Science.gov

Sample records for systemic steroid injection

  1. Steroid injections - tendon, bursa, joint

    MedlinePlus

    ... ency/article/007678.htm Steroid injections - tendon, bursa, joint To use the sharing features on this page, ... often painful. It can be injected into a joint, tendon, or bursa. Description Your health care provider ...

  2. Epidural Steroid Injections

    MedlinePlus

    ... slipped vertebrae’, also known as spondylolisthesis). The epidural space is a fat filled ‘sleeve’ that surrounds the ... spinal cord. Steroids (‘cortisone’) placed into the epidural space have a very potent anti-inflammatory action that ...

  3. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial.

    PubMed

    Ribeiro, Luiza Helena; Furtado, Rita Nely Vilar; Konai, Monique Sayuri; Andreo, Ana Beatriz; Rosenfeld, Andre; Natour, Jamil

    2013-11-01

    Randomized clinical trial. To compare the effectiveness of facet joint injection versus systemic steroid in patients with a diagnosis of facet joint syndrome. The term facet joint syndrome has been used to define back pain originating from the facet joints. Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting. Sixty subjects with a diagnosis of facet joint syndrome were enrolled in the study. They were randomized into experimental and control groups. The experimental group was administered with intra-articular injection of 6 lumbar facet joints with triamcinolone hexacetonide; the control group was administered with triamcinolone acetonide intramuscular injection of 6 lumbar paravertebral points. Visits were taken at baseline and at 1, 4, 12, and 24 weeks after interventions. Outcome measures were used: pain visual analogue scale, pain visual analogue scale during extension of the spine, Likert scale, improvement percentage scale, Roland-Morris, 36-Item Short Form Health Survey, and accountability of medications taken.Homogeneity was tested using the Student t, Pearson χ, and Mann-Whitney tests. Analysis of variance was used to analyze differences in the groups over time and the Student t test to analyze differences between groups at each time evaluation. The groups were similar at baseline. Comparisons between the groups showed, in analysis of variance analysis, an improvement in the experimental group regarding diclofenac intake and quality of life, in the "role physical" profile, assessed by 36-Item Short Form Health Survey.In the analysis at each time point, an improvement in the experimental group was also found in the Roland-Morris questionnaire, in the improvement percentage scale and in the response to treatment

  4. Characterization of polymeric poly(epsilon-caprolactone) injectable implant delivery system for the controlled delivery of contraceptive steroids.

    PubMed

    Dhanaraju, Magharla Dasaratha; Gopinath, Damodaran; Ahmed, Mohamed Rafiuddin; Jayakumar, Rajadas; Vamsadhara, Chandrasekar

    2006-01-01

    Contraceptive steroids levonorgestrel (LNG) and ethinyl estradiol (EE) have been encapsulated with poly(epsilon-caprolactone) (PCL) microspheres using a w / o /w double emulsion method. The microspheres prepared were smooth and spherical, with a mean size from 8-25 microm. In vitro release profiles of microspheres showed a trend of increasing initially at the first week, and thereafter the release was sustained. At the end of the seventh week LNG/EE from 1:5 and 1:10 PCL microspheres were 60 and 48%, 52 and 46%, respectively. An in vitro degradation study shows that at the 20th week the microspheres maintained the surface integrity. The PCL microspheres showed a triphasic in vivo release profile with an initial burst effect due to the release of the steroid adsorbed on the microsphere surface, a second sustained release phase due to the steroid diffusion through the pores or channels formed in the polymer matrix, and third phase due to polymer bioerodible. Histological examination of PCL microspheres injected intramuscularly into thigh muscle of a rat showed a minimal inflammatory reaction demonstrating that contraceptive steroid-loaded microspheres were biocompatible. The level of inflammatory cytokines determined by immunostaining for IL-1alpha, the tissue response to formulations at the first week was considered mild, whereas at the end of the 20th week the inflammatory response ceased. Thus, this study helped us to evaluate the feasibility of using these microspheres as a long-acting biodegradable drug delivery system for contraceptive steroids.

  5. Paraplegia After Thoracic Epidural Steroid Injection.

    PubMed

    Loomba, Vivek; Kaveeshvar, Hirsh; Dwivedi, Samvid

    2016-09-01

    Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.

  6. Rupture of the triceps tendon associated with steroid injections.

    PubMed

    Stannard, J P; Bucknell, A L

    1993-01-01

    Rupture of the triceps mechanism is an uncommon injury that has been recognized with increasing frequency in recent years. It has been proposed that such injuries commonly accompany fractures of the radial head and must be actively evaluated in the presence of such a fracture. We present a unique case of isolated rupture of the triceps tendon in an athlete who was lifting weights. This case was complicated by a history of olecranon bursitis that had been treated with numerous local steroid injections, as well as a history of anabolic steroid abuse. Both systemic steroids and local injections may predispose tendons to rupture. Triceps tendon ruptures may result in uniformly good to excellent results if recognized and treated surgically. This case also serves as a reminder of the risks of treating inflamed tissues with local steroid injections, especially in strength athletes who place high demands on their musculoskeletal structures. Finally, this case documents a second case of triceps mechanism rupture in an athlete who has abused anabolic steroids. A study by Hunter et al. suggests that oral steroid abuse may be associated with detrimental effects on the mechanical properties of connective tissue, demonstrating another negative effect of anabolic steroid use in athletes.

  7. Fluoroscopy-guided intra-articular steroid injection for sternoclavicular joint arthritis secondary to limited cutaneous systemic sclerosis: a case report

    PubMed Central

    Güler, Emel; Cüce, Isa; Erol, Kemal

    2017-01-01

    We report a case of fluoroscopy-guided intraarticular steroid injection for sternoclavicular joint (SCJ) arthritis caused by limited cutaneous systemic sclerosis (SSc). A 50-year-old woman diagnosed with limited cutaneous SSc presented with swelling and pain in the right SCJ. MRI revealed signs of inflammation consistent with right-sided sternoclavicular joint arthritis. After the failure of oral medications, we performed fluoroscopy-guided injection in this region. She reported complete resolution of her symptoms at 4 and 12-week follow-ups. This outcome suggests that a fluoroscopy-guided SCJ injection might be a safe and successful treatment option for sternoclavicular joint arthritis. PMID:28119772

  8. [Temporomandibular joint arthropathy in situ steroid injection].

    PubMed

    Gagé, J; Gallucci, A; Arnaud, M; Chossegros, C; Foletti, J M

    2016-09-01

    Temporomandibular disorders (TMDs) affect the masticatory muscles and the temporomandibular joints (TMJs). TMDs most often result from occlusal and/or muscular disorders and are then called primary or idiopathic TMDs. Less frequently, TMDs are related to local (trauma, infection) or general (rheumatoid arthritis) causes and are then called secondary TMDs. A little known iatrogenic cause of secondary TDM is the osteoarthritis that may be induced by intra-articular cortisone injections. We report one case of condylar lysis that occurred after one single intra-articular cortisone injection. A 62-years-old woman consulted for a long-lasting TMD on the left side manifesting itself through pain and noise. She benefited one year before from an intra-articular injection of cortisone by her rheumatologist for repeated closed lock of her left TMJ. Physical examination showed limited mouth opening with deviation on the left side. Lateral movements on the right side were impossible. The panoramic X-ray showed a condylar lysis on the left side that was on the CT scan. MRI additionally showed an anteriorly displaced and severely reshaped disc and an articular inflammation without intra-articular effusion. TMJ osteoarthritis secondary to unique or repeated intra-articular steroid injections are little-known. They are clinically expressed as typical TMDs and characterized on X-rays by condylar lysis and inflammation. Intra-articular injections of steroids are not totally harmless and other treatments must be preferred. Copyright © 2016. Published by Elsevier Masson SAS.

  9. Cervical epidural steroid injection for cervicobrachialgia.

    PubMed

    Stav, A; Ovadia, L; Sternberg, A; Kaadan, M; Weksler, N

    1993-08-01

    Fifty patients with chronic resistant cervicobrachialgia were randomly divided into two groups. Twenty-five patients (group A) were treated with cervical epidural steroid/lidocaine injections and 17 patients (group B) were treated with steroid/lidocaine injections into the posterior neck muscles. Another eight patients from group B were excluded from the study because they had started the process of litigation of insurance claims and their subjective analysis of pain relief might therefore not be trustworthy. One to three injections were administered at 2-week intervals according to the clinical response. All patients continued their various pre-study treatments: non-steroidal anti-inflammatory drugs, non-opioid analgesics and physiotherapy. Pain relief was evaluated by the visual analogue scale 1 week after the last injection and then 1 year later. One week after the last injection we rated pain relief as very good and good in 76% of the patients in group A, as compared to 35.5% of the patients in group B. One year after the treatment 68% of the group A patients still had very good and good pain relief, whereas only 11.8% of group B patients reported this degree of pain relief. These differences were statistically significant. We failed to achieve significant improvement of tendon reflexes or of sensory loss in both groups, but the increase in the range of motion, the fraction of patients who were able to decrease their daily dose of analgesics, and recovery of the capacity for work were significantly better in group A. We encountered no complications in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

    PubMed

    Furman, Michael B; Giovanniello, Michael T; O'Brien, Erin M

    2003-01-01

    STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood

  11. Correlation of the Patient Reported Outcomes Measurement Information System with legacy outcomes measures in assessment of response to lumbar transforaminal epidural steroid injections.

    PubMed

    Shahgholi, L; Yost, K J; Carter, R E; Geske, J R; Hagen, C E; Amrami, K K; Diehn, F E; Kaufmann, T J; Morris, J M; Murthy, N S; Wald, J T; Thielen, K R; Kallmes, D F; Maus, T P

    2015-03-01

    The Patient Reported Outcomes Measurement Information System is a newly developed outcomes measure promulgated by the National Institutes of Health. This study compares changes in pain and physical function-related measures of this system with changes on the Numeric Rating Pain Scale, Roland Morris Disability Index, and the European Quality of Life scale 5D questionnaire in patients undergoing transformational epidural steroid injections for radicular pain. One hundred ninety-nine patients undergoing transforaminal epidural steroid injections for radicular pain were enrolled in the study. Before the procedure, they rated the intensity of their pain by using the 0-10 Numeric Rating Pain Scale, Roland Morris Disability Index, and European Quality of Life scale 5D questionnaire. Patients completed the Patient Reported Outcomes Measurement Information System Physical Function, Pain Behavior, and Pain Interference short forms before transforaminal epidural steroid injections and at 3 and 6 months. Seventy and 43 subjects replied at 3- and 6-month follow-up. Spearman rank correlations were used to assess the correlation between the instruments. The minimally important differences were calculated for each measurement tool as an indicator of meaningful change. All instruments were responsive in detecting changes at 3- and 6-month follow-up (P < .0001). There was significant correlation between changes in Patient Reported Outcomes Measurement Information System scores and legacy questionnaires from baseline to 3 months (P < .05). There were, however, no significant correlations in changes from 3 to 6 months with any of the instruments. The studied Patient Reported Outcomes Measurement Information System domains offered responsive and correlative psychometric properties compared with legacy instruments in a population of patients undergoing transforaminal epidural steroid injections for radicular pain. © 2015 by American Journal of Neuroradiology.

  12. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection

    PubMed Central

    Kim, Joon-Sung; Kim, Ji Yeon

    2015-01-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  13. Incidence of intradiscal injection during lumbar fluoroscopically guided transforaminal and interlaminar epidural steroid injections.

    PubMed

    Candido, Kenneth D; Katz, Jeffrey A; Chinthagada, Mariadas; McCarthy, Robert A; Knezevic, Nebojsa Nick

    2010-05-01

    Intradiscal injections during transforaminal epidural steroid injections and interlaminar lumbar epidural steroid injections have been reported rarely. In that regard, this retrospective observational report is the first attempt to quantify the overall rate of this complication. A retrospective analysis of 3 years of accrued data (2004-2007) showed that 2412 transforaminal epidural steroid injections were performed at the 2 training institutions (Loyola University Medical Center and Northwestern University/Feinberg School of Medicine). There were 6 intradiscal (annular) injections of contrast, for a rate of 1:402. Over the same interval, 4723 lumbar epidural steroid injections were performed, with 1 intradiscal injection, for a rate of 1:4723.

  14. Exserohilum Infections Associated with Contaminated Steroid Injections

    PubMed Central

    Ritter, Jana M.; Muehlenbachs, Atis; Blau, Dianna M.; Paddock, Christopher D.; Shieh, Wun-Ju; Drew, Clifton P.; Batten, Brigid C.; Bartlett, Jeanine H.; Metcalfe, Maureen G.; Pham, Cau D.; Lockhart, Shawn R.; Patel, Mitesh; Liu, Lindy; Jones, Tara L.; Greer, Patricia W.; Montague, Jeltley L.; White, Elizabeth; Rollin, Dominique C.; Seales, Cynthia; Stewart, Donna; Deming, Mark V.; Brandt, Mary E.; Zaki, Sherif R.

    2014-01-01

    September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratory-confirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. PMID:23809916

  15. Hazards of steroid injection: Suppurative extensor tendon rupture.

    PubMed

    Woon, Colin Yi-Loong; Phoon, Ee-San; Lee, Jonathan Yi-Liang; Ng, Siew-Weng; Teoh, Lam-Chuan

    2010-01-01

    Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain's tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.

  16. Pneumocephalus and seizures following epidural steroid injection.

    PubMed

    Sorber, Joseph; Levy, David; Schwartz, Adam

    2017-09-18

    We describe a patient with pneumocephalus following an epidural steroid injection (ESI) who presented with altered mental status, headache, focal neurologic findings and seizures. Pneumocephalus has rarely been described following ESI. A 34-year-old female presented with an altered level of consciousness worsening over approximately 18h following an ESI for lumbar back pain. She had associated headache, right-sided facial twitching and right upper extremity weakness. A brain CT scan revealed pneumocephalus in the right lateral ventricle and quadrigeminal plate cistern. While in the emergency department she experienced a self-limited generalized seizure. She was admitted and her symptoms persisted. Seven days following admission she was discharged to a rehabilitation facility, but her arm weakness persisted for greater than a month before resolving. Epidural anesthesia relies on the localization of the epidural space. The manual loss of resistance technique is widely used to identify the epidural space. The incidence of adverse effects is unknown. Case reports noting complications associated with this technique have been reported; rarely including pneumocephalus. Complications from the pneumocephalus are even less commonly reported. Though rare following an ESI and generally self-limited without complication, pneumocephalus should be considered in the differential diagnosis when evaluating a patient with neurologic deficits after instrumentation. Copyright © 2017. Published by Elsevier Inc.

  17. Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections.

    PubMed

    Furman, M B; O'Brien, E M; Zgleszewski, T M

    2000-10-15

    A prospective, observational, human, in vivo study. To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced, transforaminal lumbar epidural steroid injections (ESIs) and determine whether a "flash" (blood in the needle hub) or aspiration of blood can be used to predict a vascular injection. Incorrectly placed, intravascular lumbosacral spinal injections result in systemic medication flow that misses the desired target. No previous studies evaluate the incidence of vascular injections in transforaminal ESIs, nor the ability of flash to predict a vascular injection. The incidence of flash or positive blood aspiration and the incidence of fluoroscopically confirmed vascular spread were prospectively observed in 670 patients treated with lumbosacral fluoroscopically guided transforaminal ESIs. Presence of a flash or positive aspiration was documented. Contrast was injected to determine whether the needle tip was intravascular. Seven hundred sixty-one transforaminal ESIs were included. The overall rate of intravascular injections was 11.2%. There was a statistically significant higher rate of intravascular injections (21.3%) noted with transforaminal ESIs performed at S1 (n = 178), compared with those at the lumbar levels (8.1%, n = 583). Using flash or positive blood aspirate to predict intravascular injections was 97.9% specific, but only 44.7% sensitive. There is a high incidence of intravascular injections in transforaminal ESIs that is significantly increased at S1. Using a flash or blood aspiration to predict an intravascular injection is not sensitive, and therefore a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are instilling medications intravascularly and therefore not into the desired epidural location. This finding confirms the need for not only fluoroscopic guidance but also contrast injection instillation in lumbosacral transforaminal ESIs.

  18. Treatment of chalazions with injection of a steroid suspension.

    PubMed

    Watson, A P; Austin, D J

    1984-11-01

    A trial was conducted to compare the efficacy of the treatment of chalazions by injection of triamcinolone acetonide with conventional incision and curettage. Of the 39 injected cases 77% resolved completely, though 54% of the injected cases required a second injection. Of the 30 surgically treated cases 90% resolved, but 27% required a second operation. Injection of chalazions with a steroid suspension is a convenient and reasonably effective alternative to the standard surgical management of this common condition.

  19. Is epidural steroid injection effective for degenerative lumbar spinal stenosis?

    PubMed

    Flores, Sebastián; Molina, Marcelo

    2015-11-16

    There are several nonsurgical alternatives to treat radicular pain in degenerative lumbar spinal stenosis. Epidural steroid injections have been used for several decades, but the different studies have shown variable effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified nine systematic reviews including seven pertinent randomized controlled trials. We concluded epidural steroid injection probably leads to little or no effect on reducing radicular pain of spinal stenosis.

  20. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    PubMed Central

    2013-01-01

    Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues. PMID:23991341

  1. Efficacy of intralesional steroid injection in head and neck hemangioma: a systematic review.

    PubMed

    Prasetyono, Theddeus O H; Djoenaedi, Intania

    2011-01-01

    The purpose of this article was to discuss about the use of corticosteroids in head and neck hemangioma as one of the safest noninvasive therapy, focusing on intralesional steroid injection, including perilesional and infusion, for curing or reducing tumor size. A systematic review was done by means of all English publication in PubMed during the period of 1996 to 2008 using the keywords "hemangioma" and "intralesional steroid injection." The studies involved were retrospective and prospective case reviews on using intralesional steroid injection with or without other treatment modalities. Exclusion criteria included letter to the editor, comment, and discussion. Evaluation was done covering the indication, age and sex of the patients, location of the lesion, reduction in volume and resolution after intralesional steroid injection, including perilesional and infusion, the improvement of symptoms and signs, local and systemic complications, dose, and the number of injections required to achieve the desired clinical and aesthetic results. Using the 7th ed. EndNote program, 81 abstracts were successfully retrieved. Finally, this study limited our analysis to 22 studies. A total of 749 patients received intralesional steroid injections, including perilesional and infusion, with or without other treatment modalities. Age of the participants ranged from 10 days to 4 years (mean, 4.17 months). Six references evaluated the percentage of reduction in volume and size after intralesional steroid injection; 71% revealed excellent clinical response, 23.4% good, 2.96% poor, 2% no response, and 0.6% were lost to follow-up. From the remaining, 82% of the participants revealed improvement in sign and symptoms. Three articles mentioned aesthetic evaluation, and all stated excellent to good outcome. Intralesional steroid injection is a good option for treating head and neck hemangioma at proliferative phase with relatively low complications.

  2. Refractory strictures despite steroid injection after esophageal endoscopic resection

    PubMed Central

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  3. Fungal Infections Associated with Contaminated Steroid Injections.

    PubMed

    Kauffman, Carol A; Malani, Anurag N

    2016-04-01

    In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke, spinal or paraspinal infection, or peripheral osteoarticular infection, and 64 (8.5%) died. Most patients had undergone epidural injection, and a few osteoarticular injection, of methylprednisolone acetate that had been manufactured at the New England Compounding Center (NECC). The offending pathogen in most cases was Exserohilum rostratum, a brown-black soil organism that previously was a rare cause of human infection. Three lots of methylprednisolone were contaminated with mold at NECC; the mold from unopened bottles of methylprednisolone was identical by whole-genome sequencing to the mold that was isolated from ill patients. Early cases manifested as meningitis, some patients suffered posterior circulation strokes, and later cases were more likely to present with localized infection at the injection site, including epidural abscess or phlegmon, vertebral diskitis or osteomyelitis, and arachnoiditis with intradural involvement of nerve roots. Many patients with spinal or paraspinal infection required surgical intervention. Recommendations for treatment evolved over the first few weeks of the outbreak. Initially, combination therapy with liposomal amphotericin B and voriconazole was recommended for all patients; later, combination therapy was recommended only for those who were most ill, and voriconazole monotherapy was recommended for most patients. Among those patients who continued antifungal therapy for at least 6 months, outcomes for most appeared to be successful, although a few patients remain on therapy.

  4. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    SciTech Connect

    Tok, Chung Hong Kaur, Shaleen; Gangi, Afshin

    2011-02-15

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  5. Epidural steroid injection for lumbar disc herniation in NFL athletes.

    PubMed

    Krych, Aaron J; Richman, Daniel; Drakos, Mark; Weiss, Leigh; Barnes, Ronnie; Cammisa, Frank; Warren, Russell F

    2012-02-01

    To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players. We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010. Our primary outcome was success of the injection, defined as return to play. The secondary outcome of the study was to evaluate risk factors for failure of this treatment approach. Seventeen players had a total of 37 injections for 27 distinct lumbar disc herniation episodes from 2003 to 2010. The success rate of returning an athlete to play for a given episode of disc herniation was 89% (24 of 27 episodes) with an average loss of 2.8 practices (range = 0-12) and 0.6 games (range = 0-2) after the injection. Four players required a repeat injection for the same episode. Three of these four players ultimately failed conservative management and required surgical intervention. Risk factors for failing injection therapy included sequestration of the disc herniation on magnetic resonance imaging (P = 0.01) and weakness on physical examination (P = 0.002). There were no complications reported. In this highly selective group of professional athletes, our results suggest that epidural steroid injections are a safe and effective therapeutic option in the treatment of symptomatic lumbar disc herniation.

  6. Transient Glaucoma after an Epidural Steroid Injection: A Case Report

    PubMed Central

    Manjiani, Deepak; Said, Salam; Kaye, Alan David

    2015-01-01

    Background Steroids are recognized as a beneficial treatment for various medical conditions, yet clinically relevant side effects of steroids are common and problematic, ranging from a minor case of acne to a potentially life-threatening Addisonian crisis. In anesthetic medicine, the use of epidural steroid injections (ESIs) for chronic low back pain and other radicular pain-related conditions has become standard practice in interventional pain management. Case Report We report the case of a patient who experienced sudden bilateral blurred vision after receiving an ESI and required urgent ophthalmic interventions and follow-up care. The main clinical findings from this case showed that the patient had high intraocular pressure (IOP) that caused unexpected short-term vision loss. The symptom resolved after 3½ months without ophthalmic treatment. Conclusion Clinicians should inform patients about the possibility of visual complications associated with pain procedures involving steroids. Among the high-risk groups with predisposing factors, such as uncontrolled hypertension and diabetes mellitus, routine eye tests that include measuring IOP prior to ESI should be recommended as a preventive measure. Alternative pain management therapies should be considered if possible. Comprehensive planning of patient care will also ensure safety and prevent unwanted outcomes, particularly with high-risk patients receiving steroids for pain procedures. PMID:25829885

  7. Thoracic epidural steroid injection for rib fracture pain.

    PubMed

    Rauchwerger, Jacob J; Candido, Kenneth D; Deer, Timothy R; Frogel, Jonathan K; Iadevaio, Robert; Kirschen, Neil B

    2013-06-01

    Treatment for rib fracture pain can be broadly divided into pharmacologic approaches with oral and/or parenteral medication and interventional approaches utilizing neuraxial analgesia or peripheral nerve blocks to provide pain relief. Both approaches attempt to control nociceptive and neuropathic pain secondary to osseous injury and nerve insult, respectively. Success of treatment is ultimately measured by the ability of the selected modality to decrease pain, chest splinting, and to prevent sequelae of injury, such as pneumonia. Typically, opioids and NSAIDs are the drugs of first choice for acute pain because of ease of administration, immediate onset of action, and rapid titration to effect. In contrast, neuropathic pain medications have a slower onset of action and are more difficult to titrate to therapeutic effect. Interventional approaches include interpleural catheters, intercostal nerve blocks, paravertebral nerve blocks, and thoracic and lumbar epidural catheters. Each intervention has its own inherent advantages, disadvantages, and success rates. Rib fracture pain management practice is founded on the thoracic surgical and anesthesiology literature. Articles addressing rib fracture pain are relatively scarce in the pain medicine literature. As life expectancy increases, and as healthcare system modifications are implemented, pain medicine physicians may be consulted to treat increasing number of patients suffering rib fracture pain and may need to resort to novel therapeutic measures because of financial constraints imposed by those changes. Here we present the first published case series of thoracic epidural steroid injections used for management of rib fracture pain. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

  8. Cervical epidural steroid injections and spinal cord injuries.

    PubMed

    Schreiber, Adam L; McDonald, Brian P; Kia, Farid; Fried, Guy W

    2016-10-01

    Cervical interlaminar and transforaminal epidural steroid injections have been increasingly performed as a medical interventional treatment for pain. This study aimed to examine if there was increasing proportion of cervical spinal cord injured acute rehabilitation hospital admissions related to cervical epidural injections because of increased use of the procedure. Additionally, this study aimed to determine risk factors that may have made these patients known higher risk premorbidly. A retrospective chart review was carried out. The sample was from a 2001 to 2008 spinal cord-related injuries admitted to Magee Rehabilitation (2,770). A total of 1,343 patients were classified as having acute spinal cord injuries (SCIs). Of these patients, seven cases of SCI occurred after cervical epidural injections. Chart data regarding characteristics of patients and proportion of SCI admissions to cervical epidural injections injuries were the outcome measures. Parameters analyzed included age, sex, American Spinal Injury Association Impairment Scale on admission, mechanism of injury, presenting symptoms, time of onset, and risk factors. Proportion of SCI admissions to cervical epidural injections injuries was also analyzed. From the years 2001 to 2008, there were seven admissions for such injury with no change in the proportion of SCIs from cervical epidural injections relative to all SCIs. All were incomplete and mechanisms included anterior cord infarction (1), intraparenchymal injection (1), epidural abscess (2), contusion (1), epidural hematoma (1), and unknown (1). Presenting symptoms included hypotension, respiratory distress, chest pain, upper limb numbness, paresthesias, weakness, and fever. Symptom onset ranged from minutes to 72 hours after injection. Although there is an increased use of interventional spine procedures to treat pain, this did not increase the proportion of cervical epidural-related SCI admissions. Additional research is needed to advocate reporting

  9. Pain-relieving effect of local steroid injection in uvulopalatopharyngoplasty.

    PubMed

    Hirunwiwatkul, P

    2001-06-01

    An analytical prospective study was performed to determine the post-operative pain-relieving effect of local steroid suspension injection in uvulopalatopharyngoplasty. From February 2000 to October 2000, 48 adult patients from 20 to 67 years of age, were scheduled to receive uvulopalatopharyngoplasty. Triamcinolone acetonide (Kenacort A) was injected onto the raw surface of the left-sided tonsillar fossa and left-sided soft palate after tonsillectomy and uvulopalatopharyngoplasty. Other preoperative and post-operative medications including antibiotics, anesthesia and surgical techniques were standardized. Visual analog scales were used to assess the level of pain sensation on the left and right side of the throat daily from day 0 (Operative day) to post-operative day 10. A paired t-test showed significant differences in post-operative pain level between the study side (left) and the control side (right) at day 2, day 4, and in the overall analysis (p < 0.05).

  10. Neuroactive steroids and central nervous system disorders.

    PubMed

    Wang, M; Bäckström, T; Sundström, I; Wahlström, G; Olsson, T; Zhu, D; Johansson, I M; Björn, I; Bixo, M

    2001-01-01

    Steroid hormones are vital for the cell life and affect a number of neuroendocrine and behavioral functions. In contrast to their endocrine actions, certain steroids have been shown to rapidly alter brain excitability and to produce behavioral effects within seconds to minutes. In this article we direct attention to this issue of neuroactive steroids by outlining several aspects of current interest in the field of steroid research. Recent advances in the neurobiology of neuroactive are described along with the impact of advances on drug design for central nervous system (CNS) disorders provoked by neuroactive steriods. The theme was selected in association with the clinical aspects and therapeutical potentials of the neuroactive steroids in CNS disorders. A wide range of topics relating to the neuroactive steroids are outlined, including steroid concentrations in the brain, premenstrual syndrome, estrogen and Alzheimer's disease, side effects of oral contraceptives, mental disorder in menopause, hormone replacement therapy, Catamenial epilepsy, and neuractive steroids in epilepsy treatment.

  11. Comparative study of intralesional steroid injection and cryotherapy in alopecia areata

    PubMed Central

    Amirnia, Mehdi; Mahmoudi, Seyed-Sajjad; Karkon-Shayan, Farid; Alikhah, Hossein; Piri, Reza; Naghavi-Behzad, Mohammad; Ranjkesh, Mohammad-Reza

    2015-01-01

    Background and Objectives: Alopecia areata (AA) is a common, non-scarring type of hair loss, affecting approximately 2.1% of the population, many modality of treatment recommended like steroid injection, topical Immunotherapy and several systemic therapies. The aim of this study was to compare intralesional steroid injection and cryotherapyoutcomes in AA. Materials and Methods: In an analytical-descriptive study, 120 AA patients treated with intralesionalsteroid injection and 120 AA patients treated with cryotherapy were randomly selected. These two groups matched for location, duration and size of lesion and also matched for age and gender. From March 2011 to September 2013, the effect and complications of the therapies after 3, 6, 9 and 12 weeks were assessed and results were compared between the two groups. Results: Mean age of patients in steroid injection group was 30.2 ± 6.8 and in cryotherapy group was 31.8 ± 7.1. Sexual distribution in both groups was 56.7% and 43.3 % for male and female, respectively. Location of disease in 80% was in scalp and 20% was in face in both groups. The time of beginning response in steroid group was 4.13 ± 2.13 weeks and in cryotherapy group was 6.14 ± 0.29 weeks, difference between two groups was significant (P = 0.001). In term of clinical response at the end of study, in steroid group,20 patients (16.7%) no response, 32 patients (26.7%), moderate response and68 patients (56.7%) had a complete response, and also in cryotherapy group was, 52 patients (43.3%) no response, 40 patients (33.3%) moderate response and 28 patients (23.3%) had a complete response. There was significant different in complete response rate and steroid injection was more effective than cryotherapy(P < 0.05). Conclusion: As the cryotherapy isa considerable treatment of AA, alsothis study proposes intralesional injection of corticosteroid, as a replacement of AA therapy; particularly the short-term complications are not significantly different. PMID

  12. Steroid injections in the upper extremity: experienced clinical opinion versus evidence-based practices.

    PubMed

    Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret

    2013-09-01

    A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence.

  13. Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

    PubMed Central

    Yu, Robinson K.; Ghodadra, Anish; Agarwal, Vikas

    2016-01-01

    Background Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. Methods Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate. Results Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P<0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both. Conclusions An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. PMID:28097241

  14. [Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain].

    PubMed

    Beyaz, Serbülent Gökhan

    A cross-sectional study. We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p<0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p>0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por

  15. Steroids

    MedlinePlus

    ... steroids (say: STARE-oydz), they often mean illegal anabolic steroids. Anabolic steroids are artificially produced hormones that are the ... these is testosterone (say: tes-TOSS-tuh-rone). Anabolic steroids can be taken in the form of ...

  16. Seasonal, extratrigeminal, episodic paroxysmal hemicrania successfully treated with single suboccipital steroid injections.

    PubMed

    Rossi, P; Di Lorenzo, G; Faroni, J; Sauli, E

    2005-11-01

    This case report describes a case of extratrigeminal, episodic paroxysmal hemicrania with a clear seasonal temporal pattern, successfully treated with repeated single suboccipital steroid injections. The pathophysiological and clinical implications of this observation are discussed.

  17. A jaundiced bodybuilder Cholestatic hepatitis as side effect of injectable anabolic-androgenic steroids.

    PubMed

    Boks, Marije N; Tiebosch, Anton T; van der Waaij, Laurens A

    2017-11-01

    The use of anabolic steroids is prevalent in recreational athletes. This case report describes a young amateur bodybuilder who was referred to our outpatient clinic with jaundice and loss of appetite due to cholestatic hepatitis. Additional tests including a liver biopsy made it likely that the hepatitis was caused by the injectable anabolic steroid trenbolone enanthate. Cholestatic hepatitis may not be limited to the use of oral anabolic-androgenic steroids, as is widely assumed. Therefore, and because of other side effects, the recreational use of all forms of anabolic steroids should be discouraged.

  18. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS): a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

    PubMed Central

    2012-01-01

    Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone). Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization and costs to assess cost

  19. Acute Paraplegia After Lumbar Steroid Injection in Patients With Spinal Dural Arteriovenous Fistulas: Case Reports

    PubMed Central

    2016-01-01

    Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformations. However, SDAVFs are still underdiagnosed entities because their clinical symptoms are usually non-specific, as they include low back pain or radiating pain to the limb. There have been several reports of acute paraplegia after lumbar epidural steroid injections in patients with SDAVFs. We present 4 patients with SDAVFs who received lumbar steroid injection. Among the 4 cases, acute paraplegia developed in 2 cases that received a larger volume of injectate than the other cases. Thus, we are suggesting that the volume of injectate may be a contributing factor for acute paraplegia after lumbar steroid injection in patients with SDAVFs. PMID:27847727

  20. Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain.

    PubMed

    Candido, Kenneth D; Knezevic, Nebojsa 'nick'

    2013-02-01

    Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques.

  1. Normalisation of asymmetric astigmatism after intralesional steroid injection for upper eye lid hemangioma in childhood.

    PubMed

    Langmann, A; Lindner, S

    1994-01-01

    Infantile hemangiomas affect about 5% (3%-8%) of the population, showing a predilection for the face. After a phase of rapid enlargement between the 3rd and the 9th month of life, 70% regress by the age of six after a period of stability. 43%-60% of the children with eye lid hemangiomas develop strabismic, anisometropic, or deprivation amblyopia. Previous studies found the majority of cases resulting from anisometropia (especially asymmetric astigmatism) rather than strabism or occlusion of the visual axis. Several methods of treatment--surgical excision, irradiation, sclerosing agents, systemic steroids, ligation, cryotherapy--have been used but all with a risk of local or systemic complications. Local injections of steroids are a simple method of therapy with a high rate of resolution of hemangiomas, but still with a high degree of bad visual output because of persistent astigmatism. In four children with asymmetric astigmatism (axis of astigmatism towards the hemangioma) in which the injection was given at the beginning of the phase of enlargement, amblyopia could be avoided by preventing corneal steepening from becoming permanent.

  2. KALK study: ultrasound guided needling and lavage (barbotage) with steroid injection versus sham barbotage with and without steroid injection - protocol for a randomized, double-blinded, controlled, multicenter study.

    PubMed

    Moosmayer, Stefan; Ekeberg, Ole Marius; Hallgren, Hanna Bjørnsson; Heier, Ingar; Kvalheim, Synnøve; Blomquist, Jesper; Pripp, Are Hugo; Juel, Nils Gunnar; Kjellevold, Stein Harald; Brox, Jens Ivar

    2017-04-04

    For the treatment of calcific tendinitis of the shoulder a variety of treatment regimes exist. Commonly used treatment measures include medication with oral analgesics, corticosteroid injections, extracorporeal shockwave therapy, ultrasound guided needling and lavage, and surgical treatment. Earlier cohort studies suggest that patients may benefit from these treatments, but there are few randomized studies and conflicting evidence about the effectiveness of the various treatments. In the present study we aim to compare the effectiveness of ultrasound guided needling and lavage (barbotage) together with a steroid injection to sham barbotage with and without an additional steroid injection. The study will be performed in six secondary-care institutions in Norway and Sweden. It is designed as a pragmatic, randomized, three-arm, parallel group, double-blinded, sham-controlled clinical trial with a 2-year follow-up. It will be performed on 210 patients, aged 30 years or older, presenting with painful arc, positive impingement sign and a calcium deposit > 5 mm. Randomization to one of the three treatment options will be performed by using an online central randomization system. The three treatment groups are barbotage together with a subacromial steroid injection (the barbotage group), sham barbotage together with a subacromial steroid injection (the steroid group) or sham barbotage without a subacromial steroid injection (the placebo group). In the placebo group the steroid injection will be replaced by a short-acting local anaesthetic. Standardized home-based post-treatment physiotherapy will be performed by all patients for 8 weeks. Follow-ups are at 2 and 6 weeks, 4, 8, 12 and 24 months after treatment was given and will be performed with the patients and the outcome assessors blinded for group assignment. Primary outcome will be the Oxford shoulder score at 4 month follow-up. Secondary outcome measures are the QuickDASH upper extremity score, the EQ-5D-5L

  3. Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder

    PubMed Central

    Sun, Yaying; Lu, Shuai; Zhang, Peng; Wang, Zhaohui; Chen, Jiwu

    2016-01-01

    Abstract To compare the effect of steroid injection and physiotherapy for patients with adhesive capsulitis of the shoulder (ACS). An electronic search was performed on Pubmed, Embase, and Cochrane library, and reference lists were also reviewed for randomized controlled trials (RCTs) comparing steroid injection and physiotherapy for patients with ACS. The quality of included studies were assessed using PEDro scale. Standardized mean differences (SMDs) and 95% confidence interval (CI) were used for comparisons. The primary outcome was functional improvement. Nine RCTs including 453 patients were identified. From 6–7 weeks to 24–26 weeks postintervention, no superiority was noted in favor of either steroid injection or physiotherapy for functional improvement (SMD 0.28; 95% CI −0.01–0.58; P = 0.06) or pain relief (SMD −0.10; 95% CI −0.70–0.50; P = 0.75). Steroid injection provided more improvement in passive external rotation at 24 to 26 weeks (3 studies, SMD 0.42; 95% CI 0.11–0.72; P = 0.007) but not at 6 to 7 weeks (4 studies, SMD 0.63; 95% CI 0.36–0.89; P = 0.32) or 12 to 16 weeks (3 studies, SMD −0.07; 95% CI −0.79–0.65; P = 0.85). Steroid injection was as safe as physiotherapy for patients with ACS (risk ratio 0.94; 95% CI 0.67–1.31). Both steroid injection and physiotherapy are equally effective for patients with ACS. One steroid injection might be the 1st choice for ACS. Results should be interpreted with caution due to the heterogeneity among the studies. PMID:27196452

  4. Steroids

    MedlinePlus

    ... about being the very best in your favorite sport, not to mention earning a big salary. But ... t the kind of steroids getting attention in sports. When people say steroids (say: STARE-oydz), they ...

  5. Cerebrospinal fluid infection after lumbar nerve root steroid injection: a case report

    PubMed Central

    Kim, Seong-Su; Shim, Sung Min; Cho, Hae Jun

    2017-01-01

    A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis. Lumbar nerve root steroid injections are commonly used to control back pain. Vigilance to "red flag signs" and a rapid diagnosis can prevent lethal outcomes produced by rare and unexpected complications related to infection. Here, we report a case of fatal meningitis after infection of the cerebrospinal fluid following a lumbar nerve root steroid injection. PMID:28184274

  6. CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material.

    PubMed

    Hoang, Jenny K; Apostol, Marc A; Kranz, Peter G; Kilani, Ramsey K; Taylor, Jeffrey N; Gray, Linda; Lascola, Christopher D

    2010-10-01

    CT fluoroscopy-assisted cervical transforaminal steroid injection is an effective therapeutic option for cervical radiculopathy, yet it is approached with trepidation by some interventionalists. CT fluoroscopy is superior to conventional fluoroscopy for delineating complex anatomic relations in the neck but must be combined with careful technique to avoid rare but serious complications. We describe the anatomy of the neural foramen, our technique of CT fluoroscopy-assisted cervical transforaminal steroid injection, and the CT appearance of appropriate and inappropriate needle positions. Understanding anatomy will help to avoid complications and optimize the therapeutic potential of cervical transforaminal steroid injection. Use of contrast material for CT fluoroscopic guidance facilitates appropriate needle positioning and reduces the risk of complications.

  7. Steroid injections for shoulder disorders: a systematic review of randomized clinical trials.

    PubMed Central

    van der Heijden, G J; van der Windt, D A; Kleijnen, J; Koes, B W; Bouter, L M

    1996-01-01

    BACKGROUND: Patients with shoulder disorders are believed to benefit considerably from steroid injections. However, the controversy about their efficacy persists. AIM: The study was designed to assess the efficacy of steroid injections for shoulder disorders. METHOD: A systematic computerized literature search in Medline (Index Medicus 1/1966-10/1995) and Embase (Excerpta Medica 1/1984-10/1995) was conducted, supplemented with citation tracking of all relevant publications. Studies published before November 1995 were selected if steroid injections were randomly allocated to patients with shoulder disorders and when clinically relevant outcome measures were reported. Because the validity of study outcomes depends heavily on the strength of methodological quality, the methods were assessed systematically by two 'blinded' independent reviewers. This resulted in a method score (maximum 100 points) that was based on four categories: study population, interventions, measurement of effect, and data presentation and analysis. Confidence intervals for the differences between groups in success rates were calculated in order to summarize the efficacy of steroid injections. RESULTS: Only three out of the 16 studies scored more than 50 points, indicating a generally poor quality of methods. Most studies reported small sample sizes. The flaws most often found were incomparability of co-interventions and poor blinding of therapist. The methods assessment was frequently hampered by incomplete information about randomization, prognostic comparability, compliance, outcome measures included, blinding of patients and blinding of outcome measurement. CONCLUSIONS: The evidence in favour of the efficacy of steroid injections for shoulder disorders is scarce. The methods of most studies appear to be of poor quality. The few studies that appear to be credible do not provide conclusive evidence about which patients at what time in the course of shoulder disorders benefit most from steroid

  8. Simultaneous bilateral septic arthritis of the knee after intraarticular steroid injection: A clinical report

    PubMed Central

    Munigangaiah, Sudarshan; O’Sullivan, Theresa A.; Lenehan, Brian

    2014-01-01

    Osteoarthritis of knee is one of the common problems in elderly population. Intraarticular corticosteroid injection is a conservative management modality in osteoarthritis of knee. Septic arthritis is an infective complication of intraarticular corticosteroid injection. Septic arthritis in rheumatoid arthritis patients have worse prognosis because of delay in diagnosis. A higher rate of infectious complications following intraarticular injection is expected in immunocompromised and rheumatoid patients. We would like to report an extremely rare case of simultaneous bilateral knee septic arthritis after bilateral knee intraarticular steroid injection in a rheumatoid arthritis patient. Patient was treated successfully with multiple bilateral knee arthroscopic washouts and long-term intravenous antibiotics. This case report emphasizes the increased risk of infection in rheumatoid arthritis patients and a risk benefit assessment on individual basis before carrying out intraarticular steroid injection. Patient should be aware of this increased risk of infection. PMID:25097444

  9. THE RHIC INJECTION SYSTEM.

    SciTech Connect

    FISCHER,W.; GLENN,J.W.; MACKAY,W.W.; PTITSIN,V.; ROBINSON,T.G.; TSOUPAS,N.

    1999-03-29

    The RHIC injection system has to transport beam from the AGS-to-RHIC transfer line onto the closed orbits of the RHIC Blue and Yellow rings. This task can be divided into three problems. First, the beam has to be injected into either ring. Second, once injected the beam needs to be transported around the ring for one turn. Third, the orbit must be closed and coherent beam oscillations around the closed orbit should be minimized. We describe our solutions for these problems and report on system tests conducted during the RHIC Sextant test performed in 1997. The system will be fully commissioned in 1999.

  10. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation

    PubMed Central

    Radcliff, Kristen; Hilibrand, Alan; Lurie, Jon D.; Tosteson, Tor D.; Delasotta, Lawrence; Rihn, Jeffrey; Zhao, Wenyan; Vaccaro, Alexander; Albert, Todd J.; Weinstein, James N.

    2012-01-01

    Background: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment. Methods: One hundred and fifty-four patients included in the intervertebral disc herniation arm of the SPORT who had received an epidural steroid injection during the first three months of the study and no injection prior to the study (the ESI group) were compared with 453 patients who had not received an injection during the first three months of the study or prior to the study (the No-ESI group). Results: There was a significant difference in the preference for surgery between groups (19% in the ESI group compared with 56% in the No-ESI group, p < 0.001). There was no difference in primary or secondary outcome measures at four years between the groups. A higher percentage of patients changed from surgical to nonsurgical treatment in the ESI group (41% versus 12% in the No-ESI, p < 0.001). Conclusions: Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22739998

  11. Primary observation of early transtympanic steroid injection in patients with delayed treatment of noise-induced hearing loss.

    PubMed

    Zhou, Yide; Zheng, Guiliang; Zheng, Hongliang; Zhou, Ronjue; Zhu, Xiaomei; Zhang, Qing

    2013-01-01

    Approximately 5% of the population worldwide suffer from varieties of noise-induced hearing loss (NIHL). Prevention and early identification remain the best methods of approaching NIHL. Over the years, numerous methods of improving the outcome in patients presenting with NIHL have been evaluated; however, these are far from sufficient. The present trial aimed to evaluate the effectiveness of early transtympanic steroid injection in patients with delayed treatment of NIHL. Because systemic steroid treatment is the most common treatment of choice in the management of NIHL, it was considered unethical to replace the first-line systemic steroid treatment with transtympanic treatment. Therefore, the present study evaluated the combination of conventional steroid treatment with a transtympanic steroid injection. A total of 53 patients diagnosed with delayed treatment of NIHL were randomized into a transtympanic group (TR group, n=27) and a control group (n=26). The TR group received the conventional steroid treatment plus four courses of additional transtympanic injections of methylprednisolone 3 days after NIHL onset, and the control group received the conventional steroid treatment. Transtympanic injection was performed through laser-assisted myringotomy (a 0.5- to 1-mm perforation was made in the tympanic membrane) under an operation microscope. A total of 51.9% of the patients in the TR group had a ≥15-dB HL improvement in pure-tone average, compared with 23.1% of the patients in the control group, at the 8-week follow-up audiogram. A total of 66.7% of the patients in the TR group had an improvement of ≥15% in the speech discrimination score, compared with 30.8% of patients in the control group, 8 weeks after the treatment. The differences between the two groups were statistically significant. The outcome of this trial indicates that delayed treatment of NIHL may be preferable if transtympanic therapy can be applied earlier. The large variability in the

  12. Efficacy of Concomitant Intratympanic Steroid Injection for Sudden Deafness According to Initial Hearing Loss.

    PubMed

    Yang, Hyung Chae; Cho, Yong Beom; Jang, Chul Ho; Cho, Hyong-Ho

    2015-12-01

    We identified the efficacy and appropriate target group for intratympanic steroid injections (ITS) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Retrospective case-control study. Fifty-five ears treated with concomitant ITS and systemic steroids and 165 ears without ITS treatment were identified. Each case had three controls matched according to the age, sex, and the presence of vertigo. Patients were divided into subgroups according to pure tone audiometric configuration and the levels of initial hearing loss. Hearing results and frequency-related hearing gain were investigated. Additional ITS was effective for patients with an ascending type audiogram or patients with Grade 3 (60-90 dB) initial hearing loss. Concomitant ITS, however, resulted in a negative effect on hearing in patients with Grades 1 and 2 (<60 dB). ITS resulted in significant (p < 0.05) hearing improvement at 250  Hz in the Grade 3 (60-90  dB) and Grade 4 (>90  dB) ITS subgroups. The efficacy of additional ITS for ISSNHL was different among subgroups with various levels of initial hearing loss or audiogram configuration.

  13. Contraceptive steroid effects on nonreproductive organ systems.

    PubMed

    Corson, S L

    1986-09-01

    Oral contraceptives affect many organ systems in addition to the reproductive tract. In some cases the alteration is just a clinical laboratory test result value; in others it represents a true alteration in metabolism, with the induction of increased enzyme activity. Even with the markedly reduced steroid content of today's oral contraceptives, the practitioner must continue to be aware of these potential and real effects on nonreproductive organ systems.

  14. Pneumocephalus during cervical transforaminal epidural steroid injections: a case report.

    PubMed

    Kim, Won-Joong; Park, Hae-Gyun; Park, Yong-Hee; Shin, Mee-Ran; Koo, Gill-Hoi; Shin, Hwa-Yong

    2015-01-01

    A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. A 64-yr-old woman with left C7 radiculopathy was undergoing C6-7 transforaminal epidural injection of anesthetic and corticosteroids. The epidural spread of contrast was checked by fluoroscope, and 5 mg of dexamethasone in 4 ml of 0.1875% ropivacaine was injected. She lost consciousness 5 mins after the procedure and regained awareness after manual ventilation. She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.

  15. Calcaneal osteomyelitis following steroid injection for plantar fasciitis: a case report.

    PubMed

    Wronka, Konrad Sebastian; Sinha, Amit

    2012-08-01

    This study reports a case of a 57-year-old woman diabetic patient who presented to the authors' institution with signs and symptoms typical of plantar fasciitis. Her condition did not resolve with nonsteroidal anti-inflammatory drug therapy, podiatry, and physiotherapy input and she was given a steroid injection for treatment of plantar fasciitis. She was admitted to the hospital 17 days following injection with signs of acute infection. Diagnostic workup revealed an acute calcaneal osteomyelitis. Infection did not respond to conservative treatment and the patient required a partial calcanectomy. This case highlights the significant risk of steroid injection in plantar fasciitis, especially in diabetic patient. The authors urge surgeons to consider this when obtaining consent for injection and they advise very close follow-up of such patients.

  16. Comparison of short term results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study.

    PubMed

    Jindal, Nipun; Gaury, Yusuf; Banshiwal, Ramesh C; Lamoria, Ravinder; Bachhal, Vikas

    2013-04-27

    It has been recently reported that local injection of autologous blood in tennis elbow offers a significant benefit by virtue of various growth factors contained therein. The objective of our study was assessment of efficacy of autologous blood injection versus local corticosteroid injection in the treatment of tennis elbow. A single blinded, prospective parallel group trial was undertaken. 50 consecutive patients of untreated lateral epicondylitis were enrolled. Randomisation was done on alternate basis and two groups were constituted, first one receiving steroid injection and second one injection of autologous blood. Both groups were evaluated at 2 and 6 weeks for pain relief and stage of disease. Baseline evaluation showed no difference between the two groups (chi square test, P > 0.05). Between group analysis at 2 weeks showed no difference in pain relief and Nirschl stage (unpaired t test, P > 0.05). Evaluation at 6 weeks demonstrated a significant decrease in pain levels and stage of disease in blood group (unpaired t test, p < 0.05). Autologous blood injection was more effective than steroid injection in the short term follow up in tennis elbow.

  17. Correlation between severity of lumbar spinal stenosis and lumbar epidural steroid injection.

    PubMed

    Park, Chan-Hong; Lee, Sang-Ho

    2014-04-01

    Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that causes mechanical compression of the spinal nerve roots. The compression of these nerve roots can cause leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with LSS. The aim of our study was to determine the relationship between the severity of LSS using a grading system (grade 1 = mild stenosis with separation of all cauda equina; grade 2 = moderate stenosis with some cauda equina aggregated; grade 3 = severe stenosis with none of the cauda equina separated) and the subject's response to computed tomography-guided lumbar epidural steroid injection (CTG-LESI) and to evaluate the short-term effectiveness. Forty-seven consecutive patients with degenerative LSS were enrolled in this prospective study. All subjects underwent lumbar spine magnetic resonance imaging. Two radiologists independently graded lumbar central canal stenosis based on T2-weighted axial images. All CTG-LESI were performed in the procedure room. Outcome measures were obtained using the 5-point patient's satisfaction scale at 2 and 8 weeks post-treatment. To evaluate the outcome, we divided the patients into two groups according to their response to the treatment. Improvement (including reports of slightly improved, much improved, and no pain) was observed in 37 patients (78.7%) at 2 weeks and 36 patients (77.6%) at 8 weeks after the procedure. There was no statistically significant correlation between pain relief and age. The grade of LSS appears to have no effect on the degree of pain relief associated with CTG-LESI. However, CTG-LESI seems to provide effective short-term pain relief due to LSS. Wiley Periodicals, Inc.

  18. A comparison of treating Unicameral bone cyst using steroids and percutaneous autologous bone marrow aspiration injection.

    PubMed

    Akram, Muhammad; Farooqi, Faheem Mubashir; Shahzad, Muhammad Latif; Awais, Syed Muhammad

    2015-11-01

    To compare the results of percutaneous autologous bone aspiration injection and steroids injections in the treatment of unicameral bone cyst. The prospective study was conducted at Mayo Hospital, Lahore, from January 2008 to March 2014, and comprised patients diagnosed radiologically as a case of unicameral bone cyst. The patients were divided into two groups, with group 1 being treated with bone marrow aspiration injection, while group 2 was given steroids injection. Aspiration of bone marrow was done from tibial tuberosity. The 30 patients in the study were divided into two groups of 15(50%) each. In group 1, 8(53.34%) patients and in group 2, 3 (20%) patients achieved healing after the first injection (p<0.05), while overall success rates were 13(86.67%) in group 1, and 11(73.33%) in group 2 (p> 0.05). The mean number of procedures required in group 1 was 1.57± 0.495 (range: 01-3) and for 2.19 ± 1.076 (range: 1-5) in group 2 (p<0.05), and mean interval-to-healing was 14.3 months ± 8.705 (range: 7-36) for group 1 and 12.5 months ± 7.88 (range: 4-32) for group 2 (p> 0.05). Bone marrow aspiration injection was better than steroids in treating unicameral bone cyst.

  19. Fuel injection system

    SciTech Connect

    Herth, H.; Kraus, B.; Sautter, W.; Wessel, W.

    1983-03-15

    A fuel injection system for an internal combustion engine includes electromagnetic injection valves controlled by a fuel control unit which receives signals from a camshaft actuated switch, a position-dependent throttle transducer and an oxygen sensor. When the oxygen sensor changes output levels, the transmission of this information is delayed, by the action of a switching transistor controlled by a monostable multivibrator, for a period of time equal to the internal time constant of the multivibrator.

  20. Gas chromatograph injection system

    NASA Technical Reports Server (NTRS)

    Pollock, G. E.; Henderson, M. E.; Donaldson, R. W., Jr. (Inventor)

    1975-01-01

    An injection system for a gas chromatograph is described which uses a small injector chamber (available in various configurations). The sample is placed in the chamber while the chamber is not under pressure and is not heated, and there is no chance of leakage caused by either pressure or heat. It is injected into the apparatus by changing the position of a valve and heating the chamber, and is volatilized and swept by a carrier gas into the analysis apparatus.

  1. National Utilization Patterns of Steroid Injection and Operative Intervention for Treatment of Common Hand Conditions

    PubMed Central

    Sears, Erika D.; Swiatek, Peter R.; Chung, Kevin C

    2015-01-01

    Purpose To conduct a population-level analysis of practice trends and probability of surgery based on the number of steroid injections for common hand conditions. Methods Patients at least 18 years old receiving injection or surgery for carpal tunnel syndrome (CTS), trigger finger (TF), or De Quervain tenovaginitis (DQ) were identified for inclusion using the 2009–2013 Truven MarketScan databases. The number of injections performed was counted, and time between injection and operation was calculated for patients receiving both treatments. A multivariable logistic regression model was created to evaluate the odds of undergoing surgery based on the number of injections performed, controlling for patient age, sex, comorbidities, and insurance type. Results The study sample included 251,030 patients who underwent steroid injection or operative release for CTS (n=129,917), TF (n=102,778), and DQ (n=18,335). The majority of CTS patients were managed with immediate surgery (71%), whereas most patients with TF and DQ were managed initially with injection (74% and 84%, respectively). Among patients receiving both an injection and an operation, a single injection was the most common practice prior to surgery (69%, 58%, and 67% of patients with CTS, TF, and DQ, respectively). Multiple injections for DQ and TF were associated with relatively low predicted probability of surgery (17% and 26%, respectively, after 2 injections). However, the predicted probability of surgery after two injections was higher in patients with CTS (44%). Conclusions Given the associated probability of surgery after multiple injections for the three hand conditions examined, the practice of repeat injections should be critically examined to determine whether underuse or overuse is present and whether efficiency and resource utilization can be improved upon. Level of Evidence Level II (retrospective prognostic study) PMID:26774548

  2. National Utilization Patterns of Steroid Injection and Operative Intervention for Treatment of Common Hand Conditions.

    PubMed

    Sears, Erika D; Swiatek, Peter R; Chung, Kevin C

    2016-03-01

    To conduct a population-level analysis of practice trends and probability of surgery based on the number of steroid injections for common hand conditions. Patients aged at least 18 years receiving injection or surgery for carpal tunnel syndrome (CTS), trigger finger (TF), or de Quervain tenovaginitis (DQ) were identified for inclusion using the 2009 to 2013 Truven MarketScan databases. The researchers counted the number of injections performed and calculated the time between injection and operation for patients receiving both treatments. A multivariable logistic regression model was created to evaluate the odds of undergoing surgery based on the number of injections performed, controlling for patient age, sex, comorbidities, and insurance type. The study sample included 251,030 patients who underwent steroid injection or operative release for CTS (n = 129,917), TF (n = 102,778), and DQ (n = 18,335). Most patients with CTS were managed with immediate surgery (71%), whereas most patients with TF and DQ were managed initially with injection (74% and 84%, respectively). Among patients receiving both an injection and an operation, a single injection was the most common practice before surgery (69%, 58%, and 67% of patients with CTS, TF, and DQ, respectively). Multiple injections for DQ and TF were associated with relatively low predicted probability of surgery (17% and 26%, respectively, after 2 injections). However, the predicted probability of surgery after 2 injections was higher in patients with CTS (44%). Given the associated probability of surgery after multiple injections for the 3 hand conditions examined, the practice of repeat injections should be critically examined to determine whether underuse or overuse is present and whether efficiency and use of resources can be improved upon. Prognostic II. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Randomised, prospective, non-blinded pilot study comparing the effect of intramuscular steroid injections and intralesional steroid injections in the management of tennis elbow

    PubMed Central

    Tahir, Hasan; Biro, Izolda; Donnelly, Simon; Greenwood, Mandy

    2016-01-01

    Background Tennis elbow is an overuse injury affecting people performing repetitive forearm movements. It is a soft tissue disorder that causes significant disability and pain. The aim of the study was to establish that an intramuscular steroid injection is effective in the short-term pain relief and functional improvement of tennis elbow. The severity of pain at the injection site was monitored to determine whether the intramuscular injection is better tolerated than the intralesional injection. Methods and results 19 patients, who had no treatment for tennis elbow in the preceding 3 months, were recruited from Whipps Cross University Hospital, London, and were randomised to receive either 80 mg of intramuscular Depo-Medrone or 40 mg of intralesional Depo-Medrone injection. Blinding proved difficult as the injection sites differed and placebo arms were not included in the study. A Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire and a 10-point Likert scale were used to assess primary outcome. Six weeks after the treatment, there was a reduction in pain, improvement in function and total PRTEE scores in both intramuscular and intralesional groups (p=0.008) using a 95% CI for mean treatment difference of −26 to +16 points. A statistically significant result (p=0.001) in favour of intramuscular causing less pain at the injection site was noted. Conclusion Non-inferiority of intramuscular to intralesional injections was not confirmed; however, the intramuscular injection proved to be effective in reducing tennis elbow-related symptoms and was found less painful at the site of injection at the time of administration. Trial registration number EUDRACT Number: 2010-022131-11. REC Number: 10/H0718/76 (NRES, Central London REC 1). PMID:28879024

  4. Intratympanic steroid injection as a first-line therapy in uremia patients with sudden sensorineural hearing loss.

    PubMed

    Tsai, Hsun-Tien; Hsueh, Naiwei; Huang, Chih-Ming; Lin, Hung-Ching

    2015-08-01

    ITSI as a first-line therapy in uremia patients with SSNHL offers a valid and safe treatment compared with intravenous systemic steroid treatment. A specific pathophysiology caused by possible sodium pump paralysis may be explained for uremia patients with SSNHL. To compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic intravenous steroids as a first-line therapy in uremia patients with sudden sensorineural hearing loss (SSNHL). A total of 23 consecutive uremia patients with SSNHL were enrolled in this study. Patients were divided into two groups: the ITSI group (n = 15) and the non-ITSI group (n = 8), in which patients received intravenous systemic steroid treatment. The two groups were homogeneous in all respects. The hearing improvement and relative gain were statistically significant between the two groups. The value of hearing gain (ΔPTA = PTA pre - PTA post) in the ITSI group and the non-ITSI group was 24.6 ± 16.4dB and 8.4 ± 19.3dB. The value of relative gain (ΔPTA/PTApre) in the ITIS group and the non-ITSI group was 31.1 ± 22% and 9.4 ± 20.5%. In the ITSI group, 11 patients (73.3%) exhibited hearing recovery (ΔPTA > 10 dB).

  5. Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment.

    PubMed

    Park, Kui Young; Lee, Yohan; Hong, Ji Yeon; Chung, Won Soon; Kim, Myeung Nam; Kim, Beom Joon

    2017-05-01

    Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well. Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.

  6. Local steroid injection for management of different types of acute idiopathic orbital inflammation: an 8-year study.

    PubMed

    El Nasser A Mohammad, Abd

    2013-01-01

    To evaluate the long-term efficacy of local injection of steroid in treatment of acute idiopathic dacryoadenitis, myositis, and diffuse anterior orbital inflammation. This prospective noncomparative interventional case study included 47 patients with acute idiopathic orbital inflammation. The disease was acute idiopathic 1) dacryoadenitis in 31 patients, 2) myositis in 12 patients, and 3) anterior diffuse orbital inflammation in 4 patients. Betamethasone suspension of 2 to 4 ml (1 ml contains 2 mg betamethasone sodium phosphate and 5 mg betamethasone dipropionate) was injected inside the inflamed gland, around the inflamed muscle and periocular in the diffuse form. Postinjection cold compression was applied for 6 hours, and systemic nonsteroidal anti-inflammatory drugs were given for 2 weeks. Dramatic response was achieved within 7 days after injection in all cases. During the follow-up period up to 8 years, 2 patients (1 with myositis and 1 with diffuse orbital inflammation) had recurrence, which was improved by the second injection. The excellent long-term results achieved will shift the treatment of idiopathic orbital inflammation from oral steroid therapy with its hazards to a safer local injection therapy.

  7. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis.

    PubMed Central

    Godwin, Marshall; Dawes, Martin

    2004-01-01

    OBJECTIVE: Do intra-articular steroid injections relieve the pain of osteoarthritis (OA) of the knee? DATA SOURCES: MEDLINE, Cochrane, and Internet databases were searched for randomized controlled trials. STUDY SELECTION: Five randomized controlled trials involving 312 patients were found. SYNTHESIS: One week after injection, treated patients were less likely to have continuing pain and had significantly lower scores on a visual analogue scale (VAS) for pain. Three to 4 weeks after injection, treated patients still had significantly less pain, but their VAS scores were no longer significantly lower than scores in the control group. Six to 8 weeks after injection, neither pain reduction nor VAS scores were significantly different between groups. CONCLUSION: Intra-articular corticosteroid injection results in clinically and statistically significant reduction in osteoarthritic knee pain 1 week after injection. The beneficial effect could last for 3 to 4 weeks, but is unlikely to continue beyond that. PMID:15000335

  8. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis.

