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Background Aims Methods Results Conclusions Connecting an infusion line to a closed stopcock results in pressurization of fluid within the syringe infusion pump assembly leading to flow irregularities when opening the stopcock and activating the pump.It was the purpose of this study to assess the extent of pressurization under different conditions and its impact on start‐up fluid delivery.Intraluminal pressures and start‐up fluid delivery at 1 mL/h flow rate were assessed with connection of the infusion line 1 min (delayed connection) or immediately after purging (immediate connection) using two different infusion lines made from polyvinylchloride (PVC) or polyethylene (PE).Delayed connection resulted in an increase of intraluminal pressures from zero to 5.1 [4.5 to 5.7] mmHg with the PVC line and from zero to 47.1 [44.8 to 49.3] mmHg with the PE line (mean difference 42.0 [95% CI 39.3–44.7] mmHg; p < .0001). Immediate connection resulted in an increase of intraluminal pressures from zero to 44.3 [41.8–46.8] mmHg with the PVC line and from zero to 61.3 [57.2–65.4] mmHg with the PE line (mean difference 17.0 [95% CI 11.8–22.2] mmHg; p < .0001). The increase in intraluminal pressures was significantly higher with PE lines for both delayed and immediate connection when compared to the PVC lines (mean difference 29.5 [95% CI 19.3–39.7] mmHg; p < .0001). Related fluid volumes delivered at 10 s and 360 s after starting the pump ranged from −252% to 1321% (10 s) of expected infusion volumes and from 59% to 129% (360 s), respectively.Both, timing of infusion line connection after purging and infusion line characteristics considerably affect intraluminal pressures and start‐up fluid delivery when connecting a new syringe infusion pump assembly to a closed stopcock. Consecutive alterations in drug administration can have considerable hemodynamic consequences when dealing with catecholamine infusions in critically ill patients. [ABSTRACT FROM AUTHOR]

Understanding the apical pressure and irrigant flow patterns in root canals is crucial for safe and effective irrigation. Therefore, this study aimed to assess the flow characteristics of irrigants in root canal models with varying tapers during final irrigation by employing various needle designs, including a back-to-back double-side-vented needle, through computational fluid dynamics. The root canal model was configured as a closed geometrical cone with a simulated apical zone (size 30) and features tapers of 4%, 6%, and 8%. Three needle types—open-ended needle (OEN), single side-vented needle (SSVN), and double side-vented needle (DSVN)—were investigated. The results indicated that for the 4% taper models, the open-ended needle generated the maximum apical pressure, followed by the double side-vented needle and the single side-vented needle. However, in the 6% and 8% tapering root canal models, the double-side-vented needle applied the lowest maximum apical pressure. Consequently, the DSVN can pose a risk for irrigant extrusion in minimally prepared canals due to heightened apical pressure. In wider canals, the DSVN exhibited lower apical pressure. The maximum irrigant replacement was observed with OEN compared to that of the closed-ended group for both flow rates. Additionally, compared with OENs, closed-ended needles exhibited nonuniform and lower shear wall stress. [ABSTRACT FROM AUTHOR]

The purpose of this in vitro study was to evaluate the impact of the vertical level of the stopcock connecting the infusion line to the central venous catheter on start-up fluid delivery in microinfusions. Start-up fluid delivery was measured under standardized conditions with the syringe outlet and liquid flow sensors positioned at heart level (0 cm) and exposed to a simulated CVP of 10 mmHg at a set flow rate of 1 ml/h. Flow and intraluminal pressures were measured with the infusion line connected to the stopcock primarily placed at vertical levels of 0 cm, + 30 cm and − 30 cm or primarily placed at 0 cm and secondarily, after connecting the infusion line, displaced to + 30 cm and − 30 cm. Start-up fluid delivery 10 s after opening the stopcock placed at zero level and after opening the stopcock primarily connected at zero level and secondary displaced to vertical levels of + 30 cm and – 30 cm were similar (− 10.52 [− 13.85 to − 7.19] µL; − 8.84 [− 12.34 to − 5.33] µL and − 11.19 [− 13.71 to − 8.67] µL (p = 0.469)). Fluid delivered at 360 s related to 65% (zero level), 71% (+ 30 cm) and 67% (− 30 cm) of calculated infusion volume (p = 0.395). Start-up fluid delivery with the stopcock primarily placed at + 30 cm and − 30 cm resulted in large anterograde and retrograde fluid volumes of 34.39 [33.43 to 35.34] µL and − 24.90 [− 27.79 to − 22.01] µL at 10 s, respectively (p < 0.0001). Fluid delivered with the stopcock primarily placed at + 30 cm and − 30 cm resulted in 140% and 35% of calculated volume at 360 s, respectively (p < 0.0001). Syringe infusion pumps should ideally be connected to the stopcock positioned at heart level in order to minimize the amounts of anterograde and retrograde fluid volumes after opening of the stopcock. [ABSTRACT FROM AUTHOR]

