of indium after preconcentration was carried out with a slotted quartz tube attached flame atomic absorption spectrometer (SQT-FAAS). The detection limit (LOD) and quantification limit (LOQ) of the developed method were calculated as 19.2 and 72.2 μg L−1, respectively. The reliability and accuracy of the developed method was tested by performing recovery studies on lake water spiked at different concentrations and the obtained percent recoveries were between 101.2 and 106.9%. [ABSTRACT FROM AUTHOR]