    PubMed

    Say, Ferhat; Gürler, Deniz; İnkaya, Erkan; Bülbül, Murat

    2014-01-01

    The aim of this study was to compare the effects of platelet-rich plasma (PRP) and steroid injections in patients diagnosed with plantar fasciitis. A total of 50 patients with chronic plantar fasciitis were included in the study and divided into 2 groups. In the PRP group (n=25), PRP taken from the patients' blood was activated using calcium chloride and injected in a single dose. In the steroid group (n=25), a single dose methylprednisolone with local anesthetic injection was given. Clinical evaluation was made using the American Foot and Ankle Score (AFAS) and the visual analog scale (VAS). No complications were seen in any patients. Mean AFAS was 85.5 ± 4.2 at 6 weeks and 90.6 ± 2.6 at 6 months in the PRP group and 75.3 ± 4.8 and 80.3 ± 4.7, respectively, in the steroid group (p<0.001). The difference in the mean VAS between the PRP group (2.4 ± 0.8 and 1 ± 0.8) and the steroid group (4 ± 1.1 and 2.6 ± 0.9) at the 6th week and 6th month was statistically significant (p<0.001). Changes in AFAS and VAS scores were significantly higher in the PRP group (p<0.001). The application of PRP appears to be more effective than steroid injection in terms of pain and functional results in the treatment of chronic plantar fasciitis.

  9. Oral opioid analgesics vs. spinal steroid injections in the treatment of low back pain syndromes.

    PubMed

    Nampiaparampil, Devi E; Nampiaparampil, Geetha M; Nampiaparampil, Robert G

    2012-02-01

    The aim of this study was to examine the outcomes related to analgesia, function, mortality, and adverse effects of oral opioid analgesics and spinal steroid injections on low back pain syndromes. Databases including Medline, EMBASE, PubMed, and Cochrane Library were searched in September 2009 using combinations of terms related to spinal pain and its treatment. A systematic review was performed of randomized controlled trials that enrolled patients with low back pain syndromes and that evaluated patient outcomes after intervention using either oral opioids or spinal steroid injections. Eight high-quality and ten moderate-quality randomized controlled trials were identified. One high-quality study on oral opioid therapy showed significant improvements in pain relief and patient function. Those on spinal steroid injections had a decreased Visual Analog Scale pain score by 7.18 (95% confidence interval, 2.21-12.1) points more than the control group at 1 mo or less and by 0.429 (95% confidence interval, -4.41 to 5.27) points at 1-3 mos. At more than 6 mos, there was no significant benefit: 0.930 (95% confidence interval, -5.03 to 6.89). Spinal steroids decreased the Oswestry Disability Index by 3.53 (95% confidence interval, 0.480-6.57) at 1 mo or less, by -0.281 (95% confidence interval, -3.18 to 2.62) at 1-3 mos, by -11.0 (95% confidence interval, -14.8 to -7.16) at 3-6 mos, and by -0.205 (95% confidence interval, -3.50 to 3.09) compared with the control group at 6 mos or more, suggesting that there was improvement in function. All-cause mortality was low in our analysis of patients attending specialty clinics. It was difficult to assess the adverse effects of opioid therapy because they influenced up to 28% of patients to withdraw from the original studies. In terms of spinal steroid injections, headache appeared to be the most common adverse effect. However, there was no significantly increased risk of headaches associated with spinal steroids compared with

  10. The VIRGO injection system

    NASA Astrophysics Data System (ADS)

    Bondu, F.; Brillet, A.; Cleva, F.; Heitmann, H.; Loupias, M.; Man, C. N.; Trinquet, H.; Virgo Collaboration

    2002-04-01

    The VIRGO injection system, designed to provide a stable single-frequency 20 W laser to the VIRGO interferometer, is under commissioning. All functions have been demonstrated to work close to requirements, and the integration of all of them is in progress.

  11. Comparison of Incidences of Intravascular Injection between Medial and Lateral Side Approaches during Traditional S1 Transforaminal Epidural Steroid Injection.

    PubMed

    Park, Sang Jun; Kim, Shin Hyung; Kim, Seon Ju; Yoon, Duck Mi; Yoon, Kyung Bong

    2017-01-01

    Purpose. Intravascular injection rates are higher during traditional S1 transforaminal epidural steroid injection (TFESI) compared with lumbar transforaminal injection. We compared the incidences of intravascular injection between the medial and lateral approaches to the S1 foramen during S1 TFESI. Materials and Methods. A total of 139 patients underwent one or more TFESIs (170 total injections). The patients received S1 TFESI by either medial or lateral side of S1 foramen under fluoroscopic anteroposterior view using digital subtraction method. The intravascular injection rates, epidural spread patterns, and contrast volumes required to reach the superior aspect of the L5-S1 intervertebral disc (SIVD) were compared between groups. Results. Intravascular injection rates during S1 TFESI were significantly lower in the medial approach compared with the lateral approach patients (4.9% versus 38.6%, resp., P < 0.001). The medial approach group had more epidural spread to the L5-S1 SIVD than the lateral group (82.1% versus 58.8%, resp.); lower contrast volume amounts were required to extend the L5-S1 SIVD (1.46 ± 0.48 versus 1.90 ± 0.62, resp.). Conclusion. During S1 TFESI, approaching the needle towards the medial part of the S1 foramen may reduce intravascular injection risk.

  12. Effectiveness of intra-articular steroid injection for atlanto-occipital joint pain.

    PubMed

    Lee, Dong-Gyu; Cho, Yun-Woo; Jang, Sung-Ho; Son, Su-Min; Kim, Gook-Joo; Ahn, Sang-Ho

    2015-06-01

    The aims of this study were to evaluate the role of intra-articular joint injection for atlanto-occipital (AO) joint pain and to determine pain referral sites from that joint. Prospective observational study. We evaluated 29 patients with chronic refractory neck pain and/or headache, and limited range of lateral bending with rotation at the AO joint on physical examination. Of the 24 patients who consented to undergo diagnostic injections, 20 patients had at least 50% relief from pain and underwent two AO intra-articular injections of mixture of local anesthetic and steroid approximately 1 week apart. Patients completed pain drawings, visual analog scales (VASs) for pain, and neck disability index (NDI) for level of function. Patients were evaluated for 2 months after the first injection. There was headache in 14/20 (70%), posterior neck pain (PNP) in 20, and referred pain in 17 (85%). The average VAS values for headache, PNP, and other referred pains were reduced significantly from 5.64, 5.70, and 5.41, respectively, before treatments to 0.64, 2.30, and 1.71, respectively, two months after injection (P < 0.01). The average NDI value was reduced significantly from 39.95% at pretreatment to 20.40% at 2 months after treatment (P < 0.01). AO intra-articular steroid injection appears effective for the short-term control of chronic refractory pain arising from the AO joint. Wiley Periodicals, Inc.

  13. Acute respiratory distress following intravenous injection of an oil-steroid solution

    PubMed Central

    Russell, Michael; Storck, Aric; Ainslie, Martha

    2011-01-01

    A case of acute respiratory distress and hypoxemia following accidental intravenous injection of an oil-steroid solution in a body builder is presented. Chest roentography at the time of presentation showed diffuse bilateral opacities, and computed tomography revealed predominantly peripheral ground-glass opacifications. The patient’s symptoms gradually improved over 48 h and imaging of the chest was unremarkable one week later. The pathophysiology, diagnosis and treatment of this rare but potentially life-threatening complication of intravenous oil injection are discussed. PMID:22059184

  14. Neutral beam injection system

    SciTech Connect

    Duesing, G.; Altmann, H.; Falter, H.; Goede, A.; Haange, R.; Hemsworth, R.S.; Kupschus, P.; Stork, D.; Thompson, E.

    1987-01-01

    The development of the neutral injection (NI) system for the Joint European Torus and its status in 1985 are reported. First the system parameters are discussed and the layout is described, followed by a summary of the physics design calculations, the development, production, and testing of the components and the subsystem assembly. The system commissioning is presented, including a description of the function and the realization of the NI test bed. A summary of performance predictions for 80-keV beam heating experiments, and of the experimental evidence on balanced versus coinjection, is presented. The operational experience with the first injector and the plasma physics results obtained so far are summarized.

  15. The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

    PubMed Central

    Byun, Jong Min; Woo, Jae Hee; Kim, Jin

    2014-01-01

    Background Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective. PMID:25317282

  16. Comparison of Pain Score Reduction Using Triamcinolone vs. Betamethasone in Transforaminal Epidural Steroid Injections for Lumbosacral Radicular Pain.

    PubMed

    McCormick, Zachary; Kennedy, David J; Garvan, Cynthia; Rivers, Evan; Temme, Kate; Margolis, Shana; Zander, Emily; Rohr, Ashley; Smith, Matthew C; Plastaras, Christopher

    2015-12-01

    Although the comparative efficacy of particulate vs. nonparticulate steroids for the treatment of radicular pain with transforaminal epidural steroid injection has been investigated, there is minimal literature comparing particulate steroids. The authors aimed to determine whether transforaminal epidural steroid injection with triamcinolone or betamethasone, two particulate corticosteroids, more effectively reduces lumbosacral radicular pain. This is a longitudinal cohort study of 1021 patients (1568 transforaminal epidural steroid injections) who received betamethasone or triamcinolone between January 2006 and October 2007 in an academic spine center. The frequency of greater than 50% pain reduction was compared between groups. This study included 42.4% (433) male and 57.6% (588) female patients, with a mean (SD) age of 54.1 (16.7) yrs. Betamethasone and triamcinolone were used in 78.8% (1235) and 21.2% (333) of subjects, respectively. Significantly more patients who received triamcinolone (44.4% [95% confidence interval, 36.2%-52.8%]) experienced greater than 50% pain reduction at short-term follow-up (1-4 wks) compared with patients who received betamethasone (26.8% [95% confidence interval, 22.7%-31.4%]). Patients who received transforaminal epidural steroid injection with triamcinolone reported more frequent pain relief of greater than 50% at short-term follow-up compared with those who received betamethasone. These findings further develop the literature on comparative effectiveness in epidural steroid injections. However, given the exploratory and retrospective nature of this investigation, further study is needed.

  17. Air injection system diagnostic

    SciTech Connect

    Kotzan, J.M.; Labus, G.E.

    1992-05-19

    This patent describes a method for diagnosing failures in an air control system that controls a quantity of air admitted into an exhaust path of an internal combustion engine. It comprises sensing the oxygen content of the exhaust gas of the engine at predetermined time intervals at a first predetermined point in the exhaust path of the engine, the oxygen content normally oscillating between a rich oxygen condition and a lean oxygen condition in the absence of air injected into the exhaust path above the first predetermined point; injecting a quantity of air into the exhaust path of the engine at a second predetermined point in the exhaust port, the second predetermined point being above the first predetermined point; counting the number of intervals at which the sensed oxygen content indicates a rich oxygen condition over a predetermined period of time; comparing the counted number of rich oxygen intervals to a predetermined threshold value, the threshold value being greater than a counted number of rich oxygen intervals over the predetermined period of time resulting from the normal oscillations between rich and lean oxygen conditions in the absence of air injected into the exhaust path; indicating the existence of a fault in the air control system when the number of rich oxygen intervals does not exceed the predetermined threshold value.

  18. Effect of relative injectate pressures on the efficacy of lumbar transforaminal epidural steroid injection in patients with lumbar foraminal stenosis.

    PubMed

    Park, Chan Hong; Lee, Sang Ho

    2014-03-01

    Transforaminal epidural steroid injections (TFESIs) are often used to treat lumbar foraminal stenosis. Injectate pressure (of contrast) was monitored during fluoroscopically guided TFESI to assess the effect on short-term pain reduction. A total of 40 patients underwent single-level lumbar TFESI for unilateral lumbar radicular pain ascribed to foraminal stenosis. Relative injectate pressure of contrast epidurography during TFESI was recorded and compared with pre- and postprocedural pain levels using the Roland 5-point pain scoring method. Pain relief achieved after TFESI revealed no statistically significant correlation with injectate pressure (mean 13.0 cm H2 O). Mean pressures in patients with and without demonstrable pain reduction were 12.9 and 13.2 cm H2 O, respectively. Secondary outcomes were not measured, and no mid- or long-term follow-up was conducted. In this setting, relative injectate pressures had no significant effect on immediate outcomes of TFESI. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

  19. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.

    PubMed

    Kim, Woong Mo; Lee, Hyung Gon; Jeong, Cheol Won; Kim, Chang Mo; Yoon, Myung Ha

    2010-12-01

    Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies. It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy. The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection. This was a prospective, randomized, controlled trial. The study was conducted at an outpatient pain medicine clinic at Chonnam National University Hospital in Gwang-ju, Korea. The study included patients with sacroiliac joint pain, confirmed by ≥50% improvement in response to local anesthetic block, lasting 3 months or longer, and who failed medical treatment. The treatment involved intra-articular dextrose water prolotherapy or triamcinolone acetonide injection using fluoroscopic guidance, with a biweekly schedule and maximum of three injections. Pain and disability scores were assessed at baseline, 2 weeks, and monthly after completion of treatment. The numbers of recruited patients were 23 and 25 for the prolotherapy and steroid groups, respectively. The pain and disability scores were significantly improved from baseline in both groups at the 2-week follow-up, with no significant difference between them. The cumulative incidence of ≥50% pain relief at 15 months was 58.7% (95% confidence interval [CI] 37.9%-79.5%) in the prolotherapy group and 10.2% (95% CI 6.7%-27.1%) in the steroid group, as determined by Kaplan-Meier analysis; there was a statistically significant difference between the groups (log-rank p < 0.005). Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid

  20. Voice Outcomes following a Single Office-Based Steroid Injection for Vocal Fold Scar.

    PubMed

    Young, William G; Hoffman, Matthew R; Koszewski, Ian J; Whited, Chad W; Ruel, Brienne N; Dailey, Seth H

    2016-11-01

    Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. We evaluated voice outcomes after a single office-based steroid injection. Case series with chart review. Academic medical center. This study was based on pre- and postoperative analysis of patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. The sample comprised 25 patients undergoing office-based dexamethasone injection into the superficial lamina propria for mild/moderate vocal fold scar. Average follow-up was 13.7 ± 4.4 weeks; patients completed 3.5 ± 2.3 sessions of voice therapy between assessments. Complete data sets were not available for each parameter; sample size is noted with results. Voice handicap index (n = 24; P < .001) and glottal function index (n = 22; P < .001) decreased after injection. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 25; P < .001). Fundamental frequency range increased (n = 24; P = .024). Phonation threshold pressure decreased (n = 14; P = .017). Videostroboscopic parameters of vocal fold edge (P = .004), glottic closure (P = .003), and right mucosal wave (P = .016) improved after injection. Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  1. Comparison of peroperative subconjunctival injection of methylprednisolone and standard postoperative steroid drops after uneventful cataract surgery.

    PubMed

    Merkoudis, Nikolaos; Wikberg Matsson, Anna; Granstam, Elisabet

    2014-11-01

    To compare the safety and efficacy of a single subconjunctival injection of methylprednisolone and a standard postoperative steroid regimen in terms of intraocular inflammation and intraocular pressure (IOP) after uncomplicated phacoemulsification surgery. Two groups of 25 patients each were included in this prospective randomized controlled trial. Patients in the injection group were given a subconjunctival injection of 20 mg methylprednisolone and the topical group received the conventional postoperative care with steroid eye drops (dexamethasone 1 mg/ml). The patients were examined 1 week and 1 month after surgery. Slit-lamp evaluation of anterior chamber inflammation and IOP were performed. Changes in IOP of ≥2.4 mmHg were considered clinically relevant. In the injection group, mean IOP decreased from 15.4 ± 2.2 mmHg (baseline) to 14.1 ± 3.2 mmHg at 1 week (p = 0.03). The topical group had a stable IOP at 1 week (16.3 ± 2.6 mmHg) compared to baseline (16.1 ± 2.7 mmHg; p = 0.74). At 1 month, mean IOP was 14.3 ± 2.6 mmHg (p = 0.03) in the injection group and 15.6 ± 2.3 mmHg (p = 0.2) in the topical group. The intragroup changes were neither statistically significant nor clinically relevant at any postoperative visit. Both groups had the highest values of intraocular inflammation at the 1-week postoperative visit, followed by a decline to barely traceable levels at 1 month. The difference was not clinically relevant at any postoperative visit. The subconjunctival injection of methylprednisolone appears to be as safe and effective as the conventional treatment, and it might therefore be considered for treatment of individuals with compliance issues. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  2. Shenqi Fuzheng Injection Alleviates the Transient Worsening Caused by Steroids Pulse Therapy in Treating Myasthenia Gravis

    PubMed Central

    Qi, Guo-Yan; Liu, Peng

    2013-01-01

    Purpose. To evaluate the treatment effect and side effect of Shenqi Fuzheng Injection (SFI) on alleviating transient worsening of myasthenia gravis (MG) symptoms caused by high-dose steroids pulse therapy. Methods. Sixty-six consecutive patients with MG were randomly divided into two groups: the treatment group treated with SFI and methylprednisolone pulse therapy (MPT) and the control group treated with MPT alone. The severity of MG before, during, and after MPT and the duration of transient worsening (TW) were evaluated and compared with the clinical absolute scoring (AS) and relative scoring (RS) system. Results. Twenty-nine patients experienced TW in each group. At TW, the AS was significantly increased (P < 0.000) in both groups compared with baseline data, with the AS increase in the treatment group (16.8 ± 2) significantly smaller (P < 0.05) than in the control group (24.9 ± 2.5). At the end of the treatment course, the AS for the treatment group was significantly decreased (7.5 ± 0.9) compared with at TW, although no significant difference compared with the control (9.7 ± 1.1). The TW lasted 1–6 days (mean 3.7) for the treatment group, significantly shorter (P < 0.05) than 2–12 days (mean 7.8) for the control. The RS for the treatment group at the end of treatment was 43.8%–100% (mean 76.8% ± 2.6%), significantly better than the control group: 33.3%–100% (mean 67.2 ± 3.6%). Slight side effects (18.75%) included maldigestion and rash in the treatment group. Conclusion. SFI has a better treatment effect and few side effects and can alleviate the severity and shorten the duration of the transient worsening of MG during steroids pulse therapy. PMID:24348721

  3. Portable Liquid-Injecting System

    NASA Technical Reports Server (NTRS)

    Shuck, T.; Chin, F.; Hansen, M.

    1988-01-01

    Portable injecting-gun system dispenses predetermined amount of liquid at moderately high pressure. Tool belt holds components of liquid-injecting system. Pump and four-way valve combined in nylon housing. Connected to injecting nozzle and other components by polyvinyl tubing.

  4. Reductant injection and mixing system

    SciTech Connect

    Reeves, Matt; Henry, Cary A.; Ruth, Michael J.

    2016-02-16

    A gaseous reductant injection and mixing system is described herein. The system includes an injector for injecting a gaseous reductant into an exhaust gas stream, and a mixer attached to a surface of the injector. The injector includes a plurality of apertures through which the gaseous reductant is injected into an exhaust gas stream. The mixer includes a plurality of fluid deflecting elements.

  5. Cost effectiveness of epidural steroid injections to manage chronic lower back pain

    PubMed Central

    2012-01-01

    Background The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. Methods Patients attending the Nottingham University Hospitals’ Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. Results 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 – 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 – 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 – 70,091). Conclusions When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness. Trial registration ISRCTN 43299460 PMID:23016755

  6. Body Builder's Nightmare: Black Market Steroid Injection Gone Wrong: a Case Report.

    PubMed

    Friedman, Or; Arad, Ehud; Ben Amotz, Oded

    2016-09-01

    In the pursuit of success in sports, some athletes are not deterred by health risks associated with the (mis)use of black market preparations of dubious origin as performance-enhancing agents. Several studies published in the recent years demonstrated that anabolic-androgenic steroids, but also stimulants and growth hormones, are misused by numerous recreational athletes from all over the world. Trenbolone is an anabolic steroid routinely used in the finishing phase of beef production to improve animal performance and feed efficiency. A 35-year-old male patient presented to our plastic surgery clinic after self-intramuscular administration of Trenbolone to the superior gluteal area bilaterally, which led to a full-thickness defect in a cone-like distribution. The wounds underwent surgical debridement and were treated locally with mafenide acetate irrigation and wound dressings. Closure was achieved by secondary intention healing. In this report, we discuss the first documented case of full-thickness skin and subcutaneous tissue necrosis after black market anabolic steroid injection. This illustrates a plastic complication and resolution of a widespread but seldom reported problem.

  7. Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

    PubMed Central

    Moon, Jangsup; Kwon, Hyung-Min

    2017-01-01

    Introduction Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid. PMID:28203184

  8. Body Builder’s Nightmare: Black Market Steroid Injection Gone Wrong: a Case Report

    PubMed Central

    Arad, Ehud; Ben Amotz, Oded

    2016-01-01

    Summary: In the pursuit of success in sports, some athletes are not deterred by health risks associated with the (mis)use of black market preparations of dubious origin as performance-enhancing agents. Several studies published in the recent years demonstrated that anabolic-androgenic steroids, but also stimulants and growth hormones, are misused by numerous recreational athletes from all over the world. Trenbolone is an anabolic steroid routinely used in the finishing phase of beef production to improve animal performance and feed efficiency. A 35-year-old male patient presented to our plastic surgery clinic after self-intramuscular administration of Trenbolone to the superior gluteal area bilaterally, which led to a full-thickness defect in a cone-like distribution. The wounds underwent surgical debridement and were treated locally with mafenide acetate irrigation and wound dressings. Closure was achieved by secondary intention healing. In this report, we discuss the first documented case of full-thickness skin and subcutaneous tissue necrosis after black market anabolic steroid injection. This illustrates a plastic complication and resolution of a widespread but seldom reported problem. PMID:27757350

  9. Piezoelectric Injection Systems

    NASA Astrophysics Data System (ADS)

    Mock, R.; Lubitz, K.

    The origin of direct injection can be doubtlessly attributed to Rudolf Diesel who used air assisted injection for fuel atomisation in his first self-ignition engine. Although it became apparent already at that time that direct injection leads to reduced specific fuel consumption compared to other methods of fuel injection, it was not used in passenger cars for the moment because of its disadvantageous noise generation as the requirements with regard to comfort were seen as more important than a reduced specific consumption.

  10. Detection of anabolic steroid abuse using a yeast transactivation system.

    PubMed

    Zierau, Oliver; Lehmann, Sylvi; Vollmer, Günter; Schänzer, Willhelm; Diel, Patrick

    2008-10-01

    The classical analytical method for detection of anabolic steroid abuse is gas chromatography followed by mass spectrometry (GC/MS). However, even molecules with a chemical structure typical for this class of substances, are sometimes not identified in routine screening by GC/MS when their precise chemical structure is still unknown. A supplementary approach to identify anabolic steroid abuse could be a structure-independent identification of anabolic steroids based on their biological activity. To test the suitability of such a system, we have analyzed the yeast androgen receptor (AR) reporter gene system to identify anabolic steroids in human urine samples. Analysis of different anabolic steroids dissolved in buffer demonstrated that the yeast reporter gene system is able to detect a variety of different anabolic steroids and their metabolites with high specificity, including the so-called 'designer steroid' tetrahydrogestrinone. In contrast, other non-androgenic steroids, like glucocordicoids, progestins, mineralocordicoids and estrogens had a low potency to stimulate transactivation. To test whether the system would also allow the detection of androgens in urine, experiments with spiked urine samples were performed. The androgen reporter gene in yeast responds very sensitive to 5alpha-dihydrotestosterone (DHT), even at high urine concentrations. To examine whether the test system would also be able to detect anabolic steroids in the urine of anabolic steroid abusers, anonymous urine samples previously characterized by GCMS were analyzed with the reporter gene assay. Even when the concentration of the anabolic metabolites was comparatively low in some positive samples it was possible to identify the majority of positive samples by their biological activity. In conclusion, our results demonstrate that the yeast reporter gene system detects anabolic steroids and corresponding metabolites with high sensitivity even in urine of anabolic steroid abusing athletes

  11. Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial.

    PubMed

    Wang, Jia-Chi; Liao, Kwong-Kum; Lin, Kon-Ping; Chou, Chen-Liang; Yang, Tsui-Fen; Huang, Yu-Fang; Wang, Kevin A; Chiu, Jan-Wei

    2017-05-01

    To compare the effectiveness of local steroid injection plus splinting with that of local steroid injection alone using clinical and electrophysiological parameters in patients with carpal tunnel syndrome (CTS). Randomized controlled study with 12 weeks of follow-up. Tertiary care center. Volunteer sample of patients (N=52) diagnosed with CTS. Participants were randomly assigned to the steroid injection group (n=26) or the steroid injection-plus-splinting group (n=26). Patients of both groups received ultrasound-guided steroid injection with 1mL of 10mg (10mg/mL) triamcinolone acetonide (Shincort) and 1mL of 2% lidocaine hydrochloride (Xylocaine). Participants in the second group also wore a volar splint in the neutral position while sleeping and also during daytime whenever possible for the 12-week intervention period. Participants were evaluated before the treatment and at 6 and 12 weeks after the onset of treatment. The primary outcome measure was Boston Carpal Tunnel Questionnaire scores. The secondary outcome measures were as follows: scores on the visual analog scale for pain; electrophysiological parameters, including median nerve distal motor latency, sensory nerve conduction velocity (SNCV), and compound muscle action potential and sensory nerve action potential (SNAP) amplitudes; and patient's subjective impression of improvement. At 12-week follow-up, improvements in symptom severity and functional status scores on the Boston Carpal Tunnel Questionnaire as well as SNCV and SNAP amplitudes were greater in the group that received steroid injection combined with splinting than in the group that received steroid injection alone. The between-group difference was .48 points (95% confidence interval [CI], .09-.88 points; P=.032) in the Symptom Severity Scale score, .37 points (95% CI, .06-.67 points; P=.019) in the Functional Status Scale score, 3.38m/s (95% CI, 0.54-6.22m/s; P=.015) in the SNCV amplitude, and 3.21μV (95% CI, 0.00-6.46μV; P=.025) in the SNAP

  12. Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: a case report.

    PubMed

    Koga, Hiroaki; Yone, Kazunori; Yamamoto, Takuya; Komiya, Setsuro

    2003-06-01

    A case report of discal cyst treated by percutaneous CT-guided puncture and steroid injection. To present the efficacy of percutaneous CT-guided puncture and steroid injection for the treatment of this disorder. Surgical removal of the cyst is usually performed for the treatment of this disorder. However, it was recently reported that direct CT-guided puncture and steroid injection was useful for the treatment of intraspinal synovial cyst. A 37-year-old man experienced low back pain and right lower extremity pain with sensory abnormality over the right leg and foot. MRI revealed an extradural spherical mass with low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging behind the L5 vertebral body. On discography, contrast medium rapidly flowed into the cyst through a thin channel from the neighboring disc cavity. Based on these findings, a diagnosis of discal cyst was made. Percutaneous CT-guided puncture and steroid injection were performed. Low back pain, right extremity pain, and numbness disappeared immediately after the procedure. On MRI examination, the cyst gradually diminished in size after the procedure. CT-guided percutaneous puncture and steroid injection may be a useful procedure for the treatment of discal cyst.

  13. Fuel injection system

    SciTech Connect

    Miyaki, M.; Iwanaga, T.; Fujisawa, H.

    1988-10-18

    This patent describes a fuel injection system for a diesel engine comprising: condition detection means for detecting operating conditions of the diesel engine including a rotational position thereof; low pressure fuel supply means for supplying fuel at a low pressure at an output port thereof; high pressure fuel pump means, having a pump chamber communicating with the output port of the low pressure fuel supply means, and plunger means reciprocable within the pump chamber for introducing fuel from the output port of the low pressure fuel supply means into the pump chamber during a movement in a predetermined direction of the plunger means and for pressurizing the introduced fuel during a movement of the plunger means in the opposite direction so that pressurized fuel is delivered from the high pressure fuel pump means at an output port thereof; common rail fuel storage means, connected to the output port of the high pressure fuel pump means, for storing pressurized fuel delivered from the high pressure pump therein at a substantially continuous pressure.

  14. Infectious disease, injection practices, and risky sexual behavior among anabolic steroid users.

    PubMed

    Ip, Eric J; Yadao, Michael A; Shah, Bijal M; Lau, Bonnie

    2016-01-01

    Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984-17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases.

  15. CT-guided cervical transforaminal steroid injections: where should the needle tip be located?

    PubMed

    Hoang, J K; Massoglia, D P; Apostol, M A; Lascola, C D; Eastwood, J D; Kranz, P G

    2013-03-01

    The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

  16. Urine Pretreat Injection System

    NASA Technical Reports Server (NTRS)

    1995-01-01

    A new method of introducing the OXONE (Registered Trademark) Monopersulfate Compound for urine pretreat into a two-phase urine/air flow stream has been successfully tested and evaluated. The feasibility of this innovative method has been established for purposes of providing a simple, convenient, and safe method of handling a chemical pretreat required for urine processing in a microgravity space environment. Also, the Oxone portion of the urine pretreat has demonstrated the following advantages during real time collection of 750 pounds of urine in a Space Station design two-phase urine Fan/Separator: Eliminated urine precipitate buildup on internal hardware and plumbing; Minimized odor from collected urine; and Virtually eliminated airborne bacteria. The urine pretreat, as presently defined for the Space Station program for proper downstream processing of urine, is a two-part chemical treatment of 5.0 grams of Oxone and 2.3 ml of H2SO4 per liter of urine. This study program and test demonstrated only the addition of the proper ratio of Oxone into the urine collection system upstream of the Fan/Separator. This program was divided into the following three major tasks: (1) A trade study, to define and recommend the type of Oxone injection method to pursue further; (2) The design and fabrication of the selected method; and (3) A test program using high fidelity hardware and fresh urine to demonstrate the method feasibility. The trade study was conducted which included defining several methods for injecting Oxone in different forms into a urine system. Oxone was considered in a liquid, solid, paste and powered form. The trade study and the resulting recommendation were presented at a trade study review held at Hamilton Standard on 24-25 October 94. An agreement was reached at the meeting to continue the solid tablet in a bag concept which included a series of tablets suspended in the urine/air flow stream. These Oxone tablets would slowly dissolve at a controlled rate

  17. High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients.

    PubMed

    Aoki, Takatoshi; Oshige, Takahisa; Matsuyama, Atsushi; Oki, Hodaka; Kinoshita, Shunsuke; Yamashita, Yoshiko; Takahashi, Hiroyuki; Hayashida, Yoshiko; Sakai, Akinori; Hisaoka, Masanori; Korogi, Yukunori

    2014-03-01

    To correlate median nerve T2 signal and shape at the carpal tunnel with steroid injection (SI) response in carpal tunnel syndrome (CTS) patients. One hundred and sixty-three CTS wrists of 92 consecutive patients who were scheduled to undergo SI were prospectively evaluated with 3-T magnetic resonance imaging (MRI) and a nerve conduction study. All patients underwent axial high-resolution T2-weighted MRI (in-plane resolution of 0.25 × 0.25 mm). The CTS wrists were classified into three groups according to the nerve T2 signal and the flattening ratio at the hook of hamate level: group 1, high and oval; group 2, high and flat; group 3, low and flat. Clinical response to SI was evaluated at 6 months after injection. One hundred and thirteen of the 163 wrists (69.3%) responded well to SI. The percentage of improvement was 81.7% (49/60) in group 1, 69.9% (51/73) in group 2, and 43.3% (13/30) in group 3 (P < 0.01). On stepwise logistic regression analysis high-resolution MRI was the only significant independent factor for SI response in CTS patients (P < 0.01). High-resolution MRI correlates well with SI response in CTS patients and seems useful for predicting SI response. • MRI may help determine appropriate care in carpal tunnel syndrome. • MRI helps in therapeutic decision-making whenever steroid injection is considered. • T2 signal decrease of the median nerve correlates with poor outcome. • T2 signal decrease of median nerve may reflect fibrosis and amyloid deposition.

  18. Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up

    PubMed Central

    Li, Shuming; Shen, Tong; Liang, Yongshan; Zhang, Ying; Bai, Bo

    2014-01-01

    Plantar fasciitis is the most common cause of heel pain in adults. A novel alternative medical instrument, the miniscalpel-needle (MSN), which is based on an acupuncture needle, has been recently developed in China. The objective of this study was to evaluate the effectiveness of the MSN release treatment versus that of traditional steroid injection for plantar fasciitis. Patients with plantar fasciitis were randomly assigned to 2 groups and followed up for 12 months, with 29 receiving MSN treatment and 25 receiving steroid injection treatment. The results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Our data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection. PMID:25114704

  19. Neuroactive steroids and the peripheral nervous system: An update.

    PubMed

    Giatti, Silvia; Romano, Simone; Pesaresi, Marzia; Cermenati, Gaia; Mitro, Nico; Caruso, Donatella; Tetel, Marc J; Garcia-Segura, Luis Miguel; Melcangi, Roberto C

    2015-11-01

    In the present review we summarize observations to date supporting the concept that neuroactive steroids are synthesized in the peripheral nervous system, regulate the physiology of peripheral nerves and exert notable neuroprotective actions. Indeed, neuroactive steroids have been recently proposed as therapies for different types of peripheral neuropathy, like for instance those occurring during aging, chemotherapy, physical injury and diabetes. Moreover, pharmacological tools able to increase the synthesis of neuroactive steroids might represent new interesting therapeutic strategy to be applied in case of peripheral neuropathy.

  20. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    SciTech Connect

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  1. Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury.

    PubMed

    Yamaguchi, Takeshi; Ochiai, Nobuyasu; Sasaki, Yu; Kijima, Takehiro; Hashimoto, Eiko; Sasaki, Yasuhito; Kenmoku, Tomonori; Yamazaki, Hironori; Miyagi, Masayuki; Ohtori, Seiji; Takahashi, Kazuhisa

    2015-12-01

    This study evaluated dorsal root ganglia from C3-C7, analyzed gait, and compared the expression of calcitonin gene-related peptide (CGRP) which was a marker of inflammatory pain in a rat rotator cuff tear model in which the supraspinatus and infraspinatus tendons were detached; comparisons were made to a sham group in which only the tendons were exposed. Fluorogold was injected into the glenohumeral joint 21 days after surgery in both groups, and saline, steroids, or hyaluronic acid was injected into the glenohumeral joint in the rotator cuff tear group 26 days after surgery. The proportions of CGRP-immunoreactive neurons were higher and the gait parameters were impaired in the rotator cuff tear group compared to in the sham group. However, the CGRP expression was reduced and the gait was improved with steroid or hyaluronic acid injection compared to saline, suggesting that both hyaluronic acid and steroid injections suppressed of inflammation which thought to be provided pain relief. While there were no significant differences, the suppression of CGRP expression and the improved gait after hyaluronic acid and steroid injections suggested that both methods were effective for rat rotator cuff tear model.

  2. A toe keloid after syndactyly release treated with surgical excision and intralesional steroid injection.

    PubMed

    Yamawaki, Satoko; Naitoh, Motoko; Ishiko, Toshihiro; Aya, Rino; Katayama, Yasuhiro; Suzuki, Shigehiko

    2014-07-01

    A keloid is a benign fibroproliferative disease of unknown etiology. Although it is common among Asians, the development of keloid on the foot is rare. We experienced a case of a keloid which arose on the foot of a 4-year-old boy after the surgical release of syndactyly. He had congenital cutaneous syndactyly of the third and fourth toes. After the reconstructive operation was performed when the patient was 2 years old, the wound became hypertrophic and grew to 37 × 37 × 8 mm. After the diagnosis of keloid based on a pathological examination, the keloid was resected completely. The web was reconstructed with a planter rectangular flap, and the skin defects were covered with a full-thickness skin graft. After the operation, we administered 5 intralesional steroid injections. Finally, the keloid was diminished 2 years after the operation.

  3. A Toe Keloid after Syndactyly Release Treated with Surgical Excision and Intralesional Steroid Injection

    PubMed Central

    Naitoh, Motoko; Ishiko, Toshihiro; Aya, Rino; Katayama, Yasuhiro; Suzuki, Shigehiko

    2014-01-01

    Summary: A keloid is a benign fibroproliferative disease of unknown etiology. Although it is common among Asians, the development of keloid on the foot is rare. We experienced a case of a keloid which arose on the foot of a 4-year-old boy after the surgical release of syndactyly. He had congenital cutaneous syndactyly of the third and fourth toes. After the reconstructive operation was performed when the patient was 2 years old, the wound became hypertrophic and grew to 37 × 37 × 8 mm. After the diagnosis of keloid based on a pathological examination, the keloid was resected completely. The web was reconstructed with a planter rectangular flap, and the skin defects were covered with a full-thickness skin graft. After the operation, we administered 5 intralesional steroid injections. Finally, the keloid was diminished 2 years after the operation. PMID:25426369

  4. Cervical foraminal steroid injections under CT guidance: retrospective study of in situ contrast aspects in a serial of 248 cases.

    PubMed

    Pottecher, Pierre; Krausé, Denis; Di Marco, Lucy; Loffroy, Romaric; Estivalet, Louis; Duhal, Romain; Demondion, Xavier

    2015-01-01

    To describe all the CT findings after in situ contrast injection just before steroid injection and to recognize the abnormal aspects associated with intravascular contamination. We retrospectively evaluated 248 cervical transforaminal steroid injections done at the university hospital in Dijon, France, in 2008-2012, to treat cervicobrachial neuralgia inadequately improved by optimal medical treatment for at least 3 weeks. Features describing the opacification patterns were recorded. Five main nonvascular opacification patterns were identified: clumps of contrast agent outside the foramen (16 %), a crab claw pattern surrounding the ganglion (13 %), a "French" circumflex accent pattern (15 %), reflux along the needle (7 %), and facet joint capsule opacification (22 %). Concerning the situations requiring a change in needle position, intravenous injection occurred in 26 % of the patients, with a crab claw pattern in half the cases and a clump pattern in half the cases. Intraarteriolar injection was noted in two patients. CT after in situ contrast injection ensures proper needle positioning outside the blood vessels before steroid injection. Penetration of the needle tip into a vein is very common, whereas arteriolar puncture is extremely rare.

  5. Epidural Steroid Injection Complicated by Intrathecal Entry, Pneumocephalus, and Chemical Meningitis.

    PubMed

    Shah, Aakash Kaushik; Bilko, Andrey; Takayesu, James Kimo

    2016-09-01

    Epidural steroid injections are frequently used to treat back and extremity pain. The procedure is generally safe, with a low rate of adverse events, including intrathecal entry, pneumocephalus, and chemical meningitis. We report a case of a 45-year-old woman who presented to the emergency department (ED) with headache, nausea, vomiting, and photophobia after a lumbar epidural steroid injection. She was afebrile and had an elevated white blood cell count. A non-contrast computed tomography scan of the head revealed pneumocephalus within the subarachnoid space and lateral ventricles. The patient was admitted to the ED observation unit for pain control and subsequently developed a marked leukocytosis and worsening meningismus. A lumbar puncture was performed yielding cerebrospinal fluid (CSF) consistent with meningitis (1,000 total nucleated cells, 89% neutrophils, 85 mg/dL total protein, and no red blood cells). Gram stain revealed no bacteria. The patient was admitted on empiric vancomycin and ceftriaxone. Antibiotics were discontinued at 48 h when CSF cultures remained negative and the patient was clinically asymptomatic. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should consider intrathecal entry and pneumocephalus in patients who present with a headache after an epidural intervention. The management of pneumocephalus includes supportive therapies, appropriate positioning, and supplemental oxygen. These symptoms can be accompanied by fever, leukocytosis, and markedly inflammatory CSF findings consistent with bacterial or chemical meningitis. Empiric treatment with broad-spectrum antibiotics should be initiated until CSF culture results are available. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Steroids

    MedlinePlus

    ... hormones that your adrenal glands make to fight stress associated with illnesses and injuries. They reduce inflammation and affect the immune system. You may need to take corticosteroids to treat Arthritis Asthma Autoimmune diseases such as lupus and multiple sclerosis Skin conditions ...

  7. Hybrid therapy with locoregional steroid injection and polyglycolic acid sheets to prevent stricture after esophageal endoscopic submucosal dissection

    PubMed Central

    Nagami, Yasuaki; Shiba, Masatsugu; Tominaga, Kazunari; Ominami, Masaki; Fukunaga, Shusei; Sugimori, Satoshi; Tanaka, Fumio; Kamata, Noriko; Tanigawa, Tetsuya; Yamagami, Hirokazu; Watanabe, Toshio; Fujiwara, Yasuhiro; Arakawa, Tetsuo

    2016-01-01

    Background and study aim: The incidence of stricture formation caused by endoscopic submucosal dissection (ESD) for widespread lesions is high, and stricture formation can reduce quality of life. We evaluated the prophylactic efficacy of hybrid therapy using a locoregional steroid injection and polyglycolic acid (PGA) sheets with fibrin glue to prevent stricture formation after esophageal ESD in high risk patients in whom we predicted stricture formation would be difficult to prevent with a single prophylactic steroid injection. Methods: Ten patients who underwent esophageal ESD were enrolled (entire-circumference: n = 6; sub-circumference, more than 5/6 of the circumference: n = 4). A single locoregional steroid injection and PGA sheets with fibrin glue were used after ESD. We evaluated the incidence of stricture formation, the number of endoscopic balloon dilation (EBD) procedures needed to treat the stricture formation, and adverse events of the therapy. Results: Esophageal stricture formation occurred in 50.0 % of patients (5/10) (median EBD sessions 0.5, range 0 – 16). Subanalysis showed that stricture formation occurred in 37.5 % of patients (3/8) excluded the lesions located near a previous scar from ESD or surgical anastomosis site (median EBD sessions 0, range 0 – 4). Conclusion: Hybrid therapy using a locoregional steroid injection and PGA sheets with fibrin glue may have the potential to prevent esophageal stricture formation after esophageal ESD in high risk patients. PMID:27652294

  8. Does Electrodiagnostic Confirmation of Radiculopathy Predict Pain Reduction after Transforaminal Epidural Steroid Injection? A Multicenter Study

    PubMed Central

    McCormick, Zachary; Cushman, Daniel; Caldwell, Mary; Marshall, Benjamin; Ghannad, Leda; Eng, Christine; Patel, Jaymin; Makovitch, Steven; Chu, Samuel K; Babu, Ashwin N.; Walega, David R.; Marciniak, Christina; Press, Joel; Kennedy, David J.; Plastaras, Christopher

    2015-01-01

    Objective Minimal definitive literature identifies patients with radicular pain who would benefit most from epidural steroid injection (ESI). This study investigated if electromyographic (EMG) confirmation of radiculopathy with active or chronic denervation predicts a positive treatment outcome following ESI. Design Longitudinal cohort study of adults who underwent EMG and subsequent transforaminal ESI within 6 months. The proportion of individuals who experienced >50% pain relief and mean change in daily morphine equivalents (DME) were calculated. Results 170 individuals with respective mean (Standard Deviation) age and duration of symptoms of 55 (15) years and 36 (56) months were included. Mean time to <30 day and >30 day follow-up post-injection were 18 (6) and 99 (130) days, respectively. At >30 day follow-up, a larger proportion of EMG-confirmed individuals (37.7%) reported >50% pain reduction compared to EMG-negative individuals (17.8%) (p=0.03). This was significant for lumbosacral (40% vs. 15%, p=0.01) but not cervical symptoms (p>0.05). Mean decrease in DME at long-term follow-up in EMG-confirmed compared to EMG-negative individuals trended toward significance (-4 vs. -1, p=0.11). There was no significant relationship between myotomal spontaneous activity and pain or opioid use. Conclusions Needle EMG predicts long-term pain reduction from transforaminal ESI in patients with lumbosacral radiculopathy, regardless of the presence of active denervation. PMID:26251843

  9. Exserohilum infections associated with contaminated steroid injections: a clinicopathologic review of 40 cases.

    PubMed

    Ritter, Jana M; Muehlenbachs, Atis; Blau, Dianna M; Paddock, Christopher D; Shieh, Wun-Ju; Drew, Clifton P; Batten, Brigid C; Bartlett, Jeanine H; Metcalfe, Maureen G; Pham, Cau D; Lockhart, Shawn R; Patel, Mitesh; Liu, Lindy; Jones, Tara L; Greer, Patricia W; Montague, Jeltley L; White, Elizabeth; Rollin, Dominique C; Seales, Cynthia; Stewart, Donna; Deming, Mark V; Brandt, Mary E; Zaki, Sherif R

    2013-09-01

    September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratory-confirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection.

  10. Particle beam injection system

    DOEpatents

    Jassby, Daniel L.; Kulsrud, Russell M.

    1977-01-01

    This invention provides a poloidal divertor for stacking counterstreaming ion beams to provide high intensity colliding beams. To this end, method and apparatus are provided that inject high energy, high velocity, ordered, atomic deuterium and tritium beams into a lower energy, toroidal, thermal equilibrium, neutral, target plasma column that is magnetically confined along an endless magnetic axis in a strong restoring force magnetic field having helical field lines to produce counterstreaming deuteron and triton beams that are received bent, stacked and transported along the endless axis, while a poloidal divertor removes thermal ions and electrons all along the axis to increase the density of the counterstreaming ion beams and the reaction products resulting therefrom. By balancing the stacking and removal, colliding, strong focused particle beams, reaction products and reactions are produced that convert one form of energy into another form of energy.

  11. Diesel fuel injection system

    SciTech Connect

    Schechter, M.M.; Simko, A.O.

    1986-04-22

    A fuel injection pump is described of the multiple plunger spill port type for an automotive type internal combustion engine, the pump including at least four axially spaced engine camshaft driven pump plungers grouped in pairs and sequentially and in succession moved in one direction through a fuel pumping stroke and oppositely through a fuel intake stroke. A fuel pressurization/supply chamber is contiquous to the end of each plunger for pressurization of the fuel therein or supply of fuel thereto from a supply passage upon coordinate movement of the plunger, fill/spill passage means connected to a single fuel return spill port and in parallel flow relationship to each of the plunger bores as a function of the position of the plungers, each plunger having a pair of internal passages connected at all times to its chamber and alternately alignable with the supply or fill/spill passage means as a function of the position of the plunger. A fuel discharge passage is operatively connecting each of the chambers to an individual engine cylinder, a single spill port control valve movable to block or permit the spill of fuel through the spill port to a return line to control the pressurization of fuel in all of the fuel chambers and associated discharge passages, a single solenoid connected to the spill control valve for moving it to block or unblock the spill port, and a single shuttle valve operatively associated with all of the fill/spill passage means and spill port reciprocably movable between positions to sequentially connect the plunger chambers one at a time in succession to the spill port during the pumping pressurization stroke of its plunger for the injection of fuel to an individual cylinder while the other chambers are in various stages of being refilled with fuel and preparing for pressurization upon successive actuation of the plungers by the camshaft.

  12. Editorial Commentary: Big Data Suggest That Because of a Significant Increased Risk of Postoperative Infection, Steroid Injection Is Not Recommended After Ankle Arthroscopy.

    PubMed

    Brand, Jefferson C

    2016-02-01

    A recent study addressing infection rate after intra-articular steroid injection during ankle arthroscopy gives pause to this practice, with an odds ratio of 2.2 in the entire population that was injected with a steroid simultaneously with ankle arthroscopy compared with patients who did not receive an ankle injection. Big data, used in the study upon which the Editor comments here, suggest that because of a significant increased risk of postoperative infection, steroid injection is not recommended after ankle arthroscopy. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. A liposomal steroid nano-drug for treating systemic lupus erythematosus.

    PubMed

    Moallem, E; Koren, E; Ulmansky, R; Pizov, G; Barlev, M; Barenholz, Y; Naparstek, Y

    2016-10-01

    Glucocorticoids have been known for years to be the most effective therapy in systemic lupus erythematosus. Their use, however, is limited by the need for high doses due to their unfavorable pharmacokinetics and biodistribution. We have previously developed a novel liposome-based steroidal (methylprednisolone hemisuccinate (MPS)) nano-drug and demonstrated its specific accumulation in inflamed tissues, as well as its superior therapeutic efficacy over that of free glucocorticoids (non-liposomal) in the autoimmune diseases, including the adjuvant arthritis rat model and the experimental autoimmune encephalomyelitis mouse model. In the present work we have evaluated the therapeutic effect of the above liposome-based steroidal (MPS) nano-drug in the MRL-lpr/lpr murine model of SLE and compared it with similar doses of the free MPS. MRL-lpr/lpr mice were treated with daily injections of free MPS or weekly injections of 10% dextrose, empty nano-liposomes or the steroidal nano-drug and the course of their disease was followed up to the age of 24 weeks. Treatment with the steroidal nano-drug was found to be significantly superior to the free MPS in suppressing anti-dsDNA antibody levels, proliferation of lymphoid tissue and renal damage, and in prolonging survival of animals. This significant superiority of our liposome based steroidal nano-drug administered weekly compared with daily injections of free methylprednisolone hemisuccinate in suppressing murine lupus indicates this glucocorticoid nano-drug formulation may be a good candidate for the treatment of human SLE. © The Author(s) 2016.

  14. Severe, disabling, and/or chronic penile pain associated with Peyronie disease: management with subcutaneous steroid injection.

    PubMed

    Dickstein, Rian; Uberoi, Jayant; Munarriz, Ricardo

    2010-01-01

    Penile pain is one of the most distressing, limiting, and difficult to treat manifestations of Peyronie disease. The use of steroid injections for penile deformities associated with Peyronie disease has been ineffective. However, use of steroid injections in managing penile pain has been poorly investigated. The aim of this study was to examine the efficacy and safety of subcutaneous, nonintralesional steroid injections in patients with severe, disabling, and/or chronic penile pain associated with Peyronie disease. This was a single-institution retrospective study of 16 patients with severe, disabling, and/or chronic penile pain associated with Peyronie disease who underwent subcutaneous, nonintralesional injection of triamcinolone (50 mg) between 2004 and 2006. Preinjection and postinjection analog pain scales were used to assess treatment efficacy. All 16 patients (mean age, 47.6 ± 11.1 years) had penile pain associated with erections for an average of 13.9 months (range, 3-36 months) prior to injections. Mean preinjection and postinjection penile pain scores were 6.6 ± 2.1 and 0.5 ± 0.5, respectively. On average, patients were pain free at follow-up visits within 10.6 ± 7.6 weeks. The mean pain-free duration was 23.8 months (range, 3-52 months). The mean cumulative dose of triamcinolone was 75.0 mg (range, 50-200 mg), with a mean of 1.5 injections (range, 1-4 injections). All 16 patients had overall improvement in pain scores. There were no adverse events or geometric penile changes after injections. Subcutaneous, nonintralesional injections of triamcinolone is an effective, safe, and durable means of managing severe, disabling, and/or chronic penile pain in patients with Peyronie disease. Future studies are needed to validate these findings.

  15. The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature

    PubMed Central

    Epstein, Nancy E.

    2013-01-01

    Background: Multiple type of spinal injections, whether epidural/translaminar or transforaminal, facet injections, are offered to patients with/without surgical spinal lesions by pain management specialists (radiologists, physiatrists, and anesthesiologists). Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications. Methods: For many patients with spinal pain alone and no surgical lesions, the “success” of epidural injections may simply reflect the self-limited course of the disease. Alternatively, although those with surgical pathology may experience transient or no pain relief, undergoing these injections (typically administered in a series of three) unnecessarily exposes them to the inherent risks, while also delaying surgery and potentially exposing them to more severe/permanent neurological deficits. Results: Multiple recent reports cite contaminated epidural steroid injections resulting in meningitis, stroke, paralysis, and death. The Center for Disease Control (CDC) specifically identified 25 deaths (many due to Aspergillosis), 337 patients sickened, and 14,000 exposed to contaminated steroids. Nevertheless, many other patients develop other complications that go unreported/underreported: Other life-threatening infections, spinal fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary retention, allergic reactions, intravascular injections (7.9-11.6%), stroke, blindness, neurological deficits/paralysis, hematomas, seizures, and death. Conclusions: Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits. PMID:23646278

  16. Multiple epidural steroid injections and body mass index linked with occurrence of epidural lipomatosis: a case series

    PubMed Central

    2014-01-01

    Background Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space, sufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors, impact on patient’s symptoms, and its possible association with epidural steroid injections. Methods History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for epidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly selected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact of EL was determined by the patient’s history and physical examination. Logistic regression was used to correlate the probability of developing EL with BMI and epidural steroid injections. Results EL was centered at L5 and S1 segments. The average BMI for patients with EL was significantly greater than that of control group (36.0 ± 0.9 vs. 29.2 ± 0.9, p <0.01). The probability of developing EL with increasing BMI was linear up to the BMI of 35 after which it plateaued. Triglycerides were significantly higher for the EL group as compared to controls (250 ± 30 vs. 186 ± 21 mg/dL p < 0.01). The odds of having EL were 60% after two epidural steroid injections, 90% after three epidural steroid injections and approached 100% with further injections, independent of BMI. Other risk factors considered included alcohol abuse, use of protease inhibitors, levels of stress, hypothyroidism and genetic predisposition. However there were insufficient quantities to determine statistical significance with a degree of confidence. The impact of EL on patient’s symptoms correlated with EL severity with Spearman correlation coefficient of 0.73 at p < 0.01 significance level. Conclusions The BMI and triglycerides levels were found to be significantly elevated for the EL group, pointing to an increased

  17. The Safety of CT-Guided Epidural Steroid Injections in an Older Patient Cohort.

    PubMed

    Fenster, Andrew J; Fernandes, Kevin; Brook, Alan L; Miller, Todd

    2016-01-01

    Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult US population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure's safety profile in an older patient population. This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. An Institutional Review Board (IRB)-approved retrospective chart review. University hospital center. A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). This study is limited by its retrospective design. CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP's and without complications in an older patient population. Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure.

  18. A Randomized Controlled Clinical Trial to Determine the Effectiveness of Caudal Epidural Steroid Injection in Lumbosacral Sciatica

    PubMed Central

    Chowdhery, Abhishek

    2017-01-01

    Introduction Caudal epidural steroid injection have been a part of nonsurgical management of lumbosacral sciatica since last half a century but various randomized controlled trials fail to provide convincing evidence in favour of its effectiveness. Aim To assess the efficacy of caudal epidural steroid injection in patients of lumbosacral sciatica in comparison to placebo. Materials and Methods The study consisted of patients of sciatica caused by lumbosacral disc prolapse (observed on Magnetic Resonance Imaging (MRI) scan). Caudal epidural injections of 80 mg methyl prednisolone were injected in 47 patients in one group. The other group consisted of 46 patients who were injected isotonic saline as placebo. Self-evaluation was the main judgment criterion at 4th week using a descriptive four item scale (recovery, marked improvement, slight improvement, or worse). Patients rating the improvement as “recovery” or “marked improvement” were considered as success. Patients rating the improvement as “slight improvement” or “worse” were considered as failure. Only paracetamol were authorized and patients requiring Non Steroidal Anti-inflammatory Drugs (NSAIDs) before 4th week were also considered as failure. Results On analysis per protocol, at 4 weeks, the two groups differed significantly with respect to the primary outcome: among the 93 patients, 8/46 (17%) in the placebo group and 32/47 (68%) in the steroid group (p=0.000) were considered as success (difference 50.7%; 95% CI for the difference 33.4 to 67.99). But at the end of the study (week 12) there was no significant difference in primary outcome between the groups: 22/46 (48%) patients in the placebo group and 28/47 (60%) in the steroid group (p=0.25) were considered as success (difference 11.8%; 95% CI for the difference -8.38 to 31.9). Conclusion Caudal epidural steroid injections provide no additional improvement over placebo in the long term natural history of lumbosacral sciatica. However, it

  19. Confirmation and 3D profiling of anabolic steroid esters in injection sites using imaging desorption electrospray ionisation (DESI) mass spectrometry.

    PubMed

    de Rijke, Eva; Hooijerink, Dick; Sterk, Saskia S; Nielen, Michel W F

    2013-01-01

    In this study, desorption electrospray ionisation (DESI) linear ion trap tandem mass spectrometry (MS(n)) was applied for the confirmation and three-dimensional profiling of anabolic steroid esters in an injection site of bovine muscle. The spatial resolution of the DESI-MS(n) was demonstrated by scanning hormone esters and marker ink lines drawn at various distances on a microscopic slide at set distances, using an x-scanner with manual y and z adjustment. Tissue slices of bovine muscle injected with a hormone cocktail were analysed. All anabolic steroid esters could be directly detected in the sample and confirmed on the basis of identification points awarded for selected MS/MS transitions according to the performance criteria given in Commission Decision 2002/657/EC. Moreover, the injection site could be mapped by two-dimensional and three-dimensional imaging MS, showing a horizontal and vertical distribution through the muscle tissue. This DESI approach offers potential for analysis of injection sites of steroid esters from illegally treated animals; moreover, direct analysis by ambient imaging DESI-MS still allows conventional extraction and analysis of the whole tissue for further confirmatory or contra-analysis afterwards.

  20. Fluoroscopy-guided Sacroiliac Joint Steroid Injection for Low Back Pain in a Patient with Osteogenesis Imperfecta

    PubMed Central

    Dawson, PUA; Rose, REC; Wade, NA

    2015-01-01

    ABSTRACT Background: Osteogenesis imperfecta, also known as ‘brittle bone disease’, is a genetic connective tissue disease. It is characterized by bone fragility and osteopenia (low bone density). In this case, a 57-year old female presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation Clinic with left low back pain rated 6/10 on the numeric rating scale (NRS). Clinically, the patient had sacroiliac joint-mediated pain although X-rays did not show the sacroiliac joint changes. Fluoroscopy-guided left sacroiliac joint steroid injection was done. Methods: Numeric rating scale and Oswestry Disability Index (ODI) questionnaire were used to evaluate outcome. This was completed at baseline, one week follow-up and at eight weeks post fluoroscopy-guided sacroiliac joint steroid injection. Results: Numeric rating scale improved from 6/10 before the procedure to 0/10 post procedure, and ODI questionnaire score improved from a moderate disability score of 40% to a minimal disability score of 13%. Up to eight weeks, the NRS was 0/10 and ODI remained at minimal disability of 15%. Conclusion: Fluoroscopy-guided sacroiliac joint injection is a known diagnostic and treatment method for sacroiliac joint mediated pain. To our knowledge, this is the first case published on the use of fluoroscopy-guided sacroiliac joint steroid injection in the treatment of sacroiliac joint mediated low back pain in a patient with osteogenesis imperfecta. PMID:26624601

  1. Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions.

    PubMed

    Wang, Chi-Te; Lai, Mei-Shu; Hsiao, Tzu-Yu

    2015-09-01

    This study investigated multidimensional treatment outcomes, including prognostic factors and side effects of vocal fold steroid injection (VFSI). We recruited 126 consecutive patients, including patients with 49 nodules, 47 polyps, and 30 mucus retention cysts. All the patients received VFSI under local anesthesia in the office settings. Treatment outcomes were evaluated 1 and 2 months after the procedure, including endoscopic evaluation, perceptual voice quality (GRB scores), acoustic analysis, and 10-item Voice Handicap Index (VHI-10). More than 80% of the patients reported subjective improvements after VFSI. Objective measurements revealed significant improvements from baseline in most of the outcome parameters (P<0.05). Higher occupational vocal demands and fibrotic vocal nodules were significantly associated with poorer clinical responses as measured by the VHI-10 and GRB scores, respectively. For vocal polyps, dysphonia for more than 12 months were significantly associated with higher postoperative VHI-10 scores, whereas patients with laryngopharyngeal reflux (LPR) showed significantly poor postoperative voice quality as measured by GRB scores. Side effects after VFSI included hematoma (27%), triamcinolone deposits (4%), and vocal atrophy (1%), which resolved spontaneously within 1-2 months. Presentation with vocal fold ectasias/varicosities and higher vocal demands were significantly correlated with postoperative vocal hematoma. This study demonstrated significant improvements after VFSI in vocal nodules, polyps, and cysts. Occupational vocal demand and subtypes of vocal nodules are closely related to the treatment outcomes after VFSI, whereas symptom duration and LPR were significant prognostic factors for VFSI treatment outcomes in vocal polyps. Side effects after receiving VFSI were mostly self-limited without sequel, whereas the incidence rates might be varied by the injection approach and the timing for postoperative follow-up. Copyright © 2015 The

  2. Factors Affecting Radiation Exposure during Lumbar Epidural Steroid Injection: A Prospective Study in 759 Patients

    PubMed Central

    Kim, Suyoung; Shin, Joon-Ho; Lee, Joon Woo; Kang, Heung Sik; Lee, Guen Young

    2016-01-01

    Objective To estimate and compare radiation exposure and intervention time during lumbar epidural steroid injection (ESI) 1) under different practitioners and methods with continuous fluoroscopic monitoring, and 2) under one practitioner with different methods and monitoring. Materials and Methods We consecutively recruited 804 patients who underwent lumbar ESI and 759 patients who underwent 922 interventions were included for analysis in this investigation. Three different practitioners (a senior faculty member, junior faculty member, trainee) performed lumbar ESI using different methods (caudal, interlaminar, transforaminal). The senior faculty member performed lumbar ESI under two different methods of fluoroscopic monitoring (continuous [CM] and intermittent monitoring [IM]). The dose area product (DAP) fluoroscopy time, and intervention time during lumbar ESI were compared for 1) ESI methods and practitioners under CM, and 2) ESI methods and monitoring. Results With CM, interaction between the effects of the practitioner and the intervention on DAP was significant (p < 0.001), but not fluoroscopy time (p = 0.672) or intervention time (p = 0.852). The significant main effects included the practitioner and intervention on DAP, fluoroscopy time, and intervention time with CM (p < 0.001). DAPs and fluoroscopy time for caudal, interlaminar, and transforaminal ESI were higher with CM than with IM (p < 0.001). Intervention time did not differ between CM and IM. Conclusion Radiation exposure is dependent on the practitioners and methods and within the established safety limits during lumbar ESIs under CM. With an experienced practitioner, IM leads to less radiation exposure than CM. PMID:27134528

  3. Isolated oculomotor nerve palsy after lumbar epidural steroid injection in a diabetic patient

    PubMed Central

    Gozal, Yair M.; Atchley, Kristine; Curt, Bradford A.

    2016-01-01

    Background: In patients with diabetes mellitus, epidural steroid injections (ESI) have been noted to cause significant elevation of blood glucose levels, typically lasting 1–3 days. Here, we describe a previously unreported complication of a diabetic third nerve palsy associated with an ESI. Case Description: A 66-year-old man with a history of coronary artery disease, hypertension, and insulin-dependent diabetes mellitus presented with low back pain and left lower extremity radiculopathy. The lumbar magnetic resonance imaging (MRI) revealed mild spondylosis, most severe at the L4-5 level, accompanied by a broad based disc protrusion resulting in mild central and moderate biforaminal stenosis. The patient underwent a left-sided L4-L5 transforaminal ESI resulting in transient elevation of his blood glucose levels. On post-procedure day 2, he developed a frontal headache and a complete right third nerve palsy with partial pupillary involvement. The MRI and MR angiography (MRA) of the brain revealed no compressive lesions or oculomotor abnormalities. Ophthalmoplegia and pupillary dysfunction resolved spontaneously over 4 months. Conclusions: Although rare, a history of a recent ESI should be considered as the etiology of an isolated oculomotor palsy in diabetic patients. PMID:28144494

  4. Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity.