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]

Food rheology is key to manage the swallowing safety of people affected by swallowing disorders (dysphagia). Simple approaches to assess the flow properties of texture-modified drinks are widely used, but relatively poorly understood. This study focuses on the International Dysphagia Diet Standardisation Initiative (IDDSI) flow test, adopted by caregivers worldwide. This test considers the gravity-driven flow in a vertical syringe. Newtonian liquids and non-Newtonian fluids obtained using a commercial starch-based thickener were considered in this study. An accurate theoretical description of the flow is proposed for Newtonian and power-law fluids considering the effect of fluid properties and of the syringe geometry. A rheological map is proposed, based on the results of several thousand simulations, to capture quantitatively the effect of rheological properties and density on the IDDSI classification, highlighting the important effect of the fluid density which is usually ignored. The sensitivity of the IDDSI results with respect to the syringe outlet diameter is discussed, as well as the different average shear rates at which different IDDSI levels are tested. The rheological map also shows quantitatively that different combinations of the fluid rheological properties and density can result in the same IDDSI classification, suggesting interesting directions for future clinical research. [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

Microinfusions are commonly used for the administration of catecholamines, but start-up delays pose a problem for reliable and timely drug delivery. Recent findings show that venting of the syringe infusion pump with draining of fluid to ambient pressure before directing the flow towards the central venous catheter does not counteract start-up delays. With the aim to reduce start-up delays, this study compared fluid delivery during start-up of syringe infusion pumps without venting, with ambient pressure venting, and with central venous pressure (CVP)-adjusted venting. Start-up fluid delivery from syringe pumps using a microinfusion of 1 mL/h was assessed by means of liquid flow measurement at 10, 60, 180 and 360 s after opening the stopcock and starting the pump. Assessments were performed using no venting, ambient pressure venting or CVP-adjusted venting, with the pump placed either at zero, − 43 cm or + 43 cm level and exposed to a simulated CVP of 10 mmHg. Measured fluid delivery was closest to the calculated fluid delivery for CVP-adjusted venting (87% to 100% at the different timepoints). The largest deviations were found for ambient pressure venting (− 1151% to + 82%). At 360 s after start-up 72% to 92% of expected fluid volumes were delivered without venting, 46% to 82% with ambient pressure venting and 96% to 99% with CVP-adjusted venting. CVP-adjusted venting demonstrated consistent results across vertical pump placements (p = 0.485), whereas the other methods had significant variances (p < 0.001 for both). In conclusion, CVP-adjusted venting effectively eliminates imprecise drug delivery and start-up delays when using microinfusions. [ABSTRACT FROM AUTHOR]

Introduction: When scanning for deep endometriosis a 20 mL syringe is used to insert gel into the vagina for a gel sonovaginography (SVG) examination. This is invasive and can cause discomfort. The aim of this study is to compare participant experience with the self‐administration of 20 mL of gel total using a 10 mL syringe versus 20 mL syringe for participants undergoing a gel SVG ultrasound to assess for any participant discomfort. Methodology: This study was a quantitative pilot study with 31 participants. Consenting participants were instructed to insert a total of 20 mL of gel divided equally into one 20 mL and one 10 mL syringe, into their own vagina prior to SVG. After the SVG, a questionnaire was provided to determine the level of discomfort experienced. Results: Overall participants found the instructions clear and the insertion of either syringe tolerable. The results demonstrated that 22/31 (71%) of participants had no discomfort inserting the 10 mL syringe. In comparison, 17/31 (55%) reported slight or mild discomfort inserting the 20 mL syringe. The majority of participants preferred inserting one 20 mL syringe rather than two 10 mL syringes. Conclusion: Participants found the gel insertion using either syringe tolerable with most participants finding the 10 mL syringe more comfortable but would overall prefer inserting one 20 mL syringe instead of two 10 mL syringes. Future studies on larger numbers of multicultural participants using variable syringe sizes with varying amounts of gel should be considered. [ABSTRACT FROM AUTHOR]

