Nose Tip Elongation and Elevation: A Novel Filler Injection Technique

Background Filler injection for nose tip improvement remains a difficult subject due to efficacy and safety issues. Objectives To better the techniques and safety for nose tip improvement with a filler. Methods Patients seeking nose tip improvement were recruited regardless of their pre-treatment conditions. A hyaluronic acid filler is injected through the skin behind the nose tip into the potential septal space. To achieve tip elevation, the filler is retro injected from the anterior nasal spine, stopping at the mid-level of medial crura. To elongate the nose, the filler is deposited just in front of the caudal septal cartilage. The tip extends in the sagittal plane, causing the nose tip to move either caudally (tip elongation) or anteriorly (tip elevation), or both, as directed by the surgeon. Results Depending on the patients, the nose could be elongated by 2 to 6mm, and the tip could be elevated by 2 to 8 mm. Additionally, stronger columellar support, finer tip structures, and improved nasolabial angle are observed. Interestingly, the upper lip appears shorter. The nostril shapes and the alar widths are also improved. A total of 1288 cases are reported. Only two patients expressed dissatisfaction. Conclusions This technique is easy and safe to perform and, the results are natural and comparable to those from rhinoplasty surgeries. Further, this report of filler nose lengthening may be the first large series in the world. Finally, this technique works well in all populations.

Synthesis of cell-laden alginate microgels with tunable compositions based on microfluidic pico-injection technique

We report a microfluidic pico-injection-based approach for reliably generating monodisperse cell-laden alginate microgels whose composition can be tuned in situ through modulation of the cross-linker concentration. Separating the gelation from emulsification allows for a better control over the microgel size with a microfluidic drop-maker, and an instant adjustment of the microgel composition with a pico-injector.

Experimental and numerical investigation of metal-polymer riveted joints

This paper presents the modeling and analysis of the joints of metal inserts with polyamide 6 using the injection technique. Based on the conducted experiments, modeling and numerical calculations of joints were carried out for various joint configurations. Metal parts, made of steel grade DC 04, are mechanically locked with polyamide 6 (PA6) with rivets. The mechanical connection with rivets of both elements was achieved by filling the holes in the metal parts in the injection process. As part of the work, mechanical-clamp connections made of steel / PA6 were mechanically tested in a single-axis joint tensile test using appropriate tabs. The main goal was to study and numerically analyze the number of rivets and their location on the metal plate for the strength of the connector. An important element of the work was the modeling process of both the PA6 material behavior and the joint itself. As part of the experimental research, the rivet deformation was also observed using computer thermography with the use of an IR camera. The tests and simulation showed that for the sample, the polymer-metal connected with less than three rivets was destroyed by shear. On the other hand, when the polymer-metal junction was made of three rivets, the jamming mechanism was mainly related to damage to the polymer part. For these joints, the maximum values of the breaking force of the joint were obtained in uniaxial tensile and shear tests where three rivets were used. Similar values were obtained during the numerical calculations performed with the use of Abaqus software.

Venous Air Microembolism in Chest CT Angiography: Evidence of Normalization of Deviance Phenomenon

Purpose This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for “normalization of deviance” phenomenon in CT. Method and Materials Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p < 0.05. Results A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44–72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex (p = 0.19), age (p = 0.46), or referral diagnosis (p = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01–3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) (p < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure.

Intramuscular injection safety without aspiration in the ventro-gluteal region during vaccination: randomized clinical trial

ABSTRACT Objectives: to compare adverse events after administrating hepatitis A vaccine intramuscularly in the ventro-gluteal region between techniques with and without aspiration. Methods: randomized double-blind clinical trial, using hepatitis A vaccine (inactivated) in the ventro-gluteal region, with a sample of 74 participants in the intervention group, vaccinated with the slow injection technique without aspiration, and 74 participants in the control group undergoing slow injection with aspiration. Daily assessment of participants was carried out in the 72 hours after vaccination, in order to ascertain local, systemic adverse events, local and contralateral temperatures. Results: the occurrence of local and systemic adverse events was homogeneous between the groups in the three days after vaccination (p>0.05). There was no influence of sex, race, pre-existing disease and use of medication. Conclusions: the intramuscular vaccination technique without aspiration in the ventro-gluteal region is safe for adverse events following immunization compared to the conventional technique with aspiration.