    PubMed

    Mori, H; Rafiq, K; Kobara, H; Fujihara, S; Nishiyama, N; Kobayashi, M; Himoto, T; Haba, R; Hagiike, M; Izuishi, K; Okano, K; Suzuki, Y; Masaki, T

    2012-07-01

    Endoscopic submucosal dissection (ESD) of large gastric lesions results in an extensive artificial ulcer that can lead to marked gastric deformity. The aim of the current study was to evaluate therapeutic efficacy in the prevention of gastric deformity of local triamcinolone acetonide (TCA) injection into the extensive artificial ulcer following ESD. A total of 45 patients who were diagnosed with early gastric cancer were enrolled. Patients were randomly assigned by the sealed-envelope randomization method to either local TCA injections (n = 21) or sham-control (n = 20) groups. Two clips were placed at the two maximum outer edges of the artificial ulcer after the lesion had been resected (Day 0). Local TCA injections were performed on postoperative Day 5 and Day 12. The distance between the two clips was measured by endoscopic measuring forceps on Days 5, 12, 30, and 60. Granulation formation and gastric deformity were evaluated by visual analog scale (VAS) on Days 30 and 60. Local TCA injection did not alter clip-to-clip distance on postoperative Day 60, and formation of flat granulation tissue over the ulcer was followed by regenerative mucosa without any gastric deformity. The sham-control group showed significant shortening of clip-to-clip distance compared with the local steroid-injected group and protruded forms of granulation tissue with mucosal convergence. Histological evaluation revealed prominent growth of neovessels, swelling, and marked increases in endothelial cells in the local steroid-injected group compared with the sham-control group. Local steroid injection into the floor of a post-ESD artificial ulcer promotes the formation of granulation tissue at an early stage of the healing process leading to regeneration of gastric mucosa without mucosal convergence or gastric deformity. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study

    PubMed Central

    Hanling, Steven; Bicket, Mark C; White, Ronald L; Veizi, Elias; Kurihara, Connie; Zhao, Zirong; Hayek, Salim; Guthmiller, Kevin B; Griffith, Scott R; Gordin, Vitaly; White, Mirinda Anderson; Vorobeychik, Yakov; Pasquina, Paul F

    2015-01-01

    Objective To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy. Design A multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes. Settings Eight military, Veterans Administration, and civilian hospitals. Participants 145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain. Interventions Participants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin. Main outcome measures Average leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit. Results There were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline −2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and −1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval −0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline −2.0 (SD 2.6) versus 3.7 (SD 2.8) and −1.6 (SD 2.7), respectively; adjusted difference 0.3, −0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (−3.0, SD 2.8) than those treated with gabapentin (−2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three

  6. Sodium storage and injection system

    NASA Technical Reports Server (NTRS)

    Keeton, A. R. (Inventor)

    1979-01-01

    A sodium storage and injection system for delivering atomized liquid sodium to a chemical reactor employed in the production of solar grade silicon is disclosed. The system is adapted to accommodate start-up, shut-down, normal and emergency operations, and is characterized by (1) a jacketed injection nozzle adapted to atomize liquefied sodium and (2) a supply circuit connected to the nozzle for delivering the liquefied sodium. The supply circuit is comprised of a plurality of replaceable sodium containment vessels, a pump interposed between the vessels and the nozzle, and a pressurizing circuit including a source of inert gas connected with the vessels for maintaining the sodium under pressure.

  7. A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3).

    PubMed

    Mizutani, Tomonori; Tanaka, Masaki; Eba, Junko; Mizusawa, Junki; Fukuda, Haruhiko; Hanaoka, Noboru; Takeuchi, Manabu; Aoyama, Ikuo; Kojima, Takashi; Takizawa, Kohei; Ono, Hiroyuki; Muto, Manabu

    2015-11-01

    A randomized Phase III trial commenced in Japan in September 2014. Endoscopic local steroid injection has been commonly used and considered acceptable as the current standard treatment for the prevention of esophageal stricture after endoscopic submucosal dissection for superficial esophageal cancer. The purpose of this study is to confirm the superiority of prophylactic oral steroid administration following endoscopic submucosal dissection in terms of stricture-free survival over endoscopic local steroid injection for patients with superficial esophageal cancer. A total of 360 patients will be accrued from 35 Japanese institutions within 2.5 years. The primary endpoint is stricture-free survival, and the secondary endpoints are the number of endoscopic balloon dilations for 12 weeks after endoscopic submucosal dissection, adverse events, serious adverse events and the proportion of patients with dysphagia score ≤1 at 12 weeks after endoscopic submucosal dissection. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000015064 (http://www.umin.ac.jp/ctr/index.htm). © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Miniaturized flow injection analysis system

    DOEpatents

    Folta, J.A.

    1997-07-01

    A chemical analysis technique known as flow injection analysis is described, wherein small quantities of chemical reagents and sample are intermixed and reacted within a capillary flow system and the reaction products are detected optically, electrochemically, or by other means. A highly miniaturized version of a flow injection analysis system has been fabricated utilizing microfabrication techniques common to the microelectronics industry. The microflow system uses flow capillaries formed by etching microchannels in a silicon or glass wafer followed by bonding to another wafer, commercially available microvalves bonded directly to the microflow channels, and an optical absorption detector cell formed near the capillary outlet, with light being both delivered and collected with fiber optics. The microflow system is designed mainly for analysis of liquids and currently measures 38{times}25{times}3 mm, but can be designed for gas analysis and be substantially smaller in construction. 9 figs.

  9. Miniaturized flow injection analysis system

    DOEpatents

    Folta, James A.

    1997-01-01

    A chemical analysis technique known as flow injection analysis, wherein small quantities of chemical reagents and sample are intermixed and reacted within a capillary flow system and the reaction products are detected optically, electrochemically, or by other means. A highly miniaturized version of a flow injection analysis system has been fabricated utilizing microfabrication techniques common to the microelectronics industry. The microflow system uses flow capillaries formed by etching microchannels in a silicon or glass wafer followed by bonding to another wafer, commercially available microvalves bonded directly to the microflow channels, and an optical absorption detector cell formed near the capillary outlet, with light being both delivered and collected with fiber optics. The microflow system is designed mainly for analysis of liquids and currently measures 38.times.25.times.3 mm, but can be designed for gas analysis and be substantially smaller in construction.

  10. Unnecessary multiple epidural steroid injections delay surgery for massive lumbar disc: Case discussion and review

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Epidural steroid injections (ESI) in the lumbar spine are not effective over the long-term for resolving “surgical” lesions. Here, we present a patient with a massive L2–L3 lumbar disk herniation whose surgery was delayed for 4 months by multiple unnecessary ESI, resulting in a cauda equina syndrome. Methods: A 54-year-old male acutely developed increased low back and radiating left leg pain in October of 2014. In December of 2014, a magnetic resonance imaging (MRI) scan showed a massive central/left sided disk herniation at the L2–L3 level resulting in marked thecal sac and left L2 foraminal and L3 lateral recess root compression. Despite the marked degree of neural compression, pain management treated him with 3 ESI over the next 3 months. Results: At the end of April of 2015, he presented to spine surgeon with a cauda equina syndrome. When the new MRI scan confirmed the previously documented massive central-left sided L2–L3 disk herniation, the patient emergently underwent an L1–L3 laminectomy with central-left sided L2–L3 lateral/foraminal diskectomy. Postoperatively, the patient was neurologically intact. Conclusions: Pain specialists performed multiple unnecessary lumbar ESI critically delaying spinal surgery for 4 months in this patient with a massive lumbar disk herniation who ultimately developed a cauda equina syndrome. Unfortunately, pain specialists (e.g., radiologists, anesthesiologists, and physiatrists), not specifically trained to perform neurological examinations or spinal surgery, are increasingly mismanaging spinal disease with ESI/variants. It is time for spine surgeons to speak out against this, and “take back” the care of patients with spinal surgical disease. PMID:26425398

  11. Comparison of clinical efficacy in epidural steroid injections through transforaminal or parasagittal approaches.

    PubMed

    Hong, Ji Hee; Park, Eun Kyul; Park, Ki Bum; Park, Ji Hoon; Jung, Sung Won

    2017-07-01

    The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI. A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated. Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm(2)]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds). ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI.

  12. Comparison of clinical efficacy in epidural steroid injections through transforaminal or parasagittal approaches

    PubMed Central

    Park, Eun Kyul; Park, Ki Bum; Park, Ji Hoon; Jung, Sung Won

    2017-01-01

    Background The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI. Methods A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated. Results Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm2]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds). Conclusions ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI. PMID:28757923

  13. 21 CFR 862.1385 - 17-Hydroxycorticosteroids (17-ketogenic steroids) test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false 17-Hydroxycorticosteroids (17-ketogenic steroids... Clinical Chemistry Test Systems § 862.1385 17-Hydroxycorticosteroids (17-ketogenic steroids) test system. (a) Identification. A 17-hydroxycorticosteroids (17-ketogenic steroids) test system is a...

  14. 21 CFR 862.1385 - 17-Hydroxycorticosteroids (17-ketogenic steroids) test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false 17-Hydroxycorticosteroids (17-ketogenic steroids... Clinical Chemistry Test Systems § 862.1385 17-Hydroxycorticosteroids (17-ketogenic steroids) test system. (a) Identification. A 17-hydroxycorticosteroids (17-ketogenic steroids) test system is a...

  15. 21 CFR 862.1385 - 17-Hydroxycorticosteroids (17-ketogenic steroids) test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false 17-Hydroxycorticosteroids (17-ketogenic steroids... Clinical Chemistry Test Systems § 862.1385 17-Hydroxycorticosteroids (17-ketogenic steroids) test system. (a) Identification. A 17-hydroxycorticosteroids (17-ketogenic steroids) test system is a...

  16. A Randomized Prospective Comparison of Ultrasound-Guided and Landmark-Guided Steroid Injections for Carpal Tunnel Syndrome.

    PubMed

    Eslamian, Fariba; Eftekharsadat, Bina; Babaei-Ghazani, Arash; Jahanjoo, Fateme; Zeinali, Mojgan

    2017-03-01

    The aim of this study was to compare the clinical and electrodiagnostic efficacy of ultrasound (US)-guided versus landmark (LM)-guided steroid injections in patients with carpal tunnel syndrome (CTS). This randomized clinical trial included 47 patients (60 affected hands) with moderate CTS (30 hands in each group). All clinically suspected patients with CTS who met the inclusion criteria confirmed by electrodiagnostic tests were enrolled. The subjects received 40 mg of methylprednisolone either with the US-guide or the LM-guided injection technique. They were evaluated using the Boston Carpal Tunnel Questionnaire (symptom/function/total) and 6 electrodiagnostic findings at the baseline and 12 weeks after injection. Symptom severity scores and functional status scores and electrodiagnostic parameters were significantly improved within each group at week 12 after treatment (P < 0.05), except for compound muscle action potential amplitude and motor nerve conduction velocity (P > 0.05). The improvement in symptom severity scores and functional status scores in the US-guided group was more than in the LM-guided group after 12 weeks, but there was no statistically significant difference (P = 0.79 and 0.64). The mean changes in electrodiagnostic parameters were also not different between groups except for the higher sensory nerve action potential amplitude in LM-guided group (P = 0.003). Both US-guided and LM-guided steroid injections were effective in reducing the symptoms, improving the function and electrodiagnostic findings of CTS. Although there was better symptomatic improvement with US-guided injections and better increase in sensory nerve action potential amplitude with LM-guided injection, a significant difference was not generally observed between US-guided and LM-guided CTS injections.

  17. Comparative Study of: Non-Invasive Conservative Treatments with Local Steroid Injection in the Management of Planter Fasciitis

    PubMed Central

    Iraqi, Aftab Ahmed; Narula, Kusum; Katyal, Rashmi; Saxena, Mridul Shanker

    2014-01-01

    Background: Planter Fasciitis is an annoying and painful condition that limits function. There is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking and is considered a self limiting condition. Symptoms resolve in 80% to 90% of cases within ten months. However, this long interval is frustrating for both patients and clinicians. Aim: This study was undertaken to compare the two different modalities of non operative treatment: Non- invasive conservative methods: NSAID’s, Soft Insoles, Stretching, Ultrasound therapy and Contrast baths versus local Steroid injection therapy. Materials and Methods: Patients by random sampling were divided in two groups. Group A as: Conservative group and Group B as Local Steroid Injections group, 100 patients in each. Patients were assessed as per Visual Analogue Scale (VAS) at the start of treatment and then after 4 wk and 8 wk duration on follow up. Statistical analysis used: SPSS for Windows (version 10.0) by the Chi-Square test. Results: The difference in the distribution of subjects belonging to either of the treatment modalities regarding the treatment outcome at four and eight week was found to be statistically insignificant. Conclusion: As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach because this can save the patients from the complications of steroid therapy. PMID:25386470

  18. Factitial soft tissue pseudotumor due to injection of anabolic steroids: a report of 3 cases in 2 patients.

    PubMed

    Weinreb, Ilan; Goldblum, John R; Rubin, Brian P

    2010-03-01

    Traumatically induced inflammation or reactive processes are a relatively well-known phenomenon in both skin and soft tissue. These include panniculitides, fat necrosis, nodular fasciitis, and nonspecific fibrosis. Occasionally, traumatic reactions can be associated with factitial injury due to self-induced blunt trauma or injection of chemical agents. Factitial pseudotumors of soft tissue mimicking neoplasms and occurring in deep-seated locations are rare and not well recognized. We have had the opportunity to review a handful of cases over the years of soft tissue pseudotumors caused by self injection of steroids for the purposes of bodybuilding. Three of these cases in 2 patients are presented here. One patient developed a deep lateral thigh mass that was radiologically suspicious for sarcoma but upon core biopsy was found to be a lipogranulomatous reaction. The second patient had 2 masses occurring in the upper and lower extremity with an interval of 1 year between the two. This patient had both masses resected. The first had the appearance of a giant cell tumor with no immediately discernible foreign material. The second mass was initially presumed to be a metastasis from the upper extremity tumor and showed similar areas to the first specimen; however, it also had areas of obvious reactive features with foreign material. These features were found in the first tumor as well upon retrospective review. Both patients admitted to self injection of anabolic steroids after further history was sought by the clinicians. Deep soft tissue pseudosarcomas caused by injection of steroids are not well documented, and patient's reluctance to provide this information leads to difficulty in arriving at a correct diagnosis. Recognition of this possibility is important in avoiding incorrect diagnoses and unnecessary treatments.

  19. In vivo absorption of steroidal hormones from smart polymer based delivery systems.

    PubMed

    Chen, Sibao; Pederson, Daniel; Oak, Mayura; Singh, Jagdish

    2010-08-01

    The purpose of this study was to develop smart polymer based controlled delivery systems to deliver steroidal hormones after single subcutaneous (s.c.) injection at predetermined rates over extended period of time. In vivo absorption and pharmacokinetics of levonorgestrel (LNG) and testosterone (TSN) were investigated from the thermosensitive and phase sensitive polymeric controlled delivery systems. A selective, reliable, and rapid method for determination of serum LNG concentration was developed using high-performance liquid chromatography-tandom mass spectrometry with atmospheric pressure chemical ionization interface (HPLC-MS-MS with APCI), while TSN in serum samples was detected and quantified by a competitive immunoassay. The delivery systems controlled the absorption of LNG in rabbits up to 6 weeks from thermosensitive and approximately 4 weeks from phase sensitive polymeric delivery systems. In vivo study of TSN delivery systems in castrated rabbits controlled the release of TSN for at least 2 months from both thermosensitive and phase sensitive polymers. Thermosensitive and phase sensitive polymer formulations significantly (p < 0.05) increased relative bioavailability of steroidal hormones compared to control. In conclusion, thermosensitive and phase sensitive polymer based delivery systems controlled the release in vivo in rabbits for longer duration after single s.c. injection. (c) 2010 Wiley-Liss, Inc. and the American Pharmacists Association

  20. A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis.

    PubMed

    Kim, Joon Yub; Chung, Seok Won; Kim, Joo Hak; Jung, Jae Hong; Sung, Gwang Young; Oh, Kyung-Soo; Lee, Jong Soo

    2016-03-01

    Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment. (1) Which treatment (compression bandaging with nonsteroidal antiinflammatory drugs [NSAIDs], aspiration, or aspiration with steroid injections) is associated with the highest likelihood of resolution of nonseptic olecranon bursitis? (2) Which treatment is associated with earliest resolution of symptoms? (3) What factors are associated with treatment failure by 4 weeks? We enrolled 133 patients from two centers; after applying prespecified exclusions (septic bursitis or concomitant inflammatory arthritis, intraarticular elbow pathology, recent aspiration or steroid injection done elsewhere, and refusal to participate), 90 patients were randomly allocated to receive compression bandaging with NSAIDs (C), aspiration (A), or aspiration with steroid injection (AS) groups (30 patients in each). The groups were similar at baseline in terms of age and gender. Seven patients (four from Group A and three from Group AS) were lost to followup. All patients were followed up weekly for 4 weeks, and the same treatment procedure was repeated if the bursitis recurred with any substantial fluid collection. At 4 weeks, the state of resolution and pain visual analog scale (VAS) were evaluated. Failed resolution was defined as presence of persistent olecranon bursal fluid collection at Week 4 after the initiation of the treatment; on the contrary, if bursal fluid collection was clinically reduced or completely disappeared by the end of Week 4, the treatment was considered successful. We compared the proportion of resolution by Week 4 and the median times to resolution among the treatment groups. In addition, we evaluated whether the resolution affected pain VAS and what factors were associated with the resolution. There were no differences in the proportion of patients whose bursitis resolved by Week 4

  1. Pushing quantitation limits in micro UHPLC-MS/MS analysis of steroid hormones by sample dilution using high volume injection.

    PubMed

    Márta, Zoltán; Bobály, Balázs; Fekete, Jenő; Magda, Balázs; Imre, Tímea; Mészáros, Katalin Viola; Szabó, Pál Tamás

    2016-09-10

    Ultratrace analysis of sample components requires excellent analytical performance in terms of limits of quantitation (LoQ). Micro UHPLC coupling with sensitive tandem mass spectrometry provides state of the art solutions for such analytical problems. Decreased column volume in micro LC limits the injectable sample volume. However, if analyte concentration is extremely low, it might be necessary to inject high sample volumes. This is particularly critical for strong sample solvents and weakly retained analytes, which are often the case when preparing biological samples (protein precipitation, sample extraction, etc.). In that case, high injection volumes may cause band broadening, peak distortion or even elution in dead volume. In this study, we evaluated possibilities of high volume injection onto microbore RP-LC columns, when sample solvent is diluted. The presented micro RP-LC-MS/MS method was optimized for the analysis of steroid hormones from human plasma after protein precipitation with organic solvents. A proper sample dilution procedure helps to increase the injection volume without compromising peak shapes. Finally, due to increased injection volume, the limit of quantitation can be decreased by a factor of 2-5, depending on the analytes and the experimental conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. [Evaluation of the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy].

    PubMed

    Riboud, C; Lerais, J M; Sailley, N; Kastler, B

    2008-06-01

    To evaluate the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy. Seventy patients underwent CT guided injections after failure of medical management. Only patients with minimal degenerative changes and diskogenic monoradicular symptoms were treated. Only two patients with fibrosis were included. 78.6% of patients experienced persistent symptomatic improvement. No difference was noted between lumbar segments and there was no more failures with epidural injections compared to transforaminal injections. Cervical disk herniations responded better than lumbar disk herniations. Good results were obtained in younger patients (M=46.25 years), symptomatic for 3-4 months or less, and with clear radicular symptoms and clinical neurological deficits (hypoesthesia, absent DTR) without motor deficit. No patient with severe spinal stenosis (S-) was included and the disk herniations were small (b1, b2, c1, c2 or d1, d2). Only a single injection was needed. Cortivazol provided superior results compared to dexamethasone. CT-guided injections should be included in the therapeutic armamentarium after standard medical management, with cure as the goal.

  3. Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy

    PubMed Central

    Yoon, Ji Young; Yoon, Young Cheol; Lee, Jongseok

    2015-01-01

    Objective The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. Materials and Methods We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. Results Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). Conclusion There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis. PMID:25995690

  4. Pitfalls in Interventional Pain Medicine: Hyponatremia after DDAVP for a Patient with Von Willebrand Disease Undergoing an Epidural Steroid Injection

    PubMed Central

    2017-01-01

    Desmopressin (DDAVP), a synthetic analog of vasopressin, has been used in patients with von Willebrand disease (VWD), mild hemophilia A, and platelet dysfunction to reduce the risk of bleeding associated with surgical and interventional procedures. We report the case of a patient with VWD presenting with a bulging disc and radicular pain that underwent transforaminal epidural steroid injections. Her course was complicated with the interval development of headaches and dizziness symptomatic of moderate hyponatremia, likely due to excessive fluid intake. This report highlights a relatively rare side effect of DDAVP when used for prophylaxis in patients with VWD and reinforces the need for vigilance in these patients. PMID:28392945

  5. Biodegradation and biocompatibility of contraceptive-steroid-loaded poly (DL-lactide-co-glycolide) injectable microspheres: in vitro and in vivo study.

    PubMed

    Dhanaraju, Magharla Dasaratha; Rajkannan, Rajagopalan; Selvaraj, Devarajan; Jayakumar, Rajadas; Vamsadhara, Chandrasekar

    2006-08-01

    A controlled-release drug delivery of contraceptive steroids levonorgestrel (LNG) and ethinyl estradiol (EE) has been developed by successful encapsulation of LNG and EE in poly (lactide-co-glycolide) (PLG) microspheres. Smooth, spherical, steroid-loaded PLG microspheres with a mean size of 10-25 microm were prepared by using the water/oil/water double-emulsion solvent evaporation method. In vitro release profiles showed an increased burst release of LNG/EE on Week 1; thereafter, the release was sustained. At the end of Week 7, the release of LNG/EE from 1:5 and 1:10 PLG microspheres was 75.64% and 62.55%. respectively. In vitro degradation studies showed that the PLG microspheres maintained surface integrity up to Week 8 and then eroded completely by Week 20. In an in vivo study, the serum concentration of LNG/EE in rats showed a triphasic release response, with an initial burst release of 8 ng/mL LNG and 14 pg/mL EE on Day 1; thereafter, a controlled release of the drugs to the systemic circulation was maintained until Week 15, maintaining constant drug levels of 2 ng/mL LNG and 3-4 pg/mL EE in the blood. Histological examination of steroid-loaded PLG microspheres injected intramuscularly into the thigh muscle of Wistar rats showed minimal inflammatory reaction, demonstrating that contraceptive-steroid-loaded microspheres were biocompatible. This controlled-release and biocompatible nature of the PLG microspheres may have potential application in contraceptive therapy.

  6. Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss.

    PubMed

    Gülüstan, Filiz; Yazıcı, Zahide Mine; Alakhras, Wesam M E; Erdur, Omer; Acipayam, Harun; Kufeciler, Levent; Kayhan, Fatma Tulin

    2016-11-22

    Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p=0.364 and p=0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    PubMed

    Armon, Carmel; Argoff, Charles E; Samuels, Jeffrey; Backonja, Misha-Miroslav

    2007-03-06

    Based on the available evidence, the Therapeutics and Technology Assessment subcommittee concluded that 1) epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments (Level C, Class I-III evidence). The average magnitude of effect is small and generalizability of the observation is limited by the small number of studies, highly selected patient populations, few techniques and doses, and variable comparison treatments; 2) in general, epidural steroid injection for radicular lumbosacral pain does not impact average impairment of function, need for surgery, or provide long-term pain relief beyond 3 months. Their routine use for these indications is not recommended (Level B, Class I-III evidence); 3) there is insufficient evidence to make any recommendation for the use of epidural steroid injections to treat radicular cervical pain (Level U).

  8. 21 CFR 862.1385 - 17-Hydroxycorticosteroids (17-ketogenic steroids) test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1385 17-Hydroxycorticosteroids (17-ketogenic steroids) test system...

  9. Negative Affect and Sleep Disturbance May Be Associated With Response to Epidural Steroid Injections for Spine-Related Pain

    PubMed Central

    Karp, Jordan F.; Yu, Lan; Friedly, Janna; Amtmann, Dagmar; Pilkonis, Paul A.

    2014-01-01

    Objective To describe whether negative affect and sleep impairment are associated with the clinical effect of epidural steroid injections (ESIs) for low back pain. Design Observational study; patients were evaluated before ESI and 1 and 3 months after ESI. Setting Spine center and related treatment sites. Participants Participants (N=158) seeking treatment for low back pain with or without radiculopathy. Intervention ESI for low back pain with or without radiculopathy. Main Outcome Measures We assessed the dependent (global pain severity for back and leg pain, pain behavior, pain interference) and independent variables (depression, sleep disturbance, and covariates of back pain response) with the Patient-Reported Outcome Measurement Information System (PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple regression and longitudinally with path analysis. Results After 1 month, sleep disturbance was the only predictor for the global ratings of improvement in back pain (R2=16.8%) and leg pain (R2=11.4%). The proportions of variance explained by sleep disturbance and negative affect for all dependent variables were greater at 3 months than 1 month. Mediation analysis was significant for negative affect for the 3-month outcomes on PROMIS pain behavior (β=.87, P<.01) and pain interference (β=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome. Conclusions Negative affect and sleep disturbance are associated with worse outcomes after ESI. Further research is needed to determine if treatment of negative affect and sleep disturbance prior to or concurrently with ESI will improve outcomes. PMID:24060493

  10. Steroid Injection and Nonsteroidal Anti-inflammatory Agents for Shoulder Pain: A PRISMA Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    PubMed

    Sun, Yaying; Chen, Jiwu; Li, Hong; Jiang, Jia; Chen, Shiyi

    2015-12-01

    Advantages and possible risks associated with steroid injection compared with nonsteroidal anti-inflammatory drugs (NSAIDs) for shoulder pain are not fully understood. To compare the efficiency and safety of steroid injection versus NSAIDs for patients with shoulder pain. PubMed, Embase, and the Cochrane Library were searched through July 2015. Study eligibility criteria, participants, and interventions: randomized controlled trials (RCTs) that assessed steroid injection versus NSAIDs for patients with shoulder pain. Study appraisal and synthesis methods: predefined primary efficacy outcome was functional improvement; and secondary efficacy outcomes included pain relief and complications. Relative risks (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model accounting for clinical heterogeneity. Eight RCTs involving 465 participants were included in the meta-analysis. Five trials compared steroid injection with oral NSAIDs, and 3 compared steroids injection with NSAIDs injection. Compared with steroid injection, oral NSAIDs were less effective in 4 or 6 weeks for functional improvement (SMD 0.61; 95% CI, 0.08-1.14; P = 0.01), while there was no significant difference in pain relief (SMD 0.45; 95% CI, -0.50-1.40; P < 0.00001) or complication rate (RR 1.10; 95% CI, 0.26-4.58; P = 0.29). Meta-analysis was not performed for NSAIDs injection due to considerable heterogeneity. Conflicting results were observed in favor of either steroid or NSAIDs injection. Not all diseases that can lead to shoulder pain were included, detailed intervention protocols were inconsistent across studies, and some estimated data were input into comparison while some data were lost, which could exert an influence on pooled results. Steroid injection, compared with oral NSAIDs, provides slightly more improvement in shoulder function without superiority in pain relief or risk of complications at 4 to 6 weeks

  11. Ultrasound-Guided Versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain

    PubMed Central

    Park, Ki Deok; Kim, Tai Kon; Lee, Woo Yong; Ahn, JaeKi; Koh, Sung Hoon; Park, Yongbum

    2015-01-01

    Abstract The aim of the article is to investigate the efficacy of ultrasound (US)-guided Caudal Epidural Steroid Injection (CESI) compared with fluoroscopy (FL)-guided CESI in patients with unilateral lower lumbar radicular pain. This case-controlled, retrospective, comparative study was done at the university hospital. A total of 110 patients treated with US- or FL-guided CESI were administered a mixture of 20 cc (0.5% lidocaine 18.0 mL + dexamethason 10 mg 2 mL). Outcome measurement was assessed by Oswestry Disability Index (ODI), verbal numeric pain scale (VNS) before injections and at 3, 6, and 12 months after the last injections. Successful outcome was defined as measured by >50% improvement in the VNS score and >40% improvement in the ODI. ODI and VNS showed improvement at 3, 6, and 12 months after the last injection in both groups. No statistical differences in ODI, VNS were observed between groups (P < 0.05). No significant differences in the proportion of patients with successful treatment were observed between the groups from the 3-month to 6-month to 12-month outcomes. US-guided CESI is deserving of consideration in conservative management of unilateral lower lumbar radicular pain. PMID:26683948

  12. Fuel injection system for diesel engines

    SciTech Connect

    Holmer, H.E.

    1981-06-16

    A fuel injection system is disclosed for direct injection diesel engines with a depression in the tops of the pistons. A first injection pump has a regulator and accompanying first injector for each cylinder , the injectors being disposed to spray the fuel in a zone around the center axis of the respective piston depression. A second injection pump has a regulator and accompanying second injector for each cylinder, the second injectors being disposed to inject fuel obliquely from the side into the respective piston depression in a direction counter to the rotation of the intake air before the fuel from the first injectors is injected.

  13. Effectiveness of splinting and splinting plus local steroid injection in severe carpal tunnel syndrome: A Randomized control clinical trial

    PubMed Central

    Khosrawi, Saeid; Emadi, Masoud; Mahmoodian, Amir Ebrahim

    2016-01-01

    Background: The Study aimed to compare the effectiveness of two commonly used conservative treatments, splinting and local steroid injection in improving clinical and nerve conduction findings of the patients with severe carpal tunnel syndrome (CTS). Materials and Methods: In this randomized control clinical trial, the patients with severe CTS selected and randomized in two interventional groups. Group A was prescribed to use full time neutral wrist splint and group B was injected with 40 mg Depo-Medrol and prescribed to use the full time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients was evaluated at baseline, 4 and 12 weeks after interventions. Results: Twenty-two and 21 patients were allocated in group A and B, respectively. Mean of clinical symptoms and functional status scores, nerve conduction variables and patients’ satisfaction score were not significant between group at baseline and 4 and 12 weeks after intervention. Within the group comparison, there was significant improvement in the patients’ satisfaction, clinical and nerve conduction items between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P < 0.01). The difference was significant for functional status score between 4 and 12 weeks after intervention in group B (P = 0.02). Conclusion: considering some findings regarding the superior effect of splinting plus local steroid injection on functional status scale and median nerve distal motor latency, it seems that using combination therapy could be more effective for long-term period specially in the field of functional improvement of CTS. PMID:26962518

  14. Common rail fuel injection system

    SciTech Connect

    Hilsbos, R.L.; Wieland, H.L.; Straub, R.D.; Teerman, R.F.; Timmer, R.C.

    1993-07-27

    A high-pressure pump is described for a fuel injection system having a fuel supply means for supplying fuel at a relatively constant pressure to the pump, the pump comprising: a pump body having a pumping chamber defined therein; a mechanically driven linearly reciprocating plunger disposed in the pumping chamber, the plunger having a head end and a tail end, the plunger being linearly reciprocatable over a stroke range between an extended position and a retracted position, the pumping chamber extending beyond the extended position of the plunger to define a head portion of the pumping chamber; plunger spring means for resiliently biasing the plunger to its retracted position; an inlet valve disposed in the pump body for admitting fuel to the pumping chamber within the stroke range of the head end of the plunger; inlet valve spring means for resiliently biasing the inlet valve to a closed position, the inlet valve being opened by a pressure differential when the head end of the plunger is retracted; an outlet valve disposed in the pump body for discharging fuel from the head portion of the pumping chamber; and outlet valve spring means for resiliently biasing the outlet valve to a closed position; the inlet valve being a ball valve; a piston, the pump body further defining therein a leakage accumulator chamber, the leakage accumulator chamber being slidably divided by the piston into an anterior portion and a posterior portion, the posterior portion being at substantially atmospheric pressure, the collector groove communicating with the anterior portion of the leakage accumulator chamber, recaptured fuel from the fuel injection nozzles also being communicated to the anterior portion of the accumulator chamber; and piston spring means for resiliently biasing the piston away from the posterior portion of the leakage accumulator chamber.

  15. Comparison Between Steroid and 2 Different Sites of Botulinum Toxin Injection in the Treatment of Lateral Epicondylalgia: A Randomized, Double-Blind, Active Drug-Controlled Pilot Study.

    PubMed

    Guo, Yao-Hong; Kuan, Ta-Shen; Chen, Kuan-Lin; Lien, Wei-Chih; Hsieh, Pei-Chun; Hsieh, I-Chieh; Chiu, Szu-Hao; Lin, Yu-Ching

    2017-01-01

    To compare the effects of 2 different injection sites of low doses of botulinum toxin type A with steroid in treating lateral epicondylalgia. Double-blind, randomized, active drug-controlled trial. Tertiary medical center. Patients with lateral epicondylalgia for >6 months were recruited from a hospital-based outpatient population (N=26). A total of 66 patients were approached, and 40 were excluded. No participant withdrew because of adverse effects. Patients were randomly assigned into 3 groups: (1) botulinum toxin epic group (n=8), who received 20U of botulinum toxin injection into the lateral epicondyle; (2) botulinum toxin tend group (n=7), who received 20U of botulinum toxin injected into tender points of muscles; and (3) steroid group (n=11), who received 40mg of triamcinolone acetonide injected into the lateral epicondyle. A visual analog scale, a dynamometer, and the Patient-Rated Tennis Elbow Evaluation were used to evaluate the perception of pain, maximal grip strength, and functional status, respectively. Outcome measures were assessed before intervention and at 4, 8, 12, and 16 weeks after treatment. The primary outcome measure was a visual analog scale. At 4 weeks after injection, the steroid group was superior to the botulinum toxin tend group in improvement on the visual analog scale (P=.006), grip strength (P=.03), and Patient-Rated Tennis Elbow Evaluation (P=.02). However, these differences were not observed at the 8-, 12-, and 16-week follow-up assessments. There was no significant difference between the steroid and botulinum toxin epic groups. Injections with botulinum toxin and steroid effectively reduced pain and improved upper limb function in patients with lateral epicondylalgia for at least 16 weeks. The onset of effect was earlier in the steroid and botulinum toxin epic groups than in the botulinum toxin tend group. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Robotic Male Vas Deferens Intraluminal Injection System

    DTIC Science & Technology

    2001-10-25

    controls an electro-mechanical device which assists the medical personnel’s hand holding the injection syringe to approach the biological structure... contraception . The system may be adapted for injection into blood vessels. Key Words: Injection; multimodal imaging; feedback electro-mechanical...based piston drive does not give the necessary "feel" required for correct injection. The force involved in free hand drive of the syringe piston

  17. [Influence of steroid therapy local injection of steroidal in the region of the stylomastoid foramen and physiotherapy on the recovery of stapedial reflex in patients with facial nerve paralysis].

    PubMed

    Krukowska, Jolanta; Czernicki, Jan; Zalewski, Piotr

    2004-01-01

    There are much more publications which informates about positive effects of advisability propose steroid's cure in patients with facial nerve palsy. The aim of the studies was to evaluate the influence of steroidal and physical treatment on the recovery of stapedial reflex and of functions of the damaged nerve. The studies were performed on 37 patients with palsy of facial nerve. Taking into account the stapedial reflex (before the beginning of the treatment) and local injection of steroidal in the region of the stylomastoid foramen, the patients were divided into two groups: I group--21 persons with lacking stapedial reflex, who were not given steroid, II group--16 persons with lacking stapedial reflex who received steroid. Evaluation of results of treatment was performed by means of the Pietruski, House and Brackmann scales, registration of stapedial reflex and accommodation coefficient. The results indicate that local steroid in palsy facial nerve is the treatment of choice in cases of intratemporal branches injury (lack of stapedial reflex) and shortens of duration of stapedial reflex and the nerve function recovery.

  18. Relationship between bone mineral density and the frequent administration of epidural steroid injections in postmenopausal women with low back pain.

    PubMed

    Kim, Sungyun; Hwang, Byeongmun

    2014-01-01

    Epidural steroid injection (ESI) is one of the most common nonsurgical treatments for low back pain. In general, corticosteroid therapy often results in bone loss and osteoporosis. In previous studies, bone mineral density (BMD) was evaluated after epidural injections of relatively small numbers and relatively low total doses of corticosteroids. However, the relationship between BMD and multiple ESIs remains to be elucidated. To explore the relationship between BMD and multiple ESIs in postmenopausal women with low back pain. Medical records of postmenopausal women with low back pain treated with or without ESIs were reviewed. BMD was measured in the lumbar spine, femoral neck and total femur after the treatments. A total of 71 patients were divided into two groups: group 1 included patients who had received non-ESI medications; and group 2 included those who had received ESIs >10 times, with a cumulative administered triamcinolone dose >200 mg. Patients in group 2 showed lower BMD in the femoral neck and total femur. However, no significant intergroup differences in the BMD of the lumbar spine were observed. The prevalences of osteoporosis and osteopenia in the lumbar spine and femoral neck were significantly higher in group 2; these patients also had lower femoral neck BMD Z-scores. Multiple ESIs (approximately 14 injections with a cumulative triamcinolone dose of approximately 400 mg) can reduce BMD in postmenopausal women with low back pain.

  19. Relationship between bone mineral density and the frequent administration of epidural steroid injections in postmenopausal women with low back pain

    PubMed Central

    Kim, Sungyun; Hwang, Byeongmun

    2014-01-01

    BACKGROUND: Epidural steroid injection (ESI) is one of the most common nonsurgical treatments for low back pain. In general, corticosteroid therapy often results in bone loss and osteoporosis. In previous studies, bone mineral density (BMD) was evaluated after epidural injections of relatively small numbers and relatively low total doses of corticosteroids. However, the relationship between BMD and multiple ESIs remains to be elucidated. OBJECTIVE: To explore the relationship between BMD and multiple ESIs in postmenopausal women with low back pain. METHODS: Medical records of postmenopausal women with low back pain treated with or without ESIs were reviewed. BMD was measured in the lumbar spine, femoral neck and total femur after the treatments. A total of 71 patients were divided into two groups: group 1 included patients who had received non-ESI medications; and group 2 included those who had received ESIs >10 times, with a cumulative administered triamcinolone dose >200 mg. RESULTS: Patients in group 2 showed lower BMD in the femoral neck and total femur. However, no significant intergroup differences in the BMD of the lumbar spine were observed. The prevalences of osteoporosis and osteopenia in the lumbar spine and femoral neck were significantly higher in group 2; these patients also had lower femoral neck BMD Z-scores. CONCLUSIONS: Multiple ESIs (approximately 14 injections with a cumulative triamcinolone dose of approximately 400 mg) can reduce BMD in postmenopausal women with low back pain. PMID:24404559

  20. Predictors of response to intra-articular steroid injection in psoriatic arthritis.

    PubMed

    Eder, Lihi; Chandran, Vinod; Ueng, Joanna; Bhella, Sita; Lee, Ker-Ai; Rahman, Proton; Pope, Angela; Cook, Richard J; Gladman, Dafna D

    2010-07-01

    To assess the effectiveness of IA corticosteroid (IAS) injections in PsA and to determine the association between macrophage migration inhibition factor (MIF) gene polymorphism and response to IAS injections. A cohort analysis of PsA patients who were followed prospectively was performed. Clinical response was defined as no tenderness or effusion in the injected joint at 3 months. Relapse was defined as re-occurrence of joint pain or effusion. MIF 173C > G genotyping (rs755622) was performed. Two hundred and twenty patients with 245 IAS injections were included in the study. The probability of responding at 3 months was 41.6%. Within 12 months, 25.5% of the joints relapsed. Clinical factors that were associated with response included duration of psoriasis [Odds ratio (OR) 1.03] and the use of MTX or anti-TNF agents at the time of injection (OR 2.68). Factors that were associated with relapse included injection into large joints (OR 4.58) and elevated sedimentation rate (OR 15.0), whereas absence of clinical and/or radiographic damage (OR 0.23) and duration of PsA (OR 0.92) reduced risk of relapse. MIF polymorphism was not associated with clinical response, but was associated with relapse (OR 3.2). On multivariate analysis including clinical covariates, the association between MIF polymorphism and relapse was lost. IAS injections are effective in PsA. MIF gene polymorphism is associated with relapse. However, this effect is explained by clinical variables that reflect disease activity, suggesting that MIF gene polymorphism influences inflammatory activity.

  1. Clinical Trial of Subcutaneous Steroid Injection in Patients with Migraine Disorder.

    PubMed

    Nikkhah, Karim; Ghandehari, Kavian; Jouybari, Ali Ghabeli; Mirzaei, Mohammad Mousavi; Ghandehari, Kosar

    2016-01-01

    Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients. Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area (exactly at retromastoid cervicocranial junction) and the other two injections in the lower medial frontal area (exactly at medial right and left eyebrows). A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis. 504 patients (378 females, 126 males) with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection. Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache.

  2. Steroid injection and needle aponeurotomy for Dupuytren contracture: a randomized, controlled study.

    PubMed

    McMillan, Catherine; Binhammer, Paul

    2012-07-01

    To compare flexion deformity at 6 months in patients with Dupuytren contracture who had percutaneous needle aponeurotomy (PNA) combined with a series of triamcinolone acetonide (TA) injections to that of patients who had PNA alone. Forty-seven patients with Dupuytren disease who were candidates for PNA (at least 1 contracture of at least 20°) participated in the study. Patients were randomized either to receive TA injections immediately following and 6 weeks and 3 months after the procedure or to receive no injections. Injections were administered into cords. The number of injections and the amount of TA per injection was determined based on the number of digits involved and the cord size. All subjects returned for 3 follow-up visits after the procedure, and contractures were measured using a goniometer. Change in total active extension deficit (TAED) was analyzed using a repeated measures analysis of variance to assess for differences between groups, time points, and interaction between group and time point. Descriptive statistics were calculated for all variables of interest. Continuous measures were summarized using means and standard deviations. There was no significant difference in TAED between groups before cord aponeurotomy. Correction at 6 months was 87% of preoperative TAED for the TA group versus 64% for the control group. This difference was statistically significant. The amount of TA administered did not correlate with TAED improvement. The study group who received TA in combination with PNA experienced a significantly greater degree of correction of flexion deformity at 6 months than those who had PNA alone. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. [Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits. A randomized, double blind study as part of a multimodal treatment concept].

    PubMed

    Niemier, K; Schindler, M; Volk, T; Baum, K; Wolf, B; Eberitsch, J; Seidel, W

    2015-07-01

    Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome. A double blind randomized prospective trial was carried out. Patients treated in hospital for a chronic lumbar pain syndrome without neurological deficits within a multimodal treatment program were screened for indications for an epidural steroid injection (e.g. diseased lumbar disc and intention to treat). Patients eligible for the study were randomized into two groups. The treatment group received an epidural injection of 80 mg triamcinolone and 8 ml bupivacaine 0.25 %. The control group received only an epidural injection of 8 ml bupivacaine 0.25 %. In both groups pain intensity and treatability showed a statistically significant improvement after the epidural injection. The differences between the control and treatment groups were small and not clinically relevant. A small subgroup might profit from the steroid injection. In addition the treatability was dependent on psychometric values and the long-term outcome from a reduction of muscular skeletal dysfunctions. After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.

  4. Transforaminal epidural steroid injection in lumbar spinal stenosis: an observational study with two-year follow-up.

    PubMed

    Davis, Niel; Hourigan, Patrick; Clarke, Andrew

    2017-04-01

    Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis. An observational study which took place between May 2010 and July 2013. All patients were seen by the Extended Scope Physiotherapist (ESP) injection service. A total of 68 consecutive patients were included. Thirty-one were male and 37 were female. The average age was 75 years. The primary outcome measure was the avoidance of decompressive surgery. Patients with radicular leg pain were seen by an ESP in an Outpatient setting. Concordant clinical examination and magnetic resonance imaging were required for diagnosis. Peri-radicular bupivacaine hydrochloride 0.25% (3 ml) and triamcinolone (40 mg) were then injected. Outcome measures were recorded at 6 weeks, 1 year and 2 years. Of 68 patients with spinal stenosis, 22 (32%) had opted for surgery at two year follow-up. Thirty (44%) patients were satisfied with non-surgical management at 2 years, required no further treatment, and were discharged. Of the remaining 24%, nine patients were referred for further injection, four declined surgery but were referred to the Pain Relief Clinic, two still had a similar level of pain but declined surgery and one had died. Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.

  5. Caudal vs transforaminal epidural steroid injections as short-term (6 months) pain relief in lumbar spinal stenosis patients with sciatica.

    PubMed

    Ploumis, Avraam; Christodoulou, Pavlos; Wood, Kirkham B; Varvarousis, Dimitrios; Sarni, James L; Beris, Alexander

    2014-03-01

    The aim of this study is to evaluate prospectively the efficacy of caudal epidural steroid injection (CESI) and transforaminal epidural steroid injection (TFESI) in lumbar spinal stenosis patients with sciatic pain. Prospective clinical study. Thirty-one patients (average age 62 years) from two hospitals, with single dermotomal distribution of sciatic pain due to spinal stenosis were included in the study. Patients underwent epidural steroid injections done by the same injectionist. Eleven patients from one hospital were included in the CESI group, while the TFESI group consisted of 20 comparable patients from the second site. Primary outcome measure was the complete relief or at least 50% reduction of pain (visual analog scale [VAS]) at 6 months postinjection. Secondary outcome measures were the improvement of function (of at least 15 points of Oswestry Disability Index [ODI]) at 6 months and the changes of VAS and ODI and at 2 weeks, at 3 months, and at 6 months postinjection. A significantly greater number of stenosis patients showed pain relief at 6 months postinjection with TFSI (90%) than with CESI (54.54%). All patients with TFSI showed improvement of function at 6 months while only three (27.27%) patients with caudal epidural improved functionally. Out of the total 31 patients, two patients from group A underwent a second CESI at 15 days postinjection and decompressive spine surgery between 3 and 6 months postinjection. The effectiveness of transforaminal steroid injection for the stenosis patients with sciatica was superior to caudal at 6 months postinjection. Wiley Periodicals, Inc.

  6. [Epidermolysis bullosa acquisita complicated by esophageal stenosis. Endoscopic treatment with thermoplastic dilators and intralesional steroid injection].

    PubMed

    Moura, E G; Couto-Júnior, D S; Alvarado-Escobar, H; da Costa-Martins, B; Sallum, R A; Artifon, E L; Sakai, P

    2011-01-01

    Epidermolysis bullosa acquisita (EBA) is a rare auto-immune dermatologic disease, produced by auto-antibodies against colagen VII. We report a 44 years old male patient with EBA diagnosed 15 years before, who presented with progressive disphagia, being diagnosed an esophageal involvement of EBA. The patient was submitted to endoscopic treatment with thermoplastic bougie dilation and intralesional corticosteroid injection. The patient improved clinically with recovery of nutritional status. Esophageal involvement in EBA is very rare and its reason is still unknown. Endoscopic approach must be cautiously performed with the use of small diameter endoscopes, small caliber dilators, intralesional injection of corticosteroid and enteral tube in order to minimize the risks of complications, as well as esophageal rest from food trauma and better reparatory molding of the epithelium.

  7. Safety of 1000 CT-guided steroid injections with air used to localize the epidural space.

    PubMed

    Chang, A; Pochert, S; Romano, C; Brook, A; Miller, T

    2011-10-01

    Historically, ESIs were performed without any imaging guidance, resulting in erroneous placement in up to 30% of injections. Fluoroscopic imaging is now used to guide most procedures. Recently, several reports have described the use of CT to guide ESIs instead of fluoroscopy. CT provides the ability to use air as contrast to localize the epidural space. This retrospective review will discuss findings in 1000 CT-guided ESIs with air localization.

  8. Psychosis in children with systemic lupus erythematosus: the role of steroids as both treatment and cause.

    PubMed

    Alpert, Orna; Marwaha, Raman; Huang, Hsiang

    2014-01-01

    Steroids may both be a cause of and treatment for pediatric patients with systemic lupus erythematosus (SLE) presenting with psychotic symptoms. We present two cases demonstrating that careful histories (including prior steroid exposure) and the use of biomarkers can help guide the management of children with SLE presenting with psychosis.

  9. Systemic lupus erythematosus with membranous glomerulonephritis and transverse myelitis associated with anabolic steroid use.

    PubMed

    Radis, C D; Callis, K P

    1997-10-01

    This report describes a 29-year-old bodybuilder taking anabolic steroids who presented with urinary retention, arthralgias, and peripheral edema, subsequently developed acute lower-extremity paralysis, and was diagnosed as having transverse myelitis and membranous glomerulonephritis secondary to systemic lupus erythematosus (SLE). The association of anabolic steroid use and hyperprolactinemia, and their possible link to the development of SLE, are reviewed.

  10. [Features of the endometrial steroid receptor system in habitual abortion with high risk of infectious complications].

    PubMed

    Demidova, E M; Alekseeva, M L; Novikov, E A; Ezhova, L S; Ankirskaia, A S; Zemlianaia, A A

    1991-09-01

    Analysis of microbiologic and histologic findings and measurements of estrogen and gestagen receptors in the endometrium have shown manifest shifts in the endometrial steroid receptor system in women with asymptomatic chronic endometritis. The authors claim that disordered reception of steroid hormones may be regarded as one of the causes of spontaneous, abortions.

  11. [Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study].

    PubMed

    Cervera-Irimia, J; Tomé-Bermejo, F

    2013-01-01

    There is no consensus on the treatment of chronic low back pain of disc origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. This is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disc pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). Lumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (P>.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend towards better results, but none reached statistical significance (P>.05). The present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disc origin. While CESI could show some improvement in patients with degenerative lumbar disc disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  12. Increased dose of betamethasone for transforaminal epidural steroid injections is not associated with superior pain outcomes at 4 weeks.

    PubMed

    Wong, Waylan; Maher, Dermot P; Iyayi, Daniel; Lopez, Raul; Shamloo, Bahman; Rosner, Howard; Yumul, Roya

    2015-01-01

    Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs) have been shown to provide both immediate and long-term improvement in patient's self-reported pain. Administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties. To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in FG-TFESI. Retrospective evaluation. Academic outpatient pain center. One hundred fifty-eight patients underwent FG-TFESI for lumbar back pain between 2012 and 2013. Depending on the date of service, a dose of 3 mg or a dose of 6 mg betamethasone was used in the single level unilateral TFESI. Opioid consumption and NRS pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally. Changes in numerical rating scale (NRS) pain score (-1.21 +' 2.61 vs. -0.81 +' 2.40 respectively, P = 0.17) and changes in opioid consumption as measured in oral morphine equivalents (-2.94 +' 16.4 mg vs. -2.93 +' 14.8 mg, P = 0.17) were statistically equivalent between both groups. Intergroup sub-analysis of those with > 50% reduction in baseline VRS {sp} pain score was not different (15.2% vs. 34%, P = 0.56), and the proportion with a VRS pain score < 3 were similar (24.5% vs. 23.8%, P = 0.92). Potential selection bias inherent with study design. Reduction in NRS pain scores and narcotic usage at 4 weeks after FG-TFESI were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone, suggesting that a lower steroid dose has similar analgesic efficacy. IRB Number: Cedars Sinai Medical Center Institutional Review Board Pro00031594

  13. A prototype space flight intravenous injection system

    NASA Technical Reports Server (NTRS)

    Colombo, G. V.

    1985-01-01

    Medical emergencies, especially those resulting from accidents, frequently require the administration of intravenous fluids to replace lost body liquids. The development of a prototype space flight intravenous injection system is presented. The definition of requirements, injectable concentrates development, water polisher, reconstitution hardware development, administration hardware development, and prototype fabrication and testing are discussed.

  14. Molecular evolution of a steroid hydroxylating cytochrome P450 using a versatile steroid detection system for screening.

    PubMed

    Virus, Cornelia; Bernhardt, Rita

    2008-12-01

    Molecular evolution is a powerful tool for improving or changing activities of enzymes for their use in biotechnological processes. Cytochromes P450 are highly interesting enzymes for biotechnological purposes because they are able to hydroxylate a broad variety of substrates with high regio- and stereoselectivity. One promising steroid hydroxylating cytochrome P450 for biotechnological applications is CYP106A2 from Bacillus megaterium ATCC 13368. It is one of a few known bacterial cytochromes P450 able to transform steroids such as progesterone and 11-deoxycortisol. CYP106A2 can be easily expressed in Escherichia coli with a high yield and can be reconstituted using the adrenal redox proteins, adrenodoxin and adrenodoxin reductase. We developed a simple screening assay for this system and performed random mutagenesis of CYP106A2, yielding variants with improved 11-deoxycortisol and progesterone hydroxylation activity. After two generations of directed evolution, we were able to improve the k (cat)/K (m) of the 11-deoxycortisol hydroxylation by a factor of more than four. At the same time progesterone conversion was improved about 1.4-fold. Mapping the mutations identified in catalytically improved CYP106A2 variants into the structure of a CYP106A2 model suggests that these mutations influence the mobility of the F/G loop, and the interaction with the redox partner adrenodoxin. The results show the evolution of a soluble steroid hydroxylase as a potential new catalyst for the production of steroidogenic compounds.

  15. Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery.

    PubMed

    van Helvoirt, Hans; Apeldoorn, Adri T; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W; Ostelo, Raymond W

    2016-04-27

    Prospective cohort study. Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain.These patients

  16. Diagnosis of Iliotibial Band Friction Syndrome and Ultrasound Guided Steroid Injection

    PubMed Central

    Kim, Ji Sub

    2013-01-01

    A 64-year-old woman visited our pain clinic with the pain of right lateral side of thigh for one year. Her pain always started from knee and was radiated to buttock area when symptom was severe. She showed significant tenderness at knee lateral side and local tightness at lateral thigh. Magnetic resonance image of the knee was performed and we could identify high signal intensity of iliotibial band through coronal and axial view. In spite of medication and physical stretching exercise of iliotibial band for one month, she did not show any improvement of pain. To alleviate her symptom, ultrasound guided local corticosteroid injection targeting beneath the iliotibial band was performed. After the procedure, the reduction of pain was significant and there was no need for further management. PMID:24156006

  17. Diagnosis of iliotibial band friction syndrome and ultrasound guided steroid injection.

    PubMed

    Hong, Ji Hee; Kim, Ji Sub

    2013-10-01

    A 64-year-old woman visited our pain clinic with the pain of right lateral side of thigh for one year. Her pain always started from knee and was radiated to buttock area when symptom was severe. She showed significant tenderness at knee lateral side and local tightness at lateral thigh. Magnetic resonance image of the knee was performed and we could identify high signal intensity of iliotibial band through coronal and axial view. In spite of medication and physical stretching exercise of iliotibial band for one month, she did not show any improvement of pain. To alleviate her symptom, ultrasound guided local corticosteroid injection targeting beneath the iliotibial band was performed. After the procedure, the reduction of pain was significant and there was no need for further management.

  18. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials.

    PubMed

    Meng, Hai; Fei, Qi; Wang, Bingqiang; Yang, Yong; Li, Dong; Li, Jinjun; Su, Nan

    2015-01-01

    Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone. PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies. We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50%) was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1) and in 56.4% of those administered with local anesthetic alone (group 2). Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups. Both epidural injections with steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no advantage compared to local anesthetic

  19. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

    PubMed Central

    Meng, Hai; Fei, Qi; Wang, Bingqiang; Yang, Yong; Li, Dong; Li, Jinjun; Su, Nan

    2015-01-01

    Background Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone. Methods PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies. Results We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50%) was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1) and in 56.4% of those administered with local anesthetic alone (group 2). Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups. Conclusion Both epidural injections with steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no

  20. Different healing process of esophageal large mucosal defects by endoscopic mucosal dissection between with and without steroid injection in an animal model.

    PubMed

    Nonaka, Kouichi; Miyazawa, Mitsuo; Ban, Shinichi; Aikawa, Masayasu; Akimoto, Naoe; Koyama, Isamu; Kita, Hiroto

    2013-04-25

    Stricture formation is one of the major complications after endoscopic removal of large superficial squamous cell neoplasms of the esophagus, and local steroid injections have been adopted to prevent it. However, fundamental pathological alterations related to them have not been well analyzed so far. The aim of this study was to analyze the time course of the healing process of esophageal large mucosal defects resulting in stricture formation and its modification by local steroid injection, using an animal model. Esophageal circumferential mucosal defects were created by endoscopic mucosal dissection (ESD) for four pigs. One pig was sacrificed five minutes after the ESD, and other two pigs were followed-up on endoscopy and sacrificed at the time of one week and three weeks after the ESD, respectively. The remaining one pig was followed-up on endoscopy with five times of local steroid injection and sacrificed at the time of eight weeks after the ESD. The esophageal tissues of all pigs were subjected to pathological analyses. For the pigs without steroid injection, the esophageal stricture was completed around three weeks after the ESD on both endoscopy and esophagography. Histopathological examination of the esophageal tissues revealed that spindle-shaped α-smooth muscle actin (SMA)-positive myofibroblasts arranged in a parallel fashion and extending horizontally were identified at the ulcer bed one week after the ESD, and increased contributing to formation of the stenotic luminal ridge covered with the regenerated epithelium three weeks after the ESD. The proper muscle layer of the stricture site was thinned with some myocytes which seemingly showed transition to the myofibroblast layer. By contrast, for the pig with steroid injection, esophageal stricture formation was not evident with limited appearance of the spindle-shaped myofibroblasts, instead, appearance of stellate or polygocal SMA-positive stromal cells arranged haphazardly in the persistent granulation

  1. Different healing process of esophageal large mucosal defects by endoscopic mucosal dissection between with and without steroid injection in an animal model

    PubMed Central

    2013-01-01

    Background Stricture formation is one of the major complications after endoscopic removal of large superficial squamous cell neoplasms of the esophagus, and local steroid injections have been adopted to prevent it. However, fundamental pathological alterations related to them have not been well analyzed so far. The aim of this study was to analyze the time course of the healing process of esophageal large mucosal defects resulting in stricture formation and its modification by local steroid injection, using an animal model. Methods Esophageal circumferential mucosal defects were created by endoscopic mucosal dissection (ESD) for four pigs. One pig was sacrificed five minutes after the ESD, and other two pigs were followed-up on endoscopy and sacrificed at the time of one week and three weeks after the ESD, respectively. The remaining one pig was followed-up on endoscopy with five times of local steroid injection and sacrificed at the time of eight weeks after the ESD. The esophageal tissues of all pigs were subjected to pathological analyses. Results For the pigs without steroid injection, the esophageal stricture was completed around three weeks after the ESD on both endoscopy and esophagography. Histopathological examination of the esophageal tissues revealed that spindle-shaped α-smooth muscle actin (SMA)-positive myofibroblasts arranged in a parallel fashion and extending horizontally were identified at the ulcer bed one week after the ESD, and increased contributing to formation of the stenotic luminal ridge covered with the regenerated epithelium three weeks after the ESD. The proper muscle layer of the stricture site was thinned with some myocytes which seemingly showed transition to the myofibroblast layer. By contrast, for the pig with steroid injection, esophageal stricture formation was not evident with limited appearance of the spindle-shaped myofibroblasts, instead, appearance of stellate or polygocal SMA-positive stromal cells arranged haphazardly in

  2. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain.

    PubMed

    Yi, Yuri; Hwang, Byeongmun; Son, Heejeong; Cheong, Ilyoung

    2012-01-01

    Therapy with glucocorticoids often results in bone loss and glucocorticoid-induced osteoporosis. However, the relationship between epidural steroid injection (ESI), bone mineral density (BMD), and vertebral fracture remains to be determined. To establish a relationship between ESI, BMD, and vertebral fracture in postmenopausal women with low back pain. This study was a retrospective, nonblinded, cross-sectional clinical study. University-based pain management center. We reviewed the medical records of postmenopausal women with low back pain who were treated with ESI. A total of 352 postmenopausal women were divided into 2 groups. Group 1 consisted of patients without fracture and Group 2 consisted of those with fractures. The results of BMD measurements, as well as any fragility fractures, the anatomical site involved, and the treatment administered, were also recorded. BMD was measured in the lumbar spine, femoral neck, and total femur after the treatment. Of the 352 patients, 218 (62%) had no fractures while 134 (38%) sustained a fracture. The age was significantly higher among patients who sustained fractures, and BMD at the lumbar spine, total femur, and femoral neck regions was significantly lower among patients who sustained fractures. In each region, the prevalence of osteoporosis was significantly higher in patients with fracture than in patients without fracture (all P < 0.05). Age, height, and weight were associated with low BMD. However, our study showed no consistent correlation between BMD and the mean number of ESIs, mean total dose of glucocorticoids, or mean duration of ESIs. First, this study is limited by the fact that it was retrospective. Second, the number of cases receiving very frequent, high-dose glucocorticoid injections was very small. Older age and lower BMD were associated with osteoporotic fracture in postmenopausal women treated for low back pain with ESI. The ESIs were not associated with low BMD or fracture.

  3. Dual fuel injection piggyback controller system

    NASA Astrophysics Data System (ADS)

    Muji, Siti Zarina Mohd.; Hassanal, Muhammad Amirul Hafeez; Lee, Chua King; Fawzi, Mas; Zulkifli, Fathul Hakim

    2017-09-01

    Dual-fuel injection is an effort to reduce the dependency on diesel and gasoline fuel. Generally, there are two approaches to implement the dual-fuel injection in car system. The first approach is changing the whole injector of the car engine, the consequence is excessive high cost. Alternatively, it also can be achieved by manipulating the system's control signal especially the Electronic Control Unit (ECU) signal. Hence, the study focuses to develop a dual injection timing controller system that likely adopted to control injection time and quantity of compressed natural gas (CNG) and diesel fuel. In this system, Raspberry Pi 3 reacts as main controller unit to receive ECU signal, analyze it and then manipulate its duty cycle to be fed into the Electronic Driver Unit (EDU). The manipulation has changed the duty cycle to two pulses instead of single pulse. A particular pulse mainly used to control injection of diesel fuel and another pulse controls injection of Compressed Natural Gas (CNG). The test indicated promising results that the system can be implemented in the car as piggyback system.

  4. Conflicting conclusions from two systematic reviews of epidural steroid injections for sciatica: which evidence should general practitioners heed?

    PubMed Central

    Hopayian, K; Mugford, M

    1999-01-01

    Systematic reviews and meta-analyses are becoming increasingly important in informing clinical practice and commissioning. Two systematic reviews of a treatment for low back pain and sciatica using epidural steroid injections, published in the same year, arrived at conflicting conclusions. Only one was reported in a digest for evidence-based medicine. This paper aims to find the reasons for the discordance between the reviews, and draw conclusions for users of reviews. Using comparative analysis of two published systematic reviews and their source material, it was found that the two reviews had the same overall aims and met the criteria for review methods. They differed in their choice of methods, including the judgement of quality of studies for inclusion and for summing-up evidence. Estimation of summary odds ratios in one review led to stronger conclusions about effectiveness. In conclusion, the choice of methods for systematic review may alter views about the current state of evidence. Users should be aware that systematic reviews include an element of judgement, whatever method is used. PMID:10622020

  5. Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?