There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis. Venous blood was collected by venipuncture from 19 healthcare workers in three 1.0 mL syringes for blood gas analysis, by manually aspirating different volumes of blood (i.e., 1.0, 0.5 and 0.25 mL). Routine blood gas analysis was then immediately performed with GEM Premier 5,000. The results of the two underfilled syringes were compared with those of the reference syringe filled with appropriate blood volume. The values of most assayed parameters did not differ significantly in the two underfilled syringes. Statistically significant variations were found for lactate, hematocrit and total hemoglobin, the values of which gradually increased as the fill volume diminished, as well as for sodium concentration, which decreased in both insufficiently filled blood gas syringes. The bias was clinically meaningful for lactate in syringe filled with 0.25 mL of blood, and for hematocrit, total hemoglobin and sodium in both syringes containing 0.5 and 0.25 mL of blood. Collection of smaller volumes of venous blood than the specified filling volume in blood gas syringes may have an effect on the quality of some test results, namely lactate, hematocrit, total hemoglobin and sodium. Specific indications must be given for standardizing the volume of blood to be collected within these syringes. [ABSTRACT FROM AUTHOR]

Start-up delays of syringe pump assemblies can impede the timely commencement of an effective drug therapy when using microinfusions in hemodynamically unstable patients. The application of the venting principle has been proposed to eliminate start-up delays in syringe pump assemblies. However, effectively delivered infusion volumes using this strategy have so far not been measured. This invitro study used two experimental setups to measure the effect of the venting principle compared to a standard non-venting approach on delivered start-up infusion volumes at various timepoints, backflow volumes, flow inversion and zero drug delivery times by means of liquid flow measurements at flow rates of 0.5, 1.0 and 2.0 mL/h. Measured delivered initial start-up volumes were negative with all flow rates in the vented and non-vented setup. Maximum backflow volumes were 1.8 [95% CI 1.6 to 2.3] times larger in the vented setup compared to the non-vented setup (p < 0.0001). Conversely, times until flow inversion were 1.5 [95% CI 1.1 to 2.9] times shorter in the vented setup (p < 0.002). This led to comparable zero drug delivery times between the two setups (p = 0.294). Start-up times as defined by the achievement of at least 90% of steady state flow rate were achieved faster with the vented setup (p < 0.0001), but this was counteracted by the increased backflow volumes. The application of the venting principle to the start-up of microinfusions does not improve the timely delivery of drugs to the patient since the faster start-up times are counteracted by higher backflow volumes when opening the three-way stopcock. [ABSTRACT FROM AUTHOR]

The acute compartment syndrome refers to an increase in pressure in a limited space within the body. This is an orthopedic emergency that requires prompt and accurate diagnosis, and objective indicators such as compartment pressure measurement are more important than the subjective judgment of the doctor. This study presents a motorized hand- held device that can accurately measure and diagnose intramuscular compartment pressure by overcoming the disadvantages of the existing compartment pressure measuring device. The device is divided into two modules: a disposable sensor part with a pressure sensor in the syringe, and a reusable electronic part including a motor, controller, dis- play unit, and battery. The assembly of these two modules is designed such that the pressure sensor and the electric parts are easily fastened in a shape similar to that of a conventional syringe. A pressure sensor is embedded into a syringe with a needle and the plunger is moved by a motor according to the user's input to inject a certain amount of liquid in the syringe to equalize the pressure in the syringe with the diagnostic area, and the sensor measures the pressure value. The measured value is shown in a display on the electric part. Each prototype was fabricated for the two different design models, and it was confirmed through a series of experiments that the designed devices have essential performance for measuring intra-compartmental pressure and the user can easily perform it for the given measurement protocol. [ABSTRACT FROM AUTHOR]