Pain in Patients with Post Paralytic Hemifacial Spasm: Before, during and after Botulinum Toxin Injections

It is well-established that botulinum toxin (BT) injections improve quality of life in patients with postparalytic hemifacial spasm. Nevertheless, injection-related pain and contracture-related pain have not yet been studied. The primary objective of our study was to evaluate injection-related pain in patients with facial palsy sequelae, and to compare the standard technique (syringe) with the Juvapen device. The secondary objective was to evaluate the improvement of contracture-related pain one month after BT injection. Methods: We conducted an observational, prospective, monocentric study based on 60 patients with facial palsy sequelae who received BT injections in our university ENT (ear, nose throat) department. There were 30 patients in the Juvapen group (J) and 30 in the standard technique group (ST). All patients completed Numerical Rating Scale (NRS) questionnaires immediately after the injections and one month later. Results: The average NRS score was 1.33/10 with Juvapen and 2.24/10 with the standard technique (p = 0.0058; Z = 2.75). In patients with contracture-related pain, the average NRS score was 3.53 before BT injection, and 0.41 one month after BT injection (p = 0.0001). Conclusions: Juvapen is a less-painful injection technique than the standard one. BT reduces contracture-related pain one month after injection.

Thermal Analysis of Tilapia Fish Drying by Hybrid Solar Thermal Drying System

The present work presents a hybrid solar thermal drying of Tilapia fish to improve the product quality and satisfy the importers. The developed hybrid dryer utilized direct solar drying, a solar air heater and a thermal backup unit which sustains the drying process during the night, cloudy and rainy weather conditions. Besides, a new feature of the developed dryer utilizes the flue gas exhausted from the thermal unit to enhance the updraft in the drying chamber by re-injection of the flue gases in the chimney. The initial moisture content of the Tilapia fish used in the investigation was 246.6% on a dry basis, equivalent to 74% on a wet basis. The investigations were repeated three times on different days. Experimental results showed that the moisture content was reduced to an average final of 17.0% db (5.0% wb) within 17.5 hours, while in the open sun drying, it required around 48-72 hours. Hybrid solar drying required around 72% shorter time than open sun drying. The average overall drying efficiency of the developed system for drying Tilapia fish was 13.0%. The Re-injection technique used in the present hybrid solar-thermal system has excluded the need for an electric source for air extraction from the drying chamber, which is highly desired in the rural and fishery regions.

Sexual rehabilitation with intracavernous alprostadil after radical prostatectomy: Outcomes from a nursing program

Introduction and objectives: Erectile dysfunction (ED) is a common complication after radical prostatectomy that affects quality of life. There are several therapeutic options, including intracavernous alprostadil injections (IAI). However, no specific recommendations have been made on the optimal rehabilitation strategy. In this study we evaluated a sexual rehabilitation program (SRP) with IAI for patients with ED after radical prostatectomy, assessing the rate of compliance and reasons for dropout.Methods: The sexual rehabilitation program (SRP) was offered to all patients who underwent radical prostatectomy from 1 January 2010 to 31 December 2019. The first consultations were performed by a urology specialist nurse, explaining the IAI procedure and possible complications. The program was considered successful when the patients achieved autonomy in the drug preparation with a good injection technique. A medical consultation was performed at 6 months evaluating the IAI usage and adverse events. In case of dropout, a questionnaire about reasons for dropout was performed. The primary endpoint was the rate of compliance and dropout of the program. Secondary endpoints were the reasons for dropout and adverse events. Results: 340 patients underwent radical prostatectomy at our institution, and 123 patients accepted to participate in the rehabilitation program. A total of 96 patients (78%) successfully completed the SRP, and at 6 months 60 (62.5%) still used IAI. Concerning the reasons for dropping out, the most frequent were the need of injectable therapy and pain. Regarding complications, 17 patients (13.8%) reported pain related to the injection and 1 patient (0.8%) had a priapism, managed with conservative treatment. Conclusions: Management of post-radical prostatectomy ED by a nursing program achieved good rates of patients’ self-injection accomplishment and treatment compliance. Close monitoring for dose adjustment and management of post-injection penile pain is required during the follow-up.