    PubMed Central

    Ghaly, Ramis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2015-01-01

    Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. Case Description: We present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology. Conclusions: We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures. PMID:25883840

  6. Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study

    PubMed Central

    Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk

    2016-01-01

    Purpose To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Materials and Methods Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0±10.5 years and duration of symptom was 12.2±8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. Results After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Conclusion Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus. PMID:26847305

  7. Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study.

    PubMed

    Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk; Lee, Sang Chul

    2016-03-01

    To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0 ± 10.5 years and duration of symptom was 12.2 ± 8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.

  8. Adhesive blood microsampling systems for steroid measurement via LC-MS/MS in the rat.

    PubMed

    Heussner, Kirsten; Rauh, Manfred; Cordasic, Nada; Menendez-Castro, Carlos; Huebner, Hanna; Ruebner, Matthias; Schmidt, Marius; Hartner, Andrea; Rascher, Wolfgang; Fahlbusch, Fabian B

    2017-04-01

    Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) allows for the direct analysis of multiple hormones in a single probe with minimal sample volume. Rodent-based animal studies strongly rely on microsampling, such as the dry blood spot (DBS) method. However, DBS suffers the drawback of hematocrit-dependence (non-volumetric). Hence, novel volumetric microsampling techniques were introduced recently, allowing sampling of fixed accurate volumes. We compared these methods for steroid analysis in the rat to improve inter-system comparability. We analyzed steroid levels in blood using the absorptive microsampling devices Whatman® 903 Protein Saver Cards, Noviplex™ Plasma Prep Cards and the Mitra™ Microsampling device and compared the obtained results to the respective EDTA plasma levels. Quantitative steroid analysis was performed via LC-MS/MS. For the determination of the plasma volume factor for each steroid, their levels in pooled blood samples from each human adults and rats (18weeks) were compared and the transferability of these factors was evaluated in a new set of juvenile (21days) and adult (18weeks) rats. Hematocrit was determined concomitantly. Using these approaches, we were unable to apply one single volume factor for each steroid. Instead, plasma volume factors had to be adjusted for the recovery rate of each steroid and device individually. The tested microsampling systems did not allow the use of one single volume factor for adult and juvenile rats based on an unexpectedly strong hematocrit-dependency and other steroid specific (pre-analytic) factors. Our study provides correction factors for LC-MS/MS steroid analysis of volumetric and non-volumetric microsampling systems in comparison to plasma. It argues for thorough analysis of chromatographic effects before the use of novel volumetric systems for steroid analysis. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis.

    PubMed

    Sun, Yaying; Zhang, Peng; Liu, Shaohua; Li, Hong; Jiang, Jia; Chen, Shiyi; Chen, Jiwu

    2017-07-01

    Intra-articular steroid injection is a common intervention for frozen shoulder (FS). This review aimed to illustrate the effects of intra-articular steroid injection for FS. Systematic review and meta-analysis. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing intra-articular steroid injection with no injection or sham injections for FS. Visual analog scale (VAS) pain scores were the primary outcome measure. Secondary outcome measures included passive external rotation, abduction, flexion, internal rotation, and functional scores. Complication rates were the safety outcome measure. Comparisons were performed with mean differences (MDs) and 95% confidence intervals (95% CIs). Three time intervals were analyzed: 4 to 6 weeks, 12 to 16 weeks, and 24 to 26 weeks postintervention. Trial sequential analysis was used to verify the pooled results. Line charts were drawn to view the recovery trend in both the intervention and control groups. Eight RCTs with 416 patients were included. Compared with controls, patients who received intra-articular steroid injection had significantly reduced VAS pain scores at 4 to 6 weeks (MD, 1.28 cm [95% CI, 0.75 to 1.82]), 12 to 16 weeks (MD, 1.00 cm [95% CI, 0.47 to 1.52]), and 24 to 26 weeks (MD, 0.65 cm [95% CI, 0.19 to 1.10]) postinjection. Trial sequential analysis confirmed the pooled results at 4 to 6 weeks and 12 to 16 weeks but not at 24 to 26 weeks. Patients who received intra-articular steroid injection had improved passive external rotation, abduction, and flexion and Shoulder Pain and Disability Index (SPADI) scores at all 3 time intervals, as well as improved American Shoulder and Elbow Surgeons (ASES) scores at 12 to 16 weeks (MD, 12.20 [95% CI, 2.55 to 21.85]). No difference was noticed in Constant scores (MD, 5.70 [95% CI, -0.59 to 11.99]) or internal rotation except at 12 to 16 weeks (MD, 0.81° [95% CI, 0.18° to 1.44°]) and 24 to 26 weeks (MD, 3.88° [95% CI, 0.51

  10. An automatic quality system for injection molding

    NASA Astrophysics Data System (ADS)

    Koikkalainen, Pasi; Haranen, Michael; Lensu, Anssi; Sippola, Risto

    2007-09-01

    This paper describes a fully automatic quality system for injection molding. The proposed system includes an on-line measurement platform with a digital camera, a methodology for adaptive design of experiments (DOE), statistical modeling, process monitoring, and a closed loop process control. The system has been tested in the manufacturing of plastic parts for mobile phones.

  11. Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss: a meta-analysis.

    PubMed

    Gao, Yang; Liu, Dong

    2016-11-01

    The main objective of the meta-analysis was to investigate whether intratympanic steroid injections in combination with systemic steroids would provide an additional advantage over systemic steroid therapy (SST) alone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). The results will provide a meaningful suggestion in clinical therapy of ISSNHL. The electronic database search was based on the database in OVID Medline, Embase and PubMed up to December 15, 2015 with the goal of identifying all available observational studies examining the effects of combination therapy and SST in ISSNHL patients. Observational studies that compared the pure tone average (PTA) improvement and recovery rate between combination therapy and SST group in ISSNHL patients were selected. Finally we have identified eight eligible studies that focused on comparing the combination therapy and SST in ISSNHL from designated researches. In the PTA improvement group, seven studies have been analyzed to compare the pooled mean differences between two therapy modalities and subgroups based on initial hearing loss and treatment delay. In the recovery rate group, six studies were calculated for pooled risk ratios and subgroup analysis was also conducted. Through our meta-analysis, we have reached the conclusion that combination therapy exhibited better outcomes in PTA improvement than SST alone, especially in severe-profound initial hearing loss cases. Combination therapy also showed advantages in recovery rate. Whether time of treatment delay would influence the PTA improvement and recovery rate requires further researches.

  12. The potential contributing effect of ketorolac and fluoxetine to a spinal epidural hematoma following a cervical interlaminar epidural steroid injection: a case report and narrative review.

    PubMed

    Chien, George C Chang; McCormick, Zack; Araujo, Marco; Candido, Kenneth D

    2014-01-01

    Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia. We report a case wherein intramuscular ketorolac and oral fluoxetine contributed to a SEH and tetraplegia following a cervical interlaminar (ESI). A 66 year-old woman with chronic renal insufficiency and neck pain radiating into her right upper extremity presented for evaluation and was deemed an appropriate CESI candidate. Cervical magnetic resonance imaging (MRI) revealed multi-level neuroforaminal stenosis and degenerative intervertebral discs. Utilizing a loss of resistance to saline technique, an 18-gauge Tuohy-type needle entered the epidural space at C6-7. After negative aspiration, 4 mL of saline with 80 mg of methyl-prednisolone was injected. Immediately thereafter, the patient reported significant spasmodic-type localized neck pain with no neurologic status changes. A decision was made to administer 30 mg intramuscular ketorolac as treatment for the spasmodic-type pain. En route home, she developed a sudden onset of acute tetraplegia. She was brought to the emergency department for evaluation including platelet and coagulation studies which were normal. MRI demonstrated an epidural hematoma extending from C5 to T7. She underwent a bilateral C5-T6 laminectomy with epidural hematoma evacuation and was discharged to an acute inpatient rehabilitation hospital. Chronic renal insufficiency, spinal stenosis, female gender, and increasing age have been

  13. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

    PubMed Central

    Manson, Neil A.; McKeon, Melissa D.; Abraham, Edward P.

    2013-01-01

    Background The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers’ compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers’ compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH. PMID:23351495

  14. Changes in bone mineral density in postmenopausal women treated with epidural steroid injections for lower back pain.

    PubMed

    Kang, Seong-Sik; Hwang, Byeong-Mun; Son, Heejeong; Cheong, Il-Young; Lee, Sang-Jin; Chung, Tae-Yoon

    2012-01-01

    Therapy with corticosteroids often results in bone loss and corticosteroid-induced osteoporosis. In previous studies, bone mineral density (BMD) has been examined after administration of relatively high oral doses of corticosteroids. However, practitioners use comparatively lower doses of corticosteroids for epidural steroid injections (ESI). The interactions and relationships between BMD and ESI remain to be determined. The aim of this study was to explore the relationship between BMD and ESI in postmenopausal women treated for lower back pain. This study was a retrospective evaluation. We reviewed the medical records of postmenopausal women with lower back pain who were treated with or without ESI. BMD was measured before treatment and one year after treatment in the lumbar spine, femoral neck, and total femur. A total of 90 postmenopausal women were divided into 2 groups. Group 1 patients received medications without ESI; Group 2 patients received ESI more than 4 times, with a cumulative administered triamcinolone dose of > 120 mg. Decreased BMD was observed in patients treated with ESI. However, no significant difference was observed between or within the groups in terms of mean percentage change from baseline BMD. First, this study is limited by the fact that it was retrospective. Second, our study did not consider the use of ESI with high-dose corticosteroids. Third, our study did not include any long-term assessments of the effects of ESI on BMD. These data suggest that ESI using triamcinolone (over 200 mg) for a period of one year will have a negative effect on BMD in postmenopausal women treated for lower back pain. However, ESI therapy using a maximum cumulative triamcinolone dose of 200 mg in one year would be a safe treatment method with no significant impact on BMD.

  15. Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint.

    PubMed

    Fatimah, Nibah; Salim, Babur; Raja, Ejaz-Ul-Haq; Nasim, Amjad

    2016-10-01

    This study aimed to determine the factors associated with response to intra-articular steroid injection (IASI) in patients with knee joint osteoarthritis. One hundred seventy-four female patients, age ranging from 30 to 80 years, diagnosed to have osteoarthritis of the knee joint, were given IASI. Response to IASI was assessed by using WOMAC and VAS at 2 weeks, 4 weeks and 3 months. At 3 months, the subjects were categorized as responders, partial responders and non-responders to treatment by IASI. Various factors were narrowed down to see their effect on response, namely age, BMI, smoking habits, comorbidities, presence of clinical effusion, radiographic score, local knee tenderness, range of movement and socioeconomic status. One hundred twenty-four patients completed the study. 16.1 % showed 50 % or more improvement in WOMAC score at 3 months post IASI therapy, whereas 38.7 % of OA patients had more than 50 % improvement in VAS score. Out of all factors, range of movement, local knee tenderness and radiographic score of the affected joint are the three parameters which can predict the improvement in WOMAC score after 3 months of IASI therapy (P = 0.013, P = 0.045 and P = 0.000, respectively). Age of the patient can predict improvement in VAS at 3 months post IASI (P = 0.027). We conclude that age, range of movement, local knee tenderness and radiographic score of the affected joint can predict response to IASI after 3 months of IASI therapy.

  16. Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings

    PubMed Central

    Choi, Ji Won; Lim, Hyung Woo; Lee, Jin Young; Lee, Won Il; Lee, Eun Kyung; Chang, Choo Hoon; Yang, Jae Young

    2016-01-01

    Background It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. Methods The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. Results Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). Conclusions We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI. PMID:27103964

  17. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation.

    PubMed

    van Helvoirt, Hans; Apeldoorn, Adri T; Ostelo, Raymond W; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W

    2014-07-01

    Prospective cohort study. To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). Noncentralizing symptoms in patients with lumbar disc herniation are associated with poor outcome. Commonly used treatments for these patients include TESIs and MDT. No study has evaluated the outcome of combining both strategies. Consecutive candidates for herniated lumbar disc surgery with noncentralizing chronic pain were eligible. Patients received TESIs followed by MDT. The primary outcomes were pain severity in the leg, disability (Roland-Morris Disability Questionnaire for Sciatica), and global perceived effect (GPE). Outcomes were measured at baseline, discharge, and 12 months. Linear mixed-models and McNemar's tests were used to analyze outcome data. Sixty-nine patients receive TESIs. After TESIs, symptoms were resolved completely in 11 patients (16%). In these patients, symptom resolution was maintained at 12 months. A second subgroup of 32 patients (46%) reported significantly less pain after TESIs and showed centralization with MDT reassessment (significant reductions in leg pain and disability [P < 0.001]) and a satisfaction rate of 90% at 12 months. A third subgroup of 11 patients (16%) reported significantly less pain after TESIs but still showed noncentralization with MDT reassessment (significant reductions in leg pain and disability [P < 0.05] and a satisfaction rate of 50% at 12 months). A fourth subgroup of 15 patients (22%) did not respond on TESIs and received an operative intervention. The results indicate that a course of TESIs followed by MDT may be able to avoid surgery in a substantial proportion of candidates for herniated lumbar disc surgery. Wiley Periodicals, Inc.

  18. Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques.

    PubMed

    Hoang, Jenny K; Yoshizumi, Terry T; Toncheva, Greta; Gray, Linda; Gafton, Andreia R; Huh, Billy K; Eastwood, James D; Lascola, Christopher D; Hurwitz, Lynne M

    2011-10-01

    The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms. We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses. The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv. The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.

  19. Common rail fuel injection system

    SciTech Connect

    Crowley, P.J.; Hilshos, R.L.; Wieland, H.L.; Straub, R.D.; Teerman, R.F.; Timmer, R.C.

    1992-07-28

    This patent describes a high-pressure pump for the injectors of an electronically controlled fuel system. It comprises: a pump body having a chamber therein, a reciprocal plunger in the chamber having a fixed stroke, a solenoid operated normally closed metering inlet valve for metering fuel into the chamber, a normally closed discharge valve, both of the valves being located within the pump body and closing respective fuel ports communicating with the chamber at one end of the plunger and means for controlling the amount of fuel discharged by the pump comprising an electronic control for the solenoid-operated valve to determine the time that the valve is held open during the intake stroke of the plunger; and a supply pump for delivering fuel at a relatively fixed pressure to the metering inlet valve.

  20. Microfabricated injectable drug delivery system

    DOEpatents

    Krulevitch, Peter A.; Wang, Amy W.

    2002-01-01

    A microfabricated, fully integrated drug delivery system capable of secreting controlled dosages of multiple drugs over long periods of time (up to a year). The device includes a long and narrow shaped implant with a sharp leading edge for implantation under the skin of a human in a manner analogous to a sliver. The implant includes: 1) one or more micromachined, integrated, zero power, high and constant pressure generating osmotic engine; 2) low power addressable one-shot shape memory polymer (SMP) valves for switching on the osmotic engine, and for opening drug outlet ports; 3) microfabricated polymer pistons for isolating the pressure source from drug-filled microchannels; 4) multiple drug/multiple dosage capacity, and 5) anisotropically-etched, atomically-sharp silicon leading edge for penetrating the skin during implantation. The device includes an externally mounted controller for controlling on-board electronics which activates the SMP microvalves, etc. of the implant.

  1. Fuel injection system for internal combustion engines

    SciTech Connect

    Yamaguchi, S.

    1986-10-28

    A fuel injection system is described for an internal combustion engine, comprising: (a) a fuel injection pump driven by the engine for fuel injection thereto and including a plunger reciprocably movable at a non-uniform speed and a control sleeve slidably fitted on the plunger; (b) first drive means operatively connected with the plunger for rotating the latter to thereby adjust the effective stroke of the plunger; (c) second drive means operatively connected with the control sleeve for displacing the latter in an axial direction to thereby adjust the pre-stroke of the control sleeve; (d) an operation sensor for detecting operating conditions of the engine; (e) a position sensor for detecting a position of the control sleeve; (f) first arithmetic means responsive to the engine operating conditions detected by the operation sensor, for computing an object injection quantity; (g) second arithmetic means responsive to the position of the control sleeve detected by the position sensor, for computing an object pre-stroke of the plunger; (h) third arithmetic means responsive to the engine operating conditions detected and the position of the control sleeve detected, for computing a correction amount; (i) first control means responsive to the correction amount computed by the third arithmetic means, for correcting the object injection quantity and for delivering a control signal to the first drive means; and (j) second control means responsive to the object injection quantity computed by the second arithmetic means, for delivering a control signal to the second drive means.

  2. Comparison of fluoroscopic Guided Transforaminal Epidural Injections of Steroid and Local Anaesthetic with Conservative Management in Patients with Chronic Lumbar Radiculopathies

    PubMed Central

    Mehta, Nandita; Salaria, Misbah; Salaria, A. Q.

    2017-01-01

    Background: Chronic lumbar radiculopathy is a common medical problem and the treatment modalities used over years have been many ranging from conservative or symptomatic management to open decompression surgery. This study was aimed at to compare two modalities of treatment, i.e., conservative and lumbar transforaminal epidural steroid injections (TFESIs). Materials and Methods: A total of 120 patients of American Society of Anesthesiology class - (a healthy patient or a patient with mild systemic disease) were randomized to two groups. Group C (n = 60) were managed conservatively with bed rest, analgesics, and physiotherapy. Group T (n = 60) received lumbar TFESIs with methylprednisolone 40 mg with 2 ml bupivacaine (0.5%). Measurements using visual analog scale (VAS) were taken before treatment and at various time intervals after the start of treatment. Results: There was no statistically significant difference regarding the demographic characteristics of both groups. The VAS scores were less and statistically significant in Group T after 30 min postinjection, at the 2nd week and after 1 month. Recovery rate of straight leg raise test was found to be 98% in those treated with TFESI. The Group T had significantly better patient satisfaction score and additionally there was drug dose intake reduction before and after the treatment. Conclusion: Patients treated with fluoroscopic-guided TFESI have better pain relief, quality-of-life, and less analgesic requirement than those managed conservatively. PMID:28298750

  3. Capsule injection system for a hydraulic capsule pipelining system

    DOEpatents

    Liu, Henry

    1982-01-01

    An injection system for injecting capsules into a hydraulic capsule pipelining system, the pipelining system comprising a pipeline adapted for flow of a carrier liquid therethrough, and capsules adapted to be transported through the pipeline by the carrier liquid flowing through the pipeline. The injection system comprises a reservoir of carrier liquid, the pipeline extending within the reservoir and extending downstream out of the reservoir, and a magazine in the reservoir for holding capsules in a series, one above another, for injection into the pipeline in the reservoir. The magazine has a lower end in communication with the pipeline in the reservoir for delivery of capsules from the magazine into the pipeline.

  4. Epidural Steroid Injections

    MedlinePlus

    ... and can be accompanied by a feeling of warmth or even a low grade increase in temperature), ... are also commonly coupled with other treatments (medications, physical therapy, etc) in an attempt to either maximize ...

  5. CONCEPTUAL DESIGN OF THE NSLS-II INJECTION SYSTEM.

    SciTech Connect

    SHAFTAN,T.; ROSE, T.; PINAYEV, I.; HEESE, R.; BENGTSSON, J.; SKARITKA, J.; MENG, W.; OZAKI, S.; MEIER, R.; STELMACH, C.; LITVINENKO, V.; PJEROV, S.; SHARMA, S.; GANETIS, G.; HSEUH, H.C.; JOHNSON, E.D.; TSOUPAS, N.; GUO, W.; BEEBE-WANG, J.; LUCCIO, A.U.; YU, L.H.; RAPARIA, D.; WANG, D.

    2007-06-25

    We present the conceptual design of the NSLS-II injection system [1,2]. The injection system consists of a low-energy linac, booster and transport lines. We review two different injection system configurations; a booster located in the storage ring tunnel and a booster housed in a separate building. We briefly discuss main parameters and layout of the injection system components.

  6. Passive safety injection system using borated water

    SciTech Connect

    Conway, Lawrence E.; Schulz, Terry L.

    1993-01-01

    A passive safety injection system relies on differences in water density to induce natural circulatory flow patterns which help maintain prescribed concentrations of boric acid in borated water, and prevents boron from accumulating in the reactor vessel and possibly preventing heat transfer.

  7. Passive injection control for microfluidic systems

    DOEpatents

    Paul, Phillip H.; Arnold, Don W.; Neyer, David W.

    2004-12-21

    Apparatus for eliminating siphoning, "dead" regions, and fluid concentration gradients in microscale analytical devices. In its most basic embodiment, the present invention affords passive injection control for both electric field-driven and pressure-driven systems by providing additional fluid flow channels or auxiliary channels disposed on either side of a sample separation column. The auxiliary channels are sized such that volumetric fluid flow rate through these channels, while sufficient to move the sample away from the sample injection region in a timely fashion, is less than that through the sample separation channel or chromatograph.

  8. Diagnosing the PEP-II Injection System

    SciTech Connect

    Decker, F.-J.; Donald, M.H.; Iverson, R.H.; Kulikov, A.; Pappas, G.C.; Weaver, M.; /SLAC

    2005-05-09

    The injection of beam into the PEP-II B-Factory, especially into the High Energy Ring (HER) has some challenges. A high background level in the BaBar detector has for a while inhibited us from trickling charge into the HER similar to the Low Energy Ring (LER). Analyzing the injection system has revealed many issues which could be improved. The injection bump between two kickers was not closed, mainly because the phase advance wasn't exactly 180{sup o} and the two kicker strengths were not balanced. Additionally we found reflections which kick the stored beam after the main kick and cause the average luminosity to drop about 3% for a 10 Hz injection rate. The strength of the overall kick is nearly twice as high as the design, indicating a much bigger effective septum thickness. Compared with single beam the background is worse when the HER beam is colliding with the LER beam. This hints that the beam-beam force and the observed vertical blow-up in the HER pushes the beam and especially the injected beam further out to the edge of the dynamic aperture or beyond.

  9. Does pain relief by CT-guided indirect cervical nerve root injection with local anesthetics and steroids predict pain relief after decompression surgery for cervical nerve root compression?

    PubMed

    Antoniadis, Alexander; Dietrich, Tobias J; Farshad, Mazda

    2016-10-01

    The relationship of pain relief from a recently presented CT-guided indirect cervical nerve root injection with local anesthetics and steroids to surgical decompression as a treatment for single-level cervical radiculopathy is not clear. This retrospective study aimed to compare the immediate and 6-week post-injection effects to the short- and long-term outcomes after surgical decompression, specifically in regard to pain relief. Patients (n = 39, age 47 ± 10 years) who had undergone CT-guided indirect injection with local anesthetics and steroids as an initial treatment for single cervical nerve root radiculopathy and who subsequently needed surgical decompression were included retrospectively. Pain levels (VAS scores) were monitored before, immediately after, and 6 weeks after injection (n = 34), as well as 6 weeks (n = 38) and a mean of 25 months (SD ± 12) after surgical decompression (n = 36). Correlation analysis was performed to find potential associations of pain relief after injection and after surgery to investigate the predictive value of post-injection pain relief. There was no correlation between immediate pain relief after injection (-32 ± 27 %) and 6 weeks later (-7 ± 19 %), (r = -0.023, p = 0.900). There was an association by tendency between immediate pain relief after injection and post-surgical pain relief at 6 weeks (-82 ± 27 %), (r = 0.28, p = 0.08). Pain relief at follow-up remained high at -70 ± 21 % and was correlated with the immediate pain amelioration effect of the injection (r = 0.37, p = 0.032). Five out of seven patients who reported no pain relief from injection had a pain relief from surgery in excess of 50 %. The amount of immediate radiculopathic pain relief after indirect cervical nerve root injection is associated with the amount of pain relief achieved at long-term follow-up after surgical decompression of single-level cervical radiculopathy

  10. [Clinical use of spinal or epidural steroids].

    PubMed

    Marinangeli, F; Ciccozzi, A; Donatelli, F; Paladini, A; Varrassi, G

    2002-01-01

    Steroids, drugs with potent antiinflammatory properties on the damaged nervous roots, have been especially used as adjuvants of local anesthetics, by spinal route, in the treatments of low-back pain. Spinal route was chosen to obtain a higher local concentration of drug, with few systemic side effects and to improve drug's action mechanism. Steroids seem to interact with GABA receptors and thus control neural excitability through a stabilising effect on membranes, modification of nervous conduction and membrane hyperpolarization, in supraspinal and spinal site. Epidural steroids are especially used in the treatment of low back pain due to irritation of nervous roots. They have been administered alone or in association with local anesthetics and/or saline solution. Slow release formulations have been generally used (methylprednisolone acetate, and triamcinolone diacetate). Other indications of epidural steroids are: postoperative hemilaminectomy pain, prevention of post herpetic neuralgia, degenerative ostheoartrithis. Intra-thecal steroids have been frequently used in the treatment of lumbar radiculopathy due to discopathy, as an alternative treatment when epidural administration is ineffective. Positive results have been obtained with methylprednisolone acetate, alone or in association with local anesthetics. Complications related to intraspinal steroids injections are due to execution of the block and side effects of drugs. Complications associated with intrathecal steroids are more frequent and severe than epidural injections and include: adhesive arachnoiditis, aseptic meningitis, cauda equina syndrome. Steroidal toxicity seems to be related to the polyethylenic glycole vehicle. Anyway, slow release formulations contain less concentrated polyethylenic glycole. The epidural administration, a correct dilution of steroid with local anesthetics solution and/or saline solution, and a limited number of injections (no more than three) allows a significant reduction of

  11. The Advanced Photon Source injection timing system

    SciTech Connect

    Lenkszus, F.R.; Laird, R.

    1995-12-31

    The Advanced Photon Source consists of five accelerators. The injection timing system provides the signals required to cause a bunch emitted from the electron gun to navigate through intermediate accelerators to a specific bucket (1 out of 1296) within the storage ring. Two linacs and a positron accumulator ring operate at 60Hz while a booster synchrotron ramps and injects into the storage ring at 2Hz. The distributed, modular VME/VXI-based injection timing system is controlled by two EPICS-based input/output controllers (IOCs). Over 40 VME/VXI cards have been developed to implement the system. Card types range from 352MHz VXI timing modules to VME-based fiber optic fanouts and logic translators/drivers. All timing is distributed with fiber optics. Timing references are derived directly from machine low-level rf of 9.77MHz and 352MHz. The timing references provide triggers to programmable delay generators. Three grades of timing are provided. Precision timing is derived from commercial digital delay generators, intermediate precision timing is obtained from VXI 8-channel digital delay generators which provide timing with 25ns peak-to-peak jitter, and modest precision timing is provided by the APS event system. The timing system is fully integrated into the APS EPICS-based control system.

  12. Injection of new technology into space systems

    NASA Astrophysics Data System (ADS)

    Curto, Paul A.; Hornstein, Rhoda Shaller

    2005-07-01

    Small satellite systems appear to be antithetical to human spaceflight systems and flagship robotic satellite systems: Small satellite missions have more focused scientific objectives, lower cost, far less complexity, and shorter development and deployment schedules. The shorter schedules offer an opportunity for injecting new technology into their design as a means for keeping costs and schedule under control, for enabling cost-effective operations, and for taking advantage of innovative ideas. It is often the case that small satellite missions benefit from technologies specifically targeted for their application, but benefits may also be realized by adopting or injecting technologies originally developed for human spaceflight systems, especially if these technologies were conceived using multi-use and multi-disciplinary development principles. In this paper, the authors discuss the precedent of injecting new technology developed for human spaceflight systems into small satellite missions. More importantly, the authors will present five new technologies recently proposed for making the NASA Space Shuttle safer to fly, all of which are directly applicable to small satellite mission design and operations. The technologies, when matured, will provide a means to create new generations of ultra-reliable flight hardware and software. The technologies are all currently at the developmental phase and require modest investment to achieve operational status.

  13. Hirsutism, virilism, polycystic ovarian disease, and the steroid-gonadotropin-feedback system: a career retrospective

    PubMed Central

    2012-01-01

    This career retrospective describes how the initial work on the mechanism of hormone action provided the tools for the study of hirsutism, virilism, and polycystic ovarian disease. After excessive ovarian and or adrenal androgen secretion in polycystic ovarian disease had been established, the question whether the disease was genetic or acquired, methods to manage hirsutism and methods for the induction of ovulation were addressed. Recognizing that steroid gonadotropin feedback was an important regulatory factor, initial studies were done on the secretion of LH and FSH in the ovulatory cycle. This was followed by the study of basic mechanisms of steroid-gonadotropin feedback system, using castration and steroid replacement and the events surrounding the natural onset of puberty. Studies in ovariectomized rats showed that progesterone was a pivotal enhancer of estrogen-induced gonadotropin release, thus accounting for the preovulatory gonadotropin surge. The effects of progesterone were manifested by depletion of the occupied estrogen receptors of the anterior pituitary, release of hypothalamic LHRH, and inhibition of enzymes that degrade LHRH. Progesterone also promoted the synthesis of FSH in the pituitary. The 3α,5α-reduced metabolite of progesterone brought about selective LH release and acted using the GABAA receptor system. The 5α-reduced metabolite of progesterone brought about selective FSH release; the ability of progesterone to bring about FSH release was dependent on its 5α-reduction. The GnRH neuron does not have steroid receptors; the steroid effect was shown to be mediated through the excitatory amino acid glutamate, which in turn stimulated nitric oxide. These observations led to the replacement of the long-accepted belief that ovarian steroids acted directly on the GnRH neuron by the novel concept that the steroid feedback effect was exerted at the glutamatergic neuron, which in turn regulated the GnRH neuron. The neuroprotective effects of

  14. Hirsutism, virilism, polycystic ovarian disease, and the steroid-gonadotropin-feedback system: a career retrospective.

    PubMed

    Mahesh, Virendra B

    2012-01-01

    This career retrospective describes how the initial work on the mechanism of hormone action provided the tools for the study of hirsutism, virilism, and polycystic ovarian disease. After excessive ovarian and or adrenal androgen secretion in polycystic ovarian disease had been established, the question whether the disease was genetic or acquired, methods to manage hirsutism and methods for the induction of ovulation were addressed. Recognizing that steroid gonadotropin feedback was an important regulatory factor, initial studies were done on the secretion of LH and FSH in the ovulatory cycle. This was followed by the study of basic mechanisms of steroid-gonadotropin feedback system, using castration and steroid replacement and the events surrounding the natural onset of puberty. Studies in ovariectomized rats showed that progesterone was a pivotal enhancer of estrogen-induced gonadotropin release, thus accounting for the preovulatory gonadotropin surge. The effects of progesterone were manifested by depletion of the occupied estrogen receptors of the anterior pituitary, release of hypothalamic LHRH, and inhibition of enzymes that degrade LHRH. Progesterone also promoted the synthesis of FSH in the pituitary. The 3α,5α-reduced metabolite of progesterone brought about selective LH release and acted using the GABA(A) receptor system. The 5α-reduced metabolite of progesterone brought about selective FSH release; the ability of progesterone to bring about FSH release was dependent on its 5α-reduction. The GnRH neuron does not have steroid receptors; the steroid effect was shown to be mediated through the excitatory amino acid glutamate, which in turn stimulated nitric oxide. These observations led to the replacement of the long-accepted belief that ovarian steroids acted directly on the GnRH neuron by the novel concept that the steroid feedback effect was exerted at the glutamatergic neuron, which in turn regulated the GnRH neuron. The neuroprotective effects of

  15. Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches

    PubMed Central

    Singh, Saru; Kaur, Sukhdeep; Singh, Kulvinder; Aujla, Kuljeet

    2014-01-01

    Background Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement

  16. High-pressure fuel injection system for diesel engine

    SciTech Connect

    Hoshi, Y.

    1986-01-21

    This patent describes a high-pressure fuel injection system for a diesel engine. This system consists of: (a) main pumps for injecting fuel each located at one of cylinders of the engine and formed with a fuel injecting port, a discharge valve located in a path connecting the first injected fuel space with the fuel injecting port. The discharge valve is opened when the fuel to be injected reaches a predetermined pressure level. A first injection timing fuel space fluidly connected with the first injected fuel space through a movable shuttle is filled with injection timing fuel, and a plunger varies the volume of the first injection timing fuel space; (b) a metering and distributing pump formed with injection fuel outputs and injection timing fuel outlets corresponding in number to the cylinders of the engine for discharging fuel in timed relation to the rotation of the engine; (c) fuel metering valves for metering fuel flowing into the second injected fuel space and second injection timing fuel space respectively; (d) pipes for fluidly connecting the first injected fuel space and first injection timing fuel space of the main pump for injecting fuel with the injected fuel outlets and injection timing fuel outlets of the metering and distributing pump respectively; and (e) a rocker arm mechanism for driving the plunger of the main pump for injecting fuel in timed relation to the rotation of the engine.

  17. Modular injection systems for miniature engines

    NASA Astrophysics Data System (ADS)

    Cochran, Mike

    1992-07-01

    Mission requirements for Kinetic Energy Weapons will require miniaturization of current vehicle propulsion systems for future Space Defence Iniative Programs. A modular injection system (MIS) valve is presented which will decrease cost, size and weight of miniaturized storable bipropellant rocket engines and features two poppet-type propellant valve modules pneumatically linked to a pilot solenoid module. A prototype modular injection valve sized for 100lbf thrust was designed and is being tested to show lower costs, fewer moving parts and a reduction in weight and size. Results show that this valve meets objectives of one-half weight, one-half cost and one-fifth the envelopment of current production valves. Studies indicate that a cruciform configuration of four nominal 100lbf thrust engines can be controlled by four modular injection valve systems in a single housing of less than 1.0 m3. Following further development and correlation of results this concept may be scaled to control four higher thrust engines.

  18. Injection System for Multi-Well Injection Using a Single Pump.

    PubMed

    Wovkulich, Karen; Stute, Martin; Protus, Thomas J; Mailloux, Brian J; Chillrud, Steven N

    2011-01-01

    Many hydrological and geochemical studies rely on data resulting from injection of tracers and chemicals into groundwater wells. The even distribution of liquids to multiple injection points can be challenging or expensive, especially when using multiple pumps. An injection system was designed using one chemical metering pump to evenly distribute the desired influent simultaneously to 15 individual injection points through an injection manifold. The system was constructed with only one metal part contacting the fluid due to the low pH of the injection solutions. The injection manifold system was used during a three-month pilot scale injection experiment at the Vineland Chemical Company Superfund site. During the two injection phases of the experiment (Phase I = 0.27 L/min total flow, Phase II = 0.56 L/min total flow), flow measurements were made 20 times over three months; an even distribution of flow to each injection well was maintained (RSD <4%). This durable system is expandable to at least 16 injection points and should be adaptable to other injection experiments that require distribution of air-stable liquids to multiple injection points with a single pump.

  19. Injection System for Multi-Well Injection Using a Single Pump

    PubMed Central

    Wovkulich, Karen; Stute, Martin; Protus, Thomas J.; Mailloux, Brian J.; Chillrud, Steven N.

    2015-01-01

    Many hydrological and geochemical studies rely on data resulting from injection of tracers and chemicals into groundwater wells. The even distribution of liquids to multiple injection points can be challenging or expensive, especially when using multiple pumps. An injection system was designed using one chemical metering pump to evenly distribute the desired influent simultaneously to 15 individual injection points through an injection manifold. The system was constructed with only one metal part contacting the fluid due to the low pH of the injection solutions. The injection manifold system was used during a three-month pilot scale injection experiment at the Vineland Chemical Company Superfund site. During the two injection phases of the experiment (Phase I = 0.27 L/min total flow, Phase II = 0.56 L/min total flow), flow measurements were made 20 times over three months; an even distribution of flow to each injection well was maintained (RSD <4%). This durable system is expandable to at least 16 injection points and should be adaptable to other injection experiments that require distribution of air-stable liquids to multiple injection points with a single pump. PMID:26140014

  20. Waterflooding injectate design systems and methods

    DOEpatents

    Brady, Patrick V.; Krumhansl, James L.

    2014-08-19

    A method of designing an injectate to be used in a waterflooding operation is disclosed. One aspect includes specifying data representative of chemical characteristics of a liquid hydrocarbon, a connate, and a reservoir rock, of a subterranean reservoir. Charged species at an interface of the liquid hydrocarbon are determined based on the specified data by evaluating at least one chemical reaction. Charged species at an interface of the reservoir rock are determined based on the specified data by evaluating at least one chemical reaction. An extent of surface complexation between the charged species at the interfaces of the liquid hydrocarbon and the reservoir rock is determined by evaluating at least one surface complexation reaction. The injectate is designed and is operable to decrease the extent of surface complexation between the charged species at interfaces of the liquid hydrocarbon and the reservoir rock. Other methods, apparatus, and systems are disclosed.

  1. Androgenic anabolic steroid abuse and the cardiovascular system.

    PubMed

    Vanberg, Paul; Atar, Dan

    2010-01-01

    Abuse of anabolic androgenic steroids (AAS) has been linked to a variety of different cardiovascular side effects. In case reports, acute myocardial infarction is the most common event presented, but other adverse cardiovascular effects such as left ventricular hypertrophy, reduced left ventricular function, arterial thrombosis, pulmonary embolism and several cases of sudden cardiac death have also been reported. However, to date there are no prospective, randomized, interventional studies on the long-term cardiovascular effects of abuse of AAS. In this review we have studied the relevant literature regarding several risk factors for cardiovascular disease where the effects of AAS have been scrutinized:(1) Echocardiographic studies show that supraphysiologic doses of AAS lead to both morphologic and functional changes of the heart. These include a tendency to produce myocardial hypertrophy (Fig. 3), a possible increase of heart chamber diameters, unequivocal alterations of diastolic function and ventricular relaxation, and most likely a subclinically compromised left ventricular contractile function. (2) AAS induce a mild, but transient increase of blood pressure. However, the clinical significance of this effect remains modest. (3) Furthermore, AAS confer an enhanced pro-thrombotic state, most prominently through an activation of platelet aggregability. The concomitant effects on the humoral coagulation cascade are more complex and include activation of both pro-coagulatory and fibrinolytic pathways. (4) Users of AAS often demonstrate unfavorable measurements of vascular reactivity involving endothelial-dependent or endothelial-independent vasodilatation. A degree of reversibility seems to be consistent, though. (5) There is a comprehensive body of evidence documenting that AAS induce various alterations of lipid metabolism. The most prominent changes are concomitant elevations of LDL and decreases of HDL, effects that increase the risk of coronary artery disease

  2. Usefulness of a Hanging Position With Internal Rotation of Shoulder in Ultrasonography-Guided Intra-articular Steroid Injection for Adhesive Capsulitis

    PubMed Central

    2016-01-01

    Objective To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. Methods A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. Results The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. Conclusion For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in

  3. An Innovative Needle-free Injection System: Comparison to 1 ml Standard Subcutaneous Injection.

    PubMed

    Kojic, Nikola; Goyal, Pragun; Lou, Cheryl Hamer; Corwin, Michael J

    2017-05-01

    A needle-free delivery system may lead to improved satisfaction and compliance, as well as reduced anxiety among patients requiring frequent or ongoing injections. This report describes a first-in-man assessment comparing Portal Instruments' innovative needle-free injection system with subcutaneous injections using a 27G needle. Forty healthy volunteer participants each received a total of four injections of 1.0 mL sterile saline solution, two with a standard subcutaneous injection using a 27G needle, and two using the Portal injection system. Perception of pain was measured using a 100-mm visual analog scale (VAS). Injection site reactions were assessed at 2 min and at 20-30 min after each injection. Follow-up contact was made 24-48 h after the injections. Subject preference regarding injection type was also assessed. VAS pain scores at Portal injection sites met the criteria to be considered non-inferior to the pain reported at 27G needle injection sites (i.e., upper 95% confidence bound less than +5 mm). Based on a mixed effects model, at time 0, accounting for potential confounding variables, the adjusted difference in VAS scores indicated that Portal injections were 6.5 mm lower than the 27G needle injections (95% CI -10.5, -2.5). No clinically important adverse events were noted. Portal injections were preferred by 24 (60%) of the subjects (P = 0.0015). As an early step in the development of this new needle-free delivery system, the current study has shown that a 1.0-mL saline injection can be given with less pain reported than a standard subcutaneous injection using a 27G needle.

  4. 21 CFR 862.1385 - 17-Hydroxycorticosteroids (17-ketogenic steroids) test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false 17-Hydroxycorticosteroids (17-ketogenic steroids) test system. 862.1385 Section 862.1385 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES...

  5. Discharge characteristics of a high speed fuel injection system

    NASA Technical Reports Server (NTRS)

    Matthews, Robertson

    1925-01-01

    Discussed here are some discharge characteristics of a fuel injection system intended primarily for high speed service. The system consisted of a cam actuated fuel pump, a spring loaded automatic injection valve, and a connecting tube.

  6. Reliability and Accuracy of MRI Laminar Angle Measurements to Determine Intra-Procedural Contralateral Oblique View Angle for Cervical or Thoracic Interlaminar Epidural Steroid Injections.

    PubMed

    Levi, David S; Horn, Scott; Collado, Alexandra

    2016-09-01

    Contralateral oblique (CLO) angle view has been a useful addition to standard views in fluoroscopically guided interlaminar epidural injections. Determination of the appropriate CLO angle is paramount in the usefulness of this technique. Using MRI laminar angle measurements as a pre-procedural guide for the intra-procedural fluoroscopic CLO angle has been proposed. The purpose of this study was to help determine if using axial MRI laminar measurements prior to a cervical or thoracic epidural steroid injection would be useful in predicting the appropriate fluoroscopic CLO angle. A retrospective review was performed for patients who underwent cervical or thoracic interlaminar injections. In the performance of interlaminar injections, the authors had routinely determined the true fluoroscopic contra-lateral oblique angle after epidural access was confirmed, for use during any potential future injections. The fluoroscopic CLO angle measurements were obtained from a chart review and compared blindly to each patient's MRI axial laminar angle measurements. 34 injections were included. Inter-rater reliability comparing the two authors' MRI angle measurements was considered fair, ICC = 0.395. Accuracy was only 57% comparing MRI laminar angle measurements to within five degrees of the true fluoroscopic CLO angle as determined during the injection procedure. Accuracy by ICC showed only fair agreement, 0.47 and 0.22, for the two authors. The findings of this study indicate fair inter-rater reliability in manual measurements of laminar angle on axial MRI images. MRI laminar angle measurements do not appear to be highly accurate in determining the appropriate fluoroscopic CLO angle. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Ultrasound-Guided Versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: Case-Controlled, Retrospective, Comparative Study.

    PubMed

    Park, Ki Deok; Kim, Tai Kon; Lee, Woo Yong; Ahn, JaeKi; Koh, Sung Hoon; Park, Yongbum

    2015-12-01

    The aim of the article is to investigate the efficacy of ultrasound (US)-guided Caudal Epidural Steroid Injection (CESI) compared with fluoroscopy (FL)-guided CESI in patients with unilateral lower lumbar radicular pain. This case-controlled, retrospective, comparative study was done at the university hospital. A total of 110 patients treated with US- or FL-guided CESI were administered a mixture of 20 cc (0.5% lidocaine 18.0  mL + dexamethason 10  mg 2  mL). Outcome measurement was assessed by Oswestry Disability Index (ODI), verbal numeric pain scale (VNS) before injections and at 3, 6, and 12 months after the last injections. Successful outcome was defined as measured by >50% improvement in the VNS score and >40% improvement in the ODI. ODI and VNS showed improvement at 3, 6, and 12 months after the last injection in both groups. No statistical differences in ODI, VNS were observed between groups (P < 0.05). No significant differences in the proportion of patients with successful treatment were observed between the groups from the 3-month to 6-month to 12-month outcomes. US-guided CESI is deserving of consideration in conservative management of unilateral lower lumbar radicular pain.

  8. Effectiveness of Ultrasound-Guided Compared to Blind Steroid Injections in the Treatment of Carpal Tunnel Syndrome.

    PubMed

    Evers, Stefanie; Bryan, Andrew J; Sanders, Thomas L; Selles, Ruud W; Gelfman, Russell; Amadio, Peter C

    2017-07-01

    To compare the effectiveness of ultrasound-guided injections to blind injections in the treatment of carpal tunnel syndrome (CTS) in a large community-based cohort. This study evaluated residents of Olmsted County, Minnesota, treated with a corticosteroid injection for CTS between 2001 and 2010. The proportion of patients receiving retreatment and the duration of retreatment-free survival between blind and ultrasound-guided injections were compared. Propensity score matching was used to control for confounding by indication. In the matched data set consisting of 234 (of 600) hands treated with a blind injection and 87 (of 89) ultrasound-guided injection cases, ultrasound guidance was associated with a reduced hazard of retreatment (hazard ratio 0.59 [95% confidence interval (95% CI) 0.37-0.93]). In addition, ultrasound guidance was associated with 55% reduced odds of retreatment within 1 year compared to blind injections (adjusted odds ratio 0.45 [95% CI 0.24-0.83]). This study indicates that ultrasound-guided injections are more effective in comparison to blind injections in the treatment of CTS. © 2016, American College of Rheumatology.

  9. Injectable electronic identification, monitoring, and stimulation systems.

    PubMed

    Troyk, P R

    1999-01-01

    Historically, electronic devices such as pacemakers and neuromuscular stimulators have been surgically implanted into animals and humans. A new class of implants made possible by advances in monolithic electronic design and implant packaging is small enough to be implanted by percutaneous injection through large-gauge hypodermic needles and does not require surgical implantation. Among these, commercially available implants, known as radio frequency identification (RFID) tags, are used for livestock, pet, laboratory animal, and endangered-species identification. The RFID tag is a subminiature glass capsule containing a solenoidal coil and an integrated circuit. Acting as the implanted half of a transcutaneous magnetic link, the RFID tag is powered by and communicates with an extracorporeal magnetic reader. The tag transmits a unique identification code that serves the function of identifying the animal. Millions of RFID tags have been sold since the early 1980s. Based on the success of the RFID tags, research laboratories have developed injectable medical implants, known as micromodules. One type of micromodule, the microstimulator, is designed for use in functional-neuromuscular stimulation. Each microstimulator is uniquely addressable and could comprise one channel of a multichannel functional-neuromuscular stimulation system. Using bidirectional telemetry and commands, from a single extracorporeal transmitter, as many as 256 microstimulators could form the hardware basis for a complex functional-neuromuscular stimulation feedback-control system. Uses include stimulation of paralyzed muscle, therapeutic functional-neuromuscular stimulation, and neuromodulatory functions such as laryngeal stimulation and sleep apnea.

  10. UP-GRADED RHIC INJECTION SYSTEM.

    SciTech Connect

    HAHN,H.FISCHER,W.SEMERTZIDIS,Y.K.WARBURTON,D.S.

    2003-05-12

    The design of the RHIC injection systems anticipated the possibility of filling and operating the rings with a 120 bunch pattern, corresponding to 110 bunches after allowing for the abort gap. Beam measurements during the 2002 run confirmed the possibility, although at the expense of severe transverse emittance growth and thus not on an operational basis. An improvement program was initiated with the goal of reducing the kicker rise time from 110 to {approx}95 ns and of minimizing pulse timing jitter and drift. The major components of the injection system are 4 kicker magnets and Blmlein pulsers using thyratron switches. The kicker terminating resistor and operating voltage was increased to reduce the rise time. Timing has been stabilized by using commercial trigger units and extremely stable dc supplies for the thyratron reservoir. A fiber optical connection between control room and the thyratron trigger unit has been provided, thereby allowing the operator to adjust timing individually for each kicker unit. The changes were successfully implemented for use in the RHIC operation.

  11. Secondary air injection system and method

    DOEpatents

    Wu, Ko-Jen; Walter, Darrell J.

    2014-08-19

    According to one embodiment of the invention, a secondary air injection system includes a first conduit in fluid communication with at least one first exhaust passage of the internal combustion engine and a second conduit in fluid communication with at least one second exhaust passage of the internal combustion engine, wherein the at least one first and second exhaust passages are in fluid communication with a turbocharger. The system also includes an air supply in fluid communication with the first and second conduits and a flow control device that controls fluid communication between the air supply and the first conduit and the second conduit and thereby controls fluid communication to the first and second exhaust passages of the internal combustion engine.

  12. Simulation of the ESR injection system

    NASA Astrophysics Data System (ADS)

    Schillinger, Brigitte; Weiland, Thomas; Langenbeck, Bernhard

    1999-05-01

    In order to improve the acceptance of the ESR beam injection system the influence of the fringe field of the main dipole magnet on the ion optics has to be analysed. Therefore, we perform a 3D MAFIA simulation of the dipole magnet and calculate the injection line which enters the radial fringe field in a tangential way. Starting from the given ESR beta function we trace the beam ellipse backwards in order to obtain the phase space requirements near the exit plane of the inflector magnet. Simulated phase space "monitors" defined at the start and the end of the curved reference trajectory give insight in the change of the beam emittance ellipse and indicate if aperture limitations may lead to beam losses. We obtain the second-order mapping of the phase space ellipse by calculating the first- and second-order field coefficients along the curved reference trajectory and solving the differential equations corresponding to each matrix element numerically. After an introduction into the field calculation method and the principles used to get the field index and second-order field coefficients, we will discuss our results and compare them with calculations based on measured field data (Spiller et al., GSI Scientific Report, 1996, p. 165).

  13. A systematic review to assess comparative effectiveness studies in epidural steroid injections for lumbar spinal stenosis and to estimate reimbursement amounts.

    PubMed

    Bresnahan, Brian W; Rundell, Sean D; Dagadakis, Marissa C; Sullivan, Sean D; Jarvik, Jeffrey G; Nguyen, Hiep; Friedly, Janna L

    2013-08-01

    To systematically appraise published comparative effectiveness evidence (clinical and economic) of epidural steroid injections (ESI) for lumbar spinal stenosis and to estimate Medicare reimbursement amounts for ESI procedures. TYPE: Systematic review. PubMed, Embase, and CINAHL were searched through August 2012 for key words that pertain to low back pain, spinal stenosis or sciatica, and epidural steroid injection. We used institutional and Medicare reimbursement amounts for our cost estimation. Articles published in English that assessed ESIs for adults with lumbar spinal stenosis versus a comparison intervention were included. Our search identified 146 unique articles, and 138 were excluded due to noncomparative study design, not having a study population with lumbar spinal stenosis, not having an appropriate outcome, or not being in English. We fully summarized 6 randomized controlled trials and 2 large observational studies. Randomized controlled trial articles were reviewed, and the study population, sample size, treatment groups, ESI dosage, ESI approaches, concomitant interventions, outcomes, and follow-up time were reported. Descriptive resource use estimates for ESIs were calculated with use of data from our institution during 2010 and Medicare-based reimbursement amounts. ESIs or anesthetic injections alone resulted in better short-term improvement in walking distance compared with control injections. However, there were no longer-term differences. No differences between ESIs versus anesthetic in self-reported improvement in pain were reported. Transforaminal approaches had better improvement in pain scores (≤4 months) compared with interlaminar injections. Two observational studies indicated increased rates of lumbar ESI in Medicare beneficiaries. Our sample included 279 patients who received at least 1 ESI during 2010, with an estimated mean total outpatient reimbursement for one ESI procedure "event" to be $637, based on 2010 Medicare reimbursement

  14. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M.; Boswell, Mark V.

    2015-01-01

    Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain. Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain. Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited. Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group. Results: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. Conclusion: This assessment shows that in patients

  15. In vitro steroid profiling system for the evaluation of endocrine disruptors.

    PubMed

    Nakano, Yosuke; Yamashita, Toshiyuki; Okuno, Masashi; Fukusaki, Eiichiro; Bamba, Takeshi

    2016-09-01

    Endocrine disruptors (ED) are chemicals that affect various aspects of the endocrine system, often leading to the inhibition of steroidogenesis. Current chemical safety policies that restrict human exposure to such chemicals describe often time-consuming and costly methods for the evaluation of ED effects. We aimed to develop an effective tool for accurate phenotypic chemical toxicology studies. We developed an in vitro ED evaluation system using gas chromatography/mass spectrometry (GC/MS/MS) methods for metabolomic analysis of multi-marker profiles. Accounting for sample preparation and GC/MS/MS conditions, we established a screening method that allowed the simultaneous analysis of 17 steroids with good reproducibility and a linear calibration curve. Moreover, we applied the developed system to H295R human adrenocortical cells exposed to forskolin and prochloraz in accordance with the Organization for Economic Cooperation and Development (OECD) guidelines and observed dose-dependent variations in steroid profiles. While the OECD guidelines include only testosterone and 17β-estradiol, our system enabled a comprehensive and highly sensitive analysis of steroid profile alteration due to ED exposure. The application of our ED evaluation screen could be economical and provide novel insights into the hazards of ED exposure to the endocrine system. Copyright © 2016 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

  16. Anabolic Steroids

    MedlinePlus

    Anabolic steroids are man-made substances related to male sex hormones. Doctors use anabolic steroids to treat some hormone problems in men, ... from some diseases. Bodybuilders and athletes often use anabolic steroids to build muscles and improve athletic performance. ...

  17. Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

    PubMed Central

    Hazra, Arindam Kumar; Bhattacharya, Dipasri; Mukherjee, Sayantan; Ghosh, Santanu; Mitra, Manasij; Mandal, Mohanchandra

    2016-01-01

    Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively, P < 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques. PMID:27330199

  18. Does the Occupational Activity Level Affect the Quality of Life of Patients Treated with Epidural Steroid Injections for Lumbar Disc Herniations?

    PubMed Central

    Pai, Sudhir

    2012-01-01

    Study Design Prospective cohort study. Purpose To determine whether there was any change in the quality of life of patients in sedentary/non sedentary occupations treated with epidural steroid injection for lumbar disc herniations using the 8 components of the SF 36 questionnaire.Overview of Literature: No previously done similar study published. Overview of Literature No previously done similar study published. Methods Ninety patients comprising sedentary and non sedentary occupations with lumbar disc herniations on magnetic resonance imaging who were treated with epidural steroid injection at St. John's Hospital Bangalore who met the Spinal Outcomes Research Trial eligibility criteria from April 2009 to May 2010. Results Of the 90 patients evaluated 44 were of Sedentary and 46 were of non sedentary activity levels, At 6 months primary outcomes physical functioning (p = 0.573, in difference between sedentary and non sedentary, improvement p = 0.001) energy/fatigue (difference between the two p = 0.917, improvement p = 0.001), emotional well being (difference p = 0.912, improvement, p = 0.001), social functioning (difference p = 0.523, improvement p = 0.232), pain (difference p = 0.535, improvement p = 0.001), general health (difference p = 0.738, improvement p < 0.001). Conclusions There was a statistically significant improvement in patients of both the sedentary and non sedentary groups p < 0.001 in all components of the SF36 in both sedentary and non sedentary patients except social functioning where the improvement was not statistically significant, and there was no significant difference between non sedentary and sedentary populations over time. PMID:22708017

  19. Does the occupational activity level affect the quality of life of patients treated with epidural steroid injections for lumbar disc herniations?

    PubMed

    Mhaskar, Vikram Arun; Pai, Sudhir

    2012-06-01

    Prospective cohort study. To determine whether there was any change in the quality of life of patients in sedentary/non sedentary occupations treated with epidural steroid injection for lumbar disc herniations using the 8 components of the SF 36 questionnaire.Overview of Literature: No previously done similar study published. No previously done similar study published. Ninety patients comprising sedentary and non sedentary occupations with lumbar disc herniations on magnetic resonance imaging who were treated with epidural steroid injection at St. John's Hospital Bangalore who met the Spinal Outcomes Research Trial eligibility criteria from April 2009 to May 2010. Of the 90 patients evaluated 44 were of Sedentary and 46 were of non sedentary activity levels, At 6 months primary outcomes physical functioning (p = 0.573, in difference between sedentary and non sedentary, improvement p = 0.001) energy/fatigue (difference between the two p = 0.917, improvement p = 0.001), emotional well being (difference p = 0.912, improvement, p = 0.001), social functioning (difference p = 0.523, improvement p = 0.232), pain (difference p = 0.535, improvement p = 0.001), general health (difference p = 0.738, improvement p < 0.001). There was a statistically significant improvement in patients of both the sedentary and non sedentary groups p < 0.001 in all components of the SF36 in both sedentary and non sedentary patients except social functioning where the improvement was not statistically significant, and there was no significant difference between non sedentary and sedentary populations over time.

  20. Diesel engine fuel injection system with a rate-of-injection control arrangement

    SciTech Connect

    Abe, S.; Igashira, T.; Sakakibara, Y.; Izawa, A.; Sekiguchi, K.

    1988-03-15

    A fuel injection system for a diesel engine is described comprising: (a) a fuel injection pump for delivering a controlled quantity of high pressure fuel cyclically at a timing synchronized with the operation of the engine; (b) a fuel injection nozzle hydraulically connected to the injection pump for receiving high pressure fuel therefrom and injecting the fuel into an engine cylinder; (c) means for controlling a rate of injection of the system in response to operating conditions of the engine; and (d) passage means for providing, during each delivery stroke of the pump plunger, fluid communication between the pumping chamber and the variable volume chamber only for a predetermined initial phase of the delivery stroke. The variable volume chamber is hydraulically isolated from the pumping chamber during subsequent phases of the delivery stroke.

  1. Tracing Injection Fluids in Engineered Geothermal Systems

    NASA Astrophysics Data System (ADS)

    Rose, P. E.; Leecaster, K.; Mella, M.; Ayling, B.; Bartl, M. H.

    2011-12-01

    The reinjection of produced fluids is crucial to the effective management of geothermal reservoirs, since it provides a mechanism for maintaining reservoir pressures while allowing for the disposal of a toxic byproduct. Tracers are essential to the proper location of injection wells since they are the only known tool for reliably characterizing the flow patterns of recirculated fluids. If injection wells are placed too close to production wells, then reinjected fluids do not have sufficient residence time to extract heat from the reservoir and premature thermal breakthrough results. If injection wells are placed too far away, then the reservoir risks unacceptable pressure loss. Several thermally stable compounds from a family of very detectable fluorescent organic compounds (the naphthalene sulfonates) were characterized and found to be effective for use as geothermal tracers. Through batch-autoclave reactions, their Arrhenius pseudo-first-order decay-rate constants were determined. An analytical method was developed that allows for the laboratory determination of concentrations in the low parts-per-trillion range. Field experiments in numerous geothermal reservoirs throughout the world have confirmed the laboratory findings. Whereas conservative tracers such as the naphthalene sulfonates are effective tools for indicating interwell flow patterns and for measuring reservoir pore volumes, 'reactive' tracers can be used to constrain fracture surface area, which is the effective area for heat extraction. This is especially important for engineered geothermal system (EGS) wells, since reactive tracers can be used to measure fracture surface area immediately after drilling and while the well stimulation equipment is still on site. The reactive properties of these tracers that can be exploited to constrain fracture surface area are reversible sorption, contrasting diffusivity, and thermal decay. Laboratory batch- and flow-reactor experiments in combination with numerical

  2. Waterflooding injectate design systems and methods

    DOEpatents

    Brady, Patrick V.; Krumhansl, James L.

    2016-12-13

    A method of recovering a liquid hydrocarbon using an injectate includes recovering the liquid hydrocarbon through primary extraction. Physico-chemical data representative of electrostatic interactions between the liquid hydrocarbon and the reservoir rock are measured. At least one additive of the injectate is selected based on the physico-chemical data. The method includes recovering the liquid hydrocarbon from the reservoir rock through secondary extraction using the injectate.

  3. Gasoline direct injection: Actual trends and future strategies for injection and combustion systems

    SciTech Connect

    Fraidl, G.K.; Piock, W.F.; Wirth, M.

    1996-09-01

    Recent developments have raised increased interest on the concept of gasoline direct injection as the most promising future strategy for fuel economy improvement of SI engines. The general requirements for mixture preparation and combustion systems in a GDI engine are presented in view of known and actual systems regarding fuel economy and emission potential. The characteristics of the actually favored injection systems are discussed and guidelines for the development of appropriate combustion systems are derived. The differences between such mixture preparation strategies as air distributed fuel and fuel wall impingement are discussed, leading to the alternative approach to the problem of mixture preparation with the fully air distributing concept of direct mixture injection.

  4. Transport of Steroid Hormones, Phytoestrogens, and Estrogenic Activity across a Swine Lagoon/Sprayfield System

    PubMed Central

    Yost, Erin E.; Meyer, Michael T.; Dietze, Julie E.; Williams, C. Michael; Worley-Davis, Lynn; Lee, Boknam; Kullman, Seth W.

    2017-01-01

    The inflow, transformation, and attenuation of natural steroid hormones, phytoestrogens, and estrogenic activity was assessed across the lagoon/sprayfield system of a prototypical commercial swine sow operation. Free and conjugated steroid hormones (estrogens, androgens, and progesterone) were detected in urine and feces of sows across reproductive stages, with progesterone being the most abundant steroid hormone. Excreta also contained phytoestrogens indicative of a soy-based diet; particularly daidzein, genistein, and equol. During storage in barn pits and the anaerobic lagoon, conjugated hormones dissipated, and androgens and progesterone were attenuated. Estrone and equol persisted along the waste disposal route. Following application of lagoon slurry to agricultural soils, all analytes exhibited attenuation within 2 days. However, analytes including estrone, androstenedione, progesterone, and equol remained detectable in soil at two months post-application. Estrogenic activity in the yeast estrogen screen and T47D-KBluc in vitro bioassays generally tracked well with analyte concentrations. Estrone found to be the greatest contributor to estrogenic activity across all sample types. This investigation encompasses the most comprehensive suite of natural hormone and phytoestrogen analytes examined to date across a lagoon/sprayfield system, and provides global insight into the fate of these analytes in this widely used waste management system. PMID:25148584

  5. Is Intra-Articular Steroid Injection to the Temporomandibular Joint for Juvenile Idiopathic Arthritis More Effective and Efficient When Performed With Image Guidance?

    PubMed

    Resnick, Cory M; Vakilian, Pouya M; Kaban, Leonard B; Peacock, Zachary S

    2017-04-01

    To compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA). This is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital (Boston, MA). Patients were divided into groups according to IASI technique: 1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance or 2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs image guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER), and total procedure time. Forty-five patients with 71 injected TMJs were included. Twenty-two patients with 36 injected TMJs were in the landmark group and 23 patients with 35 injected joints were in the image-guided group. There were no relevant differences in age, gender, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (P = 1.00), increase in MIO (P = .975), or decrease in ER (P = .492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (P < .008). There were no statistical differences in short-term outcomes, but procedure times were longer for the image-guided group. Although specific indications for the use of image guidance might exist, routine use of this procedure cannot be justified. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. H-reflex latency and nerve root tension sign correlation in fluoroscopically guided, contrast-confirmed, translaminar lumbar epidural steroid-bupivacaine injections.