Background: Connection and opening a syringe infusion pump to a central venous line can lead to acute anterograde or retrograde fluid shifts depending on the level of central venous pressure. This may lead to bolus events or to prolonged lag times of intravenous drug delivery, being particularly relevant when administering vasoactive or inotropic drugs in critically ill patients using microinfusion. The aim of this study was to assess the effect of syringe pump positioning at different vertical heights on start‐up fluid delivery before versus after purging and connection the pump to the central venous catheter. Methods: This in vitro study measured ante‐ and retrograde infusion volumes delivered to the central venous line after starting the syringe pump at a set infusion rate of 1 mL/h. In setup one, the pump was first positioned to vertical levels of +43 cm or –43 cm and then purged and connected to a central venous catheter. In setup two, the pump was first purged and connected at zero level and secondarily positioned to a vertical level of +43 cm or –43 cm. Central venous pressure was adjusted to 10 mmHg in both setups. Results: Positioning of the pump prior to purging and connection to the central venous catheter resulted in a better start‐up performance with delivered fluid closer to programmed and expected infusion volumes when compared to the pump first purged, connected, and then positioned. Significant backflow volumes were observed with the pump purged and connected first and then positioned below zero level. No backflow was measured with the pump positioned first below zero level and then purged and connected. Conclusions: Syringe infusion pump assemblies should be positioned prior to purging and connection to a central venous catheter line when starting a new drug, particularly when administering highly concentrated vasoactive or inotropic drugs delivered at low flow rates. [ABSTRACT FROM AUTHOR]

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.

To evaluate the accuracy with which veterinary anaesthetists and nurses of different experience draw up small volumes of liquid. Prospective blinded randomized study. A group of seven European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates, six ECVAA residents and six anaesthesia nurses participated in the study. For each participant, five target volumes between 0.01 and 1.0 mL were randomly allocated. They were drawn up 20 times in random order using a 1 mL syringe attached to a 23 gauge needle. A total of 1900 measurements were analysed. An investigator filled the syringe and needle dead space with water for injection before each experiment. The change in mass of the syringe once filled to the target volume was used to calculate the actual volume of liquid drawn up. Large errors were made with measurements < 0.04 mL, so they were excluded from the statistical analysis. There was a significant effect of the target volume (p < 0.001) and of the order (p < 0.01). For each mL increase in the target volume, the absolute error decreased by 4% and from the first to the hundredth withdrawal each participant's absolute error decreased by 1%. The target volume was underestimated in 52.3% of measurements, 42% were overestimated and 5.7% were on target. None of the between-subject predictor variables approached significance. Accuracy of veterinary anaesthetists and nurses in drawing up medications decreases as the target volume becomes smaller. Small veterinary patients receive small volumes of anaesthetic drugs with higher risks of overdosing compared with larger dogs. Years of experience and staff grade are not associated with greater accuracy. Large percentage errors may be seen with target volumes less than 0.04 mL. Dilutions are recommended for volumes > 0.19 mL in 1 mL syringe. [ABSTRACT FROM AUTHOR]

A rapid and sensitive strategy was proposed for the detection of fluoranthene (FL), which is a polycyclic aromatic hydrocarbon (PAH), in water samples. In this work, syringe solid‐phase extraction (SPE) combined with solid‐phase fluorescence spectrometry was used to determine FL in PAHs polluted environmental samples. The fluorescence signals were directly monitored on the membrane surface after FL was enriched by syringe SPE. Under the optimal conditions, the proposed method showed a linear relationship in the concentration range 2–50 μg/L with a correlation coefficient (R2) of 0.998, and the limit of detection was 0.143 μg/L. The recoveries varied from 93.47% to 109.81% in the actual samples, with the relative standard deviations (n = 3) ranging from 2.06% to 6.32%. According to the results, the established method can be applied in the field of rapid detection as it is fast, simple, portable, and highly sensitive, and has strong anti‐interference. [ABSTRACT FROM AUTHOR]

Background: Intravenous administration of highly concentrated and potent drugs at low flow rates is common practice, particularly in critically ill children. Drug delivery during infusion start‐up can be considerably delayed by intrinsic factors of syringe infusion pump assemblies. The impact of central venous pressures on the course of start‐up fluid delivery of such microinfusions remains unknown. Methods: Infusion volumes delivered after activation of the start button in a conventional 50 mL syringe infusion pump assembly equilibrated (representing classical in vitro testing) and not equilibrated (representing real clinical conditions) to central venous pressure levels of 0, 10 and 20 mmHg at a set infusion flow rate of 1 mL/h were measured using a fluidic flow sensor. Results: The experimental setup mimicking real life conditions demonstrated considerable differences in fluid delivery during pump start‐up depending on central venous pressure. A central venous pressure of 0 mmHg resulted in massive fluid delivery at infusion start‐up, while central venous pressure levels of 10 and 20 mmHg resulted in retrograde flows with related mean (95% CI) zero‐drug delivery times of 3.22 (2.98–3.46) min and 4.51 (4.33–4.69) min, respectively (p <.0001). Conclusion: Depending on central venous pressure level, connection and starting a new syringe pump can result in significant antegrade or retrograde fluid volumes. In clinical practice, this can lead to hemodynamic instability and hence requires clinical alertness. Further research and methods to improve start‐up performance in syringe infusion pump systems are desirable. [ABSTRACT FROM AUTHOR]