    PubMed

    Stretanski, Michael F

    2004-09-01

    To examine the correlation between physical examination parameters, commonly referred to as "nerve root tension signs," and H-reflex latency measurements both pre- and postepidural steroid-bupivacaine (Marcaine) injection, and to propose mechanisms of pain alleviation. Prospective observational, with H-reflex latency measurement and physical examination at baseline and at 10 minutes postinjection. Physical medicine and rehabilitation practice, outpatient surgical center, and community setting. Ten consecutively recruited patients (6 women, 4 men; age range, 40-71 y) with clinical radiculopathy and compatible magnetic resonance imaging findings, who were unaware of the outcome measures. Patients received a fluoroscopically guided, contrast-confirmed, paramedian translaminar lumbar epidural injection of 120 mg of methylprednisolone acetate (80 mg/mL) and 2.0 mL of .25% preservative-free Marcaine. Seated slump testing (SST), straight-leg raising (SLR), and H-reflex latency were measured bilaterally both pre- and postinjection. Differences were measured by using the paired t test in an A-B design. All SST of the affected (injected) side improved from pre- to postinjection, with 3 patients reporting discordant hamstring pain and 7 reporting no pain. SLR ability increased by an average of 29 degrees +/-12 degrees, corresponding to an average relative increase of 54% on the affected side. A statistically significant difference was found (Student t test, P=.02) between pre and post H-reflex latency on the affected side but not when comparing changes between affected and unaffected sides (Student t test, P=0.6). Significant improvements in SST and SLR result from low volume epidural injection of Marcaine, with questionable prolongation of the H-reflex to the gastrocnemius-soleus complex on the affected side.

  7. Exuberant local tissue reaction to intramuscular injection of nandrolone decanoate (Deca-Durabolin)--a steroid compound in a sesame seed oil base--mimicking soft tissue malignant tumors: a case report and review of the literature.

    PubMed

    Khankhanian, N K; Hammers, Y A; Kowalski, P

    1992-12-01

    We present an unusual pseudotumor that formed in reaction to self-administered intramuscular injections of an anabolic steroid, nandrolone decanoate (Deca-Durabolin) in a young soldier. The histopathologic features which closely mimicked several malignant neoplasms could have led to an incorrect diagnosis of malignancy and unnecessary extensive surgery. To our knowledge, this phenomenon has not been previously reported.

  8. Induction of ovulation in Xenopus without hCG injection: the effect of adding steroids into the aquatic environment

    PubMed Central

    2011-01-01

    Background The African clawed frog, Xenopus laevis, is widely used in studies of oogenesis, meiotic cell cycle and early embryonic development. However, in order to perform such studies, eggs are normally collected after the injection of hCG into the dorsal lymph sac of fully-grown female frogs following pre-injection of PMSF. Although this protocol is established and used as standard laboratory approach, there are some concerns over whether the injections could cause the transmission of deleterious microorganisms. Moreover, these injection protocols require a competent skilled worker to carry out the procedure efficiently. Methods Recently, we established a novel method to induce fish ovulation by simply adding the natural maturation-inducing hormone of teleosts, 17 alpha, 20 beta-dihydroxy-4-pregnen-3-one (17,20 beta-DHP), into the surrounding water. In the present study, we demonstrate how we can induce ovulation in frogs using the same methodology. Results In frogs, progesterone was effective in the induction of oocyte maturation in vitro. We then examined the ability of progesterone to induce ovulation in frogs. However treatment of frogs with progesterone alone only occasionally induced ovulation in vivo. The number of oocytes and the frequency of ovulation were significantly lower than that induced by hCG-injection. Thus, conditions were improved by using a combination of progesterone with estradiol and by pre-treating frogs with low concentrations of progesterone or estradiol. Finally, we established an efficient means of inducing ovulation in frogs which involved pre-treatment of frogs with salt solution followed by a mixture of estradiol and progesterone at high concentration. The frequency and numbers of oocytes obtained were identical to those resulting from PMSG-hCG induction. Fertilization rate of eggs ovulated by the new treatment method was comparable to eggs obtained by hCG-injection and juveniles developed normally. Conclusions To conclude, we

  9. Chronic actinic dermatitis: two patients with successful management using narrowband ultraviolet B phototherapy with systemic steroids.

    PubMed

    Khaled, Aida; Kerkeni, Nadia; Baccouche, Dora; Zeglaoui, Faten; Kamoun, Mohamed Ridha; Fazaa, Becima

    2011-01-01

    Chronic actinic dermatitis (CAD) is a debilitating photodermatosis with characteristic clinical, histological and photobiological features (reduced minimal erythema dose: MED). Its management involves various therapeutic approaches, among them there is phototherapy. Efficacy of psoralen ultraviolet therapy (PUVA therapy) was previously demonstrated but there are no current data on the use of narrowband ultra violet B (UVB) therapy (NB-UVB) in CAD. NB-UVB has already been proven to be effective and safe in several other photodermatoses. We report here two dark-skinned patients (skin type IV and V) with CAD, successfully treated with an incremental regimen of NB-UVB phototherapy coupled to a 3 month-course of systemic steroids (1mg/Kg/day). Our protocol of NB-UVB with steroids seems to be effective for the management of CAD with a good short term safety profile. © 2011 Société Française de Pharmacologie et de Thérapeutique.

  10. Steroid injection and needle aponeurotomy for Dupuytren disease: long-term follow-up of a randomized controlled trial.

    PubMed

    McMillan, Catherine; Binhammer, Paul

    2014-10-01

    To compare long-term outcomes and retreatment rates for patients with Dupuytren disease who underwent needle aponeurotomy (NA) combined with a series of triamcinolone acetonide injections or underwent NA alone as part of a prior randomized controlled trial. During this follow-up study, 44 of 47 participants in the original study were examined as needed between 6 and 53 months from their initial procedure. Those who had not been reassessed within 18 months of the original NA were asked to return for follow-up. The average total active extension deficit (TAED) of previously treated joints was compared between groups 7 to 12, 13 to 24, 25 to 36, and 37 to 48 months following treatment. Timing of retreatment (if performed) was recorded. Forty-four participants returned for assessment an average of 4.8 times over 53 months. Mean TAED was significantly less in needle aponeurotomy triamcinolone injection patients at 6 months and between 13 and 24 months. Sixty-two percent of NA group patients and 30% of needle aponeurotomy triamcinolone injection patients returned for a second treatment on the same digit(s) (retreatment). This difference was not significant. Mean time to retreatment and mean TAED immediately prior to retreatment did not differ significantly between groups. Kaplan-Meier survival estimates demonstrated a significantly higher percentage of NA group patients expected to return for retreatment by 24 but not by 36 months. Younger age, more than one joint treated at the initial NA, and TAED severity throughout the follow-up period were associated with earlier retreatment. Serial triamcinolone injections combined with NA was associated with lower TAED for up to 24 months. A larger study would more accurately quantify the potential benefits of combining triamcinolone injections with NA for treatment of Dupuytren disease. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Transport of steroid hormones, phytoestrogens, and estrogenic activity across a swine lagoon/sprayfield system.

    PubMed

    Yost, Erin E; Meyer, Michael T; Dietze, Julie E; Williams, C Michael; Worley-Davis, Lynn; Lee, Boknam; Kullman, Seth W

    2014-10-07

    The inflow, transformation, and attenuation of natural steroid hormones and phytoestrogens and estrogenic activity were assessed across the lagoon/sprayfield system of a prototypical commercial swine sow operation. Free and conjugated steroid hormones (estrogens, androgens, and progesterone) were detected in urine and feces of sows across reproductive stages, with progesterone being the most abundant steroid hormone. Excreta also contained phytoestrogens indicative of a soy-based diet, particularly, daidzein, genistein, and equol. During storage in barn pits and the anaerobic lagoon, conjugated hormones dissipated, and androgens and progesterone were attenuated. Estrone and equol persisted along the waste disposal route. Following application of lagoon slurry to agricultural soils, all analytes exhibited attenuation within 2 days. However, analytes including estrone, androstenedione, progesterone, and equol remained detectable in soil at 2 months postapplication. Estrogenic activity in the yeast estrogen screen and T47D-KBluc in vitro bioassays generally tracked well with analyte concentrations. Estrone was found to be the greatest contributor to estrogenic activity across all sample types. This investigation encompasses the most comprehensive suite of natural hormone and phytoestrogen analytes examined to date across a livestock lagoon/sprayfield and provides global insight into the fate of these analytes in this widely used waste management system.

  12. Intratympanic steroids injection is effective for the treatment of drop attacks with Ménière's disease and delayed endolymphatic hydrops

    PubMed Central

    Liu, Bo; Leng, Yangming; Zhou, Renhong; Liu, Jingjing; Liu, Dongdong; Zhang, Su-Lin; Kong, Wei-Jia

    2016-01-01

    Abstract Drop attack (DA) associated with Ménière's disease (MD) and delayed endolymphatic hydrops (DEH) is not common and may cause life-threatening clinical problems. The intratympanic dexamethasone (ITD) is one of primary treatments for MD or DEH. Our study investigated the effect of ITD on the DA associated with endolymphatic hydrops (EH). We retrospectively reviewed 10 patients with MD- and DEH-associated DA between January 2009 and December 2013 in Outpatient Department of Otolaryngology, Union Hospital, Wuhan, China. Among them, 7 patients (5 cases with MD, 2 cases of DEH) received ITD (4 times, on weekly basis). Further repeated ITD courses or intratympanic gentamicin (ITG) were given if the vertigo was not satisfactorily controlled. The number of DA and status of vertigo control after intratympanic injection were evaluated. After a follow-up study lasting from 19 to 35 months, DA in 5 cases (71.4%) disappeared after initial ITD course. In 2 cases, DA was altogether controlled after an additional intratympanic injection (repeated ITD or/and ITG). This study showed that ITD promises to be a first-line conservative treatment for MD- or DEH-related DA since the steroid possesses no inner-ear toxicity. Furthermore, for MD- or DEH-related DA refractory to ITD, ITG can be an effective alternative. PMID:28033296

  13. Fuel Lubricity Requirements for Diesel Injection Systems

    DTIC Science & Technology

    1991-02-01

    8. Montemayor , A.F. and Owens, E.C., "Comparison of 6.2L Arctic and Standard Fuel Injection Pumps Using JP-8 Fuel," Interim Report BFLRF No. 218 (AD A...injection pumps. The unitest pump stand and test equipment specification are described in more detail in the report by Montemayor and Owens*. A schematic...operation. * Montemayor , A.F. and Owens, E.C., "Comparison of 6.2L Arctic and Standard Fuel Injection Pumps Using JP-8 Fuel," Interim Report BFLRF No. 218

  14. Analytical steam injection model for layered systems

    SciTech Connect

    Abdual-Razzaq; Brigham, W.E.; Castanier, L.M.

    1993-08-01

    Screening, evaluation and optimization of the steam flooding process in homogeneous reservoirs can be performed by using simple analytical predictive models. In the absence of any analytical model for layered reservoirs, at present, only numerical simulators can be used. And these are expensive. In this study, an analytical model has been developed considering two isolated layers of differing permeabilities. The principle of equal flow potential is applied across the two layers. Gajdica`s (1990) single layer linear steam drive model is extended for the layered system. The formulation accounts for variation of heat loss area in the higher permeability layer, and the development of a hot liquid zone in the lower permeability layer. These calculations also account for effects of viscosity, density, fractional flow curves and pressure drops in the hot liquid zone. Steam injection rate variations in the layers are represented by time weighted average rates. For steam zone calculations, Yortsos and Gavalas`s (1981) upper bound method is used with a correction factor. The results of the model are compared with a numerical simulator. Comparable oil and water flow rates, and breakthrough times were achieved for 100 cp oil. Results with 10 cp and 1000 cp oils indicate the need to improve the formulation to properly handle differing oil viscosities.

  15. Estimated Deaths and Illnesses Averted During Fungal Meningitis Outbreak Associated with Contaminated Steroid Injections, United States, 2012–2013

    PubMed Central

    Derado, Gordana; Wise, Matthew; Harris, Julie R.; Chiller, Tom; Meltzer, Martin I.; Park, Benjamin J.

    2015-01-01

    During 2012–2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients. PMID:25989264

  16. Estimated deaths and illnesses averted during fungal meningitis outbreak associated with contaminated steroid injections, United States, 2012-2013.

    PubMed

    Smith, Rachel M; Derado, Gordana; Wise, Matthew; Harris, Julie R; Chiller, Tom; Meltzer, Martin I; Park, Benjamin J

    2015-06-01

    During 2012-2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients.

  17. Steroid Receptor RNA Activator bi-faceted genetic system: Heads or Tails?

    PubMed

    Cooper, Charlton; Vincett, Daniel; Yan, Yi; Hamedani, Mohammad K; Myal, Yvonne; Leygue, Etienne

    2011-11-01

    The Steroid Receptor RNA Activator (SRA) was first identified by Lanz et al. in 1999 as a functional non-coding RNA able to co-activate steroid nuclear receptors. Since this incipient study, our understanding of SRA as a broader co-regulator of nuclear receptors as well as other transcription factors has greatly expanded. Accumulated data has now revealed the diverse roles played by this transcript in both normal biological processes such as myogenesis and adipogenesis, as well as in mechanisms underlying diseases including cardio-myopathies and cancers. Remarkably, as early as 2000, SRA isoforms were identified that were also able to code for a protein now referred to as the Steroid Receptor RNA Activator Protein (SRAP). SRA and SRAP now define a very intriguing bi-faceted genetic system, where both RNA and protein products of the same gene play specific and sometime overlapping roles in cell biology. Due to its initial molecular characterization as an RNA, most reports have in the last ten years focused on the non-coding part of this twosome. As such, only a handful of laboratories have investigated the molecular and biological roles played by SRAP. The scope of this review is to summarize and discuss our current knowledge of the molecular features and functions specifically attributable to the coding nature of the bi-faceted products of the SRA1 gene.

  18. Differential effects of glucocorticoids and gonadal steroids on glutathione levels in neuronal and glial cell systems.

    PubMed

    Schmidt, A J; Krieg, J -C; Vedder, H

    2002-02-15

    The aim of the present study was to investigate the short- and long-term effects of glucocorticoids [corticosterone (CORT), dexamethasone (DEX), 6-methylprednisolone (6-MP)] and gonadal steroids [17beta-estradiol (E(2)), progesterone (PROG), testosterone (TEST)] on the levels of the antioxidant glutathione (GSH) in different cell systems of the CNS (neuronal hippocampal HT22 cells, primary hippocampal and neocortical brain cells, and C(6) glioma cells). In HT22 cells, steroids exerted mainly long-term effects. Significant increases of GSH levels were detectable after a 24 hr treatment with 10(-7) M of DEX (122% +/- 5%), 6-MP (208% +/- 32%), E(2) (134% +/- 10%), and TEST (155% +/- 17%). A significant decrease occurred after incubation with PROG for 24 hr (79% +/- 9%). In primary hippocampal cultures, a 24 hr treatment with DEX (140% +/- 8%), E(2) (123% +/- 6%), and PROG (118% +/- 5%) led to significant increases of the GSH levels, whereas, in neocortical primary cultures, only an incubation with E(2) increased GSH (149% +/- 8%). In C(6) cells, hormone treatment led to both significant short-term (1 hr: CORT 114% +/- 5%, DEX 90% +/- 3%, E(2) 88% +/- 3%; 3 hr: DEX 115% +/- 5%, E(2) 122% +/- 6%, TEST 78% +/- 4%) and significant long-term (24 hr: CORT 74% +/- 4%, 6-MP 84% +/- 5%, E(2) 115% +/- 6%, PROG 91% +/- 4%, TEST 116% +/- 5%) effects. In summary, we were able to demonstrate differential effects of steroids on GSH levels in different cellular CNS models, showing an important influence of steroids and especially E(2) on antioxidative cellular functions in neuronal and glial cells.

  19. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

    PubMed Central

    Manchikanti, Laxmaiah; Nampiaparampil, Devi E.; Manchikanti, Kavita N.; Falco, Frank J.E.; Singh, Vijay; Benyamin, Ramsin M.; Kaye, Alan D.; Sehgal, Nalini; Soin, Amol; Simopoulos, Thomas T.; Bakshi, Sanjay; Gharibo, Christopher G.; Gilligan, Christopher J.; Hirsch, Joshua A.

    2015-01-01

    Background: The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups. Methods: Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV). Results: A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone. Conclusion: This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone. PMID:26005584

  20. The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain: A Systematic Review and Meta-Analysis.

    PubMed

    Liu, Jun; Zhou, Hengxing; Lu, Lu; Li, Xueying; Jia, Jun; Shi, Zhongju; Yao, Xue; Wu, Qiuli; Feng, Shiqing

    2016-05-01

    Epidural steroid injection (ESI) is one of the most commonly used treatments for radiculopathy. Previous studies have described the effectiveness of ESI in the management of radiculopathy. However, controversy exists regarding the route that is most beneficial and effective with respect to the administration of epidural steroids, as both transforaminal (TF) and caudal (C) routes are commonly used.This analysis reviewed studies comparing the effectiveness of TF-ESIs with that of C-ESIs in the treatment of radiculopathy as a means of providing pain relief and improving functionality. This meta-analysis was performed to guide clinical decision-making.The study was a systematic review of comparative studies.A systematic literature search was performed using the PubMed, EMBASE, and Cochrane Library databases for trials written in English. The randomized trials and observational studies that met our inclusion criteria were subsequently included. Two reviewers, respectively, extracted data and estimated the risk of bias. All statistical analyses were performed using Review Manager 5.3.Six prospective and 2 retrospective studies involving 664 patients were included. Statistical analysis was performed utilizing only the 6 prospective studies. Although slight pain and functional improvements were noted in the TF-ESI groups compared with the C-ESI groups, these improvements were neither clinically nor statistically significant.The limitations of this meta-analysis resulted primarily from the weaknesses of the comparative studies and the relative paucity of patients included in each study.Both the TF and C approaches are effective in reducing pain and improving functional scores, and they demonstrated similar efficacies in the management of lumbosacral radicular pain.

  1. Active waste-injection systems in Florida, 1976

    USGS Publications Warehouse

    Vecchioli, John; McKenzie, D.J.; Pascale, C.A.; Wilson, W.E.

    1979-01-01

    As of the end of 1976, seven systems were injecting liquid wastes into Florida 's subsurface environment at a combined average rate of 15 million gallons per day. This report presents for each of these systems information on the kind and amount of waste injected and type of pretreatment, construction characteristics of the injection and monitor wells, type of test and monitoring data available, and brief discussion of any operational problems experienced. (Kosco-USGS)

  2. Systemic Steroid Exposure Is Associated with Differential Methylation in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Qiu, Weiliang; Baccarelli, Andrea; Carey, Vincent J.; Bacherman, Helene; Rennard, Stephen I.; Agustí, Alvar; Anderson, Wayne H.; Lomas, David A.; DeMeo, Dawn L.

    2012-01-01

    Rationale: Systemic glucocorticoids are used therapeutically to treat a variety of medical conditions. Epigenetic processes such as DNA methylation may reflect exposure to glucocorticoids and may be involved in mediating the responses and side effects associated with these medications. Objectives: To test the hypothesis that differences in DNA methylation are associated with current systemic steroid use. Methods: We obtained DNA methylation data at 27,578 CpG sites in 14,475 genes throughout the genome in two large, independent cohorts: the International COPD Genetics Network (ndiscovery = 1,085) and the Boston Early Onset COPD study (nreplication = 369). Sites were tested for association with current systemic steroid use using generalized linear mixed models. Measurements and Main Results: A total of 511 sites demonstrated significant differential methylation by systemic corticosteroid use in all three of our primary models. Pyrosequencing validation confirmed robust differential methylation at CpG sites annotated to genes such as SLC22A18, LRP3, HIPK3, SCNN1A, FXYD1, IRF7, AZU1, SIT1, GPR97, ABHD16B, and RABGEF1. Functional annotation clustering demonstrated significant enrichment in intrinsic membrane components, hemostasis and coagulation, cellular ion homeostasis, leukocyte and lymphocyte activation and chemotaxis, protein transport, and responses to nutrients. Conclusions: Our analyses suggest that systemic steroid use is associated with site-specific differential methylation throughout the genome. Differentially methylated CpG sites were found in biologically plausible and previously unsuspected pathways; these genes and pathways may be relevant in the development of novel targeted therapies. PMID:23065012

  3. Variable volume combustor with pre-nozzle fuel injection system

    DOEpatents

    Keener, Christopher Paul; Johnson, Thomas Edward; McConnaughhay, Johnie Franklin; Ostebee, Heath Michael

    2016-09-06

    The present application provides a combustor for use with a gas turbine engine. The combustor may include a number of fuel nozzles, a pre-nozzle fuel injection system supporting the fuel nozzles, and a linear actuator to maneuver the fuel nozzles and the pre-nozzle fuel injection system.

  4. A volumetric flow sensor for automotive injection systems

    NASA Astrophysics Data System (ADS)

    Schmid, U.; Krötz, G.; Schmitt-Landsiedel, D.

    2008-04-01

    For further optimization of the automotive power train of diesel engines, advanced combustion processes require a highly flexible injection system, provided e.g. by the common rail (CR) injection technique. In the past, the feasibility to implement injection nozzle volumetric flow sensors based on the thermo-resistive measurement principle has been demonstrated up to injection pressures of 135 MPa (1350 bar). To evaluate the transient behaviour of the system-integrated flow sensors as well as an injection amount indicator used as a reference method, hydraulic simulations on the system level are performed for a CR injection system. Experimentally determined injection timings were found to be in good agreement with calculated values, especially for the novel sensing element which is directly implemented into the hydraulic system. For the first time pressure oscillations occurring after termination of the injection pulse, predicted theoretically, could be verified directly in the nozzle. In addition, the injected amount of fuel is monitored with the highest resolution ever reported in the literature.

  5. Mixed Mode Fuel Injector And Injection System

    DOEpatents

    Stewart, Chris Lee; Tian, Ye; Wang, Lifeng; Shafer, Scott F.

    2005-12-27

    A fuel injector includes a homogenous charge nozzle outlet set and a conventional nozzle outlet set that are controlled respectively by first and second three way needle control valves. Each fuel injector includes first and second concentric needle valve members. One of the needle valve members moves to an open position for a homogenous charge injection event, while the other needle valve member moves to an open position for a conventional injection event. The fuel injector has the ability to operate in a homogenous charge mode with a homogenous charge spray pattern, a conventional mode with a conventional spray pattern or a mixed mode.

  6. The Brookhaven accelerator test facility injection system

    SciTech Connect

    Wang, X.J.; Kirk, H.G.; Pellegrini, C.; McDonald, K.T.; Russell, D.P.

    1989-01-01

    The Brookhaven Accelerator Test Facility (ATF) consists of a 50-MeV/c electron linac and a high-brightness RF-gun both operating at 2856 MHz. An extremely short (a few picoseconds) electron pulse with low transverse emittance is generated by the RF-gun. In order to preserve both longitudinal and transverse emittances, great care must be taken in transporting the electron beam from the RF-gun to the linac. We describe the injection line, present first- and second-order lattice studies of the injection line, and study nonlinear effects on the emittance. 11 refs., 4 figs., 4 tabs.

  7. Calcitonin as an Additive to Local Anesthetic and Steroid Injection Using a Modified Coronoid Approach in Trigeminal Neuralgia.

    PubMed

    Elsheikh, Nabil Ail; Amr, Yasser M

    2016-01-01

    Pharmacotherapy is the main treatment for management of trigeminal neuralgia. However, many patients become refractory to drugs. The present study aimed to evaluate the effect of adding calcitonin to local anesthetic and methylprednisolone using a modified coronoid approach in management of trigeminal neuralgia pain involving the mandibular and/or maxillary branches. Randomized double blind clinical trial. Hospital outpatient setting. Thirty-three patients received maxillary and mandibular blocks by a modified coronoid approach. Patients were allocated into 2 groups. Group 1 received a block with 3 mL of lidocaine 0.5% plus 40 mg of methylprednisolone and another syringe contained 1 mL of 0.9% saline. Group 2 received a block with 3 mL of lidocaine 0.5% plus 40 mg of methylprednisolone and another syringe contained 50 international units of calcitonin. Pain was evaluated by visual analog scale (VAS) before the block (basal), at 2 weeks, one month after the procedure, and monthly for one year. Duration of the effective pain relief of the first block (VAS = 3) was reported. Repeated blockade was allowed for any patient reporting a VAS > 30 mm during one year of follow-up and the number of blocks were reported. Adverse effects were also reported. A significantly longer duration of effective pain relief was noticed in group 2 compared with group 1 (P < 0.0004) while the duration of effective pain relief of the second block in group 1 was 28.5 ± 8.9 weeks. Four patients did not need repeated blocks in group 1 versus 15 in group 2. Six patients received 2 blocks versus 2 patients in each group, respectively. Moreover, 6 patients needed 3 blocks in group1 versus none in group 2. No serious adverse events were reported during or after the interventional procedure. VAS was comparable in both groups (P > 0.05). Small sample size. Calcitonin may be a useful additive to local anesthetic and steroid in management of trigeminal neuralgia. Also, a modified coronoid approach for

  8. Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case.

    PubMed

    Vilella, Giuseppe Maria; Guerrisi, Pietro; Lucignani, Giulia; Pasquali, Gaia; Drudi, Francesco Maria

    2015-09-01

    Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient.

  9. ISIS-DME: a prospective, randomized, dose-escalation intravitreal steroid injection study for refractory diabetic macular edema.

    PubMed

    Kim, Judy E; Pollack, John S; Miller, David G; Mittra, Robert A; Spaide, Richard F

    2008-05-01

    : To determine safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for refractory clinically significant diabetic macular edema (DME). : Prospective, randomized, dose-escalation pilot study comparing single injection of 2 mg versus 4 mg doses of IVTA. : Inclusion criteria included clinically significant DME persisting >/=3 months after maximal laser treatment and visual acuity injection. : Mean change in visual acuity at 3 months compared to baseline was 7.1 letters (P = 0.01) in the 2 mg group and 12.5 letters in the 4 mg group (P < 0.0001). However, there was not a significant difference in visual improvement between the 2 mg and 4 mg dose groups (P = 0.11). Vision improved >15 letters at 3 months in 23% (3/13) of 2 mg group and in 33% (5/15) of 4 mg group (P = 0.69), and 0% (0/11) and 21% (3/14) at 6 months, respectively (P = 0.23). Visual improvement was more likely in cystoid-type DME than diffuse DME. Intraocular pressure rise of >/=10 mmHg occurred in 19% (3/16) of 2 mg group and 41% (7/17) of 4 mg group. : Both doses of IVTA were well tolerated and had significant positive effects on refractory DME for short term. There were consistent trends throughout the study that suggest that a 4 mg IVTA may be more effective than a 2 mg dose. The benefit of IVTA was greater for cystoid-type DME.

  10. Influence of pre-injection control parameters on main-injection fuel quantity for an electronically controlled double-valve fuel injection system of diesel engine

    NASA Astrophysics Data System (ADS)

    Song, Enzhe; Fan, Liyun; Chen, Chao; Dong, Quan; Ma, Xiuzhen; Bai, Yun

    2013-09-01

    A simulation model of an electronically controlled two solenoid valve fuel injection system for a diesel engine is established in the AMESim environment. The accuracy of the model is validated through comparison with experimental data. The influence of pre-injection control parameters on main-injection quantity under different control modes is analyzed. In the spill control valve mode, main-injection fuel quantity decreases gradually and then reaches a stable level because of the increase in multi-injection dwell time. In the needle control valve mode, main-injection fuel quantity increases with rising multi-injection dwell time; this effect becomes more obvious at high-speed revolutions and large main-injection pulse widths. Pre-injection pulse width has no obvious influence on main-injection quantity under the two control modes; the variation in main-injection quantity is in the range of 1 mm3.

  11. Omalizumab Injection

    MedlinePlus

    ... steroids. Omalizumab is also used to treat chronic hives without a known cause that cannot successfully be ... is not used to treat other forms of hives or allergic conditions. Omalizumab injection is in a ...

  12. The Prognostic Value of Enhanced-MRI and Fluoroscopic Factors for Predicting the Effects of Transforaminal Steroid Injections on Lumbosacral Radiating Pain

    PubMed Central

    2016-01-01

    Objective To investigate the predictive value of enhanced-magnetic resonance imaging (MRI) and fluoroscopic factors regarding the effects of transforaminal epidural steroid injections (TFESIs) in low back pain (LBP) patients with lumbosacral radiating pain. Methods A total of 51 patients who had LBP with radiating pain were recruited between January 2011 and December 2012. The patient data were classified into the two groups ‘favorable group’ and ‘non-favorable group’ after 2 weeks of follow-up results. The favorable group was defined as those with a 50%, or more, reduction of pain severity according to the visual analogue scale (VAS) for back or leg pain. The clinical and radiological data were collected for univariate and multivariate analyses to determine the predictors of the effectiveness of TFESIs between the two groups. Results According to the back or the leg favorable-VAS group, the univariate analysis revealed that the corticosteroid approach for the enhanced nerve root, the proportion of the proximal flow, and the contrast dispersion of epidurography are respectively statistically significant relative to the other factors. Lastly, the multiple logistic regression analysis showed a significant association between the corticosteroid approach and the enhanced nerve root in the favorable VAS group. Conclusion Among the variables, MRI showed that the corticosteroid approach for the enhanced target root is the most important prognostic factor in the predicting of the clinical parameters of the favorable TFESIs group. PMID:28119838

  13. Effect of Interlaminar Epidural Steroid Injection in Acute and Subacute Pain Due to Lumbar Disk Herniation: A Randomized Comparison of 2 Different Protocols

    PubMed Central

    Gelalis, I.D; Arnaoutoglou, E; Pakos, E.E; Politis, A.N; Rapti, M; Xenakis, T.A; Papadopoulos, G

    2009-01-01

    In order to assess the efficacy of epidural steroid injections (ESI) in acute and subacute pain due to lumbar spine disk herniation, we conducted a randomized trial, comparing 2 different protocols. Fourty patients with radicular pain due to L4-L5 and L5-S1 disc herniation were assigned to receive either 3 consecutive ESI every 24 hours through a spinal catheter (group A) or 3 consecutive ESI every 10 days with an epidural needle (group B). All patients had improved Oswestry Disabilty Index (ODI) and the Visual Analog Scale (VAS) for pain scores at 1 month of follow-up compared to baseline, while no significant differences were observed between the 2 groups. The scores for group B were statistically significant lower at 2 months of follow-up compared to those of group A. The improvement in the scores of group B was continuous since the mean scores at 2 months of follow up were lower compared to the respective scores at 1 month. Protocol B (3 consecutive ESI every 10 days) was found more effective in the treatment of subacute pain compared to Protocol A (3 consecutive ESI every 24 hours) with statistically significant differences in the ODI and VAS scores at 2 months of follow-up. PMID:20111695

  14. Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

    PubMed Central

    Park, Yongbum; Lee, Woo Yong; Ahn, Jae Ki; Nam, Hee-Seung

    2015-01-01

    Objective To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. Methods This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. Results ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. Conclusion Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary. PMID:26798608

  15. Design and Testing of Trace Contaminant Injection and Monitoring Systems

    NASA Technical Reports Server (NTRS)

    Broerman, Craig D.; Sweterlitsch, Jeff

    2009-01-01

    In support of the Carbon dioxide And Moisture Removal Amine Swing-bed (CAMRAS) testing, a contaminant injection system as well as a contaminant monitoring system has been developed by the Johnson Space Center Air Revitalization Systems (JSC-ARS) team. The contaminant injection system has been designed to provide trace level concentrations of contaminants generated by humans in a closed environment during space flight missions. The contaminant injection system continuously injects contaminants from three gas cylinders, two liquid reservoirs and three permeation ovens. The contaminant monitoring system has been designed to provide real time gas analysis with accurate flow, humidity and gas concentration measurements for collection during test. The contaminant monitoring system consists of an analytical real time gas analyzer, a carbon monoxide sensor, and an analyzer for ammonia and water vapor.

  16. Design and Testing of Trace Contaminant Injection and Monitoring Systems

    NASA Technical Reports Server (NTRS)

    Broerman, Craig D.; Sweterlitsch, Jeff

    2009-01-01

    In support of the Carbon dioxide And Moisture Removal Amine Swing-bed (CAMRAS) testing, a contaminant injection system as well as a contaminant monitoring system has been developed by the Johnson Space Center Air Revitalization Systems (JSC-ARS) team. The contaminant injection system has been designed to provide trace level concentrations of contaminants generated by humans in a closed environment during space flight missions. The contaminant injection system continuously injects contaminants from three gas cylinders, two liquid reservoirs and three permeation ovens. The contaminant monitoring system has been designed to provide real time gas analysis with accurate flow, humidity and gas concentration measurements for collection during test. The contaminant monitoring system consists of an analytical real time gas analyzer, a carbon monoxide sensor, and an analyzer for ammonia and water vapor.

  17. Effect of CRF injected into the median eminence on GH secretion in female rats under different steroid status.

    PubMed

    Puertas, A; Frias, J; Ruiz, E; Ortega, E

    1996-08-01

    To evaluate whether the median eminence (ME) is a site of action of CRF (corticotropin releasing factor) on GH secretion and to determine the possible role of estradiol and progesterone in modifying theses secretion, we injected CRF (0.25, 0.75, 1, and 1.5 nmol of peptide dissolved in 1 microliter of water) directly into the ME in three experimental groups of rats: Long-term ovariectomized (OVX); OVX primed by estradiol (OVX +/- E) and OVX primed by estradiol plus progesterone (OVX +/- EP). Blood was collected to determine GH (30, 60, 90, and 120 min postinjection). Serum T3, T4, and glucose levels were measured in OVX +/- E rats 30 min postinjection. CRF at all doses studied significantly decreased serum GH levels in the three experimental groups. Serum T3, T4, and glucose levels were unchanged after CRF administration. The results suggest that: CRF inhibits "per se" GH secretion, at least in part, by a central action in the ME. The inhibitory effect of CRF on GH is independent of the estrogen/progesterone status of the animal. CRF at ME levels may participate in a variety of stress-related responses, including growth inhibition, through GH suppression.

  18. The role of full-thickness skin grafting and steroid injection in the treatment of auricular keloids.

    PubMed

    Brown, Nefertiti A; Ortega, F Raymond

    2010-05-01

    Keloids are a response to wound healing that occurs due to hyperproliferation of dermal collagen in response to skin injury (Olabanji et al, Surg Pract. 2005;9:2-7). Multiple modalities have been described in the literature to target these lesions, but treatment and prevention remain a challenge because of the high rate of recurrence (Brissett and Sherris, Facial Plast Surg. 2001;17:263-272; Kelly, Dermatol Ther. 2004;17:212-218; Robles and Berg, Clin Dermatol. 2007;25:26-32; Porter, Otolaryngol Clin North Am. 2002;35:207-220, viii). We studied the rate of recurrence of auricular keloids through a technique previously described in the literature (Converse and Stallings, Plast Reconstr Surg. 1972;49:461-463), but over a series of patients. Keloids were treated with total excision in combination with coverage of the resulting defect with a full-thickness skin graft and intradermal injection of triamcinolone acetonide solution at the periphery of the donor and recipient sites. From April 2006 to February 2007, 10 patients with auricular keloids were done using this technique, and during an 11-month follow-up no recurrence was observed. These results support that full-thickness skin grafts can be used to address keloid lesions without recurrence.

  19. [Steroid-induced myopathy].

    PubMed

    Polunina, A G; Isaev, F V; Dem'ianova, M A

    2012-01-01

    Physiological effects of glucocorticoids include the inhibition of protein synthesis and the increase in catabolic processes in muscles. Consequently, a long-term intake of steroids in high doses causes myopathy. Myopathic effects of glucocorticoids are observed during systemic as well as inhallatory use. Most frequently, steroid myopathy manifests as the weakness and hypotrophy of lower limbs muscles, weakness of respiratory muscles, dysphonia. Prevention and treatment of steroid myopathy include limitation of indications for long-term usage of glucocorticoids, alternating regimens of treatment, adequate physical activity. The current data demonstrate the efficacy of vitamin D and amino acids mixtures in the prevention and treatment of steroid myopathy.

  20. INJECTION SYSTEM DESIGN FOR THE BSNS/RCS.

    SciTech Connect

    WEI, J.; TANG, J.Y.; CHEN, Y.; CHI, Y.L.; JIANG, Y.L.; KANG, W.; PANG, J.B.; QIN, Q.; QIU, J.; SHEN, L.; WANG, W.

    2006-06-23

    The BSNS injection system is designed to take one uninterrupted long drift in one of the four dispersion-free straight sections to host all the injection devices. Painting bumper magnets are used for both horizontal and vertical phase space painting. Closed-orbit bumper magnets are used for facilitating the installation of the injection septa and decreasing proton traversal in the stripping foil. Even with large beam emittance of about 300 {pi}mm.mrad used, BSNS/RCS still approaches the space charge limit during the injection/trapping phase for the accumulated particles of 1.9*10{sup 13} and at the low injection energy of 80 MeV. Uniform-like beam distribution by well-designed painting scheme is then obtained to decrease the tune shift/spread. ORBIT code is used for the 3D simulations. Upgrading to higher injection energy has also been considered.

  1. Economics of water injected air screw compressor systems

    NASA Astrophysics Data System (ADS)

    Venu Madhav, K.; Kovačević, A.

    2015-08-01

    There is a growing need for compressed air free of entrained oil to be used in industry. In many cases it can be supplied by oil flooded screw compressors with multi stage filtration systems, or by oil free screw compressors. However, if water injected screw compressors can be made to operate reliably, they could be more efficient and therefore cheaper to operate. Unfortunately, to date, such machines have proved to be insufficiently reliable and not cost effective. This paper describes an investigation carried out to determine the current limitations of water injected screw compressor systems and how these could be overcome in the 15-315 kW power range and delivery pressures of 6-10 bar. Modern rotor profiles and approach to sealing and cooling allow reasonably inexpensive air end design. The prototype of the water injected screw compressor air system was built and tested for performance and reliability. The water injected compressor system was compared with the oil injected and oil free compressor systems of the equivalent size including the economic analysis based on the lifecycle costs. Based on the obtained results, it was concluded that water injected screw compressor systems could be designed to deliver clean air free of oil contamination with a better user value proposition than the oil injected or oil free screw compressor systems over the considered range of operations.

  2. A homologues prediction strategy for comprehensive screening and characterization of C21 steroids from Xiao-ai-ping injection by using ultra high performance liquid chromatography coupled with high resolution hybrid quadrupole-orbitrap mass spectrometry.

    PubMed

    Wang, Pei-le; Sun, Zhi; Lv, Xiao-Jing; Xu, Tan-Ye; Jia, Qing-Quan; Liu, Xin; Zhang, Xiao-Fang; Zhu, Zhen-Feng; Zhang, Xiao-Jian

    2017-09-22

    Because of the complicated chemical composition of Traditional Chinese Medicines, their chemical profile study has been a great challenge. In the present work, a homologues prediction strategy for rapid screening and identification of C21 steroids in Xiao-ai-ping injection was developed by using an ultra high performance liquid chromatography coupled with high resolution hybrid quadrupole-orbitrap mass spectrometry. This strategy was characterized by the design of C21 steroidal skeleton, substituent group and glycan chain in an orderly way, which could quickly and efficiently screen the interested precursor ions. As a result, a total of 95C21 steroids including 47 potential new ones were identified or tentatively identified, which greatly expanded our knowledge of C21 steroids in Xiao-ai-ping injection. The results indicated that the homologues prediction strategy not only provided an efficient technique to screen and identify target constituents, but also offered a new perspective for discovery new components in Traditional Chinese Medicines. Copyright © 2017. Published by Elsevier B.V.

  3. Cardiac effects of anabolic steroids

    PubMed Central

    Payne, J R; Kotwinski, P J; Montgomery, H E

    2004-01-01

    Anabolic steroid abuse in athletes has been associated with a wide range of adverse conditions, including hypogonadism, testicular atrophy, impaired spermatogenesis, gynaecomastia, and psychiatric disturbance. But what effect does steroid abuse have on the cardiovascular system? PMID:15084526

  4. Extended use of systemic steroid is beneficial in preserving hearing in guinea pigs after cochlear implant.

    PubMed

    Rah, Yoon Chan; Lee, Min Young; Kim, Shin Hye; Kim, Doo Hee; Eastwood, Hayden; O'Leary, Stephen J; Lee, Jun Ho

    2016-12-01

    Seven-day administration of systemic steroids was more effective in preserving hearing for 12 weeks after cochlear implantation (CI) than a 3-day delivery. To determine the effectiveness of extended delivery of systemic steroids to preserve hearing in guinea pigs after CI. Dexamethasone (4 mg/ml) was delivered parenterally via a mini-osmotic pump for either 3 or 7 days. A dummy CI electrode was inserted via cochleostomy approach in 8-week-old guinea pigs. Auditory thresholds were assessed from tone burst auditory brainstem responses (2, 8, 16, 24, and 32 kHz) at 1 day prior to CI, and 1, 4, and 12 weeks after implantation. Histologic evaluation of the cochleae was carried out. No differences were observed in hearing thresholds among groups before CI. Significant hearing preservation was achieved at 8, 16, 24, and 32 kHz only in the 7-day infusion group compared with the control group at 1 week after CI. The same trend was maintained at 4 weeks (16, 24 kHz) and 12 weeks (16, 24, and 32 kHz). Histologic review of the 7-day infusion group revealed less fibrosis and ossification in the scala tympani and the preservation of more spiral ganglion cells, compared with the control group.

  5. Nox reduction system utilizing pulsed hydrocarbon injection

    DOEpatents

    Brusasco, Raymond M.; Penetrante, Bernardino M.; Vogtlin, George E.; Merritt, Bernard T.

    2001-01-01

    Hydrocarbon co-reductants, such as diesel fuel, are added by pulsed injection to internal combustion engine exhaust to reduce exhaust NO.sub.x to N.sub.2 in the presence of a catalyst. Exhaust NO.sub.x reduction of at least 50% in the emissions is achieved with the addition of less than 5% fuel as a source of the hydrocarbon co-reductants. By means of pulsing the hydrocarbon flow, the amount of pulsed hydrocarbon vapor (itself a pollutant) can be minimized relative to the amount of NO.sub.x species removed.

  6. [Development of a novel liquid injection system].

    PubMed

    Chen, Kai; Lv, Yong-Gui

    2009-11-01

    A liquid jet injector employs compressed gas or spring to produce a high-velocity stream to deliver liquid drug into human body through skin. There are many clinical jet injection products available, none of which is domestic. A new liquid jet injector is designed based on a comprehensive analysis of the current products. The injector consists of an ejector, trigger and a re-positioning mechanism. The jets characteristics of sample injector are tested, and the results show that the maximum exit pressure is above 15 MPa, a threshold value for penetrating into the skin.

  7. Development of a new feed system for pulverized coal injection installations with high injection rates

    SciTech Connect

    Ohtaka, Matsuo; Masters, R.

    1994-12-31

    Pulverized Coal Injection (PCI) systems of the original Sumitomo design, developed in 1981--1985, are now in successful operation on three blast furnaces at Sumitomo Metal Industries. Because mechanical coal feeders have limited capacity, however, multiple units would be required for high injection rates on large furnaces. This not only results in additional complexity, and higher cost but also greater land requirements. Therefore, a study was initiated in 1990 to develop a new feeding system which would have high capacity, company size and accurately controlled feed rate. After a year, a new feeder was developed which could be used without changes to the basic Sumitomo injection system; i.e., a single supply line from an injection tank, controlled by a flow meter and split into the appropriate number of tuyere feed lines through two stages of multi-outlet distributors. The major improvements are that the injection tanks operate continuously instead of in a cyclic mode and a specific, unique feed valve with twin cylinders is used as a feed adjusting instrument instead of a rotary feeder or a pneumatic injector. The advantages of the new feeding system are increased capacity (60--70 t/hr), compact size, easy maintenance, low cost and accuracy of feed rate. A commercial installation, employing twin units, of this improved system was made on Wakayama No. 5, Blast Furnace (inner volume 2,700m, hearth diameter 11.1m) in October 1991. Maximum injection capacity is 80 t/hr or 200 kg/thm (400 lbs/thm). Operation has been successful without any major outages attributable to the PCI system.

  8. Oral Steroids (Steroid Pills and Syrups)

    MedlinePlus

    ... Disease Medications Quick-Relief Medications Oral Steroids Oral Steroids Make an Appointment Ask a Question Refer Patient ... Want to learn more about steroids? How are steroid pills and syrups used? Steroid pills and syrups ...

  9. Steroidal Saponins

    NASA Astrophysics Data System (ADS)

    Sahu, N. P.; Banerjee, S.; Mondal, N. B.; Mandal, D.

    The medicinal activities of plants are generally due to the secondary metabolites (1) which often occur as glycosides of steroids, terpenoids, phenols etc. Saponins are a group of naturally occurring plant glycosides, characterized by their strong foam-forming properties in aqueous solution. The cardiac glycosides also possess this, property but are classified separately because of their specific biological activity. Unlike the cardiac glycosides, saponins generally do not affect the heart. These are classified as steroid or triterpenoid saponins depending on the nature of the aglycone. Steroidal glycosides are naturally occurring sugar conjugates of C27 steroidal compounds. The aglycone of a steroid saponin is usually a spirostanol or a furostanol. The glycone parts of these compounds are mostly oligosaccharides, arranged either in a linear or branched fashion, attached to hydroxyl groups through an acetal linkage (2, 3). Another class of saponins, the basic steroid saponins, contain nitrogen analogues of steroid sapogenins as aglycones.

  10. Fluid injection device for high-pressure systems

    NASA Technical Reports Server (NTRS)

    Copeland, E. J.; Ward, J. B.

    1970-01-01

    Screw activated device, consisting of a compressor, shielded replaceable ampules, a multiple-element rubber gland, and a specially constructed fluid line fitting, injects measured amounts of fluids into a pressurized system. It is sturdy and easily manipulated.

  11. Closed-Loop Control of Chemical Injection Rate for a Direct Nozzle Injection System

    PubMed Central

    Cai, Xiang; Walgenbach, Martin; Doerpmond, Malte; Schulze Lammers, Peter; Sun, Yurui

    2016-01-01

    To realize site-specific and variable-rate application of agricultural pesticides, accurately metering and controlling the chemical injection rate is necessary. This study presents a prototype of a direct nozzle injection system (DNIS) by which chemical concentration transport lag was greatly reduced. In this system, a rapid-reacting solenoid valve (RRV) was utilized for injecting chemicals, driven by a pulse-width modulation (PWM) signal at 100 Hz, so with varying pulse width the chemical injection rate could be adjusted. Meanwhile, a closed-loop control strategy, proportional-integral-derivative (PID) method, was applied for metering and stabilizing the chemical injection rate. In order to measure chemical flow rates and input them into the controller as a feedback in real-time, a thermodynamic flowmeter that was independent of chemical viscosity was used. Laboratory tests were conducted to assess the performance of DNIS and PID control strategy. Due to the nonlinear input–output characteristics of the RRV, a two-phase PID control process obtained better effects as compared with single PID control strategy. Test results also indicated that the set-point chemical flow rate could be achieved within less than 4 s, and the output stability was improved compared to the case without control strategy. PMID:26805833

  12. Closed-Loop Control of Chemical Injection Rate for a Direct Nozzle Injection System.

    PubMed

    Cai, Xiang; Walgenbach, Martin; Doerpmond, Malte; Schulze Lammers, Peter; Sun, Yurui

    2016-01-20

    To realize site-specific and variable-rate application of agricultural pesticides, accurately metering and controlling the chemical injection rate is necessary. This study presents a prototype of a direct nozzle injection system (DNIS) by which chemical concentration transport lag was greatly reduced. In this system, a rapid-reacting solenoid valve (RRV) was utilized for injecting chemicals, driven by a pulse-width modulation (PWM) signal at 100 Hz, so with varying pulse width the chemical injection rate could be adjusted. Meanwhile, a closed-loop control strategy, proportional-integral-derivative (PID) method, was applied for metering and stabilizing the chemical injection rate. In order to measure chemical flow rates and input them into the controller as a feedback in real-time, a thermodynamic flowmeter that was independent of chemical viscosity was used. Laboratory tests were conducted to assess the performance of DNIS and PID control strategy. Due to the nonlinear input-output characteristics of the RRV, a two-phase PID control process obtained better effects as compared with single PID control strategy. Test results also indicated that the set-point chemical flow rate could be achieved within less than 4 s, and the output stability was improved compared to the case without control strategy.

  13. Role of systemic injection of rabies immunoglobulin in rabies vaccination.

    PubMed

    Wu, Weichen; Liu, Shuqing; Yu, Pengcheng; Tao, Xiaoyan; Lu, Xuexin; Yan, Jianghong; Wang, Qian; Zhang, Zongshen; Zhu, Wuyang

    2017-06-01

    To determine the role of systemic injection of rabies immunoglobulin (RIG) in rabies vaccination, we analyzed the level of antibody against rabies virus in the serum of mice that received various doses of RIG combined with rabies vaccine. Our results indicate that systemic injection of RIG does not contribute detectably to passive or adaptive immunization, suggesting that the main function of RIG in individuals with category III exposure is to neutralize rabies virus via immediate local infiltration of the wound.

  14. Steroid therapy for problematic proliferating haemangioma.

    PubMed

    Tan, Beryl H; Leadbitter, Philip H; Aburn, Neil H; Tan, Swee T

    2011-02-11

    To evaluate the effectiveness and the safety of systemic and intralesional steroid therapy for problematic proliferating haemangioma. 233 patients with haemangioma were identified from our vascular anomalies database 1996-2007. 46 (36%) out of 129 patients with proliferating haemangioma required intervention. 24 of these patients received steroid therapy. Indications for steroid therapy, the response and side effects of treatment and the need for other treatment were recorded. Intralesional triamcinolone up to 4 mg/kg/injection was preferred for small, localised non-periorbital lesions in 5 patients and oral prednisolone 2.0-2.5 mg/kg/day was used for larger lesions, especially around the periorbital region in 19 patients. Accelerated regression of the haemangioma was observed in four of the five patients who received intralesional triamcinolone and there was no complication. Overall, the haemangioma in 17 (89%) of the 19 patients responded to high dose oral prednisolone with accelerated regression noted in 10 (53%) patients. Rebound growth was observed in 5 patients during dose tapering, requiring dose increment in three patients and debulking surgery in one patient. Three patients developed growth retardation during treatment but this normalised 3-10 months following cessation of steroid therapy. Other side effects included mild Cushingoid features (n=2), irritability (n=2), increased appetite (n=3). Intralesional and systemic steroid are relatively safe and effective in treating problematic proliferating haemangioma. Systemic steroid therapy is associated with few short-term side effects. A multidisciplinary management is essential. Propranolol is likely to replace steroid as the first-line treatment for problematic proliferating haemangioma.

  15. Discharge characteristics of a simulated unit injection system

    NASA Technical Reports Server (NTRS)

    Marsh, Edred T

    1938-01-01

    Rate-of-discharge curves that show the discharge characteristics of an injection system having a very short fuel passage are presented. The rate of discharge closely follows the rate of displacement of the injection-pump plunger for open nozzles in which the maximum calculated pressures at the orifice do not exceed a certain value, which is dependent on the particular injection pump. With small orifices and high pump speeds, the rate of discharge does not follow the rate of plunger displacement because the higher discharge pressure results in increased leakage with corresponding decrease in discharge rate. The rate of discharge is not directly related to the rate of plunger displacement with automatic injection valves having closed nozzles. The types of pump check valve tested did not control the rate of cut-off or the discharge rate but they did affect the injection lag. Use of the short fuel passage eliminated the formation of secondary discharges.

  16. Radiation dose incurred in the exclusion of vascular filling in transforaminal epidural steroid injections: fluoroscopy, digital subtraction angiography, and CT/fluoroscopy.

    PubMed

    Maus, Timothy; Schueler, Beth A; Leng, Shuai; Magnuson, Dayne; Magnuson, Dixon J; Diehn, Felix E

    2014-08-01

    This study seeks to measure the radiation dose incurred in the evaluation of vascular filling during transforaminal epidural steroid injections (TFESI) using conventional fluoroscopy (CF), digital subtraction angiography (DSA), and multislice, pulsed computed tomography fluoroscopy (CT/F). Three portable C-arms and a fixed multipurpose C-arm were evaluated. The radiation dose rate was measured using an anthropomorphic phantom during CF and DSA in anterior-posterior positions for cervical and lumbar TFESIs. Effective doses were calculated for 5-second exposures. The effective doses incurred in the cervical and lumbar spine during two CT/F exposures were calculated based on the reported volume CT dose index and dose length product. DSA imaging increased the effective dose incurred over CF with portable C-arms (medium dose rate) by 2.5-4.3 fold for cervical TFESI and 2.3-4.2 fold for lumbar TFESI. The incremental dose incurred with DSA ranged from 4.0 to 7.7 μSv in the cervical region and from 22-38 μSv in the lumbar spine. CT/F increased the incurred dose 19-fold in the cervical region and 8.0-fold in the lumbar region (incremental doses 49 μSv and 140 μSv, respectively) relative to CF. The use of DSA imaging to exclude vascular uptake during TFESI increases radiation dose over CF. CT/F incurs additional dose beyond most DSA. Minimizing radiation dose by limiting DSA and CT/F use to spine segments or clinical situations involving higher risk may be desirable. However, the incremental radiation doses incurred by DSA or CT/F are of such low magnitude that health risks cannot currently be estimated. Wiley Periodicals, Inc.

  17. Prevention of co-elution of steroid sulfates with serum proteins from pre-column in column-switching HPLC system.

    PubMed

    Tagawa, N; Tsuruta, H; Fujinami, A; Kobayashi, Y

    1998-11-01

    A method to prevent co-elution of steroid sulfates with proteins in serum from the pre-column in column-switching HPLC was developed. The pre-column, a polymer-coated mixed function column, was used for ion-pair chromatography with 5 mM tetra-n-butylammonium (TBA) ion. As steroid sulfates, estriol 3-sulfate, dehydroepiandrosterone 3-sulfate and pregnenolone 3-sulfate were used. Human serum (25 microl) was diluted with mobile phases including 5, 100 and 500 mM TBA ion, and then injected directly into the pre-column. The peak areas of the steroid sulfates in serum samples were compared with those of the steroid standards without serum. When 25/microl of serum was diluted with mobile phase including 100 or 500 mM TBA ion, the steroid sulfates in serum were retained in the pre-column; however, the steroid sulfates from the same sample diluted with mobile phase containing 5 mM TBA ion were not retained in the pre-column. Addition of an excess amount of counter ion (TBA ion) into the serum sample made it possible to retain the steroid sulfates in the pre-column. This method was applied to column-switching HPLC for measurement of steroid sulfates in serum using a semi-microcolumn as the analytical column.

  18. Dynamic Particle Injections in the Magnetospheres of the Solar System

    NASA Astrophysics Data System (ADS)

    Mauk, B.

    2014-12-01

    The occurrence of dynamic, planetward injections of plasma and energetic particles on the nightside magnetosphere is one of the defining characteristics of magnetospheric substorms at Earth. And yet, with the exploration of the solar system with planetary probes, it has become clear that dynamic planetward injections are if fact a ubiquitous characteristic of most strongly magnetized planets; only Neptune did not reveal the signatures of such processes when visited. But, within this diversity of magnetospheric environments, it is clear that the driving forces associated with injections can be very different from those at Earth. Jupiter, for example, is known to be powered by planetary rotation rather than the solar wind. Saturn has injections that are clearly powered by rotations, but it also has nightside injections that are, at minimum, triggered by solar wind events if not powered by the solar wind. Even for those magnetospheres clearly powered by rotation, there appears to be substantial similarity between the physical processes involved with the extraterrestrial planetary injections and recent formulations of injections within Earth's near-Earth magnetotail. With a focus on comparisons between Earth, Jupiter, Saturn, Uranus and Neptune, I here review the state of understanding generally of injections within extraterrestrial planets and what the comparisons might tell us about our understanding of substorm phenomena at Earth.

  19. Availability of high-pressure safety injection system in PWRs

    SciTech Connect

    Sun, Y.H.; Fresco, A.; Papazoglou, I.A.

    1983-01-01

    This paper presents an evaluation of the impact of typical variations in configuration of the design of the High Pressure Injection (HPSI) System on system unavailability. The HPSI systems in seventeen nuclear power plants were reviewed for variations in design, systems operation, testing and maintenance policies, and possible sources for common cause failures. The power plants reviewed include PWRs with two, three and four loop Reactor Coolant Systems and cover all three PWR vendors. As a result of this effort, the following five representative configurations (along with some variations) were identified and their unavailability to initiate injection was estimated.

  20. Fuel injector and fuel injection system

    SciTech Connect

    Igashira, T.; Sakakibara, Y.; Yoshinaga, T.; Watanabe, K.; Takigawa, M.; Natsuyama, Y.; Daido, S.

    1988-11-15

    This patent describes a fuel injector comprising; a housing having formed therein a fuel pressure control chamber and an accumulator, which temporarily retain fuel, a path leading into the fuel pressure control chamber and accumulator, so that they receive which is intermitently fed under pressure from a fuel source through the path, and formed with a nozzle hold through which fuel in the accumulator is injected; a piezo actuator accommodated in the housing, defining the fuel pressure control chamber and expanding and contracting in accordance with a voltage applied thereto to change the volume of the fuel pressure control chamber; needle valve, of a type which opens and closes a responsive to an applied pressure, provided reciprocally movable within the housing between the accumulator and the nozzle hold and which, responsive to a pressure from the fuel pressure control chamber an accumulator, opens and closes communication between the accumulator and the nozzle hold; check valve means for normally closing communication between the path and the fuel pressure control chamber and between the path and the accumulator and for opening the communication according to pressure in the path and/or in the fuel pressure control chamber; and an electric circuit which controls a voltage applied to the piezo-actuator.

  1. SNS INJECTION AND EXTRACTION SYSTEMS ? ISSUES AND SOLUTIONS

    SciTech Connect

    Plum, Michael A

    2008-01-01

    Beam loss is higher than expected in the Ring injection section and in the injection dump beam line. The primary causes are fairly well understood, and we have made some equipment modifications to reduce the loss. In the ring extraction beam line the beam distribution exhibits cross-plane coupling (tilt), and the cause has been traced to a large skew-quadrupole component in the extraction Lambertson septum magnet. In this paper we will discuss the issues surrounding the ring injection and extraction systems, the solutions we have implemented to date, and our plans for future improvements.

  2. Cell culture approaches to understanding the actions of steroid hormones on the insect nervous system.

    PubMed

    Levine, R B; Weeks, J C

    1996-01-01

    During metamorphosis of the hawkmoth, Manduca sexta, ecdysteroids regulate the dendritic remodeling and programmed death of identified motoneurons. These changes contribute to the dramatic reorganization of behavior that accompanies metamorphosis. As a step toward elucidating cellular and molecular mechanisms by which ecdysteroids affect neuronal phenotype, we have investigated the responses of Manduca motoneurons to ecdysteroids in vitro. Following dendritic regression at the end of larval life, thoracic leg motoneurons placed in culture respond to ecdysteroids by an increase in branching complexity, similar to events in vivo. Growth cone structure is affected markedly by ecdysteroids. At pupation, a rise in ecdysteroids triggers the segment-specific death of proleg motoneurons: the same segmental pattern of death is observed when motoneurons from different segments are removed from the nervous system and exposed to ecdysteroids in vitro. These studies provide strong evidence that Manduca motoneurons are direct targets of steroid action and set the stage for further studies of the specific mechanisms involved.

  3. Optomechatronic System For Automated Intra Cytoplasmic Sperm Injection

    NASA Astrophysics Data System (ADS)

    Shulev, Assen; Tiankov, Tihomir; Ignatova, Detelina; Kostadinov, Kostadin; Roussev, Ilia; Trifonov, Dimitar; Penchev, Valentin

    2015-12-01

    This paper presents a complex optomechatronic system for In-Vitro Fertilization (IVF), offering almost complete automation of the Intra Cytoplasmic Sperm Injection (ICSI) procedure. The compound parts and sub-systems, as well as some of the computer vision algorithms, are described below. System capabilities for ICSI have been demonstrated on infertile oocyte cells.

  4. Pressure Fluctuations in a Common-Rail Fuel Injection System

    NASA Technical Reports Server (NTRS)

    Rothrock, A M

    1931-01-01

    This report presents the results of an investigation to determine experimentally the instantaneous pressures at the discharge orifice of a common-rail fuel injection system in which the timing valve and cut-off valve were at some distance from the automatic fuel injection valve, and also to determine the methods by which the pressure fluctuations could be controlled. The results show that pressure wave phenomena occur between the high-pressure reservoir and the discharge orifice, but that these pressure waves can be controlled so as to be advantageous to the injection of the fuel. The results also give data applicable to the design of such an injection system for a high-speed compression-ignition engine.

  5. Scleroderma renal crisis precipitated by steroid treatment in systemic lupus erythematosus and scleroderma overlap syndrome.

    PubMed

    Alayoud, Ahmed; Qamouss, Ouadie; Hamzi, Amine; Benyahia, Mohammed; Oualim, Zouhir

    2012-09-01

    Connective tissue disorders can overlap in various ways. Patients may present with features of more than one specific disease without satisfying the diagnostic criteria and thereafter evolve into a specific disease entity. Occasionally, patients may fulfil simultaneously the diagnostic criteria of two or more diseases. Several cases of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap syndrome have been reported. SLE patients often develop lupus nephritis, the treatment of which is based on immunosuppression with corticosteroids (CS) and cytotoxic drugs. However, the use of high dose of CS has been associated with scleroderma renal crisis (SRC) in patient with SSc. a 43-year-old woman presented to the nephrology department of the Military hospital in Rabat, Morocco, in August 2011 with progressive dyspnea and oliguria. She was diagnosed as SLE and scleroderma overlap syndrome based on clinical and serological markers. Renal biopsy showed lupus nephritis. Immunosuppression consisting of high-dose steroid and cyclophosphamide pulses was given. There was response to treatment but 15 days later the course of the disease was complicated by scleroderma renal crisis evidenced by elevated blood pressure, deteriorating kidney function, hemolysis and thrombocytopenia. The patient was treated with perindopril and rapid reduction of steroid doses. This was followed by correction of hemolysis and thrombocytopenia. Two months later, the patient was off dialysis, but had chronic renal insufficiency with an estimated GFR of 25 ml/minute. This report describes the occurrence of SRC in a patient with lupus nephritis and SSc/ SLE overlap syndrome who was treated by CS and cyclophosphamide.

  6. Electromagnetically controlled distributor-type fuel injection system

    SciTech Connect

    Schechter, M.M.; Levin, M.B.; Dutcher, W.R. Jr.

    1989-01-01

    With the advent of electronic controls and development of electromagnetically controlled fuel injection pumps, the cost of fuel systems using plunger-type pumps was substantially reduced. Further reduction in cost can be achieved if fewer solenoid valves are used. A new type of injection pump combining electromagnetic spill control principle with distributor-type operation is described. A review of the basic concept and operating principles is given, and test results as well as cost considerations are discussed.

  7. Injection locked oscillator system for pulsed metal vapor lasers

    DOEpatents

    Warner, Bruce E.; Ault, Earl R.

    1988-01-01

    An injection locked oscillator system for pulsed metal vapor lasers is disclosed. The invention includes the combination of a seeding oscillator with an injection locked oscillator (ILO) for improving the quality, particularly the intensity, of an output laser beam pulse. The present invention includes means for matching the first seeder laser pulses from the seeding oscillator to second laser pulses of a metal vapor laser to improve the quality, and particularly the intensity, of the output laser beam pulse.

  8. Omni-axis secondary injection thrust vector control system

    NASA Technical Reports Server (NTRS)

    Kirkley, D. J.

    1973-01-01

    The concept, development, design study and preliminary analysis and layout of the required digital logic scheme to be used for injection valve control are presented. An application and optimization study of an Omni-Axis Secondary Injection Control System applicable to the proposed Space Shuttle Pressure Fed Engine is reported. Technical definition and analysis control procedures and test routines, as well as a supporting set of drawing sketches and reference manual, are enclosed.

  9. Steroid osteopathy

    SciTech Connect

    Conway, J.J.; Weiss, S.C.

    1984-01-01

    Patients receiving steroids or having disease processes which increase natural steroid production often demonstrate ''the classic x-ray changes'' of avascular necrosis of bone. Bone scintigraphy in these patients most frequently demonstrates an increased radionuclide localization. The literature suggests that the increased activity is related to healing of the avascular process. In a recent study of Legg-Calve-Perthes Disease (LCPD), 37 of the children had multiple studies and increased activity within the epiphysis during revascularization was extremely rare. Not only are the scintigraphic findings in steroid osteopathy dissimilar to that in healing LCPD, but the time interval for healing is much to short for that of a vascular necrosis and no patients demonstrated an avascular phase on bone scintigraphy. Of 15 children with renal transplants on steroid therapy, 9 demonstrated x-ray and clinical findings of osteopathy. In 8 of 9 instances, bone scintigraphy showed increased localization of radionuclide in the affected bone. Improvement or a return to normal occurred in those patients in whom steroids were discontinued. The following is a proposed mechanism for steroid osteopathy. Steroids affect the osteoblastic and osteoclastic activity of bone and weaken its internal structure. Ordinary stress produces microtrabecular fractures. Fractures characteristically stimulate reactive hyperemia and increase bone metabolism. The result is increased bone radiopharmaceutical localization. The importance of recognizing this concept is that steroid osteopathy is preventable by reducing the administered steroid dose. As opposed to avascular necrosis, bone changes are reversible.

  10. TPX Neutral Beam Injection System design

    SciTech Connect

    von Halle, A.; Bowen, O.N.; Edwards, J.W.

    1993-11-01

    The existing Tokamak Fusion Test Reactor Neutral Beam system is proposed to be modified for long pulse operation on the Tokamak Physics Experiment (TPX). Day one of TPX will call for one TFTR beamline modified for 1000 second pulse lengths oriented co-directional to the plasma current. The system design will be capable of accommodating an additional co-directional and a single counter directional beamline. For the TPX conceptual design, every attempt was made to use existing Neutral Beam hardware, plant facilities, auxiliary systems, service infrastructure, and control systems. This paper describes the moderate modifications required to the power systems, the ion sources, and the beam impinged surfaces of the ion dumps, the calorimeters, the various beam scrapers, and the neutralizers. Also described are the minimal modifications required to the vacuum, cryogenic, and gas systems and the major modification of replacing the beamline-torus duct in its entirety. Operational considerations for Neutral Beam subsystems over 1000 second pulse lengths will be explored including proposed operating scenarios for full steady state operation.

  11. Mycobacterium intracellulare infection of the shoulder and spine in a patient with steroid-treated systemic Lupus erythematosus

    SciTech Connect

    Zvetina, J.R.; Rubinstein, H.; Demos, T.C.

    1982-05-01

    Atypical mycobacterial infections of bone are rare. A patient with systemic lupus erythematosus treated with steroids developed an M. intracellulare infection of the shoulder and spine. These infections are insidious and diagnosis is difficult. Marked involvement of one joint, large effusion, or aspirated small synovial fragments suggest an atypical tuberculous joint infection.

  12. FPGA-Based Multiprocessor System for Injection Molding Control

    PubMed Central

    Muñoz-Barron, Benigno; Morales-Velazquez, Luis; Romero-Troncoso, Rene J.; Rodriguez-Donate, Carlos; Trejo-Hernandez, Miguel; Benitez-Rangel, Juan P.; Osornio-Rios, Roque A.

    2012-01-01

    The plastic industry is a very important manufacturing sector and injection molding is a widely used forming method in that industry. The contribution of this work is the development of a strategy to retrofit control of an injection molding machine based on an embedded system microprocessors sensor network on a field programmable gate array (FPGA) device. Six types of embedded processors are included in the system: a smart-sensor processor, a micro fuzzy logic controller, a programmable logic controller, a system manager, an IO processor and a communication processor. Temperature, pressure and position are controlled by the proposed system and experimentation results show its feasibility and robustness. As validation of the present work, a particular sample was successfully injected. PMID:23202036

  13. FPGA-based multiprocessor system for injection molding control.

    PubMed

    Muñoz-Barron, Benigno; Morales-Velazquez, Luis; Romero-Troncoso, Rene J; Rodriguez-Donate, Carlos; Trejo-Hernandez, Miguel; Benitez-Rangel, Juan P; Osornio-Rios, Roque A

    2012-10-18

    The plastic industry is a very important manufacturing sector and injection molding is a widely used forming method in that industry. The contribution of this work is the development of a strategy to retrofit control of an injection molding machine based on an embedded system microprocessors sensor network on a field programmable gate array (FPGA) device. Six types of embedded processors are included in the system: a smart-sensor processor, a micro fuzzy logic controller, a programmable logic controller, a system manager, an IO processor and a communication processor. Temperature, pressure and position are controlled by the proposed system and experimentation results show its feasibility and robustness. As validation of the present work, a particular sample was successfully injected.

  14. [Genetic polymorphism of steroidogenic enzymes and steroid receptor level in tumors of the reproductive system].

    PubMed

    Berstein, L M; Zimarina, T S; Tsyrlina, E V; Kovalevskiĭ, A Iu; Imianitov, E N

    2004-01-01

    The strategy of therapy and prognosis of reproductive system neoplasia generally depend on the steroid receptor status of tumor. The causes of formation of steroid receptor-free tumors are to be investigated. The genetic polymorphism of CYP19 (aromatase), CYP17 (17-hydroxylase; 17,20-lyase), CYP1B1 (4-estrogen hydroxylase) and COMT (catechol-O-methyl transferase) was studied in a total of 254 patients with breast and endometrial cancer, with particular reference to the association of certain polymorphisms and receptor status of tumor. It was found that the lack of estrogen receptor (ER) in breast tumor was due to a deficit in the A3A6 allele (p(0.01), while the absence of progesterone receptors was associated with a lower incidence of the A1A1 and A1A2 variants (p = 0.022) of tetranucleotide repeats in the CYP19 gene. In the same patients, receptor-negative tumors occurred more often (p = 0.032) than in combinations of higher level of 4-hydroxylase estradiol of S-allele in position 48 (Gly/Arg) of the CYP1B1 gene. Moreover, endometrial carcinoma patients tended to reveal (p = 0.058) an increased ratio of A6A7-CYP19 to allele A1-containing variant. No other distinctions between R(+) and R(-) tumors were identified. It is suggested that peculiar polymorphisms of steroidogenic enzymes may moderately influence the genesis of R(-) neoplasms which may be associated with either the rate of estrogen biosynthesis or, as in the case of CYP1B1, with formation of genotoxic derivatives of estrogens. The latter point is to be investigated further.

  15. Transition duct with late injection in turbine system

    DOEpatents

    LeBegue, Jeffrey Scott; Pentecost, Ronnie Ray; Flanagan, James Scott; Kim, Won -Wook; McMahan, Kevin Weston

    2015-09-15

    A system for supplying an injection fluid to a combustor is disclosed. The system includes a transition duct comprising an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The passage defines a combustion chamber. The system further includes a tube providing fluid communication for the injection fluid to flow through the transition duct and into the combustion chamber.

  16. Steroid biotransformations in biphasic systems with Yarrowia lipolytica expressing human liver cytochrome P450 genes

    PubMed Central

    2012-01-01

    Background Yarrowia lipolytica efficiently metabolizes and assimilates hydrophobic compounds such as n-alkanes and fatty acids. Efficient substrate uptake is enabled by naturally secreted emulsifiers and a modified cell surface hydrophobicity and protrusions formed by this yeast. We were examining the potential of recombinant Y. lipolytica as a biocatalyst for the oxidation of hardly soluble hydrophobic steroids. Furthermore, two-liquid biphasic culture systems were evaluated to increase substrate availability. While cells, together with water soluble nutrients, are maintained in the aqueous phase, substrates and most of the products are contained in a second water-immiscible organic solvent phase. Results For the first time we have co-expressed the human cytochromes P450 2D6 and 3A4 genes in Y. lipolytica together with human cytochrome P450 reductase (hCPR) or Y. lipolytica cytochrome P450 reductase (YlCPR). These whole-cell biocatalysts were used for the conversion of poorly soluble steroids in biphasic systems. Employing a biphasic system with the organic solvent and Y. lipolytica carbon source ethyl oleate for the whole-cell bioconversion of progesterone, the initial specific hydroxylation rate in a 1.5 L stirred tank bioreactor was further increased 2-fold. Furthermore, the product formation was significantly prolonged as compared to the aqueous system. Co-expression of the human CPR gene led to a 4-10-fold higher specific activity, compared to the co-overexpression of the native Y. lipolytica CPR gene. Multicopy transformants showed a 50-70-fold increase of activity as compared to single copy strains. Conclusions Alkane-assimilating yeast Y. lipolytica, coupled with the described expression strategies, demonstrated its high potential for biotransformations of hydrophobic substrates in two-liquid biphasic systems. Especially organic solvents which can be efficiently taken up and/or metabolized by the cell might enable more efficient bioconversion as compared

  17. Water injected fuel cell system compressor

    DOEpatents

    Siepierski, James S.; Moore, Barbara S.; Hoch, Martin Monroe

    2001-01-01

    A fuel cell system including a dry compressor for pressurizing air supplied to the cathode side of the fuel cell. An injector sprays a controlled amount of water on to the compressor's rotor(s) to improve the energy efficiency of the compressor. The amount of water sprayed out the rotor(s) is controlled relative to the mass flow rate of air inputted to the compressor.

  18. 30 CFR 36.22 - Fuel-injection system.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS APPROVAL REQUIREMENTS FOR PERMISSIBLE MOBILE DIESEL-POWERED TRANSPORTATION EQUIPMENT Construction and Design Requirements § 36.22 Fuel-injection system. This system shall be...

  19. System and method for injecting fuel

    SciTech Connect

    Uhm, Jong Ho; Johnson, Thomas Edward

    2012-12-04

    According to various embodiments, a system includes a staggered multi-nozzle assembly. The staggered multi-nozzle assembly includes a first fuel nozzle having a first axis and a first flow path extending to a first downstream end portion, wherein the first fuel nozzle has a first non-circular perimeter at the first downstream end portion. The staggered multi-nozzle assembly also includes a second fuel nozzle having a second axis and a second flow path extending to a second downstream end portion, wherein the first and second downstream end portions are axially offset from one another relative to the first and second axes. The staggered multi-nozzle assembly further includes a cap member disposed circumferentially about at least the first and second fuel nozzles to assemble the staggered multi-nozzle assembly.

  20. Turbomachine injection nozzle including a coolant delivery system

    DOEpatents

    Zuo, Baifang [Simpsonville, SC

    2012-02-14

    An injection nozzle for a turbomachine includes a main body having a first end portion that extends to a second end portion defining an exterior wall having an outer surface. A plurality of fluid delivery tubes extend through the main body. Each of the plurality of fluid delivery tubes includes a first fluid inlet for receiving a first fluid, a second fluid inlet for receiving a second fluid and an outlet. The injection nozzle further includes a coolant delivery system arranged within the main body. The coolant delivery system guides a coolant along at least one of a portion of the exterior wall and around the plurality of fluid delivery tubes.

  1. Fuel injection system for an internal combustion engine

    SciTech Connect

    Freyer, E.; Steinwart, J.; Will, P.

    1981-01-06

    A fuel injection system for an internal combustion engine includes an air suction pipe, a throttle valve located in the pipe, and a member, upstream of the throttle valve, which is actuatable by air flowing through the suction pipe so as to move a piston valve to dose a quantity of fuel to a fuel injection nozzle. The system includes a duct which bypasses the throttle valve, the duct having a valve which closes the duct when the throttle valve is closed and when the engine is above the idling speed. Dosing of fuel is thereby stopped during coasting of a vehicle, leading to decreased fuel consumption.

  2. Development of gas turbine steam injection water recovery (SIWR) system

    SciTech Connect

    Nguyen, H.B.; Otter, A. den )

    1994-01-01

    This paper describes and discusses a closed-loop'' steam injection water recovery (SIWR) cycle that was developed for steam-injected gas turbine applications. This process is needed to support gas turbine steam injection especially in areas where water cannot be wasted and complex water treatment is discouraged. The development of the SIWR was initiated by NOVA in an effort to reduce the environmental impact of operating gas turbines and to find suitable solution for its expanding gas transmission system to meet further air emission restrictions. While turbine steam injection provides many benefits, it has not been considered for remote, less supported environments such as gas transmission applications due to its high water consumption. The SIWR process can alleviate this problem regardless of the amount of injection required. The paper also covers conceptual designs of a prototype SIWR system on a small gas turbine unit. However, because of relatively high costs, it is generally believed that the system is more attractive to larger size turbines and especially when it is used in conjunction with cogeneration or combined cycle applications.

  3. Steroid therapy in clinically stable but serologically active systemic lupus erythematosus prevents severe disease flares.

    PubMed

    Cardiel, Mario H; Almagro, Raúl Menor

    2007-05-01

    Evaluation of: Tseng CE, Buyon JP, Kim M et al. The effect of moderate-dose corticosteroids in preventing severe flares in patients with serologically active, but clinically stable, systemic lupus erythematosus: findings of a prospective, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 54, 3623-3632 (2006). Systemic lupus erythematosus is an autoimmune disease of unknown origin. Flares and remissions are commonly seen in clinical settings. These clinical flares can have several degrees of severity, some of which require intensive immunosuppressive treatment and/or hospitalization. Clinicians treating these patients have looked at different strategies for prevention, early detection and prompt treatment of a lupus flare. Clinical information and laboratory findings have been proposed to reach these goals and preventive steroid adjustment has even been used in some cases without convincing results. This paper presents results from a controlled, multicenter, double-blind clinical trial evaluating the effectiveness of short-term corticosteroid treatment for preventing severe flares in which elevations of C3a by 50% were accompanied by a 25% increase in the anti-double-stranded DNA titer in patients with inactive or stable/active systemic lupus erythematosus. Results suggest that this strategy can prevent severe lupus flares.

  4. Injection timing control system for fuel-injection pump for engine

    SciTech Connect

    Imasato, K.; Shiozaki, T.; Yoshizawa, S.

    1981-12-15

    An injection timing control system for a fuel-injection pump for an engine has a phase angle regulator for varying the rotational phase angle of a drive shaft of the fuel-injection pump in which a cylindrical extension of one of an input shaft adapted to be driven by the engine and an output shaft for driving the drive shaft of the pump surrounds an end portion of the other shaft in spaced apart relationship. A male spline is formed on the end portion over some axial length thereof while a female spline is formed on the extension over some axial length thereof, at least one of the splines being a helical spline. A slider is located in an annular space between the splines and formed with splines meshing therewith respectively. An annular cylinder is formed between the substantial parts of the rest axial length portions of the extension and end portion, and a piston is reciprocally received in the cylinder, the slider and piston being formed as a unit. The system also has a hydraulic pump for supplying pressurized fluid to the cylinder, the hydraulic pump being mounted on a casing enclosing the extension and rotatably supporting the one shaft and extension and being operatively connected to the extension through gear means to be driven by rotation of the extension.

  5. Environmental fate of non-steroidal anti-inflammatory drugs in river water/sediment systems.

    PubMed

    Koumaki, Elena; Mamais, Daniel; Noutsopoulos, Constantinos

    2017-02-05

    Laboratory tests were conducted with four non-steroidal anti-inflammatory drugs (naproxen, ibuprofen, diclofenac and ketoprofen) under different redox conditions (aerobic, anoxic, anaerobic and sulfate-reducing conditions) in order to assess abiotic and biotic degradation in a river water/sediment system. The river water was sampled from Sperchios River and the sediment was collected from the banks of a rural stream where the discharge point of a wastewater treatment plant is located. To quantitatively describe degradation kinetics of the selected compounds, pseudo first-order kinetics were adopted. According to the results, it can be stated that the concentration of the substances remained constant or decreased only marginally (p≥0.05) in the sterile experiments and this excludes abiotic processes such as hydrolysis or sorption as major removal mechanisms of the target compounds from the water phase and assign their removal to microbial action. Results showed that the removal rate of the compounds decreases as dissolved oxygen concentration in the river water/sediment system decreases. All compounds were found to be biodegradable under aerobic conditions at dissipation half-lives between 1.6 and 20.1days, while dissipation half-lives for naproxen and ketoprofen increase by a factor of 2 under all tested conditions in the absence of oxygen.

  6. Fate and occurrence of steroids in swine and dairy cattle farms with different farming scales and wastes disposal systems.

    PubMed

    Liu, Shan; Ying, Guang-Guo; Zhang, Rui-Quan; Zhou, Li-Jun; Lai, Hua-Jie; Chen, Zhi-Feng

    2012-11-01

    Fate and occurrence of fourteen androgens, four estrogens, five glucocorticoids and five progestagens were investigated in three swine farms and three dairy cattle farms with different farming scales and wastes disposal systems in China. Twenty-one, 22, and 12 of total 28 steroids were detected in feces samples with concentrations ranging from below method limit of quantitation (steroids via swine farms and human sources were mainly originated from wastewater into the receiving environments while those steroids via cattle farms were mainly from cattle feces. The total contributions of steroids to the environment in China are estimated to be 139, 65.8 and 60.7 t/year from swine, dairy cattle and human sources, respectively.

  7. The effect of anabolic steroids on the gastrointestinal system, kidneys, and adrenal glands.

    PubMed

    Modlinski, Ryan; Fields, Karl B

    2006-04-01

    Over the past several decades we have seen an increase in the prevalence of anabolic steroid use by athletes. Because use of anabolic steroids is illicit, much of our knowledge of their side effects is derived from case reports, retrospective studies, or comparisons with studies in other similar patient groups. It has been shown that high-dose anabolic steroids have an effect on lowering high-density lipoprotein, increasing low-density lipoprotein, and increasing the atherogenic-promoting apolipoprotein A. Steroid abuse can also be hepatotoxic, promoting disturbances such as biliary stasis, peliosis hepatis, and even hepatomas, which are all usually reversible upon discontinuation. Suppression of the hypothalamic adrenal axis can also lead to profound adrenal changes that are also reversible with time. Although rare, renal side effects have also been documented, leading to acute renal failure and even Wilms' tumors in isolated cases. Much of our knowledge of these potentially severe but usually limited side effects is confounded by use of combinations of different steroid preparations and by the concomitant use with other substances. Physicians must target their efforts at counseling adolescents and other athletes about the potential harms of androgenic anabolic steroids and the legal options to improve strength and performance.

  8. Flow monitoring and control system for injection wells

    DOEpatents

    Corey, J.C.

    1991-01-01

    The present invention relates to a system for monitoring and controlling the rate of fluid flow from an injection well used for in-situ remediation of contaminated groundwater. The United States Government has rights in this invention pursuant to Contract No. DE-AC09-89SR18035 between the US Department of Energy and Westinghouse Savannah River Company.

  9. Online assay of bone specific alkaline phosphatase with a flow injection-bead injection system.

    PubMed

    Hartwell, Supaporn Kradtap; Somprayoon, Duangporn; Kongtawelert, Prachya; Ongchai, Siriwan; Arppornchayanon, Olarn; Ganranoo, Lucksagoon; Lapanantnoppakhun, Somchai; Grudpan, Kate

    2007-09-26

    Alkaline phosphatase (ALP) has been used as one of the biomarkers for bone resorption and liver diseases. Normally, total alkaline phosphatase is quantified along with other symptoms to determine the releasing source of the alkaline phosphatase. A semi-automated flow injection-bead injection system was proposed to conveniently and selectively assay bone alkaline phosphatase (BALP) based on its specific binding to wheat germ coated beads. Amount of BALP in serum was determined from the intensity of the yellow product produced from bound BALP on the retained beads and its substrate pNPP. The used beads were discarded and the fresh ones were introduced for the next analysis. The reaction cell was designed to be opened and closed using a computer controlled solenoid valve for a precise incubation time. The performance of the proposed system was evaluated by using it to assay BALP in human serum. The results were compared to those obtained by using a commercial ELISA kit. The system is proposed to be an easy and cost effective system for quantification of BALP as an alternative to batch wise wheat germ specific binding technique.

  10. Inhaled Steroids

    MedlinePlus

    ... side effects with inhaled steroids are thrush (a yeast infection of the mouth or throat that causes ... There have been concerns regarding the possibility of growth suppression in children. Recent studies have not shown ...

  11. Fuel injection system electromagnetic-valve controlled type

    SciTech Connect

    Oshizawa, H.; Ishikawa, M.

    1989-01-31

    A fuel injection system for an engine is described including: (a) a fuel injection pump having a pump housing, a plunger associated with the pump housing and reciprocatively movable in relation to rotation of a crankshaft of the engine, and a fuel pressurizing chamber associated with the pump housing and variable in volume in response to reciprocative movement of the plunger; (b) supply passage means supplying fuel to the fuel pressurizing chamber, the supply passage means being closed substantially during a forward stroke of the plunger and being opened substantially during a backward stroke of the plunger; (c) forcible-delivery passage means connecting the fuel pressurizing chamber to at least one fuel injection nozzle of the engine; (d) release passage means communicating with the fuel pressurizing chamber.

  12. Variable stroke, electronically controlled fuel injection control system

    SciTech Connect

    O'Neill, C.G.

    1987-02-17

    A fuel injection control system is described comprising an internal combustion engine having a crankshaft, a fuel supply, a spill valve in fluid communication with the fuel supply, a fuel injection nozzle, a fuel pump comprising a piston and cylinder, the cylinder in fluid communication with the fuel injection nozzle and the spill valve, means for actuating the fuel pump piston comprises means for actuating the fuel pump piston to achieve a constant velocity relative to angular rotation of the crankshaft for the piston during the delivery portion of the pumpstroke during the travel of the piston in the cylinder, means for closing the spill valve when the piston, during the delivery portion of the pumpstroke, reaches a first predetermined position in the fuel pump cylinder and opening the spill valve when the piston, during the delivery portion, reaches a second predetermined position in the fuel pump cylinder.

  13. The Injection Laser System on the National Ignition Facility

    SciTech Connect

    Bowers, M; Burkhart, S; Cohen, S; Erbert, G; Heebner, J; Hermann, M; Jedlovec, D

    2006-12-13

    The National Ignition Facility (NIF) is currently the largest and most energetic laser system in the world. The main amplifiers are driven by the Injection Laser System comprised of the master oscillators, optical preamplifiers, temporal pulse shaping and spatial beam formatting elements and injection diagnostics. Starting with two fiber oscillators separated by up to a few angstroms, the pulse is phase modulated to suppress SBS and enhance spatial smoothing, amplified, split into 48 individual fibers, and then temporally shaped by an arbitrary waveform generator. Residual amplitude modulation induced in the preamplifiers from the phase modulation is also precompensated in the fiber portion of the system before it is injected into the 48 pre-amplifier modules (PAMs). Each of the PAMs amplifies the light from the 1 nJ fiber injection up to the multi-joule level in two stages. Between the two stages the pre-pulse is suppressed by 60 dB and the beam is spatially formatted to a square aperture with precompensation for the nonuniform gain profile of the main laser. The input sensor package is used to align the output of each PAM to the main laser and acquire energy, power, and spatial profiles for all shots. The beam transport sections split the beam from each PAM into four main laser beams (with optical isolation) forming the 192 beams of the NIF. Optical, electrical, and mechanical design considerations for long term reliability and availability will be discussed.

  14. Advanced information processing system: Fault injection study and results

    NASA Technical Reports Server (NTRS)

    Burkhardt, Laura F.; Masotto, Thomas K.; Lala, Jaynarayan H.

    1992-01-01

    The objective of the AIPS program is to achieve a validated fault tolerant distributed computer system. The goals of the AIPS fault injection study were: (1) to present the fault injection study components addressing the AIPS validation objective; (2) to obtain feedback for fault removal from the design implementation; (3) to obtain statistical data regarding fault detection, isolation, and reconfiguration responses; and (4) to obtain data regarding the effects of faults on system performance. The parameters are described that must be varied to create a comprehensive set of fault injection tests, the subset of test cases selected, the test case measurements, and the test case execution. Both pin level hardware faults using a hardware fault injector and software injected memory mutations were used to test the system. An overview is provided of the hardware fault injector and the associated software used to carry out the experiments. Detailed specifications are given of fault and test results for the I/O Network and the AIPS Fault Tolerant Processor, respectively. The results are summarized and conclusions are given.

  15. Hypothalamic transcriptional expression of the kisspeptin system and sex steroid receptors differs among polycystic ovary syndrome rat models with different endocrine phenotypes.

    PubMed

    Marcondes, Rodrigo Rodrigues; Carvalho, Kátia Cândido; Giannocco, Gisele; Duarte, Daniele Coelho; Garcia, Natália; Soares-Junior, José Maria; da Silva, Ismael Dale Cotrim Guerreiro; Maliqueo, Manuel; Baracat, Edmund Chada; Maciel, Gustavo Arantes Rosa

    2017-08-01

    Polycystic ovary syndrome is a heterogeneous endocrine disorder that affects reproductive-age women. The mechanisms underlying the endocrine heterogeneity and neuroendocrinology of polycystic ovary syndrome are still unclear. In this study, we investigated the expression of the kisspeptin system and gonadotropin-releasing hormone pulse regulators in the hypothalamus as well as factors related to luteinizing hormone secretion in the pituitary of polycystic ovary syndrome rat models induced by testosterone or estradiol. A single injection of testosterone propionate (1.25 mg) (n=10) or estradiol benzoate (0.5 mg) (n=10) was administered to female rats at 2 days of age to induce experimental polycystic ovary syndrome. Controls were injected with a vehicle (n=10). Animals were euthanized at 90-94 days of age, and the hypothalamus and pituitary gland were used for gene expression analysis. Rats exposed to testosterone exhibited increased transcriptional expression of the androgen receptor and estrogen receptor-β and reduced expression of kisspeptin in the hypothalamus. However, rats exposed to estradiol did not show any significant changes in hormone levels relative to controls but exhibited hypothalamic downregulation of kisspeptin, tachykinin 3 and estrogen receptor-α genes and upregulation of the gene that encodes the kisspeptin receptor. Testosterone- and estradiol-exposed rats with different endocrine phenotypes showed differential transcriptional expression of members of the kisspeptin system and sex steroid receptors in the hypothalamus. These differences might account for the different endocrine phenotypes found in testosterone- and estradiol-induced polycystic ovary syndrome rats.

  16. High pressure common rail injection system modeling and control.

    PubMed

    Wang, H P; Zheng, D; Tian, Y

    2016-07-01

    In this paper modeling and common-rail pressure control of high pressure common rail injection system (HPCRIS) is presented. The proposed mathematical model of high pressure common rail injection system which contains three sub-systems: high pressure pump sub-model, common rail sub-model and injector sub-model is a relative complicated nonlinear system. The mathematical model is validated by the software Matlab and a virtual detailed simulation environment. For the considered HPCRIS, an effective model free controller which is called Extended State Observer - based intelligent Proportional Integral (ESO-based iPI) controller is designed. And this proposed method is composed mainly of the referred ESO observer, and a time delay estimation based iPI controller. Finally, to demonstrate the performances of the proposed controller, the proposed ESO-based iPI controller is compared with a conventional PID controller and ADRC.

  17. Steroid-refractory GVHD: T-cell attack within a vulnerable endothelial system.

    PubMed

    Luft, Thomas; Dietrich, Sascha; Falk, Christine; Conzelmann, Michael; Hess, Michael; Benner, Axel; Neumann, Frank; Isermann, Berend; Hegenbart, Ute; Ho, Anthony D; Dreger, Peter

    2011-08-11

    Acute graft-versus-host disease (GVHD) is a major complication of allogeneic stem cell transplantation (SCT) and can be readily controlled by systemic high-dose steroids in many patients. However, patients whose GVHD is refractory to this therapy have a poor prognosis. Refractory patients have ongoing end-organ damage despite effective immunosuppression with second-line regimens, suggesting pathomechanisms independent from the initiating T-cell attack. To explore whether endothelial damage might contribute to GVHD refractoriness and to study the role of angiopoietin-2 (ANG2) in this process, we have compared kinetics of T-cell activation markers and markers of endothelial dysfunction in the serum of patients with sensitive (n = 23) and refractory GVHD (n = 25). Longitudinal measurements of soluble FAS ligand along with other immune markers demonstrate that refractory patients are not exposed to an overwhelming or unresponsive T-cell attack. However, in contrast to sensitive GVHD, refractory GVHD was associated with rising thrombomodulin levels and high ANG2/ vascular endothelial-derived growth factor ratios. Patients with refractory GVHD showed significantly increased ANG2 levels already before SCT. These results suggest that endothelial cell vulnerability and dysfunction, rather than refractory T-cell activity, drives treatment refractoriness of GVHD and opens new avenues for prediction and control of this devastating condition.

  18. Dermoscopy could be useful in differentiating sarcoidosis from necrobiotic granulomas even after treatment with systemic steroids

    PubMed Central

    Ramadan, Shahira; Hossam, Dalia; Saleh, Marwah A.

    2016-01-01

    Background: Diagnosing cutaneous sarcoidosis and necrobiotic granulomas is challenging. Objective: Assessing the value of dermoscopy in differentiating cutaneous sarcoidosis from necrobiotic granulomas and evaluating whether their dermoscopic features will be altered after treatment. Methods: Nineteen cutaneous sarcoidosis and 11 necrobiotic granuloma patients (2 necrobiosis lipoidica, 4 granuloma annulare and 5 rheumatoid nodule) were included in this study. The diagnosis was confirmed by skin biopsy. The lesions were examined using non-contact polarized dermoscope (Dermlite 2 HR-Pro; 3Gen, San Juan Capistrano, CA). Results: Ten out of 19 cutaneous sarcoidosis patients and 7/11 necrobiotic cases group were receiving treatments (topical, intralesional or systemic steroids ± chloroquine) but still have cutaneous lesions. Treatment duration in the sarcoidosis group ranged from 2 months to 10 years (median 3 years) and in the necrobiotic cases group ranged from 3 months to 16 years (median 2 years). Pink homogenous background, translucent orange areas, white scar-like depigmentation and fine white scales were significantly associated with the cutaneous sarcoidosis compared to necrobiotic cases group. On the other hand mixed pink, white and yellowish background was significantly associated with the necrobiotic cases group. No significant difference in the dermoscopic findings was detected between treated and non-treated patients. Conclusion: Some dermoscopic findings are shared between the cutaneous sarcoidosis group and the necrobiotic cases group, yet dermoscopy could be a useful aid in differentiating them even after treatment. PMID:27648379

  19. Effect of premedication with systemic steroids on surgical field bleeding and visibility during nasosinusal endoscopic surgery.

    PubMed

    Fraire, María E; Sanchez-Vallecillo, María V; Zernotti, Mario E; Paoletti, Oscar A

    2013-01-01

    Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS). Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure. Non-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded. Each group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly. Even though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. Anabolic steroids.

    PubMed

    Mottram, D R; George, A J

    2000-03-01

    Anabolic steroids are synthetic derivatives of testosterone modified to enhance the anabolic rather than the androgenic actions of the hormone. The anabolic effects are considered to be those promoting protein synthesis, muscle growth and crythopoiesis. There are numerous side-effects to anabolic steroids, including hypertension and atherosclerosis, blood clotting, jaundice, hepatic carcinoma, tendon damage, psychiatric and behavioural effects and, in males, reduced fertility and gynaccomastia. Anabolic steroids were added to the International Olympic Committee's list of banned substances in 1975. The majority of 'evidence' concerning the efficacy of anabolic steroids as performance enhancing agents is anecdotal. In the main, experimental investigations have been poorly designed scientifically, clinically and statistically. The percentage of positive test results from IOC accredited laboratories has remained consistently low. However, athletes take their steroids during training and out-of-competition testing is not conducted in all countries, although international co-operation is now under consideration. Despite the lack of conclusive evidence, steroids users will continue to hold the view that their effects are efficacious and they are therefore unlikely to be persuaded to curtail their use.

  1. Flow monitoring and control system for injection wells

    DOEpatents

    Corey, John C.

    1993-01-01

    A system for monitoring and controlling the injection rate of fluid by an injection well of an in-situ remediation system for treating a contaminated groundwater plume. The well is fitted with a gated insert, substantially coaxial with the injection well. A plurality of openings, some or all of which are equipped with fluid flow sensors and gates, are spaced along the insert. The gates and sensors are connected to a surface controller. The insert may extend throughout part of, or substantially the entire length of the injection well. Alternatively, the insert may comprise one or more movable modules which can be positioned wherever desired along the well. The gates are opened part-way at the start of treatment. The sensors monitor and display the flow rate of fluid passing through each opening on a controller. As treatment continues, the gates are opened to increase flow in regions of lesser flow, and closed to decrease flow in regions of greater flow, thereby approximately equalizing the amount of fluid reaching each part of the plume.

  2. Flow monitoring and control system for injection wells

    DOEpatents

    Corey, J.C.

    1993-02-16

    A system for monitoring and controlling the injection rate of fluid by an injection well of an in-situ remediation system for treating a contaminated groundwater plume. The well is fitted with a gated insert, substantially coaxial with the injection well. A plurality of openings, some or all of which are equipped with fluid flow sensors and gates, are spaced along the insert. The gates and sensors are connected to a surface controller. The insert may extend throughout part of, or substantially the entire length of the injection well. Alternatively, the insert may comprise one or more movable modules which can be positioned wherever desired along the well. The gates are opened part-way at the start of treatment. The sensors monitor and display the flow rate of fluid passing through each opening on a controller. As treatment continues, the gates are opened to increase flow in regions of lesser flow, and closed to decrease flow in regions of greater flow, thereby approximately equalizing the amount of fluid reaching each part of the plume.

  3. The SuperNEMO light injection and monitoring system

    NASA Astrophysics Data System (ADS)

    Cesar, J.; Le Noblet, T.; Salazar, R.; NEMO-3; SuperNEMO collaborations

    2017-09-01

    SuperNEMO is the successor of the NEMO-3 experiment and will search for the hypothetical process of 0νββ by combining tracking and calorimetric measurements. The SuperNEMO calorimeter consists of 712 optical modules made of scintillator blocks directly coupled to photomultiplier tubes. 207Bi sources will be used to calibrate the energy scale of the calorimeter in dedicated calibration runs separated by a few weeks. In between these runs, a Light Injection (LI) system will guarantee the stability of the calorimetric response to 1%. The LI system injects pulsed LED light into each scintillator block via optical fibers. A reference optical module is used to monitor the light level against a 241Am source. The details of the LI system and its performance are presented.

  4. Steroid-inducible BABY BOOM system for development of fertile Arabidopsis thaliana plants after prolonged tissue culture.

    PubMed

    Lutz, Kerry A; Martin, Carla; Khairzada, Sahar; Maliga, Pal

    2015-10-01

    We describe a steroid-inducible BABY BOOM system that improves plant regeneration in Arabidopsis leaf cultures and yields fertile plants. Regeneration of Arabidopsis thaliana plants for extended periods of time in tissue culture may result in sterile plants. We report here a novel approach for A. thaliana regeneration using a regulated system to induce embryogenic cultures from leaf tissue. The system is based on BABY BOOM (BBM), a transcription factor that turns on genes involved in embryogenesis. We transformed the nucleus of A. thaliana plants with BBM:GR, a gene in which the BBM coding region is fused with the glucocorticoid receptor (GR) steroid-binding domain. In the absence of the synthetic steroid dexamethasone (DEX), the BBM:GR fusion protein is localized in the cytoplasm. Only when DEX is included in the culture medium does the BBM transcription factor enter the nucleus and turn on genes involved in embryogenesis. BBM:GR plant lines show prolific shoot regeneration from leaf pieces on media containing DEX. Removal of DEX from the culture media allowed for flowering and seed formation. Therefore, use of BBM:GR leaf tissue for regeneration of plants for extended periods of time in tissue culture will facilitate the recovery of fertile plants.

  5. Interaction of steroids with the transport system of glucose in human erythrocytes.

    PubMed

    Lacko, L; Wittke, B; Geck, P

    1975-12-01

    Steroids inhibit the exchange transport of glucose in human erythrocytes. The extent of inhibition is roughly correlated to the affinity of the steroids to the membrane lipids. All C-21-steroids tested show a competitive inhibition while the C-19-steriods show different types of inhibition. 5Beta-androstane-3,17-dione acts as a competitive inhibitor. The inhibition by testosterone is of mixed type, while with androst-4-ene-3,17-dione and 5alpha-androstane-3,17-dione a non-competitive inhibition is observed. In this case two inhibitor molecules can be bound per transport molecule. The "non-competitive" inhibitors compete also to some extent with the glucose binding. This effect, however, is at high inhibitor concentrations masked by the more powerful non-competitive inhibition. Competitive and non-competitive inhibitors compete with each other. The structural requirements for the different types of inhibition are discussed.

  6. Steroid hormones, prostanoids, and angiogenic systems during rescue of the corpus luteum in pigs.

    PubMed

    Przygrodzka, E; Kaczmarek, M M; Kaczynski, P; Ziecik, A J

    2016-02-01

    In order to characterize the transition of the corpora lutea (CL) from acquisition of luteolytic sensitivity to rescue of luteal function: i) the expression of 38 factors associated with steroids, prostanoids, and angiogenic systems and ii) concentrations of the main hormones responsible for maintenance of CL function in cyclic and pregnant pigs were examined. Additionally, the effect of prostaglandin (PG) E2 and F2 α on luteal function during the estrous cycle and pregnancy was evaluated in vitro. Significantly up-regulated gene expression was revealed in CL collected on day 14 of the estrous cycle (CYP19A1, ESR2, PTGS2, HIF1A, and EDN1) and on days 12-14 of pregnancy (SCARB1, PGRMC1, STAR, HSD3B1, NR5A1, PTGFR, PTGER4, and VEGFA). Elevated concentrations of estradiol-17β and PGE2 occurred in CL on days 12 and 14 of pregnancy respectively, while an increased intraluteal PGF2 α content was noted on day 14 of the estrous cycle. Both PGs increased the synthesis of progesterone by cultured luteal slices obtained on day 14 of pregnancy, in contrast to the action of PGF2 α on the corresponding day of the estrous cycle. PGE2 stimulated cAMP production via PTGER2 and PTGER4, while PGF2 α elevated the content of CREB in cultured luteal slices from CL of pregnant pigs. In silico analysis showed that infiltration of lymphocytes and apoptosis of microvascular endothelium were activated in CL on day 12 of the estrous cycle vs pregnancy. Summarizing, an abundance of E2 and PGE2 during pregnancy regulates specific pathways responsible for steroidogenesis, the prostanoid signaling system and angiogenesis during rescue from luteolysis in porcine CL.

  7. Sexual differentiation of the copulatory neuromuscular system in green anoles (Anolis carolinensis): normal ontogeny and manipulation of steroid hormones.

    PubMed

    Holmes, Melissa M; Wade, Juli

    2005-09-05

    The copulatory neuromuscular system of green anoles is sexually dimorphic and differentiates during embryonic development, although details of the process were unknown. In Experiment 1, we determined the time course of normal ontogeny. Both male and female embryos possessed bilateral copulatory organs (hemipenes) and associated muscles until incubation day 13; the structures completely regressed in female embryos by incubation day 19 (total incubation 34 days). In Experiment 2, we treated eggs with testosterone, dihydrotestosterone, estradiol, or vehicle on both incubation days 10 and 13 to determine whether these steroid hormones mediate sexual differentiation. These time points fall between gonadal differentiation, which was determined in Experiment 1 to complete before day 10, and regression of the peripheral copulatory system in females. Tissue was collected on the day of hatching. Gonads were classified as testes or ovaries; presence versus absence of hemipenes and muscles, and the number and size of copulatory motoneurons were determined. Copulatory system morphology of vehicle-treated animals matched their gonadal sex. Hemipenes and muscles were absent in estradiol-treated animals, and androgens rescued the hemipenes and muscles in most females. Both testosterone and dihydrotestosterone treatment also caused hypertrophy of the hemipenes, which were everted in animals treated with these steroids. Copulatory motoneurons, assessed on the day of hatching in both experiments, were not dimorphic in size or number. Steroid treatment significantly increased motoneuron size and number overall, but no significant differences were detected in pairwise comparisons. These data demonstrate that differentiation of peripheral copulatory neuromuscular structures occurs during embryonic development and is influenced by gonadal steroids (regression by estradiol and enhancement by androgens), but associated motoneurons do not differentiate until later in life.

  8. Aging study of boiling water reactor high pressure injection systems

    SciTech Connect

    Conley, D.A.; Edson, J.L.; Fineman, C.F.

    1995-03-01

    The purpose of high pressure injection systems is to maintain an adequate coolant level in reactor pressure vessels, so that the fuel cladding temperature does not exceed 1,200{degrees}C (2,200{degrees}F), and to permit plant shutdown during a variety of design basis loss-of-coolant accidents. This report presents the results of a study on aging performed for high pressure injection systems of boiling water reactor plants in the United States. The purpose of the study was to identify and evaluate the effects of aging and the effectiveness of testing and maintenance in detecting and mitigating aging degradation. Guidelines from the United States Nuclear Regulatory Commission`s Nuclear Plant Aging Research Program were used in performing the aging study. Review and analysis of the failures reported in databases such as Nuclear Power Experience, Licensee Event Reports, and the Nuclear Plant Reliability Data System, along with plant-specific maintenance records databases, are included in this report to provide the information required to identify aging stressors, failure modes, and failure causes. Several probabilistic risk assessments were reviewed to identify risk-significant components in high pressure injection systems. Testing, maintenance, specific safety issues, and codes and standards are also discussed.

  9. New insights into the role and mechanism of macrophage migration inhibitory factor in steroid-resistant patients with systemic lupus erythematosus.

    PubMed

    Wang, Fang-Fang; Zhu, Li-An; Zou, Yu-Qiong; Zheng, Hui; Wilson, Alisa; Yang, Cheng-De; Shen, Nan; Wallace, Daniel J; Weisman, Michael H; Chen, Shun-Le; Lu, Liang-Jing

    2012-05-02

    Glucocorticoid (GC) therapy remains important in improving the prognosis of patients with systemic lupus erythematosus (SLE). However, some patients do not achieve an effective response with GC treatment, creating an obstacle to the remission of SLE. Identification of the underlying mechanisms responsible for steroid resistance can be significant. Macrophage migration inhibitory factor (MIF) arouses our interest because of its reciprocal relationship with GCs. In the present study, we investigated for the first time whether MIF correlated with steroid resistance in SLE and explored potential mechanisms of action. Sixty-two patients with SLE (40 steroid sensitive and 22 steroid resistant) and 21 normal controls were recruited. Serum levels of MIF were measured by ELISA. Cytosolic MIF and IκB expression in peripheral blood mononuclear cells (PBMCs) were determined by western blotting. The electrophoretic mobility shift assay was assessed by NF-κB in nuclear aliquots. Gene silencing was applied to reduce expression of MIF in PBMCs in steroid-resistant patients. PBMCs obtained from steroid-sensitive patients were treated with recombinant human MIF of different concentrations. MIF levels in serum and PBMCs were higher in steroid-resistant patients compared with steroid-sensitive patients and controls. In contrast to the steroid-sensitive group, NF-κB levels were significantly higher and IκB levels lower in steroid-resistant patients. After MIF gene silencing, IκB levels in cells from steroid-resistant patients were increased. In steroid-sensitive patients, a decrease in IκB levels and an increase in NF-κB expression from baseline were detected in PBMCs treated with a higher concentration of recombinant human MIF. Treatment with recombinant human MIF did not regulate expression of IκB and NF-κB in PBMCs from patients treated with an anti-MIF monoclonal antibody. Our results indicated that MIF may play a role in the formation of steroid resistance in SLE by

  10. Biodegradable block copolymers as injectable drug-delivery systems

    NASA Astrophysics Data System (ADS)

    Jeong, Byeongmoon; Bae, You Han; Lee, Doo Sung; Kim, Sung Wan

    1997-08-01

    Polymers that display a physicochemical response to stimuli are widely explored as potential drug-delivery systems. Stimuli studied to date include chemical substances and changes in temperature, pH and electric field. Homopolymers or copolymers of N-isopropylacrylamide, and poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (known as poloxamers) are typical examples of thermosensitive polymers, but their use in drug delivery is problematic because they are toxic and non-biodegradable. Biodegradable polymers used for drug delivery to date have mostly been in the form of injectable microspheres or implant systems, which require complicated fabrication processes using organic solvents. Such systems have the disadvantage that the use of organic solvents can cause denaturation when protein drugs are to be encapsulated. Furthermore, the solid form requires surgical insertion, which often results in tissue irritation and damage. Here we report the synthesis of a thermosensitive, biodegradable hydrogel consisting of blocks of poly(ethylene oxide) and poly(L-lactic acid). Aqueous solutions of these copolymers exhibit temperature-dependent reversible gel-sol transitions. The hydrogel can be loaded with bioactive molecules in an aqueous phase at an elevated temperature (around 45 °C), where they form a sol. In this form, the polymer is injectable. On subcutaneous injection and subsequent rapid cooling to body temperature, the loaded copolymer forms a gel that can act as a sustained-release matrix for drugs.

  11. LIGHT SOURCE: Conceptual design of Hefei Advanced Light Source (HALS) injection system

    NASA Astrophysics Data System (ADS)

    Zhang, Shan-Cai; Wang, Lin; Feng, Guang-Yao; Wu, Cong-Feng; Li, Wei-Min; Xu, Hong-Liang; Liu, Zu-Ping

    2009-06-01

    The Hefei Advanced Light Source(HALS) is a super low emittance storage ring and has a very short beam life time. In order to run the ring stablely, top-up injection will be necessary. The injection system will greatly affect the quality of beam. This article first gives a physics design of the injecting system. Then the injecting system is tracked under different errors. The responses of storage beam and injecting beam are given in the article.

  12. The injection laser system on the National Ignition Facility

    NASA Astrophysics Data System (ADS)

    Bowers, Mark; Burkhart, Scott; Cohen, Simon; Erbert, Gaylen; Heebner, John; Hermann, Mark; Jedlovec, Don

    2007-02-01

    The National Ignition Facility (NIF) is currently the largest and most energetic laser system in the world. The main amplifiers are driven by the Injection Laser System comprised of the master oscillators, optical preamplifiers, temporal pulse shaping and spatial beam formatting elements and injection diagnostics. Starting with two fiber oscillators separated by up to a few angstroms, the pulse is phase modulated to suppress SBS and enhance spatial smoothing, amplified, split into 48 individual fibers, and then temporally shaped by an arbitrary waveform generator. Residual amplitude modulation induced in the preamplifiers from the phase modulation is also pre-compensated in the fiber portion of the system before it is injected into the 48 pre-amplifier modules (PAMs). Each of the PAMs amplifies the light from the 1 nJ fiber injection up to the multi-joule level in two stages. Between the two stages the pre-pulse is suppressed by 60 dB and the beam is spatially formatted to a square aperture with pre-compensation for the nonuniform gain profile of the main laser. The input sensor package is used to align the output of each PAM to the main laser and acquire energy, power, and spatial profiles for all shots. The beam transport sections split the beam from each PAM into four main laser beams (with optical isolation) forming the 192 beams of the NIF. Optical, electrical, and mechanical design considerations for long term reliability and availability will be discussed. Work performed under the auspices of the U. S. Department of Energy under contract W-7405-Eng-48.

  13. Mechanisms of crosstalk between endocrine systems: regulation of sex steroid hormone synthesis and action by thyroid hormones.

    PubMed

    Duarte-Guterman, Paula; Navarro-Martín, Laia; Trudeau, Vance L

    2014-07-01

    Thyroid hormones (THs) are well-known regulators of development and metabolism in vertebrates. There is increasing evidence that THs are also involved in gonadal differentiation and reproductive function. Changes in TH status affect sex ratios in developing fish and frogs and reproduction (e.g., fertility), hormone levels, and gonad morphology in adults of species of different vertebrates. In this review, we have summarized and compared the evidence for cross-talk between the steroid hormone and thyroid axes and present a comparative model. We gave special attention to TH regulation of sex steroid synthesis and action in both the brain and gonad, since these are important for gonad development and brain sexual differentiation and have been studied in many species. We also reviewed research showing that there is a TH system, including receptors and enzymes, in the brains and gonads in developing and adult vertebrates. Our analysis shows that THs influences sex steroid hormone synthesis in vertebrates, ranging from fish to pigs. This concept of crosstalk and conserved hormone interaction has implications for our understanding of the role of THs in reproduction, and how these processes may be dysregulated by environmental endocrine disruptors.

  14. Systemic siRNA delivery via hydrodynamic intravascular injection.

    PubMed

    Lewis, David L; Wolff, Jon A

    2007-03-30

    The main barrier to the use of RNAi in mammalian systems is the difficulty in delivering siRNA or shRNA to the appropriate tissues. Although progress has been made in this area, many of the technologies developed require specialized expertise and reagents that are beyond the reach of most investigators. In contrast, the hydrodynamic injection technique is simple to perform and enables highly efficient delivery of naked, unmodified siRNA to a number of tissues, especially the liver. This review describes the development of the technique and explores the possible mechanisms that enable uptake of siRNA to biological effect. Examples of the use of hydrodynamic injection in animal models of disease and for the study of gene function are presented and discussed.

  15. System Study: High-Pressure Coolant Injection 1998-2012

    SciTech Connect

    T. E. Wierman

    2013-10-01

    This report presents an unreliability evaluation of the high-pressure coolant injection system (HPCI) at 69 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2012 for selected components were obtained from the Equipment Performance and Information Exchange (EPIX). The unreliability results are trended for the most recent 10 year period while yearly estimates for system unreliability are provided for the entire active period. No statistically significant increasing or decreasing trends were identified in the HPCI results.

  16. Injection mode-locking Ti-sapphire laser system

    DOEpatents

    Hovater, James Curtis; Poelker, Bernard Matthew

    2002-01-01

    According to the present invention there is provided an injection modelocking Ti-sapphire laser system that produces a unidirectional laser oscillation through the application of a ring cavity laser that incorporates no intracavity devices to achieve unidirectional oscillation. An argon-ion or doubled Nd:YVO.sub.4 laser preferably serves as the pump laser and a gain-switched diode laser serves as the seed laser. A method for operating such a laser system to produce a unidirectional oscillating is also described.

  17. System Study: High-Pressure Coolant Injection 1998-2014

    SciTech Connect

    Schroeder, John Alton

    2015-12-01

    This report presents an unreliability evaluation of the high-pressure coolant injection system (HPCI) at 25 U.S. commercial boiling water reactors. Demand, run hours, and failure data from fiscal year 1998 through 2014 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10 year period, while yearly estimates for system unreliability are provided for the entire active period. No statistically significant increasing or decreasing trends were identified in the HPCI results.

  18. System Study: High-Pressure Coolant Injection 1998–2013

    SciTech Connect

    Schroeder, John Alton

    2015-01-31

    This report presents an unreliability evaluation of the high-pressure coolant injection system (HPCI) at 25 U.S. commercial boiling water reactors. Demand, run hours, and failure data from fiscal year 1998 through 2013 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10-year period, while yearly estimates for system unreliability are provided for the entire active period. No statistically significant increasing or decreasing trends were identified in the HPCI results.

  19. System Study: High-Pressure Safety Injection 1998–2013

    SciTech Connect

    Schroeder, John Alton

    2015-02-01

    This report presents an unreliability evaluation of the high-pressure safety injection system (HPSI) at 69 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2013 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10-year period while yearly estimates for system unreliability are provided for the entire active period. No statistically significant increasing or decreasing trends were identified in the HPSI results.

  20. System Study: High-Pressure Safety Injection 1998-2014

    SciTech Connect

    Schroeder, John Alton

    2015-12-01

    This report presents an unreliability evaluation of the high-pressure safety injection system (HPSI) at 69 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2014 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10 year period, while yearly estimates for system unreliability are provided for the entire active period. No statistically significant increasing or decreasing trends were identified in the HPSI results.

  1. System Study: High-Pressure Safety Injection 1998–2012

    SciTech Connect

    T. E. Wierman

    2013-10-01

    This report presents an unreliability evaluation of the high-pressure safety injection system (HPSI) at 69 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2012 for selected components were obtained from the Equipment Performance and Information Exchange (EPIX). The unreliability results are trended for the most recent 10 year period while yearly estimates for system unreliability are provided for the entire active period. No statistically significant increasing or decreasing trends were identified in the HPSI results.

  2. Strontium-rich injectable hybrid system for bone regeneration.

    PubMed

    Neves, Nuno; Campos, Bruno B; Almeida, Isabel F; Costa, Paulo C; Cabral, Abel Trigo; Barbosa, Mário A; Ribeiro, Cristina C

    2016-02-01

    Current challenges in the development of scaffolds for bone regeneration include the engineering of materials that can withstand normal dynamic physiological mechanical stresses exerted on the bone and provide a matrix capable of supporting cell migration and tissue ingrowth. The objective of the present work was to develop and characterize a hybrid polymer–ceramic injectable system that consists of an alginate matrix crosslinked in situ in the presence of strontium(Sr), incorporating a ceramic reinforcement in the form of Sr-rich microspheres. The incorporation of Sr in the microspheres and in the vehicle relies on the growing evidence that Sr has beneficial effects in bone remodeling and in the treatment of osteopenic disorders and osteoporosis. Sr-rich porous hydroxyapatite microspheres with a uniform size and a mean diameter of 555 μm were prepared, and their compression strength and friability tested. A 3.5% (w/v) ultrapure sodium alginate solution was used as the vehicle and its in situ gelation was promoted by the addition of calcium (Ca) or Sr carbonate and Glucone-δ-lactone. Gelation times varied with temperature and crosslinking agent, being slower for Sr than for Ca, but adequate for injection in both cases. Injectability was evaluated using a device employed in vertebroplasty surgical procedures, coupled to a texture analyzer in compression mode. Compositions with 35%w of microspheres presented the best compromise between injectability and compression strength of the system, the force required to extrude it being lower than 100 N.Micro CT analysis revealed a homogeneous distribution of the microspheres inside the vehicle, and a mean inter-microspheres space of 220 μm. DMA results showed that elastic behavior of the hybrid is over the viscous one and that the higher storage modulus was obtained for the 3.5%Alg–35%Sr-HAp-Sr formulation.

  3. Active Ultrasound Pattern Injection System (AUSPIS) for Interventional Tool Guidance

    PubMed Central

    Guo, Xiaoyu; Kang, Hyun-Jae; Etienne-Cummings, Ralph; Boctor, Emad M.

    2014-01-01

    Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking. PMID:25337784

  4. Use of liposomes as injectable-drug delivery systems.

    PubMed

    Ostro, M J; Cullis, P R

    1989-08-01

    The formation of liposomes and their application as delivery systems for injectable drugs are described. Liposomes are microscopic vesicles composed of one or more lipid membranes surrounding discrete aqueous compartments. These vesicles can encapsulate water-soluble drugs in their aqueous spaces and lipid-soluble drugs within the membrane itself. Liposomes release their contents by interacting with cells in one of four ways: adsorption, endocytosis, lipid exchange, or fusion. Liposome-entrapped drugs are distributed within the body much differently than free drugs; when administered intravenously to healthy animals and humans, most of the injected vesicles accumulate in the liver, spleen, lungs, bone marrow, and lymph nodes. Liposomes also accumulate preferentially at the sites of inflammation and infection and in some solid tumors; however, the reason for this accumulation is not clear. Four major factors influence liposomes' in vivo behavior and biodistribution: (1) liposomes tend to leak if cholesterol is not included in the vesicle membrane, (2) small liposomes are cleared more slowly than large liposomes, (3) the half-life of a liposome increases as the lipid dose increases, and (4) charged liposomal systems are cleared more rapidly than uncharged systems. The most advanced application of liposome-based therapy is in the treatment of systemic fungal infections, especially with amphotericin B. Liposomes are also under investigation for treatment of neoplastic disorders. Liposomes' uses in cancer therapy include encapsulation of known antineoplastic agents such as doxorubicin and methotrexate, delivery of immune modulators such as N-acetylmuramyl-L-alanine-D-isoglutamine, and encapsulation of new chemical entities that are synthesized with lipophilic segments tailored for insertion into lipid bilayers. Liposomal formulations of injectable antimicrobial agents and antineoplastic agents already are undergoing clinical testing, and most probably will receive

  5. Active ultrasound pattern injection system (AUSPIS) for interventional tool guidance.

    PubMed

    Guo, Xiaoyu; Kang, Hyun-Jae; Etienne-Cummings, Ralph; Boctor, Emad M

    2014-01-01

    Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking.

  6. Pre-injection of hyaluronic acid does not affect the systemic effects of intra-articular depot betamethasone injection at the knee joint.

    PubMed

    Habib, George; Khatib, Muhamad; Sakas, Fahed; Artul, Suheil; Jabaly-Habib, Haneen

    2017-01-01

    Intra-articular injection (IAI) of both hyaluronic acid (HA) and depot-steroid preparations had the advantage of quick and prolonged favorable effects on pain relief among patients with symptomatic osteoarthritis of the knee (OAK). The effect of IAI of HA on the systemic effects of the intra-articular steroids had not been investigated. Non-selected patients attending the rheumatology clinic with symptomatic OAK who failed NSAIDS and physical therapy were offered an IAI of HA at the knee joint followed 20 min later by an IAI of 1 ml of Celestone Chronodose at the same joint (group 1). Morning serum levels of cortisol were obtained just prior to the IAI and 1, 2 and 8 days later. Demographic, clinical, and laboratory parameters were obtained also from all the patients. Age- and sex-matched group of patients from the same clinic were recruited as a control group (group 2). Mean baseline serum cortisol levels in group 1 was 381 ± 154 mmol/l vs. 376 ± 119 in group 2 (p = 0.954). Morning serum cortisol levels at day 1 and day 2 were 24 ± 6 and 22 ± 6 mmol/l, respectively, in group 1 patients vs. 27 ± 5.8 (p = 0.214) and 25 ± 5.6 mmol/l (p = 0.200), respectively, in group 2. These levels were significantly lower than baseline levels in each group. Morning serum cortisol levels at day 8 in group 1 and group 2 were 349 ± 128 and 314 ± 99 mmol/l, respectively (p = 0.419). Pre-injection of HA at the knee joint did not affect the systemic effect on the hypothalamic-pituitary-adrenal axis of IAI of Celestone Chronodose.

  7. Designer steroids.

    PubMed

    Kazlauskas, Ray

    2010-01-01

    Anabolic steroids have been studied for over 50 years and during that time numerous compounds with a variety of functional groups have been produced and many have been published. Of these only a small number have been introduced to the pharmaceutical market. WADA has continued the work begun by the IOC banning the use of these agents within sport as performance enhancing substances. Athletes, however, continue to use these anabolic steroids but tighter testing and the introduction of unannounced sample collection has made this form of cheating harder.In order to try to evade detection, athletes who continue to dope are having to resort to the use of a far more dangerous form of drug - the designer steroid. These steroids are manufactured to closely resemble existing known compounds, but with sufficient chemical diversity to ensure that their detection by the WADA accredited laboratories is more difficult. A worrying feature of the use of these compounds is that no data is available to evaluate either the efficacy or the safety of these substances. Many such drugs are now being made in clandestine ways (as demonstrated by the recent BALCO case) and then passed on to athletes who become the guinea pigs determining the potential of the substances as doping agents.Methods for the detection of these new compounds are being developed using emerging techniques such as gas chromatography or liquid chromatography attached to a variety of mass spectrometry instruments. This technology as well as vigilance by laboratories and enforcement agencies can all help in early detection of designer steroids being used for doping.

  8. Lack of sensorial innervation in the newborn female rats affects the activity of hypothalamic monoaminergic system and steroid hormone secretion during puberty.

    PubMed

    Quiróz, Ubaldo; Morales-Ledesma, Leticia; Morán, Carolina; Trujillo, Angélica; Domínguez, Roberto

    2014-06-01

    There is evidence that sensory innervation plays a role regulating ovarian functions, including fertility.Since sensory denervation by means of capsaicin in newborn female rats results in a lower response togonadotropins, the present study analyzed the effects that sensory denervation by means of capsaicin in neonatal rats has on the concentration of monoamines in the anterior(AH) and medium (MH) hypothalamus, and on steroid hormone levels in serum. Groups of newborn female rats were injected subcutaneously with capsaicin and killed at 10, 20, and 30 days of age and on the first vaginal estrous.The concentrations of noradrenaline, dopamine, serotonin(5-HT), and their metabolites in the AH and MH were measured using HPLC, and the levels of estradiol (E),progesterone (P), testosterone (T), FSH, and luteinizing hormone using radioimmunoanalysis. The results show thatat 20 days of age, capsaicin-treated rats have lowernoradrenergic and serotonergic activities in the AH, and that the dopaminergic activity was lower in the MH. These results suggest that the sensorial system connections within the monoaminergic systems of the AH and MH are different.Capsaicin-treated animals had lower T, E, and P levels than in the control group, suggesting that the lower activity in the AH monoaminergic system and lower hormonesecretion could be explained by the blockade of information mediated by the sensory innervation (probably substance P), mainly between the ovary and the AH.

  9. A study of fault injection in multichannel spacecraft power systems

    NASA Technical Reports Server (NTRS)

    Dugal-Whitehead, Norma R.; Johnson, Yvette B.

    1991-01-01

    NASA/Marshall Space Flight Center proposes to implement fault injection into an electrical power system breadboard to study the reactions of the various control elements of this breadboard. Among the elements to be studied are the remote power controllers, the algorithms in the control computers, and the artificially intelligent control programs resident in this breadboard. To this end, a study of electrical power is being performed to yield a list of the most common power system faults. The results of this study are being applied to a multichannel high-voltage DC spacecraft power system called the Large Autonomous Spacecraft Electrical Power System Breadboard. Some of the reactions of the breadboard to some of the faults which have been encountered are presented along with the results of this study.

  10. A study of fault injection in multichannel spacecraft power systems

    NASA Technical Reports Server (NTRS)

    Dugal-Whitehead, Norma R.; Johnson, Yvette B.