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]

Irrigant delivery by a syringe and needle is still widely used during root canal treatment. It seems to perform similarly to other irrigation methods in the main root canal, provided that the needle is inserted close to working length, the canal is adequately enlarged and the irrigant is delivered at a sufficient flow rate. However, additional delivery and activation methods are needed to clean and disinfect areas beyond the main root canal. Neither the entrapment of air bubbles in the apical part of the root canal ('apical vapor lock') nor the surface tension of irrigants are limiting irrigant penetration during syringe irrigation. [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]

Since the mid-2010s, slamsex—sexualized drug use involving intravenously injecting meth—has rapidly emerged in metropolitan gay communities as a sociosexual practice necessitating harm reduction interventions. However, its impact on gay men's sociosexual lives and HIV technologies is not well understood. This paper addresses this gap by investigating two intertwined temporal dimensions of slamsex, viewing it as a form of slow edgework in post-AIDS Taiwan. Ethnographic research was conducted in Taiwan between 2022 and 2024, involving 30 interviews with gay men who practice slamsex and 7 HIV/AIDS NGO representatives. Semi-structured interviews focused on slamming events, covering their edge, transition, and healthcare network. Findings reveal paradoxes within edgework, demonstrating that slamsex can be both extreme and risky, as well as slow and mundane. Participants navigated state surveillance and the materiality of syringes through meticulous risk calculations and digital-savvy strategies for acquiring clean syringes. The practice involved risk and a networked economy of care services provided by other injectors. In response to HIV technologies (PrEP and viral load disclosure), gay men in this study normalized HIV/AIDS while developing a sense of vulnerability to their own infection. In the era of HIV/AIDS normalization, slamsex as slow edgework underscores the need for temporally and spatially nuanced discussions on drug policy. This study highlights the importance of culturally tailored interventions that consider slow, networked interactions to provide harm reduction for men on the chemsex scene, as well as the needs for more evidence-based, non-discriminatory research on queer sexual health and drug studies. [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.

This study was conducted to investigate the effects of feeding methods of bottle and injector on the transition to full breastfeeding and sucking success in preterm newborns. This study was a randomized controlled type experimental study. The study sample included 62 preterm newborns, resulting from the strength analysis, who were treated in the neonatal intensive care unit of a university hospital (31 bottle-feeding group, 31 injector feeding group). Data were collected using the Descriptive Information Form, Preterm Infant Follow-up Form and LATCH Breastfeeding Diagnostic Scale. The infants in the syringe and the bottle-feeding group were fed, and the sucking successes and transition times to breastfeeding were evaluated during the first breastfeeding, after 48 h and before discharge. When sucking successes and transition times to breastfeeding were evaluated, LATCH scores of the mothers in the syringe feeding group were significantly higher than the mothers in the bottle-feeding group, and infants switched to full breastfeeding in a shorter time (p < 0.05). When the physical parameter results were evaluated, the mean heart rate of the babies in the bottlefed group was significantly higher than the injector-fed group (p < 0.05). It has been seen that injecting feeding method has a positive effect on the success of the newborn, the time of transition to full breastfeeding and life signs according to the bottle-feeding method. The findings obtained in this study suggest that to increase the success of sucking, shortening the transition time to full breastfeeding and using the injector feding method to maintain stabile physical parameters. The findings obtained in this study suggest that to increase the success of sucking, shortening the transition time to full breastfeeding and using the injector feding method to maintain stabile physical parameters. • There is no universally accepted approach to feeding preterm infants. • The injector feeding method has a positive effect on the sucking success of the newborn, the transition time to full breastfeeding and the vital signs than the bottle-feeding method. [ABSTRACT FROM AUTHOR]

Black rails (Laterallus jamaicensis) are a rare and protected bird species. They are also notoriously difficult to monitor. eDNA surveys have proven beneficial for the detection of this elusive species, but additional developments are needed to enhance eDNA survey utility (including reliability of outcomes) in light of black rail status and associated high-profile conservation actions. The use of multiple assays functions to increase eDNA detection confidence by increasing the probability of amplification in low concentration, highly degraded samples (i.e., reducing the risk of false negatives) and by providing a multiplicative test for ruling out contamination as the source of qPCR amplification (i.e., reducing the risk of false positives). The two eDNA assays developed, optimized, and validated in this study will prove valuable for the continued surveillance of the secretive black rail, offering data to measure its distribution and occurrence over time and as influenced by anticipated climate-change-induced disturbances and/or habitat restoration/creation initiatives. The assays are applicable to both Eastern black rails and California black rails, and do not exhibit qPCR amplification in non-target, co-distributed taxa (including other Rallidae species) in the United States. [ABSTRACT FROM AUTHOR]