    1991-01-01

    NASA/Marshall Space Flight Center proposes to implement fault injection into an electrical power system breadboard to study the reactions of the various control elements of this breadboard. Among the elements to be studied are the remote power controllers, the algorithms in the control computers, and the artificially intelligent control programs resident in this breadboard. To this end, a study of electrical power is being performed to yield a list of the most common power system faults. The results of this study are being applied to a multichannel high-voltage DC spacecraft power system called the Large Autonomous Spacecraft Electrical Power System Breadboard. Some of the reactions of the breadboard to some of the faults which have been encountered are presented along with the results of this study.

  11. Piezo stack actuation control system for sperm injection

    NASA Astrophysics Data System (ADS)

    Tan, K. K.; Putra, A. S.

    2005-12-01

    Among the electric motor drives, the piezoelectric actuator (PA) is one drive which is becoming very popular in high precision biomedical applications, such as intracytoplasmic sperm injection. The main benefits of a PA include low thermal losses and, most importantly, the high precision and accuracy achievable consequent of the driect drive principle. One major source of uncertainties in PA control design is the hysteresis behavior which yields a rate-independent lag and residual displacement near zero input, reducing the precision of the actuators. Due to the typical precision positioning requirements and low offset tolerance of PA applications, the design and control of these systems, under the influence of these uncertainties, is particularly challenging since conventional PID control usually does not suffice in these application domains to meet the stringent performance requirements. In this paper, we consider the design and realization of a piezo stack actuator which is capable of linear motion and non-full rotation to fulfill the stringent requirements associated with sperm injection applications. A complementary precise control system is developed employing a robust adaptive control algorithm to reject the hysteresis phenomenon associated with general PAs and to achieve rapid and highly precise positioning. The controller comprises of a PID feedback component and an adaptive component for hysteresis compensation. The adaptive component is continuously refined based on just prevailing input and output signals. In the paper, it will be proven that the tracking error can asymptotically converge to zero. In addition, analytical quantification is given to illustrate the improvement of the system's transient performance. Real-time experimental results verify the effectiveness of the proposed micro actuator for high precision motion trajectory tracking in intracytoplasmic sperm injection using mice eggs.

  12. Simulated respiratory system for in vitro evaluation of two inhalation delivery systems using selected steroids.

    PubMed

    Sciarra, J J; Cutie, A

    1978-10-01

    A simulated respiratory system was developed for the in vitro evaluation of two differently designed oral inhalation delivery systems. The deposition properties of a newly designed delivery system used for triamcinolone acetonide were compared to the more conventional, commercially available adapter utilized for an aerosol containing beclomethasone dipropionate. The simulated respiratory system was constructed so that the delivered dose of active ingredient could be classified into two fractions: the fraction that would be deposited in the oral cavity and throat and the fraction that would reach the desired site of activity in the respiratory tract. Based on this method, the newly designed system delivered more than 95% of the labeled dose to the desired site. The beclomethasone dipropionate aerosol system, which was observed to discharge the active ingredient with a greater intensity, delivered approximately 40% of the labeled dose. The particle-size distribution of the dose dispensed from the newly designed delivery system attached to the triamcinolone acetonide aerosol was determined using an impactor technique. No effort was made to correlate these results with an in vivo response.

  13. Control System of Neutral Beam Injection on HT-7

    NASA Astrophysics Data System (ADS)

    Wang, Yongjun; Hu, Chundong; Liu, Zhimin; Liu, Sheng; Song, Shihua; Yang, Daoye

    2005-06-01

    Neutral Beam Injection control system (NBICS) is constructed to measure the plasma current, Magnet current, vacuum pressure, cryopump temperature, control water cooling, filament voltage, and power supply, etc. The NBICS, consisting mainly of a Programmable Logic Controller (PLC) subsystem, data acquisition and processing subsystem and cryopump and vacuum pressure monitoring subsystem, has successfully been used on a NBI device. In this article, the design of NBICS on HT-7 is discussed and each subsystem is described in particular. In addition, some experimental results are reported which are very important data for further research related to the HT-7 tokamak.

  14. Dual mode fuel injection system and fuel injector for same

    SciTech Connect

    Lawrence, Keith E.; Tian, Ye

    2005-09-20

    A fuel injection system has the ability to produce two different spray patterns depending on the positioning of a needle control valve member. Positioning of the needle control valve member determines which of the two needle control chambers are placed in a low pressure condition. First and second needle valve members have closing hydraulic surfaces exposed to fluid pressure in the two needle control chambers. The injector preferably includes a homogenous charge nozzle outlet set and a conventional nozzle outlet set controlled respectively, by the first and second needle valve members.

  15. Linearisation via input-output injection of time delay systems

    NASA Astrophysics Data System (ADS)

    García-Ramírez, Eduardo; Moog, Claude H.; Califano, Claudia; Alejandro Márquez-Martínez, Luis

    2016-06-01

    This paper deals with the problem of linearisation of systems with constant commensurable delays by input-output injection using algebraic control tools based on the theory of non-commutative rings. Solutions for the problem of linearisation free of delays, and with delays of an observable nonlinear time-delay systems are presented based on the analysis of the input-output equation. These results are achieved by means of constructive algorithms that use the nth derivative of the output expressed in terms of the state-space variables instead of the explicit computation of the input-output representation of the system. Necessary and sufficient conditions are established in both cases by means of an invertible change of coordinates.

  16. INJECTION PAINTING OPTIMIZATION WITH FUZZY LOGIC EXPERT SYSTEM.

    SciTech Connect

    BEEBE-WANG,J.; TANG,J.

    2001-06-18

    Optimizing transverse particle distributions in the accumulator ring is one of most important factors to the future performance of the Spallation Neutron Source (SNS) [l]. This can only be achieved by optimizing the injection bumps that paint the beam in phase space. The process is complex due to the vague distribution inputs and the multiple optimization goals. Furthermore, the priority of the optimization criteria could change at different operational stages. We propose optimizing transverse phase space painting with fuzzy logic and present our initial studies toward that end. The focus of this paper is on how the problem can be solved with a Fuzzy Logic (FL) expert system through the creation of a set of rules that can be applied by the system. Various particle distributions, from computer simulations, are analyzed with FL and the results are compared and discussed. Finally, a run-time optimization control system is proposed.

  17. An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

    PubMed Central

    Neve, Leon; Orchard, John; Gibbs, Nathan; van Mechelen, Willem; Verhagen, Evert; Sesel, Ken; Burgess, Ian; Hines, Brett

    2010-01-01

    Background Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2). These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI) or computed tomography (CT), even though this treatment scenario has not been adequately studied for this last diagnosis. Objectives To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain. Study design Retrospective case series. Methods Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N. Results 153 patients were eligible for the study (Group D: 93/Group N: 60). Eventually 110 patients responded (Group D: 67/Group N: 43). Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the long term. A larger proportion however, indicated that the injection had certainly improved their symptoms in the short term, but noted that the effects were non-lasting (Group D: 28%/Group N: 30%). Two patients were certain the injections had actually worsened their symptoms. No significant differences in characteristics and outcomes between Group D and Group N were noted. Conclusions Outcomes of this study suggest fluoroscopically

  18. Fuel system for rotary distributor fuel injection pump

    SciTech Connect

    Klopfer, K.H.; Kelly, W.W.

    1993-06-01

    In a fuel injection pump having a drive shaft, a pump rotor driven by the drive shaft, reciprocating pumping means with periodic intake and pumping strokes to periodically receive an intake charge of fuel and deliver fuel at high pressure for fuel injection is described; a distributor head with a plurality of angularly spaced distributor outlets, the pump rotor providing a distributor rotor with a distributor port connected to the pumping means, the distributor rotor being rotatably mounted in the distributor head for sequential registration of the distributor port with the distributor outlets for distributing said high pressure delivery of fuel thereto; a fuel system for supplying fuel to the pumping means, having an end chamber at one end of the pump rotor and a fuel supply pump driven by the drive shaft and having an inlet and outlet, the supply pump outlet being connected to the end chamber for supplying fuel thereto, and a pressure regulator for regulating the fuel pressure in the end chamber; and a control valve connected between the pumping means and the end chamber and selectively opened during the intake strokes to supply fuel to the pumping means from the end chamber and during the pumping strokes to spill fuel from the pumping means into the end chamber to terminate said high pressure delivery of fuel; the improvement wherein the fuel system comprises a fuel return passage connected in series with the end chamber downstream thereof, wherein the pressure regulator is mounted in the return passage for regulating the upstream fuel pressure, including the upstream fuel pressure within the end chamber, and is connected for conducting excess fuel for return to the supply pump inlet, and wherein the supply pump is driven by the drive shaft to supply fuel at a rate exceeding the rate of said high pressure delivery of fuel for fuel injection and to provide excess fuel flow continuously through the end chamber and return passage to the pressure regulator.

  19. Discharge characteristics of a double injection-valve single-pump injection system

    NASA Technical Reports Server (NTRS)

    Lee, Dana W; Marsh, E T

    1937-01-01

    The discharge characteristics of two similar injection valves operated by a single-cylinder fuel-injection pump were determined with an apparatus that measured the quantity of fuel discharged from each valve during every 0.5 degrees of pump rotation. It was found that similar discharges took place from the two valves at all pump speeds when the valve-opening pressures, the nozzle-orifice diameters, and the injection-tube lengths were the same for both valves. Under these conditions, the effects of changing the pump speed, the pump throttle setting, or the nozzle orifice diameter were very similar to those occurring with a single-injection valve. By a proper selection of discharge-orifice areas and valve-opening pressures it was possible to obtain a great many combinations of discharge quantities, discharge rates, and injection timings for the two valves. A series of tests using injection tubes of unequal lengths for the two valves showed that under these conditions the injection timing and the fuel quantity discharged from each valve varies widely and erratically with changes in the pump speed.

  20. The Determination of Several Spray Characteristics of a High-Speed Oil Engine Injection System with an Oscilloscope

    NASA Technical Reports Server (NTRS)

    Hicks, Chester W; Moore, Charles S

    1928-01-01

    An investigation was conducted to determine the injection lag, duration of injection, and spray start and cut-off characteristics of a fuel injection system operated on an engine and injecting fuel into the atmosphere.

  1. Hypothalamic transcriptional expression of the kisspeptin system and sex steroid receptors differs among polycystic ovary syndrome rat models with different endocrine phenotypes

    PubMed Central

    Marcondes, Rodrigo Rodrigues; Carvalho, Kátia Cândido; Giannocco, Gisele; Duarte, Daniele Coelho; Garcia, Natália; Soares-Junior, José Maria; da Silva, Ismael Dale Cotrim Guerreiro; Maliqueo, Manuel; Baracat, Edmund Chada; Maciel, Gustavo Arantes Rosa

    2017-01-01

    OBJECTIVES: Polycystic ovary syndrome is a heterogeneous endocrine disorder that affects reproductive-age women. The mechanisms underlying the endocrine heterogeneity and neuroendocrinology of polycystic ovary syndrome are still unclear. In this study, we investigated the expression of the kisspeptin system and gonadotropin-releasing hormone pulse regulators in the hypothalamus as well as factors related to luteinizing hormone secretion in the pituitary of polycystic ovary syndrome rat models induced by testosterone or estradiol. METHODS: A single injection of testosterone propionate (1.25 mg) (n=10) or estradiol benzoate (0.5 mg) (n=10) was administered to female rats at 2 days of age to induce experimental polycystic ovary syndrome. Controls were injected with a vehicle (n=10). Animals were euthanized at 90-94 days of age, and the hypothalamus and pituitary gland were used for gene expression analysis. RESULTS: Rats exposed to testosterone exhibited increased transcriptional expression of the androgen receptor and estrogen receptor-β and reduced expression of kisspeptin in the hypothalamus. However, rats exposed to estradiol did not show any significant changes in hormone levels relative to controls but exhibited hypothalamic downregulation of kisspeptin, tachykinin 3 and estrogen receptor-α genes and upregulation of the gene that encodes the kisspeptin receptor. CONCLUSIONS: Testosterone- and estradiol-exposed rats with different endocrine phenotypes showed differential transcriptional expression of members of the kisspeptin system and sex steroid receptors in the hypothalamus. These differences might account for the different endocrine phenotypes found in testosterone- and estradiol-induced polycystic ovary syndrome rats.

  2. Anabolic steroids.

    PubMed

    Kuhn, Cynthia M

    2002-01-01

    The term "anabolic steroids" refers to testosterone derivatives that are used either clinically or by athletes for their anabolic properties. However, scientists have questioned the anabolic effects of testosterone and its derivatives in normal men for decades. Most scientists concluded that anabolic steroids do not increase muscle size or strength in people with normal gonadal function and have discounted positive results as unduly influenced by positive expectations of athletes, inferior experimental design, or poor data analysis. There has been a tremendous disconnect between the conviction of athletes that these drugs are effective and the conviction of scientists that they aren't. In part, this disconnect results from the completely different dose regimens used by scientists to document the correction of deficiency states and by athletes striving to optimize athletic performance. Recently, careful scientific study of suprapharmacologic doses in clinical settings - including aging, human immunodeficiency virus, and other disease states - supports the efficacy of these regimens. However, the mechanism by which these doses act remains unclear. "Anabolism" is defined as any state in which nitrogen is differentially retained in lean body mass, either through stimulation of protein synthesis and/or decreased breakdown of protein anywhere in the body. Testosterone, the main gonadal steroid in males, has marked anabolic effects in addition to its effects on reproduction that are easily observed in developing boys and when hypogonadal men receive testosterone as replacement therapy. However, its efficacy in normal men, as during its use in athletes or in clinical situations in which men are eugonadal, has been debated. A growing literature suggests that use of suprapharmacologic doses can, indeed, be anabolic in certain situations; however, the clear identification of these situations and the mechanism by which anabolic effects occur are unclear. Furthermore, the

  3. A Compact Flexible Pellet Injection System for Fueling Studies

    NASA Astrophysics Data System (ADS)

    Baylor, L. R.; Combs, S. K.; Fehling, D. T.; Fisher, P. W.; Foust, C. R.; Gouge, M. J.; Rasmussen, D. A.

    2000-10-01

    A compact pellet injection system is being designed and built at ORNL to provide a flexible pellet fueling system for studies in magnetic confinement fusion devices. The system known as a ``pellet injector in a suitcase (PIS)'' is a pipe gun device with four barrels that uses a cryocooler for in-situ hydrogenic pellet formation. The system is being built to provide a flexible, low-cost fueling system that can be used on a number of plasma confinement experiments with minimal installation and operation costs. components in the system. It will use both propellant gas and a mechanical punch to accelerate the 1 - 4 mm size pellets to 100-1500 m/s. With the mechanical punch alone a low speed pellet, useful for curved guide tube applications, can be produced with minimal gas load eliminating the need for a large ballast volume. can be independently fired. diagnose the injector. The PIS is a flexible tool for fueling alternative concept devices such as MST and NSTX and for specialized studies in mainline tokamak experiments such as DIII-D and JET. The small size makes installation on such devices more feasible. of the system design and the expected performance will be presented.

  4. Performance analysis of the BNL FACE gas injection system

    SciTech Connect

    Lipfert, F.W.; Hendrey, G.R.; Lewin, K.F.; Nagy, J.; Alexander, Y.

    1992-12-31

    As described elsewhere in this volume, the criteria for successful operation of a FACE-type crop fumigation system include the spatial uniformity of the gas injected over the crop growing area, the efficiency of gas usage, and the overall cost of the system. Efficiency of gas usage is important not only from a cost standpoint, but also to reduce the distances required to preclude interference between replicate FACE arrays or control plots. The details of the FACE design and analyses of the important fluid mechanical concepts are described below. A more detailed description of the hardware was given. Additional FACE performance and CO{sub 2} distribution data are given. 7 refs., 25 figs.

  5. A factorial design for optimizing a flow injection analysis system.

    PubMed

    Luna, J R; Ovalles, J F; León, A; Buchheister, M

    2000-05-01

    The use of a factorial design for the response exploration of a flow injection (FI) system is described and illustrated by FI spectrophotometric determination of paraquat. Variable response (absorbance) is explored as a function of the factors flow rate and length of the reaction coil. The present study was found to be useful to detect and estimate any interaction among the factors that may affect the optimal conditions for the maximal response in the optimization of the FI system, which is not possible with a univariate design. In addition, this study showed that factorial experiments enable economy of experimentation and yield results of high precision due to the use of the whole data for calculating the effects.

  6. Circulating gonadotropins and ovarian adiponectin system are modulated by acupuncture independently of sex steroid or β-adrenergic action in a female hyperandrogenic rat model of polycystic ovary syndrome.

    PubMed

    Maliqueo, Manuel; Benrick, Anna; Alvi, Asif; Johansson, Julia; Sun, Miao; Labrie, Fernand; Ohlsson, Claes; Stener-Victorin, Elisabet

    2015-09-05

    Acupuncture with combined manual and low-frequency electrical stimulation, or electroacupuncture (EA), reduces endocrine and reproductive dysfunction in women with polycystic ovary syndrome (PCOS), likely by modulating sympathetic nerve activity or sex steroid synthesis. To test this hypothesis, we induced PCOS in rats by prepubertal implantation of continuous-release letrozole pellets (200 µg/day) or vehicle. Six weeks later, rats were treated for 5-6 weeks with low-frequency EA 5 days/week, subcutaneous injection of 17β-estradiol (2.0 µg) every fourth day, or a β-adrenergic blocker (propranolol hydrochloride, 0.1 mg/kg) 5 days/week. Letrozole controls were handled without needle insertion or injected with sesame oil every fourth day. Estrous cyclicity, ovarian morphology, sex steroids, gonadotropins, insulin-like growth factor I, bone mineral density, and gene and protein expression in ovarian tissue were measured. Low-frequency EA induced estrous-cycle changes, decreased high levels of circulating luteinizing hormone (LH) and the LH/follicle-stimulating hormone (FSH) ratio, decreased high ovarian gene expression of adiponectin receptor 2, and increased expression of adiponectin receptor 2 protein and phosphorylation of ERK1/2. EA also increased cortical bone mineral density. Propranolol decreased ovarian expression of Foxo3, Srd5a1, and Hif1a. Estradiol decreased circulating LH, induced estrous cycle changes, and decreased ovarian expression of Adipor1, Foxo3, and Pik3r1. Further, total bone mineral density was higher in the letrozole-estradiol group. Thus, EA modulates the circulating gonadotropin levels independently of sex steroids or β-adrenergic action and affects the expression of ovarian adiponectin system. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Microcontroller-driven fluid-injection system for atomic force microscopy.

    PubMed

    Kasas, S; Alonso, L; Jacquet, P; Adamcik, J; Haeberli, C; Dietler, G

    2010-01-01

    We present a programmable microcontroller-driven injection system for the exchange of imaging medium during atomic force microscopy. Using this low-noise system, high-resolution imaging can be performed during this process of injection without disturbance. This latter circumstance was exemplified by the online imaging of conformational changes in DNA molecules during the injection of anticancer drug into the fluid chamber.

  8. Multiple dopant injection system for small rocket engines

    NASA Technical Reports Server (NTRS)

    Sakala, G. G.; Raines, N. G.

    1992-01-01

    The Diagnostics Test Facility (DTF) at NASA's Stennis Space Center (SSC) was designed and built to provide a standard rocket engine exhaust plume for use in the research and development of engine health monitoring instrumentation. A 1000 lb thrust class liquid oxygen (LOX)-gaseous hydrogen (GH2) fueled rocket engine is used as the subscale plume source to simulate the SSME during experimentation and instrument development. The ability of the DTF to provide efficient, and low cost test operations makes it uniquely suited for plume diagnostic experimentation. The most unique feature of the DTF is the Multiple Dopant Injection System (MDIS) that is used to seed the exhaust plume with the desired element or metal alloy. The dopant injection takes place at the fuel injector, yielding a very uniform and homogeneous distribution of the seeding material in the exhaust plume. The MDIS allows during a single test firing of the DTF, the seeding of the exhaust plume with up to three different dopants and also provides distilled water base lines between the dopants. A number of plume diagnostic-related experiments have already utilized the unique capabilities of the DTF.

  9. New ion source for KSTAR neutral beam injection system.

    PubMed

    Kim, Tae-Seong; Jeong, Seung Ho; In, Sang-Ryul

    2012-02-01

    The neutral beam injection system (NBI-1) of the KSTAR tokamak can accommodate three ion sources; however, it is currently equipped with only one prototype ion source. In the 2010 and 2011 KSTAR campaigns, this ion source supplied deuterium neutral beam power of 0.7-1.6 MW to the KSTAR plasma with a beam energy of 70-100 keV. A new ion source will be prepared for the 2012 KSTAR campaign with a much advanced performance compared with the previous one. The newly designed ion source has a very large transparency (∼56%) without deteriorating the beam optics, which is designed to deliver a 2 MW injection power of deuterium beams at 100 keV. The plasma generator of the ion source is of a horizontally cusped bucket type, and the whole inner wall, except the cathode filaments and plasma grid side, functions as an anode. The accelerator assembly consists of four multi-circular aperture grids made of copper and four electrode flanges made of aluminum alloy. The electrodes are insulated using PEEK. The ion source will be completed and tested in 2011.

  10. Jet plume injection and combustion system for internal combustion engines

    DOEpatents

    Oppenheim, Antoni K.; Maxson, James A.; Hensinger, David M.

    1993-01-01

    An improved combustion system for an internal combustion engine is disclosed wherein a rich air/fuel mixture is furnished at high pressure to one or more jet plume generator cavities adjacent to a cylinder and then injected through one or more orifices from the cavities into the head space of the cylinder to form one or more turbulent jet plumes in the head space of the cylinder prior to ignition of the rich air/fuel mixture in the cavity of the jet plume generator. The portion of the rich air/fuel mixture remaining in the cavity of the generator is then ignited to provide a secondary jet, comprising incomplete combustion products which are injected into the cylinder to initiate combustion in the already formed turbulent jet plume. Formation of the turbulent jet plume in the head space of the cylinder prior to ignition has been found to yield a higher maximum combustion pressure in the cylinder, as well as shortening the time period to attain such a maximum pressure.

  11. Jet plume injection and combustion system for internal combustion engines

    DOEpatents

    Oppenheim, A.K.; Maxson, J.A.; Hensinger, D.M.

    1993-12-21

    An improved combustion system for an internal combustion engine is disclosed wherein a rich air/fuel mixture is furnished at high pressure to one or more jet plume generator cavities adjacent to a cylinder and then injected through one or more orifices from the cavities into the head space of the cylinder to form one or more turbulent jet plumes in the head space of the cylinder prior to ignition of the rich air/fuel mixture in the cavity of the jet plume generator. The portion of the rich air/fuel mixture remaining in the cavity of the generator is then ignited to provide a secondary jet, comprising incomplete combustion products which are injected into the cylinder to initiate combustion in the already formed turbulent jet plume. Formation of the turbulent jet plume in the head space of the cylinder prior to ignition has been found to yield a higher maximum combustion pressure in the cylinder, as well as shortening the time period to attain such a maximum pressure. 24 figures.

  12. Imaging system for hypervelocity dust injection diagnostic on NSTX

    SciTech Connect

    Dorf, L. A.; Roquemore, A. L.; Wurden, G. A.; Ticos, C. M.; Wang Zhehui

    2006-10-15

    The novel hypervelocity dust injection diagnostic will facilitate our understanding of basic aspects of dust-plasma interaction and magnetic field topology in fusion plasma devices, by observing 'comet tails' associated with the injected micron-size dust particles. A single projection of the tail onto an image plane will not provide sufficient information; therefore, we plan to use two views, with intensified DiCam-Pro cameras on two NSTX ports. Each camera can furnish up to five overlaying sequential images with gate times greater than 3 ns and 1280x1024 pixel resolution. A coherent fiber bundle with 1500x1200 fibers will relay the image from an imaging lens installed directly on the port to the camera optics. The lens receives light from the outer portion of the NSTX cross section and focuses a 1 cm tail onto at least 60 fibers for adequate resolution. The estimated number of photons received by the camera indicates signal-to-noise ratios of 10{sup 2}-10{sup 4}, with the use of a 10 nm bandwidth filter. The imaging system with one camera was successfully tested on NSTX in 2005. Photographing lithium pellets yielded bright and distinctive pictures of the tails nearly aligned with B lines. We also observed that the bright 'filaments' - plasma cords with high density and temperature - are present in both top and bottom portions of the machine.

  13. Jet plume injection and combustion system for internal combustion engines

    SciTech Connect

    Oppenheim, A.K.; Maxson, J.A.; Hensinger, D.M.

    1992-12-31

    This invention is comprised of an improved combustion system for an internal combustion engine is disclosed wherein a rich air/fuel mixture is furnished at high pressure to one or more jet plume generator cavities adjacent to a cylinder and then injected through one or more orifices from the cavities into the head space of the cylinder to form one or more turbulent jet plumes in the head space of the cylinder prior to ignition of the rich air/fuel mixture in the cavity of the jet plume generator. The portion of the rich air/fuel mixture remaining in the cavity of the generator is then ignited to provide a secondary jet, comprising incomplete combustion products which are injected into the cylinder to initiate combustion in the already formed turbulent jet plume. Formation of the turbulent jet plume in the head space of the cylinder prior to ignition has been found to yield a higher maximum combustion pressure in the cylinder, as well as shortening the time period to attain such a maximum pressure.

  14. Multiple dopant injection system for small rocket engines

    NASA Astrophysics Data System (ADS)

    Sakala, G. G.; Raines, N. G.

    1992-07-01

    The Diagnostics Test Facility (DTF) at NASA's Stennis Space Center (SSC) was designed and built to provide a standard rocket engine exhaust plume for use in the research and development of engine health monitoring instrumentation. A 1000 lb thrust class liquid oxygen (LOX)-gaseous hydrogen (GH2) fueled rocket engine is used as the subscale plume source to simulate the SSME during experimentation and instrument development. The ability of the DTF to provide efficient, and low cost test operations makes it uniquely suited for plume diagnostic experimentation. The most unique feature of the DTF is the Multiple Dopant Injection System (MDIS) that is used to seed the exhaust plume with the desired element or metal alloy. The dopant injection takes place at the fuel injector, yielding a very uniform and homogeneous distribution of the seeding material in the exhaust plume. The MDIS allows during a single test firing of the DTF, the seeding of the exhaust plume with up to three different dopants and also provides distilled water base lines between the dopants. A number of plume diagnostic-related experiments have already utilized the unique capabilities of the DTF.

  15. Sorption of steroid estrogens to soil and soil constituents in single- and multi-sorbate systems.

    PubMed

    Bonin, Julia L; Simpson, Myrna J

    2007-12-01

    The sorptive behavior of 17 beta-estradiol (estradiol), estrone, and 17alpha-ethinylestradiol (EE2) from aqueous solutions to four soil samples, two clay minerals, and sand was examined. The measured sorption isotherms were found to be nonlinear and soil isotherm data fit the Freundlich model. Alternatively, both the Langmuir and Freundlich models were used for the mineral samples. The sorption affinity of steroid estrogens was found to be greater for montmorillonite than kaolinite and the sand. The soil Freundlich coefficients (K(F)) for estradiol, estrone, and EE2 were observed to increase with organic carbon (OC) content, and resulting Freundlich coefficients that were normalized to the OC content (K(F)OC) were observed to be within the same range for estradiol and estrone but not for EE2. Sorption of steroid estrogens in soil appears to be governed by OC and expanding clay mineral content; thus, estimating sorption coefficients from physicochemical properties may underestimate sorption in soils or sediments that are rich in OC and smectitic clay minerals. Analysis of soils by solid-state (13)C nuclear magnetic resonance did not reveal any trends between sorption capacity and organic matter structure. Competitive sorption experiments revealed that the degree of competition varied with the OC and mineral content, further suggesting that specific soil properties are important for understanding sorption of estrogens in terrestrial environments.

  16. Embedded computer controlled premixing inline injection system for air-assisted variable-rate sprayers

    USDA-ARS?s Scientific Manuscript database

    Improvements to reduce chemical waste and environmental pollution for variable-rate sprayers used in orchards and ornamental nurseries require inline injection techniques. A microprocessor controlled premixing inline injection system implementing a ceramic piston chemical metering pump and two small...

  17. Hydrologic characteristics of the Bandelier Tuff as determined through an injection well system

    SciTech Connect

    Purtymun, W.D.; Enyart, E.A.; McLin, S.G.

    1989-08-01

    Injection wells were used to determine some of the hydrologic transmitting characteristics of the unsaturated Bandelier Tuff. At site 1, a 60-ft injection well with a 5-ft injection zone was used to conduct four tests. These preliminary tests were made in order to design an injection-well monitoring system that could track the movement of fluids in the tuff. At site 2, a second injection well with a 10-ft injection zone and seven observation holes was used to monitor the movement of 335,000 gal. of water injected into the tuff. The initial injection rate at site 2 was 5.8 gallons per minute (gpm), but that rate gradually declined to 0.4 gpm after 89 days of the test; 289 days after the test ended, the pear-shaped nephol (the shape of moisture injected into the tuff) reached a maximum depth of 210 ft and had a diameter of about 120 ft. A second test at site 2 indicated that intermittent use of an injection system would allow for short periods of higher injection rates, thereby extending the life of the system. Finally, a third test at site 2 was made using a 50-ft injection zone, which resulted in an injection rate of 15.8 gpm, or about 3 times the initial rate achieved when a 10-ft injection zone was used. 8 refs., 10 figs., 5 tabs.

  18. Propellant Feed System for Swirl-Coaxial Injection

    NASA Technical Reports Server (NTRS)

    Reynolds, David Christopher (Inventor)

    2015-01-01

    A propellant feed system for swirl-coaxial injection of a liquid propellant includes a reservoir having a bottom plate and at least one tube originating in the bottom plate and extending therefrom. The tube has rectangular slits defined in and distributed tangentially and evenly about a portion of the tube that is disposed in the bottom plate. Drain holes are provided in the bottom plate and tunnels are defined in the bottom plate. Each tunnel fluidly couples one of the drain holes to a corresponding one of the rectangular slits. Each tunnel includes (i) a bend of at least 90.degree., and (ii) a straight portion leading to its corresponding rectangular slit wherein the straight portion is at least five times as long as a hydraulic diameter of the corresponding rectangular slit.

  19. Performance of the RHIC Injection Line Instrumentation Systems

    NASA Astrophysics Data System (ADS)

    Shea, T. J.; Witkover, R. L.; Cameron, P.; Connolly, R.; Ryan, W. A.; Smith, G.; Zitvogel, E.

    1997-05-01

    The beam injection line from the Alternating Gradient Synchrotron (AGS) to the Relativistic Heavy Ion Collider (RHIC) transports proton and heavy ion bunches. This line and the RHIC first sextant currently contain thefollowing complement of beam instrumentation: stripline position monitors, ionization loss monitors, video profile monitors, and commercial current transformers. Over several years, these systems have been designed and bench tested to assure a desired performance level. The design criteria will be briefly reviewed. Then, using data from laboratory tests and the recent single pass beam tests, desired performance and attained performance will be compared. Finally, experience from the beam based tests will be applied to the design criteria for the future collider ring instrumentation.

  20. Vacuum systems of linear accelerators of the NICA injection complex

    NASA Astrophysics Data System (ADS)

    Kosachev, V. V.; Bazanov, A. M.; Butenko, A. V.; Galimov, A. R.; Nesterov, A. V.; Pivin, R. V.; Smirnov, A. V.

    2016-12-01

    The NICA project, which includes several accelerators of charged particles, is under construction in the Laboratory of High Energy Physics, Joint Institute for Nuclear Research (JINR), Dubna. Obtaining the required vacuum conditions is one of the key points in implementing the project, because reaching the required ion lifetime at all stages of particle acceleration is what determines the effective luminosity of the experiments in the long run. Currently, modernization of the vacuum system of the injection complex of the LU-20 linear accelerator of light ions, one of oldest accelerators in the JINR, is being carried out and the new HILAC linear accelerator for the acceleration of gold ions in the collider mode of the NICA complex is being installed. At the end parts of the linear accelerators, the residual gas pressure must be approximately 10-5 Pa, which is determined by the maximum amplitude of the RF electric field used for the acceleration of ions.

  1. The role of epidural contrast distribution in predicting the effectiveness of steroid and local anesthetic injection in patients with lumbar spinal stenosis.

    PubMed

    Kwon, Jong Won; Kim, Sang Jun

    2017-07-14

    A prospective observational comparative study. Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection. To determine whether spread of a lidocaine and triamcinolone mixture over the stenotic areas improves clinical symptom of spinal stenosis more effectively. Twenty-four patients with lumbar spinal stenosis were enrolled in this study. A lumbar inter-laminar epidural injection under fluoroscopic guidance was administered to each patient. A numeric rating scale (NRS), claudication distance, the Romberg test, and the Oswestry Disability Index (ODI) were checked pre-injection and at 2, 6, and 12 weeks after the epidural injection. Vertebrae that showed more than moderate stenosis were considered stenosis levels. Inter-laminar epidural injection was performed with radiopaque contrast and lidocaine mixed with triamcinolone acetate. When the contrast covered all of the stenosis levels, this was considered a sufficient distribution (SD) and when the contrast did not cover all stenosis levels, this was considered an insufficient distribution (ID). At 2 weeks, percentages of NRS improvement were 71.4 (IQR, 20.2) in SD group and 50.0 (IQR, 31.4) in ID group (P= 0.02), changes in Romberg test time were 0.0 (IQR, 35.0) in SD group and -3.0 (IQR, 12.0) in ID group (P= 0.02), decreases in ODI were 9.6 (IQR, 11.2) in SD group and 0.0 (IQR, 7.8) in ID group (P= 0.02). However, these parameters were not significantly different at 6 weeks and 12 weeks. Claudication distance showed no significant group difference. Coverage of the stenotic area by the lidocaine, triamcinolone, and contrast dye mixture during inter-laminar epidural injection was an

  2. Steroid hormone regulation of the voltage-gated, calcium-activated potassium channel expression in developing muscular and neural systems.

    PubMed

    Garrison, Sheldon L; Witten, Jane L

    2010-11-01

    A precise organization of gene expression is required for developing neural and muscular systems. Steroid hormones can control the expression of genes that are critical for development. In this study we test the hypothesis that the steroid hormone ecdysone regulates gene expression of the voltage-gated calcium-activated potassium ion channel, Slowpoke or KCNMA1. Late in adult development of the tobacco hawkmoth Manduca sexta, slowpoke (msslo) levels increased contributing to the maturation of the dorsal longitudinal flight muscles (DLMs) and CNS. We show that critical components of ecdysteroid gene regulation were present during upreglation of msslo in late adult DLM and CNS development. Ecdysteroid receptor complex heterodimeric partner proteins, the ecdysteroid receptor (EcR) and ultraspiracle (USP), and the ecdysone-induced early gene, msE75B, were expressed at key developmental time points, suggesting that ecdysteroids direct aspects of gene expression in the DLMs during these late developmental stages. We provide evidence that ecdysteroids suppress msslo transcription in the DLMs; when titers decline msslo transcript levels increase. These results are consistent with msslo being a downstream gene in an ecdysteroid-mediated gene cascade during DLM development. We also show that the ecdysteroids regulate msslo transcript levels in the developing CNS. These results will contribute to our understanding of how the spatiotemporal regulation of slowpoke transcription contributes to tailoring cell excitability to the differing physiological and behavioral demands during development.

  3. Anabolic steroids.

    PubMed

    Brower, K J

    1993-03-01

    Anabolic-androgenic steroids are controlled substances that are taken illicitly to enhance physical appearance and performance. In addition to the desired somatic effects, reasonably good evidence suggests that AASs are capable of influencing mood and behavior. A myriad of adverse effects have been reported. Although many of these effects appear to reverse with cessation of use, fatalities due to suicides, homicides, liver disease, heart attacks, and cancer have been reported infrequently among illicit users. Although studies are needed to quantify more precisely the long-term consequences and risks of using AASs, patterns of illicit use are particularly troublesome. The use of extremely high doses, needles, counterfeit and veterinary drugs, and multiple steroidal and nonsteroidal drugs simultaneously may further enhance the risks of using AASs. The clinician should suspect AAS use in high-risk individuals who manifest any of the possible consequences described in this article. Laboratory tests can be valuable for detection of use and assessment of consequences. Treatment approaches may borrow from proven techniques employed with other substance abusers, but should also address the special value that physical attributes and body image have for the AAS user.

  4. Anabolic steroids.

    PubMed

    Snow, D H

    1993-12-01

    Anabolic steroids have been employed extensively in equine practice over the past 25 years. Their usefulness is largely dependent on subjective opinions, as only minimal studies have been carried out in horses. Therefore, their use will vary markedly between practitioners depending on their personal experiences and pressures by trainers to use them. They form part of rational therapy in a variety of conditions. In addition to use for increasing muscle mass, they are used to a varying extent in the raising of yearlings and in the training and racing of horses with the view of improving performance. However, in almost all countries, the latter use is largely curtailed, and the presence of these substances in postrace urine samples constitutes use of an illegal substance. To detect the use of anabolic steroids, including testosterone, sensitive ELISA tests for screening and GC/MS for confirmation have been developed. These compounds can be used safely. Risks can be encountered if too high doses are used, as horses may become difficult to manage due to increased aggressiveness and other stallion-like behavior. Reproductive efficiency in both stallions and mares may be temporarily impaired, but this is quite rapidly reversible following cessation of treatment.

  5. Long-acting steroid contraceptive technology.

    PubMed

    Grubb, G

    1991-01-01

    Long-acting steroid contraceptive technologies that have either been recently approved or are currently under study are reviewed and the status of contraceptive research in the US is noted. The benefits and drawbacks, as well as the duration and possible cost, of each method are discussed. Approved by the Food and Drug Administration on December 10, 1990, Norplant is reportedly the first new contraceptive technology available to women in the US since the 1960s. This implant delivery system, which lasts up to 5 years, is cheaper than the pill and nearly as effective as sterilization. Study is currently under way on other multiyear, nonbiodegradable and biodegradable implants. Although already used by 4 million women worldwide, the long-acting injectable Depo-Provera has yet to be approved for use in the US. 5 new types of injectables are being developed. Steroid-containing IUDs have been in the market for some time, and current research is attempting to increase their contraceptive life beyond 1 year. Contraceptive developers are also exploring transdermal delivery systems, vaginal rings, and buccal and sublingual delivery. It is considered misleading to call Norplant the first new contraceptive introduced since the pill. Over the past 20 years, virtually every contraceptive has been significantly improved, developments that have enhanced the contraceptive options of couples. Because new contraceptive technologies are increasingly complex, their development is much slower. Consequently, it is concluded that in the foreseeable future, the demand for more acceptable contraceptives will be met through improvements of currently available technologies.

  6. The clinical and cost effectiveness of steroid injection compared with night splints for carpal tunnel syndrome: the INSTINCTS randomised clinical trial study protocol.

    PubMed

    Chesterton, Linda S; Dziedzic, Krysia S; van der Windt, Danielle A; Davenport, Graham; Myers, Helen L; Rathod, Trishna; Blagojevic-Bucknall, Milica; Jowet, Sue M; Burton, Claire; Roddy, Edward; Hay, Elaine M

    2016-10-06

    Patients diagnosed with idiopathic mild to moderate carpal tunnel syndrome (CTS) are usually managed in primary care and commonly treated with night splints and/or corticosteroid injection. The comparative effectiveness of these interventions has not been reliably established nor investigated in the medium and long term. The primary objective of this trial is to investigate whether corticosteroid injection is effective in reducing symptoms and improving hand function in mild to moderate CTS over 6 weeks when compared with night splints. Secondary objectives are to determine specified comparative clinical outcomes and cost effectiveness of corticosteroid injection over 6 and 24 months. A multicentre, randomised, parallel group, clinical pragmatic trial will recruit 240 adults aged ≥18 years with mild to moderate CTS from GP Practices and Primary-Secondary Care Musculoskeletal Interface Clinics. Diagnosis will be by standardised clinical assessment. Participants will be randomised on an equal basis to receive either one injection of 20 mg Depo-Medrone or a night splint to be worn for 6 weeks. The primary outcome is the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. Secondary outcomes are the BCTQ symptom severity and function status subscales, symptom intensity, interrupted sleep, adherence to splinting, perceived benefit and satisfaction with treatment, work absence and reduction in work performance, EQ-5D-5L, referral to surgery and health utilisation costs. Participants will be assessed at baseline and followed up at 6 weeks, 6, 12 and 24 months. The primary analysis will use an intention to treat (ITT) approach and multiple imputation for missing data. The sample size was calculated to detect a 15 % greater improvement in the BTCQ overall score in the injection group compared to night-splinting at approximately 90 % power, 5 % two-tailed significance and allows for 15 % loss to follow-up. The trial makes an important

  7. Penetration and Duration of Fuel Sprays from a Pump Injection System

    NASA Technical Reports Server (NTRS)

    Rothrock, A M; Marsh, E T

    1931-01-01

    High-speed motion pictures were taken of individual fuel sprays from a pump injection system. The changes in the spray-tip penetration with changes in the pump speed, injection-valve opening and closing pressures, discharge-orifice area, injection-tube length and diameter, and pump throttle setting were measured. In addition, the effects of the variables on the time lag and duration of injection can be controlled by the dimensions of the injection tube, the area of the discharge orifice, and the injection-valve opening and closing pressures.

  8. Combustion in a Bomb with a Fuel-Injection System

    NASA Technical Reports Server (NTRS)

    Cohn, Mildred; Spencer, Robert C

    1935-01-01

    Fuel injected into a spherical bomb filled with air at a desired density and temperature could be ignited with a spark a few thousandths of a second after injection, an interval comparable with the ignition lag in fuel-injection engines. The effect of several variables on the extent and rate of combustion was investigated: time intervals between injection and ignition of fuel of 0.003 to 0.06 second and one of 5 minutes; initial air temperatures of 100 degrees C. to 250 degrees C.; initial air densities equivalent to 5, 10, and 15 absolute atmospheres pressure at 100 degrees C.; and air-fuel ratios of 5 to 25.

  9. Using Digital Images of the Zebra Finch Song System as a Tool to Teach Organizational Effects of Steroid Hormones: A Free Downloadable Module

    ERIC Educational Resources Information Center

    Grisham, William; Schottler, Natalie A.; Beck McCauley, Lisa M.; Pham, Anh P.; Ruiz, Maureen L.; Fong, Michelle C.; Cui, Xinran

    2011-01-01

    Zebra finch song behavior is sexually dimorphic: males sing and females do not. The neural system underlying this behavior is sexually dimorphic, and this sex difference is easy to quantify. During development, the zebra finch song system can be altered by steroid hormones, specifically estradiol, which actually masculinizes it. Because of the…

  10. Using Digital Images of the Zebra Finch Song System as a Tool to Teach Organizational Effects of Steroid Hormones: A Free Downloadable Module

    ERIC Educational Resources Information Center

    Grisham, William; Schottler, Natalie A.; Beck McCauley, Lisa M.; Pham, Anh P.; Ruiz, Maureen L.; Fong, Michelle C.; Cui, Xinran

    2011-01-01

    Zebra finch song behavior is sexually dimorphic: males sing and females do not. The neural system underlying this behavior is sexually dimorphic, and this sex difference is easy to quantify. During development, the zebra finch song system can be altered by steroid hormones, specifically estradiol, which actually masculinizes it. Because of the…

  11. Comparison of liquid chromatography-microchip/mass spectrometry to conventional liquid chromatography-mass spectrometry for the analysis of steroids.

    PubMed

    Ahonen, Linda; Keski-Rahkonen, Pekka; Saarelainen, Taija; Paviala, Jenni; Ketola, Raimo A; Auriola, Seppo; Poutanen, Matti; Kostianen, Risto

    2012-04-06

    The feasibility of a microfluidic-based liquid chromatography-electrospray ionization/mass spectrometric system (HPLC-Chip/ESI/MS) was studied and compared to a conventional narrow-bore liquid chromatography-electrospray ionization/mass spectrometric (LC-ESI/MS) system for the analysis of steroids. The limits of detection (LODs) for oxime derivatized steroids, expressed as concentrations, were slightly higher with the HPLC-Chip/MS system (50-300 pM) using an injection volume of 0.5 μL than with the conventional LC-ESI/MS (10-150 pM) using an injection volume of 40 μL. However, when the LODs are expressed as injected amounts, the sensitivity of the HPLC-Chip/MS system was about 50 times higher than with the conventional LC-ESI/MS system. The results indicate that the use of HPLC-Chip/MS system is clearly advantageous only in the analysis of low-volume samples. Both methods showed good linearity and good quantitative and chromatographic repeatability. In addition to the instrument comparisons with oxime derivatized steroids, the feasibility of the HPLC-Chip/MS system in the analysis of non-derivatized and oxime derivatized steroids was compared. The HPLC-Chip/MS method developed for non-derivatized steroids was also applied to the quantitative analysis of 15 mouse plasma samples. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Injection molding lens metrology using software configurable optical test system

    NASA Astrophysics Data System (ADS)

    Zhan, Cheng; Cheng, Dewen; Wang, Shanshan; Wang, Yongtian

    2016-10-01

    Optical plastic lens produced by injection molding machine possesses numerous advantages of light quality, impact resistance, low cost, etc. The measuring methods in the optical shop are mainly interferometry, profile meter. However, these instruments are not only expensive, but also difficult to alignment. The software configurable optical test system (SCOTS) is based on the geometry of the fringe refection and phase measuring deflectometry method (PMD), which can be used to measure large diameter mirror, aspheric and freeform surface rapidly, robustly, and accurately. In addition to the conventional phase shifting method, we propose another data collection method called as dots matrix projection. We also use the Zernike polynomials to correct the camera distortion. This polynomials fitting mapping distortion method has not only simple operation, but also high conversion precision. We simulate this test system to measure the concave surface using CODE V and MATLAB. The simulation results show that the dots matrix projection method has high accuracy and SCOTS has important significance for on-line detection in optical shop.

  13. A 1-Joule laser for a 16-fiber injection system

    SciTech Connect

    Honig, J

    2004-04-06

    A 1-J laser was designed to launch light down 16, multi-mode fibers (400-{micro}m-core dia.). A diffractive-optic splitter was designed in collaboration with Digital Optics Corporation (DOC), and was delivered by DOC. Using this splitter, the energy injected into each fiber varied <1%. The spatial profile out of each fiber was such that there were no ''hot spots,'' a flyer could successfully be launched and a PETN pellet could be initiated. Preliminary designs of the system were driven by system efficiency where a pristine TEM{sub 00} laser beam would be required. The laser is a master oscillator, power amplifier (MOPA) consisting of a 4-mm-dia. Nd:YLF rod in the stable, q-switched oscillator and a 9.5-mm-dia. Nd:YLF rod in the double-passed amplifier. Using a TEM{sub 00} oscillator beam resulted in excellent transmission efficiencies through the fibers at lower energies but proved to be quite unreliable at higher energies, causing premature fiber damage, flyer plate rupture, stimulated Raman scattering (SRS), and stimulated Brillouin scattering (SBS). Upon further investigation, it was found that both temporal and spatial beam formatting of the laser were required to successfully initiate the PETN. Results from the single-mode experiments, including fiber damage, SRS and SBS losses, will be presented. In addition, results showing the improvement that can be obtained by proper laser beam formatting will also be presented.

  14. No abatement of steroid injections for tennis elbow in Australian General Practice: A 15-year observational study with random general practitioner sampling.

    PubMed

    Vicenzino, Bill; Britt, Helena; Pollack, Allan J; Hall, Michelle; Bennell, Kim L; Hunter, David J

    2017-01-01

    Evaluate general practitioner (GP) management of tennis elbow (TE) in Australia. Data about the management of TE by GPs from 2000 to 2015 were extracted from the Bettering the Evaluation of Care of Health program database. Patient and GP characteristics and encounter management data were classified by the International Classification of Primary Care, version 2, and reported using descriptive statistics with point estimates and 95% confidence intervals. TE was managed by GPs 242,000 times per year on average. Patients were mainly female (52.3%), aged between 35 and 64 years (mean: 49.3 yrs), had higher relative risks of concomitant disorders (e.g. carpal tunnel syndrome and other tendonitis) and their TE was 10 times more likely to be work related than problems managed for patients who did not have TE. Use of diagnostic tests was low, implying a clinical examination based diagnosis of TE. Management was by procedural treatments (36 per 100 TE problems), advice, education or counselling (25 per 100), and referral to other health care providers (14 per 100, mainly to physiotherapy). The rate of local injection did not change over the 15 years and was performed at similar rates as physiotherapy referral. The high risk of comorbidities and work relatedness and no abatement in the reasonably high rate of local injections (which is contrary to the evidence from clinical trials) provides support for the development and dissemination of TE clinical guidelines for GPs.

  15. Adaptation of a load-inject valve for a flow injection chemiluminescence system enabling dual-reagent injection enhances understanding of environmental Fenton chemistry.

    PubMed

    Jones, Matthew R; Nightingale, Philp D; Turner, Suzanne M; Liss, Peter S

    2013-09-24

    Environmental Fenton chemistry has been poorly constrained within the marine environment at a multi-component level. A simple, unique, reconfiguration of a flow-injection analytical system combined with luminol chemiluminescence allows quasi-simultaneously the measurement, using a single load-inject valve and a single photon multiplier tube, of reduced iron, Fe(II), and hydrogen peroxide. The system enables rapid, every 22s, measurements with good accuracy at environmentally relevant concentrations, less than 5% relative standard deviations on both a 5 nM Fe(II) standard and a 60 nM hydrogen peroxide standard. Limits of detection were as low as 40 pM Fe(II) and 100 pM hydrogen peroxide. The system showed excellent capability by measuring from within an organic rich seawater the photochemically induced production of Fe(II) and hydrogen peroxide and their subsequent cycling and Fenton like interactions.

  16. An Apparatus for Measuring Rates of Discharge of a Fuel-Injection System

    NASA Technical Reports Server (NTRS)

    Dutee, Francis J

    1941-01-01

    A portable apparatus for rapidly determining rates of discharge of a fuel-injection system is described. Satisfactory operation of this apparatus with injection-pump speeds up to 2400 r.p.m was obtained. Rate-of-discharge tests were made with several cam-plunger-valve injection systems with long injection tubes. A check valve designed to reduce secondary discharges was tested. This check valve was operated with injection-pump speeds up to 2400 r.p.m without the occurrence of large secondary discharges.

  17. Honey plus coffee versus systemic steroid in the treatment of persistent post-infectious cough: a randomised controlled trial.

    PubMed

    Raeessi, Mohammad Ali; Aslani, Jafar; Raeessi, Neda; Gharaie, Homa; Karimi Zarchi, Ali Akbar; Raeessi, Fereshteh

    2013-09-01

    Persistent post-infectious cough (PPC) is a cough that remains after a common cold or an upper respiratory tract infection for more than three weeks or perhaps for many months. Two of the suggested treatments for PPC are systemic steroid and honey plus coffee. The aim of this study was to evaluate and compare scientifically the therapeutic effects of these two regimens. A double-blind randomised controlled trial was conducted from 2008 to 2011 at the Baqiyatallah University Hospital, Tehran, Iran. Included in the study were 97 adults who had experienced PPC for more than three weeks. Patients with other causes of chronic cough, systemic disease, or abnormal routine laboratory tests were excluded. The participants were distributed into three groups. A jam like paste was prepared which consisted of honey plus coffee for the first group ('HC'), prednisolone for the second group (steroid, 'S'), and guaifenesin for the third group (control, 'C'). The participants were told to dissolve a specified amount of their product in warm water and to drink the solution every eight hours for one week. All the participants were evaluated before treatment and one week after completion of treatment to measure the severity of their cough. The main outcome measure was the mean cough frequency before and after one week's treatment calculated by a validated visual analogue cough questionnaire score. There were 97 adult patients (55 men) enrolled in this study with the mean of age of 40.1 years. The mean (+/- SD) cough scores pre- and post-treatment were: HC group 2.9 (0.3) pre-treatment and 0.2 (0.5) post-treatment (p < 0.001); steroid ('S') group 3.0 (0.0) pre-treatment and 2.4 (0.6) post-treatment (p < 0.05); control ('C') group 2.8 (0.4) pre-treatment and 2.7 (0.5) post-treatment (p > 0.05). Analysis of variance showed a significant difference between the mean cough frequency before and after treatment in the HC group versus the S group (p< 0.001). Honey plus coffee was found to be

  18. Self-curing controlled release systems for steroids. Application of prednisolone-based polymeric systems to ear diseases.

    PubMed

    Fernandez, Mar; Parra, Juan; Vazquez, Blanca; Lopez-Bravo, Antonio; Román, Julio San

    2005-06-01

    An injectable delivery system for prednisolone has been prepared based on a self-curing formulation comprised of poly(methyl methacrylate) particles and hydroxyethyl methacrylate as monomer. The polymerisation reaction was initiated by the redox system 4,4'-bis (dimethylaminobenzydrol)/benzoyl peroxide (BZN/BPO) and followed at 25 degrees C by measuring the time-temperature profile. A maximum temperature of 53 degrees C and a setting time of 15 min were obtained, calculated according to standard specifications. The swelling of the cured system was studied in phosphate-buffered saline (PBS) at 37 degrees C giving a hydration degree at equilibrium of 20%. The swelling kinetics fitted a fickian behaviour at the initial stages of the experiments, with a diffusion coefficient of 0.72 x 10(-7) cm2/s. The release of the drug was sustained from the beginning without an initial drug burst. The study of the wettability showed a rather hydrophilic character of the surface of the loaded system, and the biocompatibility evaluated through MTT assay revealed the absence of cytotoxicity due to the release of toxic substances.

  19. Variation in steroid hormone levels among Caribbean Anolis lizards: endocrine system convergence?

    PubMed

    Husak, Jerry F; Lovern, Matthew B

    2014-04-01

    Variation in aggression among species can be due to a number of proximate and ultimate factors, leading to patterns of divergent and convergent evolution of behavior among even closely related species. Caribbean Anolis lizards are well known for their convergence in microhabitat use and morphology, but they also display marked convergence in social behavior and patterns of aggression. We studied 18 Anolis species across six ecomorphs on four different Caribbean islands to test four main hypotheses. We hypothesized that species differences in aggression would be due to species differences in circulating testosterone (T), a steroid hormone implicated in numerous studies across vertebrate taxa as a primary determinant of social behavior; more aggressive species were expected to have higher baseline concentrations of T and corticosterone. We further hypothesized that low-T species would increase T and corticosterone levels during a social challenge. Within three of the four island assemblages studied we found differences in T levels among species within an island that differ in aggression, but in the opposite pattern than predicted: more aggressive species had lower baseline T than the least aggressive species. The fourth island, Puerto Rico, showed the pattern of baseline T levels among species we predicted. There were no patterns of corticosterone levels among species or ecomorphs. One of the two species tested increased T in response to a social challenge, but neither species elevated corticosterone. Our results suggest that it is possible for similarities in aggression among closely related species to evolve via different proximate mechanisms.

  20. SRS supplemental safety system injection (gas pressurizer) test

    SciTech Connect

    Howarth, W.L.; Dimenna, R.A.

    1992-12-31

    An evaluation and validation of an existing version of the RELAP5 thermal hydraulics computer code was undertaken for the purpose of certification for use in the new production reactor - heavy water reactor (NPR-HWR) program. This version of the code was RELAP5/MOD3 Version 5q, designated for the purposes of the NPR-HWR program as RELAP5/NPR Version 0. As part of the evaluation and assessment, test data from theSRS Supplemental Safety System Injection (Gas Pressurizer) was used to verify and assess the ability of RELAP5/NPR Version 0 to perform thermal-hydraulic model analysis using the test data. Specifically, the assessment determines RELAP5/NPR Version 0 capability in modeling sudden depressurization phenomena. Two RELAP5/NPR Version 0 components (pipe and accumulator) were used to compare calculated pressure and temperature against test data. The code deficiencies are a temperature clamp in the accumulator component prevents the gas temperature from going below {minus}9{degrees}F, and RELAP5 accumulator and pipe components wall-to-fluid heat transfer correlation and interfacial vapor heat transfer correlation need substantial improvement. Only the code pipe component calculated pressures and temperatures within the specified 10 percent accuracy.

  1. SRS supplemental safety system injection (gas pressurizer) test

    SciTech Connect

    Howarth, W.L.; Dimenna, R.A.

    1992-01-01

    An evaluation and validation of an existing version of the RELAP5 thermal hydraulics computer code was undertaken for the purpose of certification for use in the new production reactor - heavy water reactor (NPR-HWR) program. This version of the code was RELAP5/MOD3 Version 5q, designated for the purposes of the NPR-HWR program as RELAP5/NPR Version 0. As part of the evaluation and assessment, test data from theSRS Supplemental Safety System Injection (Gas Pressurizer) was used to verify and assess the ability of RELAP5/NPR Version 0 to perform thermal-hydraulic model analysis using the test data. Specifically, the assessment determines RELAP5/NPR Version 0 capability in modeling sudden depressurization phenomena. Two RELAP5/NPR Version 0 components (pipe and accumulator) were used to compare calculated pressure and temperature against test data. The code deficiencies are a temperature clamp in the accumulator component prevents the gas temperature from going below [minus]9[degrees]F, and RELAP5 accumulator and pipe components wall-to-fluid heat transfer correlation and interfacial vapor heat transfer correlation need substantial improvement. Only the code pipe component calculated pressures and temperatures within the specified 10 percent accuracy.

  2. Efficacy of percutaneous intramyocardial injections using a nonfluoroscopic 3-D mapping based catheter system.

    PubMed

    Smits, Pieter C; van Langenhove, Glenn; Schaar, Michael; Reijs, Ambrose; Bakker, Willem H; van der Giessen, Wim J; Verdouw, Pieter D; Krenning, Eric P; Serruys, Patrick W

    2002-12-01

    Percutaneous transendomyocardial injection with an injection catheter is a new drug delivery method for e.g. therapeutic angiogenesis. Little is known about the efficacy of this drug delivery technique. We studied efficiency and retention of transendomyocardial injections with a NOGA guided injection catheter system by using scintigraphy with radio-labeled model drugs. Ten non-ischemic landrace pigs were used. In each animal 2-3 transendomyocardial injections were performed using a 3-D mapping based catheter system called NOGA. As a model for proteins like angiogenic growth factors we used (99m)Tc labeled albumin and as a model for small particles like microspheres or adenovirus we used (99m)Tc labeled colloid albumin. Efficiency of the injections and retention of the transendomyocardial deposited substance were evaluated by a gamma camera during and after injection of 0.1 or 0.2 ml. All 29 injections showed scintigraphic proof of intramyocardial deposition. The average injection efficiency of all 29 injections was 26 +/- 23%. The average injection efficiency of 0.1 and 0.2 ml injections were 33 +/- 30% (n = 8) and 24 +/- 20% (n = 21), respectively (p = 0.33). Intramyocardial retention curves of albumin showed a rapid wash-out within the first 2 hours of the injection, whereas the retention of colloid albumin showed no decrease. In conclusion, transendomyocardial delivery of proteins or particles with an injection catheter show favorable efficiency rates, however the retention time of intramyocardial deposited small proteins like albumin is short. This may indicate the need for sustained release systems of angiogenic growth factors for intramyocardal injection in therapeutic angiogenesis.

  3. Central nervous system toxicity after botulinum neurotoxin injection.

    PubMed

    Ilkhchoui, Yashar; Ghaly, Ramsis F; Knezevic, N Nick; Candido, Kenneth D

    2013-01-01

    Since Its first description of botulism toxicity in 1820s, specific formulations of botulinum neurotoxin (BoNT) have been introduced with different clinical benefits. However, there is increasing number of adverse events reported to Food and Drug Administration. This report presents the case of 62-year-old woman with Parkinson's disease who received BoNT injections to treat painful spasticity in her hands. She developed severe generalized dystonia shortly after BoNT injections.

  4. Central Nervous System Toxicity After Botulinum Neurotoxin Injection

    PubMed Central

    Ilkhchoui, Yashar; Ghaly, Ramsis F.; Knezevic, N. Nick; Candido, Kenneth D

    2013-01-01

    Since Its first description of botulism toxicity in 1820s, specific formulations of botulinum neurotoxin (BoNT) have been introduced with different clinical benefits. However, there is increasing number of adverse events reported to Food and Drug Administration. This report presents the case of 62-year-old woman with Parkinson’s disease who received BoNT injections to treat painful spasticity in her hands. She developed severe generalized dystonia shortly after BoNT injections. PMID:24223367

  5. Adolescent Steroid Use.

    ERIC Educational Resources Information Center

    Office of Inspector General (DHHS), Washington, DC.

    The study focused on non-medical steroid use by adolescents according to data obtained from the National Institute on Drug Abuse, professional literature, 30 key informants knowledgeable in steroid issues, and 72 current or former steroid users. The findings indicated: (1) over 250,000 adolescents, primarily males, used or have used steroids, and…

  6. Impact of systemic steroids on posttonsillectomy bleeding: analysis of 61 430 patients using a national inpatient database in Japan.

    PubMed

    Suzuki, Sayaka; Yasunaga, Hideo; Matsui, Hiroki; Horiguchi, Hiromasa; Fushimi, Kiyohide; Yamasoba, Tatsuya

    2014-10-01

    Although postoperative bleeding after tonsillectomy is rare, it is potentially life-threatening. The association between steroid administration and postoperative bleeding remains controversial. The findings of previous studies were limited by small sample sizes. To examine the impact of intravenous steroid administration on posttonsillectomy bleeding requiring reoperation in children and adults. Retrospective cohort study of 61 430 patients from 718 hospitals who underwent tonsillectomy between 2007 and 2013, using the Diagnosis Procedure Combination database in Japan. Intravenous steroid administration on the day of tonsillectomy. The main outcome measure was reoperation for hemostasis under general anesthesia. Patient characteristics (age, sex, comorbidities) and steroid use were examined. Patients were classified as children (age ≤15 years, n = 31 934) and adults (age >15 years, n = 29 496), and subclassified into those who received intravenous steroid therapy on the day of tonsillectomy (steroid group) and those who did not (control group). Multivariable logistic regression analysis was performed to analyze the association between steroid use and posttonsillectomy bleeding with adjustment for patient characteristics. The rate of reoperation was significantly higher in the steroid group than in the control group for children (1.2% vs 0.5%) (P < .001) but not for adults (1.7% vs 1.4%) (P = .14). Reoperation was most frequently performed at about 7 days after tonsillectomy. After adjusting for patient characteristics, we found a significant increase in the rate of reoperation in the steroid group in children (adjusted odds ratio [OR], 2.50 [95% CI, 1.47-4.23]) (P = .001) but not in adults (OR, 1.18 [95% CI, 0.85-1.64]) (P = .31). Intravenous steroid administration on the day of tonsillectomy in children was an independent risk factor for severe bleeding requiring reoperation.

  7. Penetration and Duration of Fuel Sprays from a Pump Injection System

    NASA Technical Reports Server (NTRS)

    Rothrock, A M; Marsh, E T

    1934-01-01

    High-speed motion pictures were taken of individual fuel sprays from a pump injection system. The changes in the spray-tip penetration with changes in the pump speed, injection-valve opening and closing pressures, discharge-orifice area, injection-tube length and diameter, and pump throttle setting were measured. The pump was used with and without a check valve. The results show that the penetration of the spray tip can be controlled by the dimensions of the injection tube, the area of the discharge orifice, and the injection-valve opening and closing pressures.

  8. Development of a particle injection system for impurity transport study in KSTAR.

    PubMed

    Lee, H Y; Hong, Suk-Ho; Hong, Joohwan; Lee, Seung Hun; Jang, Siwon; Jang, Juhyeok; Jeon, Taemin; Park, Jae Sun; Choe, Wonho

    2014-11-01

    A solid particle injection system is developed for KSTAR. The system has a compact size, compatibility with a strong magnetic field and high vacuum environment, and the capability to inject a small amount of solid particles with a narrow injection angle. The target flight-distance of 10 cm has been achieved with a particle loss rate of less than 10%. Solid impurity particles such as tungsten and carbon will be injected by this system at the midplane in KSTAR. The impurity transport feature will be studied with a soft X-ray array, a vacuum ultra-violet diagnostic, and Stand Alone Non-Corona code.

  9. Development of a particle injection system for impurity transport study in KSTAR

    SciTech Connect

    Lee, H. Y.; Hong, Joohwan; Lee, Seung Hun; Jang, Siwon; Jang, Juhyeok; Jeon, Taemin; Park, Jae Sun; Choe, Wonho; Hong, Suk-Ho

    2014-11-15

    A solid particle injection system is developed for KSTAR. The system has a compact size, compatibility with a strong magnetic field and high vacuum environment, and the capability to inject a small amount of solid particles with a narrow injection angle. The target flight-distance of 10 cm has been achieved with a particle loss rate of less than 10%. Solid impurity particles such as tungsten and carbon will be injected by this system at the midplane in KSTAR. The impurity transport feature will be studied with a soft X-ray array, a vacuum ultra-violet diagnostic, and Stand Alone Non-Corona code.

  10. Tracer-Encapsulated Solid Pellet (TESPEL) injection system for the TJ-II stellarator

    NASA Astrophysics Data System (ADS)

    Tamura, N.; McCarthy, K. J.; Hayashi, H.; Combs, S. K.; Foust, C.; García, R.; Panadero, N.; Pawelec, E.; Hernández Sánchez, J.; Navarro, M.; Soleto, A.

    2016-11-01

    A tracer-encapsulated solid pellet (TESPEL) injection system for the TJ-II stellarator was recently developed. In order to reduce the time and cost for the development, we combined a TESPEL injector provided by National Institute for Fusion Science with an existing TJ-II cryogenic pellet injection system. Consequently, the TESPEL injection into the TJ-II plasma was successfully achieved, which was confirmed by several pellet diagnostics including a normal-incidence spectrometer for monitoring a tracer impurity behavior.

  11. Tracer-Encapsulated Solid Pellet (TESPEL) Injection System for the TJ-II Stellarator

    SciTech Connect

    Tamura, N.; McCarthy, K. J.; Hayashi, H.; Combs, Stephen Kirk; Foust, Charles R; Garcia, R.; Panadero, N.; Pawelec, E.; Sanchez, J. Hernandez; Navarro, M.; Soleto, A.

    2016-01-01

    A tracer-encapsulated solid pellet (TESPEL) injection system for the TJ-II stellarator was recently developed. In order to reduce the time and cost for the development, we combined a TESPEL injector provided by National Institute for Fusion Science with an existing TJ-II cryogenic pellet injection system. Consequently, the TESPEL injection into the TJ-II plasma was successfully achieved, which was confirmed by several pellet diagnostics including a normal-incidence spectrometer for monitoring a tracer impurity behavior.

  12. Steroid Shots Offer No Long-Term Relief for Low-Back Pain

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_164172.html Steroid Shots Offer No Long-Term Relief for Low- ... back pain affects millions of Americans. Many try steroid injections to ease their discomfort, but researchers now ...

  13. The Effectiveness of Intraocular Methotrexate in the Treatment of Posterior Uveitis in Behçet's Disease Patients Compared to Retrobulbar Steroids Injection

    PubMed Central

    Khalil, Hossam El Din Mohamed; Youssef, Hala Ahmed Raafat; Haroun, Hazem Effat; Gheita, Tamer Atef; Bakir, Hossam Mahmoud

    2016-01-01

    Aim of Work. To evaluate the efficacy of intravitreal methotrexate (MTX) compared to retrobulbar triamcinolone acetonide (TAA), in controlling posterior segment involvement and inducing remissions among Behçet's disease (BD) patients. Study Design. This is a cross-sectional nonrandomized comparative study. Patients and Methods. 31 adult BD male patients with a mean disease duration of 5.45 years who presented with bilateral posterior segment involvement were included. Each patient received intravitreal injection of 400 μg/0.1 mL (MTX) for the right eye (Group A) and 1 mL of retrobulbar 40 mg/mL TAA for the left eye (Group B). Results. 90% of eyes showed complete improvement of anterior chamber reaction, whereas an improvement in vitreous activity in 77% with no significant differences between both groups (p ≤ 0.1). BCVA improved in 77.4% eyes (Group A) compared to 87.1% (Group B) (p ≤ 0.4). Relapses were noted in 11 eyes (35.5%), in group A, with the mean duration of remission being 19.1 weeks ± 2.13 compared to 7.35 ± 2.8 in 20 eyes (64.5%) in group B (p ≤ 0.1). Conclusion. No statistical differences were found between both treatment modalities; however, based on clinical observations, intravitreal MTX may ensure better control of inflammatory reaction and may encourage longer remission as compared to retrobulbar TAA in BD patients. PMID:28070412

  14. Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy?

    PubMed

    Dean, Benjamin John Floyd; Franklin, Sarah Louise; Murphy, Richard J; Javaid, Muhammad K; Carr, Andrew Jonathan

    2014-12-01

    Glucocorticoid injection (GCI) and surgical rotator cuff repair are two widely used treatments for rotator cuff tendinopathy. Little is known about the way in which medical and surgical treatments affect the human rotator cuff tendon in vivo. We assessed the histological and immunohistochemical effects of these common treatments on the rotator cuff tendon. Controlled laboratory study. Supraspinatus tendon biopsies were taken before and after treatment from 12 patients undergoing GCI and 8 patients undergoing surgical rotator cuff repair. All patients were symptomatic and none of the patients undergoing local GCI had full thickness tears of the rotator cuff. The tendon tissue was then analysed using histological techniques and immunohistochemistry. There was a significant increase in nuclei count and vascularity after rotator cuff repair and not after GCI (both p=0.008). Hypoxia inducible factor 1α (HIF-1α) and cell proliferation were only increased after rotator cuff repair (both p=0.03) and not GCI. The ionotropic N-methyl-d-aspartate receptor 1 (NMDAR1) glutamate receptor was only increased after GCI and not rotator cuff repair (p=0.016). An increase in glutamate was seen in both groups following treatment (both p=0.04), while an increase in the receptor metabotropic glutamate receptor 7 (mGluR7) was only seen after rotator cuff repair (p=0.016). The increases in cell proliferation, vascularity and HIF-1α after surgical rotator cuff repair appear consistent with a proliferative healing response, and these features are not seen after GCI. The increase in the glutamate receptor NMDAR1 after GCI raises concerns about the potential excitotoxic tendon damage that may result from this common treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Data acquisition system for sorbent injection test program at Virginia Power Yorktown Power Station Unit 2

    SciTech Connect

    Francis, C.; Scharpf, G.H. Jr.

    1995-06-01

    Virginia Power has installed an ABB Boiler Performance Optimization System (BPOS) at their Yorktown Power Station Unit 2, in conjunction with an in-furnace, sorbent injection, sulfur dioxide emissions reduction test program., This system was selected as offering lower cost and long-term benefits to the station than using dedicated test equipment and personnel for the test program. In addition to providing data acquisition and storage functions for characterization of the effect of sorbent injection on boiler performance, sorbent injection equipment performance, and emissions reduction, the system performs on-line plant heat rate and controllable losses calculations. The BPOS included the following advanced features: (1) Access to test and operating results for station operators, station engineering staff and sorbent injection project staff at their own work spaces at the station and at remote locations. (2) Boiler section surface cleanliness models to aid the boiler operators with soot blowing and to assess the impact of sorbent injection on individual boiler surfaces. (3) Interfaces to the station`s distributed control system (DCS), the sorbent injection system`s programmable logic controller (PLC), and to a data logger used for test instrumentation. (4) Model-based calculations for sorbent injection system control setpoints implemented in BPOS computer system. (5) On-line continuous calculation of sorbent injection system performance indices.

  16. Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis.

    PubMed

    Ng, Jia Hui; Ho, Roger Chun Man; Cheong, Crystal Shuk Jin; Ng, Adele; Yuen, Heng Wai; Ngo, Raymond Yeow Seng

    2015-10-01

    Sudden sensorineural hearing loss is typically treated with systemic steroids. The aim of this meta-analysis was to evaluate the efficacy of salvage intratympanic steroid treatment in patients who have initial treatment failure with systemic steroids. A MEDLINE literature search was performed, supported by searches of Web of Science, Biosis, and Science Direct. Articles of all languages were included. Selection of relevant publications was conducted independently by three authors. Only randomized controlled trials were considered. In one arm of the studies, the patients received salvage intratympanic steroids. In the other arm, patients did not receive further treatment. The standard difference in mean (SDM) amount of improvement in hearing threshold between patients who did and did not receive salvage intratympanic steroids was calculated. From an initial 184 studies found via the search strategy, 5 studies met inclusion criteria and were included. There was a statistically significant greater reduction in hearing threshold on pure-tone audiometry in patients who received salvage intratympanic steroids than in those who did not (SDM = -0.401, p = 0.005). Subgroup analysis showed that administration by intratympanic injection (SDM = -0.375, p = 0.013) rather than a round window catheter (SDM = -0.629, p = 0.160) yielded significant improvement in outcome. The usage of dexamethasone yielded better outcomes (SDM = -0.379, p = 0.039) than the use of methylprednisolone (SDM = -0.459, p = 0.187). No serious side effect of treatment was reported. In patients who have failed initial treatment with systemic steroids, additional treatment with salvage intratympanic dexamethasone injections demonstrate a statistically significant reduction in the hearing thresholds as compared to controls.

  17. Comparison of a needle-free high-pressure injection system with needle-tipped injection of intracavernosal alprostadil for erectile dysfunction.

    PubMed

    Harding, L M; Adeniyi, A; Everson, R; Barker, S; Ralph, D J; Baranowski, A P

    2002-12-01

    Patients identified from hospital records as using alprostadil injections for erectile dysfunction were invited to take part in this open crossover study. On alternate weeks eight patients were given intracavernosal needle injections and transdermal needle-free injection of alprostadil in a randomized order. Efficacy of injection and associated pain were assessed and compared for the two methods. Pain produced during injection was significantly greater with the needle-free system than with the needle-tipped injection whilst efficacy was significantly less. Bruising was reported in all except one patient following needle-free injection only. Patient ratings of the needle-free injector were significantly lower than ratings for needle-tipped alprostadil delivery and when asked to express a preference, every patient chose the needle-tipped injection over the needle-free device.

  18. Dry low NOx combustion system with pre-mixed direct-injection secondary fuel nozzle

    DOEpatents

    Zuo, Baifang; Johnson, Thomas; Ziminsky, Willy; Khan, Abdul

    2013-12-17

    A combustion system includes a first combustion chamber and a second combustion chamber. The second combustion chamber is positioned downstream of the first combustion chamber. The combustion system also includes a pre-mixed, direct-injection secondary fuel nozzle. The pre-mixed, direct-injection secondary fuel nozzle extends through the first combustion chamber into the second combustion chamber.

  19. Sequential injection system for phospholipase A2 activity evaluation: studies on liposomes using an environment-sensitive fluorescent probe.

    PubMed

    Araujo, André R T S; Gaspar, Diana; Lúcio, Marlene; Reis, Salette; Saraiva, M Lúcia M F S; Lima, José L F C

    2009-09-15

    This work reports the development of an automatic methodology based on the use of 1-anilinonaphthalene-8-sulfonate (ANS) as an interfacial fluorescent probe for detecting the hydrophobic environment shift around the probe, caused by the hydrolytic action of PLA(2) on the liposomes. The implementation of this reaction in a sequential injection analysis (SIA) system along with the use of the mixing chambers permitted the evaluation of PLA(2) activity and assessment of the inhibitory effect of the non-steroidal anti-inflammatory drugs (NSAIDs) on PLA(2) activity. Several studies were performed with the aim of establishing the appropriate flow system configuration: the liposome substrate; PLA(2) and ANS optimum concentrations and incubation times before and after the enzyme addition. Based on these studies, the optimum reaction conditions were selected. It was shown that PLA(2) is effectively inhibited by the NSAIDs tested (meloxicam, tolmetin and ibuprofen) and by the alpha-lipoic acid, used as a positive control. Results obtained from the flow system are in agreement with those provided by the comparison batch procedures. The proposed methodology is in fact more efficient and rapid than the comparison batch experiments, enabling the exact timing of fluidic manipulations and precise control of the reaction conditions.

  20. Improvement of fuel injection system of locomotive diesel engine.

    PubMed

    Li, Minghai; Cui, Hongjiang; Wang, Juan; Guan, Ying

    2009-01-01

    The traditional locomotive diesels are usually designed for the performance of rated condition and much fuel will be consumed. A new plunger piston matching parts of fuel injection pump and injector nozzle matching parts were designed. The experimental results of fuel injection pump test and diesel engine show that the fuel consumption rate can be decreased a lot in the most of the working conditions. The forced lubrication is adopted for the new injector nozzle matching parts, which can reduce failure rate and increase service life. The design has been patented by Chinese State Patent Office.

  1. Status of the NSLS-II Injection System Design

    SciTech Connect

    Shaftan,T.

    2008-06-23

    The NSLS-II is a new ultra-bright 3rd generation 3 GeV light source that will be built at Brookhaven National Laboratory. Its design is well under way. The requirements for the compact injector complex, which will continuously provide 3 GeV electrons for top-off injection into the storage ring, are demanding: high reliability, relatively high charge and low losses. The injector consists of a linear accelerator, a full-energy booster, as well as transport lines, and an injection straight section. In this paper we give an overview of the NSLS-II injector, discuss its status, specifications, and the design challenges.

  2. Participation of the opioid system in the regulation of prolactin secretion in androgenized rats: effect of ovarian steroids.

    PubMed

    Soaje, M; Deis, R P

    1999-04-23

    We examined the role of the opioid system on the regulation of prolactin secretion in neonatally androgenized rats and evaluated the participation of ovarian steroids in this regulation. Androgenized rats exhibited an increase of prolactin secretion with higher serum circulating levels in the afternoon (1800) than in the morning (1000). The administration of the opioid antagonist naloxone (2 mg/kg, 30 min before decapitation) reduced serum prolactin levels in both groups. To identify the opioid receptor subtypes involved in this regulation, opioid agonists were administered i.c.v. 15 min before the decapitation (1000). The mu-opioid receptor agonist DAMGO ([D-Ala2, NMe-Phe4, Gly5-ol]-enkephalin) caused a significant increase in serum prolactin concentration. The selective kappa-opioid receptor agonist U-50, 488H (trans-(+/-)-3,4-dichloro-N-[2(1-pyrrolidinyl)-cyclohexyl]-benzene acetamide methane sulfonate salt) induced a small but significant increase in serum prolactin levels but no effect was observed after administration of the delta-opioid agonist DPDPE ([D-Pen2, D-Pen5]-enkephalin). The role of oestradiol and the opioid system in the continuous secretion of prolactin was also study. Chronic gonadectomy (3-4 weeks) reduced serum prolactin concentrations measured at 1000 but the administration of naloxone had no effect. Three days of oestrogen treatment (2 microg/rat in oil) restored serum prolactin levels compared with ovariectomized animals and this effect was abolished by naloxone treatment. Interestingly, acute ovariectomy or administration of tamoxifen to intact androgenized rats did not prevent the continuous secretion of prolactin observed in these animals and naloxone treatment reduced serum prolactin levels in both groups of rats. We also examine the participation of adrenal progesterone and the endogenous opioid peptides on the regulation of prolactin levels in androgenized rats. After adrenalectomy, no changes in serum prolactin levels (1000) were

  3. Pesticide- and sex steroid analogue-induced endocrine disruption differentially targets hypothalamo-hypophyseal-gonadal system during gametogenesis in teleosts - A review.

    PubMed

    Senthilkumaran, Balasubramanian

    2015-08-01

    Pesticide-induced endocrine disruption often mimics sex steroidal action resulting in physiological functional disarray of hypothalamo-hypophyseal-gonadal (HHG) system at multiple levels. Among various group of pesticides, organochlorine and organophosphate family of pesticides are known to impart sex steroidal mimicking activity with slightly higher resemblance to estrogens when compared to androgenic action. This review will highlight the effects of organochlorine (for e.g. endosulfan) and organophosphate (for e.g. malathion) pesticides in comparison with sex-steroid analogue-induced changes on HHG axis during gametogenesis in few teleost fish models. Interestingly, the effects of these compounds have produced differential effects in juveniles and adults which also vary based on exposure dosage and duration. Further, the treatments had caused at times sexually dimorphic effects indicating that the action of these compounds bring out serious implications in sexual development. A comprehensive overview has been provided by considering all these aspects to recognize the adverse impacts of pesticide-induced endocrine disruption with special reference to endosulfan and malathion as those had been applied even today or used before for controlling agricultural pests in several Asian countries including India. This review also compares the effects of sex-steroid analogues where in sex reversal to reproductive dysfunction is evident, which may imply the extent of sexual plasticity in teleosts compared to other vertebrates. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Patient satisfaction and clinical outcome after injecting gonadotropins with use of a needle-free carbon dioxide injection system for controlled ovarian hyperstimulation for in vitro fertilization.

    PubMed

    Solnica, Amy; Oh, Cheongeun; Cho, Michael M; Loughlin, Jacquelyn S; McCulloh, David H; McGovern, Peter G

    2009-10-01

    In this prospective, randomized clinical trial, we tested the hypothesis that a needle-free CO(2) injection system (Biojector 2000) would be better tolerated by patients when compared with traditional sharp needles used for gonadotropin injections during stimulation for IVF. As measured by our questionnaire, the needle-free CO(2) injection system was not better tolerated by patients, even though it was equally effective clinically.

  5. Validation of an automatic dose injection system for Ictal SPECT in epilepsy.

    PubMed

    Setoain, Xavier; Pavía, Javier; Serés, Eulalia; Garcia, Ramiro; Carreño, Maria Mar; Donaire, Antonio; Rubí, Sebastià; Bargalló, Nuria; Rumià, Jordi; Boget, Teresa; Pintor, Luís; Fuster, David; Pons, Francesca

    2012-02-01

    The purpose of our study was to evaluate the performance and clinical usefulness of an automated injector system (AIS) that administers an automated injection for ictal SPECT after calculating the volume of tracer to be injected over time. To test the AIS, repeated injections were performed at different times after tracer preparation. The clinical study consisted of 56 patients with drug-resistant, complex partial seizures. Tracer for ictal SPECT was injected using automated injection in 27 patients and manual injection (MI) in the remaining 29. Injection time (T(I)) was measured in seconds from seizure onset to the end of volume injection. The SISCOM (Subtraction Ictal Spect Co-registered to MRI) procedure was used to locate the epileptogenic seizure focus with SPECT. The definition of seizure focus was made by consensus of the epilepsy unit using conventional diagnostic methods. During the experimental phase, there were no system failures, and the error in injected doses when using automated injection was lower than with MI. During the clinical phase, T(I) using manual injection was 41 s with a range of 14-103 s, compared with an AIS average of 33 s with a range of 19-63 s (P < 0.05). Ictal SPECT and SISCOM successfully localized the seizure focus in 21 of the 27 patients (78%) by AIS and in 19 of the 29 patients (65%) by MI (P = 0.14). Furthermore, nursing staff found the AIS method more convenient than the MI method. An AIS can improve the quality of work of the nursing staff in the neurology ward and allow a finer adjustment of the injection dose. Early results using an AIS would indicate a reduction in injection time and improved SPECT accuracy.

  6. Experimental Investigation of Different Scramjet Hydrogen Injection Systems

    NASA Astrophysics Data System (ADS)

    Hannemann, K.; Martinez Schramm, J.; Karl, S.; Steelant, J.

    2009-01-01

    Supersonic combustion experiments of a complete scramjet configuration consisting of intake, combustor and nozzle were performed in the High Enthalpy Shock Tunnel Göttingen (HEG) of the German Aerospace Center in the framework of the European Commission funded LAPCAT (Long term Advanced Propulsion Concepts and Technologies) project [1]. The test campaigns in HEG focused on two scramjet configurations used during the HyShot flight experiments ([2], [3]). In addition to the wall normal hydrogen fuel injection of the HyShot II configuration, a second fuel injection technique referred to as the hypermixer injector was investigated. The latter was proposed by JAXA (Japan Aerospace Exploration Agency) for the HyShot IV flight experiment. Wind tunnel models equipped with wall pressure and heat flux gauges and providing optical access for high speed flow visualisation were designed, built and utilised. The performance characteristic of both injector types was analysed based on the comparison of surface pressure data obtained from experiments with hydrogen / air combustion with those data obtained by injecting the same amount of hydrogen into a nitrogen flow.

  7. Coanda injection system for axially staged low emission combustors

    DOEpatents

    Evulet, Andrei Tristan [Clifton Park, NY; Varatharajan, Balachandar [Cincinnati, OH; Kraemer, Gilbert Otto [Greer, SC; ElKady, Ahmed Mostafa [Niskayuna, NY; Lacy, Benjamin Paul [Greer, SC

    2012-05-15

    The low emission combustor includes a combustor housing defining a combustion chamber having a plurality of combustion zones. A liner sleeve is disposed in the combustion housing with a gap formed between the liner sleeve and the combustor housing. A secondary nozzle is disposed along a centerline of the combustion chamber and configured to inject a first fluid comprising air, at least one diluent, fuel, or combinations thereof to a downstream side of a first combustion zone among the plurality of combustion zones. A plurality of primary fuel nozzles is disposed proximate to an upstream side of the combustion chamber and located around the secondary nozzle and configured to inject a second fluid comprising air and fuel to an upstream side of the first combustion zone. The combustor also includes a plurality of tertiary coanda nozzles. Each tertiary coanda nozzle is coupled to a respective dilution hole. The tertiary coanda nozzles are configured to inject a third fluid comprising air, at least one other diluent, fuel, or combinations thereof to one or more remaining combustion zones among the plurality of combustion zones.

  8. FAST INJECTION SYSTEM R&D FOR THE APS UPGRADE

    SciTech Connect

    Lenkszus, F.; Carwardine, J.; Cours, A.; Decker, G.; Morrison, L.; Sun, X.; Westferro, F.; Yao, C. Y.; Krasnykh, Anatoly

    2015-06-01

    The MBA upgrade for the APS will operate with bunch swap out and on axis injection. The planned 324 bunch fill pattern places difficult demands on the injection and extraction kickers. The present concept uses dual stripline kickers driven by high Voltage pulsers. Minimizing perturbation on adjacent bunches requires very fast rise and fall times with relatively narrow ~20 nsec, 15 kV pulses. To achieve these requirements we have initiated a multifaceted R&D program. The R&D includes the HV pulser, stripline kicker and HV feedthrough. We have purchased a commercial dual channel HV pulser and are evaluating its performance and reliability. In addition, we are investigating the feasibility of using nonlinear ferrite loaded coaxial cables (shockwave transmission line) to sharpen the leading and trailing edges of high voltage pulses. We are also developing a prototype kicker and high voltage feedthrough. The requirements for injection and extraction, progress on prototype development and results of our HV pulser investigations will be reported.

  9. An automatic system for acidity determination based on sequential injection titration and the monosegmented flow approach.

    PubMed

    Kozak, Joanna; Wójtowicz, Marzena; Gawenda, Nadzieja; Kościelniak, Paweł

    2011-06-15

    An automatic sequential injection system, combining monosegmented flow analysis, sequential injection analysis and sequential injection titration is proposed for acidity determination. The system enables controllable sample dilution and generation of standards of required concentration in a monosegmented sequential injection manner, sequential injection titration of the prepared solutions, data collecting, and handling. It has been tested on spectrophotometric determination of acetic, citric and phosphoric acids with sodium hydroxide used as a titrant and phenolphthalein or thymolphthalein (in the case of phosphoric acid determination) as indicators. Accuracy better than |4.4|% (RE) and repeatability better than 2.9% (RSD) have been obtained. It has been applied to the determination of total acidity in vinegars and various soft drinks. The system provides low sample (less than 0.3 mL) consumption. On average, analysis of a sample takes several minutes.

  10. Refractory ascites in systemic lupus erythematosus: further biological support of intraperitoneal steroid treatment as a suitable therapeutical option.

    PubMed

    Atisha-Fregoso, Yemil; Hernández-Ramírez, Diego F; Olivares-Martínez, Elizabeth; Núñez-Alvarez, Carlos A; Llorente, Luis; Hernández-Molina, Gabriela

    2017-03-01

    The objective of this report was to evaluate the ascitic fluid of a patient with refractory lupus ascites (proband) at different time points-pre- and post-intraperitoneal treatment with dexamethasone-using a multiparametric approach which included the presence of autoantibodies and pro- and anti-inflammatory cytokines and chemokines, and a proteomic analysis. As controls, we studied two additional patients also with lupus ascites (only at basal evaluation) and two patients with ascites due to alcoholic liver cirrhosis. High levels of anti-dsDNA and anti-nucleosomes autoantibodies were detected in the ascitic fluid of all lupus patients and remained elevated in the proband throughout the follow-up. All lupus patients have detectable ascitic high levels of IL-6, IL-8, IL-10, TNF-α, MCP-1, and IGF-1 which diminished gradually in the proband after intraperitoneal dexamethasone. In the proteomic analysis of the ascitic fluid, a marked increment of apolipoprotein A1 was observed and again, it diminished gradually after intraperitoneal treatment. Our findings further support the use of intraperitoneal steroids as an effective therapeutic option for refractory ascites in systemic lupus erythematosus.

  11. Antiphospholipids Syndrome Complicated by a Systemic Capillary Leak-Like Syndrome Treated With Steroids and Intravenous Immunoglobulins

    PubMed Central

    Prete, Marcella; Urso, Livio; Fatone, Maria Celeste; Pinto, Vincenzo; Perosa, Federico

    2016-01-01

    Abstract This report describes the onset of systemic capillary leak (SCL)-like syndrome in a 30-year-old woman with antiphospholipids syndrome (APS) during puerperium. Twelve hours after a cesarean section, she presented a sudden fever and abdominal pains followed by dyspnea, severe edema of the limbs and pelvis. Computer tomography shows congestion of interstitial pulmonary parenchyma, pericardial and pleural effusion, edema of intestinal wall and of perivisceral adipose tissue, and periportal lymphedema. Laboratory tests showed neutrophilic leukocytosis, hypoalbuminemia, and an increase of erythrocyte sedimentation rate and C-reactive protein. Because fever and raised inflammation parameters are not observed in idiopathic capillary leak syndrome (SCLS; Clarkson disease), a diagnosis of SCL-like syndrome was made. Albumin solution, high-dose methylprednisolone and intravenous immunoglobulins (IVIG) infusion were administered with a rapid improvement of her clinical condition. The prompt treatment with steroids and IVIG likely prevented the life-threatening shock syndrome that can occur in SCLS, with acute hypotensive attacks, and severe limbs edema requiring fasciotomy. All clinical and laboratory findings supported autoinflammation as the underlying pathogenic mechanism of the syndrome. The data indicate that SCL-like syndrome can be considered a novel clinical syndrome, which can complicate APS. PMID:26844485

  12. The effect of a systemically-administered non-steroidal anti-inflammatory drug (flurbiprofen) on experimental gingivitis in humans.

    PubMed

    Heasman, P A; Seymour, R A

    1989-10-01

    Non-steroidal anti-inflammatory drugs reduce the acute inflammatory reaction and alveolar bone loss of experimental periodontitis in dogs by mechanism thought to be associated with the inhibition of prostaglandin synthesis. 25 healthy volunteers abstained from tooth cleaning for 21 days. Experimental gingivitis developed in all subjects. On day 21, the subjects were divided into 3 treatment groups: oral flurbiprofen (100 mg/day)/toothbrushing (A), placebo+toothbrushing (B) and oral flurbiprofen (100 mg/day) only (C). Treatment continued for 6 days. Plaque indices (PI), gingival indices (GI) and probing pocket depths (PPD) were recorded at 6 points on each of 6 maxillary teeth on days 1. 22, 23, 24 and 27. Crevicular fluid flow (CFF) was quantified with a Periotron on days 1, 22 and 27 in groups A and B, and on days 1 and 27 in group C. There were no changes in PPD throughout the study. A reduction of GI occurred between days 22 and 27 for all treatment groups. CFF was also reduced between days 22 and 27 in groups A and B. The differences between the 3 treatments were very small. It is concluded that systemic flurbiprofen (100 mg/day) can reduce the signs of an experimental gingivitis over 6 days. This effect may be seen when the drug is used alone and as an adjunct to toothbrushing.

  13. Gym and tonic: a profile of 100 male steroid users.

    PubMed Central

    Evans, N A

    1997-01-01

    OBJECTIVE: To identify unsupervised anabolic steroid regimens used by athletes. METHODS: 100 athletes attending four gymnasia were surveyed using an anonymous self administered questionnaire. RESULTS: Anabolic steroid doses ranged from 250 to 3200 mg per week and users combined different drugs to achieve these doses. Injectable and oral preparations were used in cycles lasting four to 12 weeks. Eighty six per cent of users admitted to the regular use of drugs other than steroids for various reasons, including additional anabolic effects, the minimisation of steroid related side effects, and withdrawal symptoms. Acne, striae, and gynaecomastia were the most commonly reported subjective side effects. CONCLUSIONS: Multiple steroids are combined in megadoses and self administered in a cyclical fashion. Polypharmacy is practised by over 80% of steroid users. Skeletal muscle hypertrophy along with acne, striae, and gynaecomastia are frequent physical signs associated with steroid use. Images Figure 2 PMID:9132214

  14. Manufacturing injection-moleded Fresnel lens parquets for point-focus concentrating photovoltaic systems

    SciTech Connect

    Peters, E.M.; Masso, J.D.

    1995-10-01

    This project involved the manufacturing of curved-faceted, injection-molded, four-element Fresnel lens parquets for concentrating photovoltaic arrays. Previous efforts showed that high-efficiency (greater than 82%) Fresnel concentrators could be injection molded. This report encompasses the mold design, molding, and physical testing of a four-lens parquet for a solar photovoltaic concentrator system.

  15. Binding of steroids to the progestin and glucocorticoid receptors analyzed by correspondence analysis.

    PubMed

    Ojasoo, T; Doré, J C; Gilbert, J; Raynaud, J P

    1988-06-01

    The relative binding affinities of over 30 steroids have been measured for the cytosol glucocorticoid receptor (GR) of thymus, liver, and hepatoma tissue culture cells and for progestin, androgen, and mineralocorticoid receptors. The data have been analyzed by correspondence analysis to reveal the singularities among the receptors of different hormonal classes, the similarities in GR of different origins, and the different specificities of the ligands. Additional data on new steroids have been injected into the system as well as results on a further parameter, namely the induction of tyrosine aminotransferase (TAT) activity, to illustrate the power and flexibility of the methodology. The analysis has confirmed previous correlations between GR binding and TAT response but also highlighted the antiglucocorticoid activity of progestins. This method should prove to be a substantial aid to the interpretation of increasingly complex data, in particular with regard to the action of existing and newly synthesized steroids on glucocorticoid systems of differential sensitivity.

  16. [Steroid induced ocular hypertension and glaucoma].

    PubMed

    Călugăru, D; Călugăru, M

    2009-01-01

    Steroid induced ocular hypertension and glaucoma represent iatrogenic changes of pharmacogenic nature. They are mainly due to exogenous steroids following ocular periocular, intravitreal and systemic administration. Elevated ocular pressure is brought about by structural trabecular changes as well as obstruction of the outflow ways of the aqueous humor localized within the trabecular juxtacanalicular area. Although mostly raised ocular pressure spontaneously descends to basal values after ceasing the steroid therapy, progressive optic nerve damages and glaucomatous visual field defects may occur. Therapy of steroid induced ocular hypertension and glaucoma is similar to that of ocular hypertension and primary open-angle glaucoma.

  17. Fault injection via on-chip debugging in the internal memory of systems-on-chip processor

    NASA Astrophysics Data System (ADS)

    Chekmarev, S. A.; Khanov, V. Kh

    2015-10-01

    The paper presents an on-chip debugging method for the injection of single faults in the processor cores of systems-on-chip. The method consists in the placement of faults injection infrastructure in a system-on-chip as an intellectual property core. This simplifies the fault injection environment, reduces delays injection and improves the performance, as well as allows doing long autonomous campaign for injection of faults without the use of external devices.

  18. Preliminary evaluation of the Highland Rim aquifer system in Tennessee for receiving injected wastes

    USGS Publications Warehouse

    Bradley, M.W.

    1986-01-01

    The EPA has authority under the Safe Drinking Water Act to protect underground sources of drinking water from contamination by deep well injection. An aquifer, however, may be exempted from protection and used for injected wastes where the aquifer meets criteria established in the Agency 's Underground Injection Control program. The Highland Rim aquifer system in Tennessee consists of Mississippian age carbonate rocks and occurs from the Valley and Ridge of East Tennessee to west of the Tennessee River. This aquifer contains potable water and is an important source of drinking water for municipal and domestic supplies on the Highland Rim. The Highland Rim aquifer system under parts of the Cumberland Plateau is not currently used as a source of drinking water and is not expected to be used in the future. These areas meet parts of the EPA 's Underground Injection Control criteria for exempting aquifers to receive injected waste. (Author 's abstract)

  19. High-throughput bioaffinity mass spectrometry for screening and identification of designer anabolic steroids in dietary supplements.

    PubMed

    Aqai, Payam; Cevik, Ebru; Gerssen, Arjen; Haasnoot, Willem; Nielen, Michel W F

    2013-03-19

    A generic high-throughput bioaffinity liquid chromatography-mass spectrometry (BioMS) approach was developed and applied for the screening and identification of known and unknown recombinant human sex hormone-binding globulin (rhSHBG)-binding designer steroids in dietary supplements. For screening, a semi-automated competitive inhibition binding assay was combined with fast ultrahigh-performance-LC-electrospray ionization-triple-quadrupole-MS (UPLC-QqQ-MS). 17β-Testosterone-D3 was used as the stable isotope label of which the binding to rhSHBG-coated paramagnetic microbeads was inhibited by any other binding (designer) steroid. The assay was performed in a 96-well plate and combined with the fast LC-MS, 96 measurements could be performed within 4 h. The concentration-dependent inhibition of the label by steroids in buffer and dietary supplements was demonstrated. Following an adjusted bioaffinity isolation procedure, suspect extracts were injected into a chip-UPLC(NanoTile)-Q-time-of-flight-MS system for full-scan accurate mass identification. Next to known steroids, 1-testosterone was identified in three of the supplements studied and the designer steroid tetrahydrogestrinone was identified in a spiked supplement. The generic steroid-binding assay can be used for high-throughput screening of androgens, estrogens, and gestagens in dietary supplements to fight doping. When combined with chip-UPLC-MS, it is a powerful tool for early warning of unknown emerging rhSHBG bioactive designer steroids in dietary supplements.

  20. Steroid-responsive interstitial pulmonary disease in systemic sclerosis. Monitoring by bronchoalveolar lavage.

    PubMed

    Kallenberg, C G; Jansen, H M; Elema, J D; The, T H

    1984-09-01

    We describe a 38-year-old woman with systemic sclerosis of recent onset and progressive dyspnea. Studies of pulmonary function revealed a restrictive ventilatory disorder with decreased diffusing capacity. Interstitial fibrosis and infiltration with lymphocytes and plasma cells with formation of follicles were observed in the lung biopsy. Analysis of fluid from bronchoalveolar lavage showed an increase in the total number of cells, with a relative increase in neutrophils. Also, the relative amount of the immunoglobulins, IgG and IgM, was increased. During corticosteroid treatment, rapid improvement of pulmonary volumes occurred, together with disappearance of neutrophils and an increase in the percentage of lymphocytes in the lavage fluid. Later on, the total number of cells in the fluid from bronchoalveolar lavage and the percentage of lymphocytes reached normal values. Bronchoalveolar lavage may be of value in assessing and monitoring pulmonary disease in patients with systemic sclerosis.

  1. Estrogenic activity and steroid hormones in swine wastewater through a lagoon constructed-wetland system.

    PubMed

    Shappell, Nancy W; Billey, Lloyd O; Forbes, Dean; Matheny, Terry A; Poach, Matthew E; Reddy, Gudigopuram B; Hunt, Patrick G

    2007-01-15

    Anaerobic lagoons and treatment wetlands are used worldwide to treat wastewater from dense livestock production facilities; however, there is very limited data on the hormonal activity of the wastewater effluent produced by these treatment systems. The objectives of this experiment were to measure (1) the hormonal activity of the initial effluent and (2) the effectiveness of a lagoon-constructed wetland treatment system for producing an effluent with a low hormonal activity. Wastewater samples were taken in April, July, and November 2004 and July 2005 from a lagoon-constructed wetland system at a swine farrowing facility. Estrogenic activity (in vitro E-screen assay), 17 beta-estradiol (E2), and testosterone concentrations (LC/MS-MS) were measured. A high correlation was found between estradiol equivalents determined by E-screen and LC/MS-MS (R2 = 0.82). Nutrient removal was measured to ensure that the wetlands were functioning in a manner similar to literature reports. Nutrient removals were typical for treatment wetlands: TKN 59-75% and orthophosphate 0-18%. Wetlands decreased estrogenic activity by 83-93%. Estrone was the most persistent estrogenic compound. Constructed wetlands produced effluents with estrogenic activity below the lowest equivalent E2 concentration known to have an effect on fish (10 ng/L or approximately 37 x 10(-12) M).

  2. Design and Analysis of a Continuous Split Typed Needle-Free Injection System for Animal Vaccination

    PubMed Central

    Chen, Kai; Pan, Min; Liu, Tingting

    2017-01-01

    Background: Liquid needle-free injection devices (NFIDs) employ a high-velocity liquid jet to deliver drugs and vaccine through transdermal injection. NFIDs for animal vaccination are more complicated than those used for human beings for their much larger and more flexible power sources, as well as rapid, repetitive and continuous injection features. Method: In the paper, spring-powered NFID is designed for animal vaccine injection. For convenience, the device is a split into a power source and handheld injector. A mathematical model is proposed to calculate the injection pressure, taking into the account pressure loss and the strain energy loss in the bendable tube due to elastic deformation. An experimental apparatus was build to verify the calculation results. Results and Conclusion: Under the same system conditions, the calculation results of the dynamic injection pressure match the experimental results. It is found that the bendable tube of the split typed NFID has significant impact on the profile of the injection pressure. The initial peak pressure is less than the initial peak pressure of NFID without bendable tube, and there is occurrence time lag of the peak pressure. The mathematical model is the first attempt to reveal the relationship between the injection pressure and the system variables of split typed NFID. PMID:28761560

  3. Lambertson magnet with shortened loop for nuclotron injection and extraction systems

    NASA Astrophysics Data System (ADS)

    Alfeev, A. V.; Butenko, A. V.; Volkov, V. I.; Vorozhtsov, S. B.; Goncharov, I. N.; Donets, D. E.; Kozlov, O. S.; Mikhailov, V. A.; Monchinsky, V. A.; Novikov, S. A.; Sidorin, A. O.; Smirnov, A. V.; Smirnov, V. L.; Romanov, S. V.

    2016-12-01

    Systems of beam injection from the Booster and fast beam extraction for injection into the collider will be developed in order for the Nuclotron to operate in the framework of the NICA accelerator complex. All systems are based on the Lambertson magnets. The shortened superconducting loop is used for compensating scattered fields in the circulating beam chamber. The finite weld resistance (on an order of several nΩ) results in gradual current storage in the loop, which influences the beam upon injection. To eliminate this effect, a heater for converting the loop into the normal conducting state in the pause between cycles is applied.

  4. The Coupling Impedance of the RHIC Injection Kicker System

    SciTech Connect

    Hahn, H.; Ratti, A.

    1996-08-30

    The RHIC injection kicker is configured as a "C" cross section magnet with interspersed ferrite (Nickel-Zinc ferrite with high permeability and resistivity for use at frequencies up to ~100 MHz) and dielectric (sintered mixture of Magnesium Titanat and Calcium Titanat with high dielectric constant ε~100) blocks as shown in Fig. 1. The deflection properties of the kicker are dominated (~85%) by the magnetic field and thus by the ferrite properties and its geometrical configuration. The dielectric block provide the capacitance required to achieve a transmission line kicker (<50 nsec current rise time) and to reduce the characteristic impedance so as to match the 50/Ω of the Blumlein pulser. The dielectric blocks impose the de-facto voltage limit of the kicker and represent one of the primary design limitations.

  5. The relationship between fuel lubricity and diesel injection system wear

    NASA Astrophysics Data System (ADS)

    Lacy, Paul I.

    1992-01-01

    Use of low-lubricity fuel may have contributed to increased failure rates associated with critical fuel injection equipment during the 1991 Operation Desert Storm. However, accurate quantitative analysis of failed components from the field is almost impossible due to the unique service history of each pump. This report details the results of pump stand tests with fuels of equal viscosity, but widely different lubricity. Baseline tests were also performed using reference no. 2 diesel fuel. Use of poor lubricity fuel under these controlled conditions was found to greatly reduce both pump durability and engine performance. However, both improved metallurgy and fuel lubricity additives significantly reduced wear. Good correlation was obtained between standard bench tests and lightly loaded pump components. However, high contact loads on isolated components produced a more severe wear mechanism that is not well reflected by the Ball-on-Cylinder Lubricity Evaluator.

  6. DURIP: Electrokinetic Injection and Separation System for Analysis of Protein and Peptide Transport, Adsorption and Kinetics Instrumentation Proposal

    DTIC Science & Technology

    2015-03-18

    SECURITY CLASSIFICATION OF: We requested equipment necessary to build an electrokinetic injection and separation system for the analysis of protein...Jul-2014 Approved for Public Release; Distribution Unlimited Final Report: DURIP: Electrokinetic Injection and Separation System for Analysis of...Injection and Separation System for Analysis of Protein and Peptide Transport, Adsorption and Kinetics Instrumentation Proposal Report Title We requested

  7. Rates of fuel discharge as affected by the design of fuel-injection systems for internal-combustion engines

    NASA Technical Reports Server (NTRS)

    Gelalles, A G; Marsh, E T

    1933-01-01

    Using the method of weighing fuel collected in a receiver during a definite interval of the injection period, rates of discharge were determined, and the effects noted, when various changes were made in a fuel-injection system. The injection system consisted primarily of a by-pass controlled fuel pump and an automatic injection valve. The variables of the system studied were the pump speed, pump-throttle setting, discharge-orifice diameter, injection-valve opening and closing pressures, and injection-tube length and diameter.

  8. Developmental Programming: Does Prenatal Steroid Excess Disrupt the Ovarian VEGF System in Sheep?1

    PubMed Central

    Ortega, Hugo Héctor; Veiga-Lopez, Almudena; Sreedharan, Shilpa; del Luján Velázquez, Melisa María; Salvetti, Natalia Raquel; Padmanabhan, Vasantha

    2015-01-01

    Prenatal testosterone (T), but not dihydrotestosterone (DHT), excess disrupts ovarian cyclicity and increases follicular recruitment and persistence. We hypothesized that the disruption in the vascular endothelial growth factor (VEGF) system contributes to the enhancement of follicular recruitment and persistence in prenatal T-treated sheep. The impact of T/DHT treatments from Days 30 to 90 of gestation on VEGFA, VEGFB, and their receptor (VEGFR-1 [FLT1], VEGFR-2 [KDR], and VEGFR-3 [FLT4]) protein expression was examined by immunohistochemistry on Fetal Days 90 and 140, 22 wk, 10 mo (postpubertal), and 21 mo (adult) of age. Arterial morphometry was performed in Fetal Day 140 and postpubertal ovaries. VEGFA and VEGFB expression were found in granulosa cells at all stages of follicular development with increased expression in antral follicles. VEGFA was present in theca interna, while VEGFB was present in theca interna/externa and stromal cells. All three receptors were expressed in the granulosa, theca, and stromal cells during all stages of follicular development. VEGFR-3 increased with follicular differentiation with the highest level seen in the granulosa cells of antral follicles. None of the members of the VEGF family or their receptor expression were altered by age or prenatal T/DHT treatments. At Fetal Day 140, area, wall thickness, and wall area of arteries from the ovarian hilum were larger in prenatal T- and DHT-treated females, suggestive of early androgenic programming of arterial differentiation. This may facilitate increased delivery of endocrine factors and thus indirectly contribute to the development of the multifollicular phenotype. PMID:26178718

  9. Developmental Programming: Does Prenatal Steroid Excess Disrupt the Ovarian VEGF System in Sheep?

    PubMed

    Ortega, Hugo Héctor; Veiga-Lopez, Almudena; Sreedharan, Shilpa; del Luján Velázquez, Melisa María; Salvetti, Natalia Raquel; Padmanabhan, Vasantha

    2015-09-01

    Prenatal testosterone (T), but not dihydrotestosterone (DHT), excess disrupts ovarian cyclicity and increases follicular recruitment and persistence. We hypothesized that the disruption in the vascular endothelial growth factor (VEGF) system contributes to the enhancement of follicular recruitment and persistence in prenatal T-treated sheep. The impact of T/DHT treatments from Days 30 to 90 of gestation on VEGFA, VEGFB, and their receptor (VEGFR-1 [FLT1], VEGFR-2 [KDR], and VEGFR-3 [FLT4]) protein expression was examined by immunohistochemistry on Fetal Days 90 and 140, 22 wk, 10 mo (postpubertal), and 21 mo (adult) of age. Arterial morphometry was performed in Fetal Day 140 and postpubertal ovaries. VEGFA and VEGFB expression were found in granulosa cells at all stages of follicular development with increased expression in antral follicles. VEGFA was present in theca interna, while VEGFB was present in theca interna/externa and stromal cells. All three receptors were expressed in the granulosa, theca, and stromal cells during all stages of follicular development. VEGFR-3 increased with follicular differentiation with the highest level seen in the granulosa cells of antral follicles. None of the members of the VEGF family or their receptor expression were altered by age or prenatal T/DHT treatments. At Fetal Day 140, area, wall thickness, and wall area of arteries from the ovarian hilum were larger in prenatal T- and DHT-treated females, suggestive of early androgenic programming of arterial differentiation. This may facilitate increased delivery of endocrine factors and thus indirectly contribute to the development of the multifollicular phenotype.

  10. Switching from systemic steroids to ciclesonide restores the hypothalamic pituitary-adrenal axis

    PubMed Central

    Ciebiada, Maciej; Górski, Paweł

    2014-01-01

    Introduction Treatment of difficult asthma with oral corticosteroids (OCS) may suppress the hypothalamic-pituitary-adrenal axis. Aim In this study we have checked if the substitution of OCS with very high doses of ciclesonide may restore the adrenal function without losing the control of the disease. Material and methods In 5 patients with difficult, uncontrolled asthma despite treatment with OCS, inhaled and systemic glucocorticosteroids were replaced with very high doses of ciclesonide (1600–2400 µg/day). The symptoms of asthma and the lung function were assessed at baseline and on the 28th, 56th and 70th day of treatment, whereas the levels of cortisol and adrenocorticotropic hormone (ACTH) in the morning were measured at baseline and on the 28th and the 56th day of treatment. Results In all patients, the control of asthma symptoms, measured with Asthma Control Test questionnaire, improved from the mean score of 9.4 to 19.8 in 70 days. In 4 subjects force expiratory volume in 1 s improved gradually through the entire study reaching a mean improvement of 585 ml in 70 days. The ACTH levels were normalized in 3 patients after 28 days of observation and in all patients after 56 days. The cortisol level was normalized in 4 patients after 28 days and in another subject after 56 days of treatment with ciclesonide. Conclusions Switching from prednisone to very high doses of ciclesonide normalized the hypothalamic-pituitary adrenal axis function and also improved the disease control and the lung function in these 5 patients with difficult asthma. PMID:25097469

  11. Designing Fault-Injection Experiments for the Reliability of Embedded Systems

    NASA Technical Reports Server (NTRS)

    White, Allan L.

    2012-01-01

    This paper considers the long-standing problem of conducting fault-injections experiments to establish the ultra-reliability of embedded systems. There have been extensive efforts in fault injection, and this paper offers a partial summary of the efforts, but these previous efforts have focused on realism and efficiency. Fault injections have been used to examine diagnostics and to test algorithms, but the literature does not contain any framework that says how to conduct fault-injection experiments to establish ultra-reliability. A solution to this problem integrates field-data, arguments-from-design, and fault-injection into a seamless whole. The solution in this paper is to derive a model reduction theorem for a class of semi-Markov models suitable for describing ultra-reliable embedded systems. The derivation shows that a tight upper bound on the probability of system failure can be obtained using only the means of system-recovery times, thus reducing the experimental effort to estimating a reasonable number of easily-observed parameters. The paper includes an example of a system subject to both permanent and transient faults. There is a discussion of integrating fault-injection with field-data and arguments-from-design.

  12. Intra-articular hyaluronic acid injection versus oral non-steroidal anti-inflammatory drug for the treatment of knee osteoarthritis: a multi-center, randomized, open-label, non-inferiority trial.

    PubMed

    Ishijima, Muneaki; Nakamura, Toshitaka; Shimizu, Katsuji; Hayashi, Kunihiko; Kikuchi, Hiraku; Soen, Satoshi; Omori, Go; Yamashita, Toshihiko; Uchio, Yuji; Chiba, Junji; Ideno, Yuki; Kubota, Mitsuaki; Kurosawa, Hisashi; Kaneko, Kazuo

    2014-01-21

    While many of the commonly used conservative treatments for knee osteoarthritis (OA) have been recognized to be effective, there is still insufficient evidence available. Among the pharmacological treatments for knee OA, oral non-steroidal anti-inflammatory drugs (NSAIDs) act rapidly and are recommended for the management of OA. However, frequent and serious adverse effects of NSAIDs have been recognized. Intra-articular injections of hyaluronic acid (IA-HA) for the treatment of knee OA have been shown to reduce pain and improve joint function. However, there has been no qualified direct comparison study of the efficacy and safety between IA-HA and NSAIDs for patients with knee OA. The aim of this study was to clarify the efficacy and safety of early-phase IA-HA in comparison to those of NSAIDs for patients with knee OA. This multicenter, randomized, open-label, parallel-group, non-inferiority comparison study with an oral NSAID involved a total of 200 patients with knee OA. An independent, computer-generated randomization sequence was used to randomly assign patients in a 1:1 ratio to NSAIDs three times per day for five weeks (n = 100) or IA-HA once a week for five weeks (n = 100). The primary endpoint was the percentage change in the patient-oriented outcome measure for knee OA, the Japanese Knee Osteoarthritis Measure (JKOM) score. All patients were questioned regarding any adverse events during treatment. The full analysis set (FAS) was used for analysis. The margin of non-inferiority was 10%. The analyses of primary endpoint included 98 patients in the IA-HA group and 86 patients in the NSAID group. The difference in the percentage changes of the JKOM score between the two intervention arms (IA-HA; -34.7% (P<0.001), NSAID; -32.2% (P<0.001)) was -2.5% (95% confidence interval (CI): -14.0 to 9.1), indicating IA-HA was not inferior to NSAID. The frequency of both withdrawal and adverse events in the IA-HA group were significantly lower than those in the

  13. Intra-articular hyaluronic acid injection versus oral non-steroidal anti-inflammatory drug for the treatment of knee osteoarthritis: a multi-center, randomized, open-label, non-inferiority trial

    PubMed Central

    2014-01-01

    Introduction While many of the commonly used conservative treatments for knee osteoarthritis (OA) have been recognized to be effective, there is still insufficient evidence available. Among the pharmacological treatments for knee OA, oral non-steroidal anti-inflammatory drugs (NSAIDs) act rapidly and are recommended for the management of OA. However, frequent and serious adverse effects of NSAIDs have been recognized. Intra-articular injections of hyaluronic acid (IA-HA) for the treatment of knee OA have been shown to reduce pain and improve joint function. However, there has been no qualified direct comparison study of the efficacy and safety between IA-HA and NSAIDs for patients with knee OA. The aim of this study was to clarify the efficacy and safety of early-phase IA-HA in comparison to those of NSAIDs for patients with knee OA. Methods This multicenter, randomized, open-label, parallel-group, non-inferiority comparison study with an oral NSAID involved a total of 200 patients with knee OA. An independent, computer-generated randomization sequence was used to randomly assign patients in a 1:1 ratio to NSAIDs three times per day for five weeks (n = 100) or IA-HA once a week for five weeks (n = 100). The primary endpoint was the percentage change in the patient-oriented outcome measure for knee OA, the Japanese Knee Osteoarthritis Measure (JKOM) score. All patients were questioned regarding any adverse events during treatment. The full analysis set (FAS) was used for analysis. The margin of non-inferiority was 10%. Results The analyses of primary endpoint included 98 patients in the IA-HA group and 86 patients in the NSAID group. The difference in the percentage changes of the JKOM score between the two intervention arms (IA-HA; -34.7% (P<0.001), NSAID; -32.2% (P<0.001)) was -2.5% (95% confidence interval (CI): -14.0 to 9.1), indicating IA-HA was not inferior to NSAID. The frequency of both withdrawal and adverse events in the IA-HA group were

  14. A new shock wave assisted wood preservative injection system

    NASA Astrophysics Data System (ADS)

    Rao, K. S.; Ravikumar, G.; Lai, Ram; Jagadeesh, G.

    Preservative treatment of many tropical hard woods and bamboo pose severe problem. A number of wood preservatives (chemical formulations toxic to wood decay/ destroying organisms like fungi, wood destroying termites, marine borers etc.) and wood impregnating techniques are currently in use for improving bio resistance of timber and bamboo and thereby enhancing service life for different end uses. How ever, some species of tropical hardwoods and many species of bamboo are difficult to treat, posing technical problems. In this paper we report preliminary results of treatment of bamboo with a novel Shockwave assisted injection treatment. Samples (30×2.5×1.00 cm) of an Indian species of bamboo Dendrocalamus strictus prepared from defect free culms of dry bamboo are placed in the driven section of a vertical shock tube filled with the 4Coppepr-Chrome-Arsenic(CCA) preservative solution.The bamboo samples are subjected to repeated shock wave loading (3 shots) with typical over pressures of 30 bar. The results from the study indicate excellent penetration and retention of CCA preservative in bamboo samples. The method itself is much faster compared to the conventional methods like pressure treatment or hot and cold process.

  15. Multipoint Grout Injection System. Innovative Technology Summary Report

    SciTech Connect

    2001-09-01

    At the Oak Ridge Reservation (ORR), radioactive waste contained in the 16 cylindrical Gunite and Associated Tanks (GAATs) must retrieved so the tanks can be closed. In many cases, removing the small amounts of sludge that remain in the tank after the bulk of the waste is retrieved is extremely costly and provides little benefit from site health and environmental standpoints. The Tanks Focus Area is working with ORR's M and I contractor (Bechtel-Jacobs), Oak Ridge National Laboratory, and Ground Environmental Services to demonstrate the application of multi-point-injection (MPI) grout emplacement technology for horizontal cylindrical tanks during a cold demonstration in FY99. GAAT TH-4 has been identified as the tank to be used for the hot demonstration in FY00. Evaluation efforts continue on the effect of slag on strength performance of the grout to be used in TH-4 tank closure. The site must find out what level of slag can be accommodated in the grout while maintaining strength performance requirements. Other efforts in support of the utilization of MPI TM technology in large-scale waste tanks will continue. Also, ORR is collaborating with SRS to evaluate the use this technology to support grouting of the Old Burial Ground tanks at SRS.

  16. Steroid hormones and BDNF.

    PubMed

    Pluchino, N; Russo, M; Santoro, A N; Litta, P; Cela, V; Genazzani, A R

    2013-06-03

    Brain-derived neurotrophic factor (BDNF) is a neurotrophin abundantly expressed in several areas of the central nervous system (CNS) and is known to induce a lasting potentiation of synaptic efficacy, to enhance specific learning and memory processes. BDNF is one of the key molecules modulating brain plasticity and it affects cognitive deficit associated with aging and neurodegenerative disease. Several studies have shown an altered BDNF production and secretion in a variety of neurodegenerative diseases like Alzheimer's and Parkinson's diseases but also in mood disorders like depression, eating disorders and schizophrenia. Plasma BDNF is also a biomarker of impaired memory and general cognitive function in aging women. Gonadal steroids are involved in the regulation of several CNS processes, specifically mood, affective and cognitive functions during fertile life and reproductive aging. These observations lead many scientists to investigate a putative co-regulation between BDNF and gonadal and/or adrenal steroids and their relationship with gender difference in the incidence of mental diseases. This overview aims to summarize the current knowledge on the correlation between BDNF expression/function and both gonadal (progesterone, estrogens, and testosterone) and adrenal hormones (mainly cortisol and dehydroepiandrosterone (DHEA)) with relevance in clinical application.

  17. [Needle-free injection--science fiction or comeback of an almost forgotten drug delivery system?].

    PubMed

    Ziegler, Andreas

    2007-08-01

    The first to create a "needle-free injector" was the American anesthetist Robert A. Hingson, 65 year ago. Since that time those devices underwent a changeful history. In 1986 an outbreak of hepatitis B among patients receiving injections from a needle-free multiple-use-nozzle injector was documented and related to the use of the injector device. Due to such risk of transmission of infection with these reusable devices, their application has been restricted. In 1998 the WHO recommended that only conventional needles and syringes should be used for immunization until safe needle-free injectors are identified through independent safety testing. Since needle-free injection has shown numerous advantages in comparison to conventional injection, new systems were developed that combine the advantages of needle-free injection with sufficient safety in mass vaccination programs. As an alternative to this early injector type, the disposable-cartridge injectors were developed. The newest research field in the area of the needle-free injection systems opened with the development of powder injectors, in which the drug preparation is no longer a suspension or solution, but a powdered solid. This injector type using powder formulations shows a number of advantages in comparison with the conventional needle/syringe injection technique as well as towards the liquid jet injectors. Due to this new kind of injectors the comeback of the needle-free injection technique in large-scale vaccination programs of the WHO seems reasonable and within reach.

  18. A CFD Model for High Pressure Liquid Poison Injection for CANDU-6 Shutdown System No. 2

    SciTech Connect

    Bo Wook Rhee; Chang Jun Jeong; Hye Jeong Yun; Dong Soon Jang

    2002-07-01

    In CANDU reactor one of the two reactor shutdown systems is the liquid poison injection system which injects the highly pressurized liquid neutron poison into the moderator tank via small holes on the nozzle pipes. To ensure the safe shutdown of a reactor it is necessary for the poison curtains generated by jets provide quick, and enough negative reactivity to the reactor during the early stage of the accident. In order to produce the neutron cross section necessary to perform this work, the poison concentration distribution during the transient is necessary. In this study, a set of models for analyzing the transient poison concentration induced by this high pressure poison injection jet activated upon the reactor trip in a CANDU-6 reactor moderator tank has been developed and used to generate the poison concentration distribution of the poison curtains induced by the high pressure jets injected into the vacant region between the pressure tube banks. The poison injection rate through the jet holes drilled on the nozzle pipes is obtained by a 1-D transient hydrodynamic code called, ALITRIG, and this injection rate is used to provide the inlet boundary condition to a 3-D CFD model of the moderator tank based on CFX4.3, a CFD code, to simulate the formation of the poison jet curtain inside the moderator tank. For validation, an attempt was made to validate this model against a poison injection experiment performed at BARC. As conclusion this set of models is judged to be appropriate. (authors)

  19. An Innovative Injection and Mixing System for Diesel Fuel Reforming

    SciTech Connect

    Spencer Pack

    2007-12-31

    This project focused on fuel stream preparation improvements prior to injection into a solid oxide fuel cell reformer. Each milestone and the results from each milestone are discussed in detail in this report. The first two milestones were the creation of a coking formation test rig and various testing performed on this rig. Initial tests indicated that three anti-carbon coatings showed improvement over an uncoated (bare metal) baseline. However, in follow-up 70 hour tests of the down selected coatings, Scanning Electron Microscope (SEM) analysis revealed that no carbon was generated on the test specimens. These follow-up tests were intended to enable a down selection to a single best anti-carbon coating. Without the formation of carbon it was impossible to draw conclusions as to which anti-carbon coating showed the best performance. The final 70 hour tests did show that AMCX AMC26 demonstrated the lowest discoloration of the metal out of the three down selected anti-carbon coatings. This discoloration did not relate to carbon but could be a useful result when carbon growth rate is not the only concern. Unplanned variations in the series of tests must be considered and may have altered the results. Reliable conclusions could only be drawn from consistent, repeatable testing beyond the allotted time and funding for this project. Milestones 3 and 4 focused on the creation of a preheating pressure atomizer and mixing chamber. A design of experiment test helped identify a configuration of the preheating injector, Build 1, which showed a very uniform fuel spray flow field. This injector was improved upon by the creation of a Build 2 injector. Build 2 of the preheating injector demonstrated promising SMD results with only 22psi fuel pressure and 0.7 in H2O of Air. It was apparent from testing and CFD that this Build 2 has flow field recirculation zones. These recirculation zones may suggest that this Build 2 atomizer and mixer would require steam injection to reduce the

  20. Updated Design of the Italian SuperB Factory Injection System

    SciTech Connect

    Guiducci, S.; Biagini, M.E.; Boni, R.; Preger, M.; Raimondi, P.; Chance, A.; Brossard, J.; Dadoun, O.; Lepercq, P.; Rimbault, C.; Variola, A.; Seeman, J.; /SLAC

    2012-04-26

    The ultra high luminosity B-factory (SuperB) project of INFN requires a high performance and reliable injection system, providing electrons at 4 GeV and positrons at 7 GeV, to fulfill the very tight requirements of the collider. Due to the short beam lifetime, continuous injection of electrons and positrons in both High Energy Ring (HER) and Low Energy Ring (LER) is necessary to keep the average luminosity at a high level. An updated version of the injection system, optimized at higher repetition frequency is presented. This scheme includes a polarized electron gun, a positron production scheme with electron/positron conversion at low energy 0.6 GeV, and a 1 GeV damping ring to reduce the injected emittance of the positron beam.

  1. Fuel injection and mixing systems having piezoelectric elements and methods of using the same

    DOEpatents

    Mao, Chien-Pei [Clive, IA; Short, John [Norwalk, IA; Klemm, Jim [Des Moines, IA; Abbott, Royce [Des Moines, IA; Overman, Nick [West Des Moines, IA; Pack, Spencer [Urbandale, IA; Winebrenner, Audra [Des Moines, IA

    2011-12-13

    A fuel injection and mixing system is provided that is suitable for use with various types of fuel reformers. Preferably, the system includes a piezoelectric injector for delivering atomized fuel, a gas swirler, such as a steam swirler and/or an air sw