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]

This paper deals with the construction and validation of a new, very simple purely mechanical rheometer, which is assembled from a syringe and a steel spring. This rheometer does not require any expensive measuring equipment and yet can measure the viscosities of common Newtonian and non-Newtonian liquids with satisfactory results. By determining the temporary position of the piston, the force applied by the spring and the piston velocity can be ascertained and the viscosity of a given sample of Newtonian liquid can be calculated with repeatability of better than 2%. When measuring non-Newtonian and viscoelastic liquids, a camera is used to record the time course of the moving piston and the swelling ratio. Preliminary tests conducted on power-law liquids demonstrate reproducibility of rheological parameters even for very high viscosity liquids. A new correction to inlet effects is also derived as a function of Reynolds number. • Construction and experimental verification of a mechanical rheometer is presented. • Rheometer is made from a syringe and driven by a steel spring. • Viscosity is evaluated from the video recording of the piston position. • Construction of the rheometer is very simple, cheap, and sterilizable. • Rheometer is validated by comparing the measured results with the viscosity of water. [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.

For a plastic syringe, a stopper at the end of plunger is usually made of polydimethylsiloxane (PDMS, and co-ingredients). To reduce friction and prevent leakage between the stopper and barrel, short chain polymer of liquid PDMS is also used as lubricant. Consequently, an injection process can release solid PDMS debris from the stopper and barrel, and liquid PDMS droplets from the lubricant, both of which are confirmed herein as solid and liquid micro(nano)plastics. From molecular spectrum perspective to directly visualise those micro(nano)plastics, Raman imaging was employed to analyse hundreds-to-thousands of spectra (hyper spectrum or hyperspectral matrix) and significantly enhance signal-to-noise ratio. From morphology perspective to provide high resolution of image, scanning electron microscopy (SEM) was engaged to cross-check with Raman images and increase assignment / quantification certainty. The weak Raman imaging signal of nanoplastics was extracted using image deconvolution algorithm to remove the background noise and average the signal variation. To increase the result's representativeness and avoid quantification bias, multiple syringes were tested and multiple areas were randomly scanned toward statistical results. It was estimated that thousands of microplastics and millions of nanoplastics of solid/liquid PDMS might be injected when using a plastic syringe of 1 mL. Overall, Raman imaging (along with algorithm and SEM) can be helpful for further research on micro(nano)plastics, and it should be cautious to use plastic syringe due to the increasing concern on the emerging contamination of not only solid but also liquid micro(nano)plastics. [Display omitted] • Thousands-to-millions of micro(nano)plastics might be injected via a plastic syringe. • Not only solid but also liquid PDMS micro(nano)plastics are injected. • Raman imaging directly visualises micro(nano)plastics towards qualification. • Weak signal of nanoplastics is extracted by algorithms. • Randomly scanning multiple areas can increase the result representativeness. [ABSTRACT FROM AUTHOR]

Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system. [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 [ABSTRACT FROM AUTHOR]

Protein-based biologic drugs encounter a variety of stress factors during drug substance (DS) and drug product (DP) manufacturing, and the subsequent steps that result in clinical administration by the end user. This article is the third in a series of commentaries on these stress factors and their effects on biotherapeutics. It focuses on assessing the potential negative impact from primary packaging, transportation, and handling on the quality of the DP. The risk factors include ingress of hazardous materials such as oxidizing residuals from the sterilization process, delamination- or rubber stopper-derived particles, silicone oil droplets, and leachables into the formulation, as well as surface interactions between the protein and packaging materials, all of which may cause protein degradation. The type of primary packaging container used (such as vials and prefilled syringes) may substantially influence the impact of transportation and handling stresses on DP Critical Quality Attributes (CQAs). Mitigations via process development and robustness studies as well as control strategies for DP CQAs are discussed, along with current industry best practices for scale-down and in-use stability studies. We conclude that more research is needed on postproduction transportation and handling practices and their implications for protein DP quality. [ABSTRACT FROM AUTHOR]