Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan.

BACKGROUND/AIMS: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation. METHODS: We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records. RESULTS: Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42-61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods. CONCLUSIONS: The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

In Vivo Feasibility Study: Evaluating Autonomous Data-Driven Robotic Needle Trajectory Correction in MRI-Guided Transperineal Procedures.

This study addresses the targeting challenges in MRI-guided transperineal needle placement for prostate cancer (PCa) diagnosis and treatment, a procedure where accuracy is crucial for effective outcomes. We introduce a parameter-agnostic trajectory correction approach incorporating a data-driven closed-loop strategy by radial displacement and an FBG-based shape sensing to enable autonomous needle steering. In an animal study designed to emulate clinical complexity and assess MRI compatibility through a PCa mock biopsy procedure, our approach demonstrated a significant improvement in targeting accuracy (p<0.05), with mean target error of only 2.2 ± 1.9 mm on first insertion attempts, without needle reinsertions. To the best of our knowledge, this work represents the first in vivo evaluation of robotic needle steering with FBG-sensor feedback, marking a significant step towards its clinical translation.

Effect of Needle Insertion Angle on Pain During Labial Infiltration Anesthesia of the Anterior Maxilla: A Randomized Clinical Trial.

OBJECTIVES: This study aimed to assess the effect of needle insertion angle on pain during labial infiltration anesthesia in the anterior maxillary region. MATERIAL AND METHODS: In this parallel-design randomized clinical trial, participants were randomly assigned to four groups for labial infiltration anesthesia of the anterior maxilla. Local anesthesia was performed with needle orientation parallel to the longitudinal axis of the tooth using a conventional syringe (Syringe-0), needle at α angle with a conventional syringe (Syringe-α), computer-controlled local anesthetic delivery (CCLAD) device parallel to the longitudinal axis of the tooth (CCLAD-0), and CCLAD at α angle (CCLAD-α). The heart rate (HR), blood pressure (BP), and respiratory rate (RR) of participants were measured before needle insertion, immediately after needle insertion, and immediately after the injection by a vital signs monitor. The level of pain experienced by participants was quantified using a numerical rating scale (NRS). Data were analyzed by repeated-measures ANOVA and regression models (α = 0.05). RESULTS: Thirty-six participants aged from 21 to 60 years, with a mean age of 35.36 years were recruited. The mean pain scores were 7.44, 4.67, 2.89, and 0.67 in groups Syringe-0, Syringe-α, CCLAD-0, and CCLAD-α, respectively (p < 0.001). Age and sex had no significant effect on pain scores (p = 0.914 and p = 0.702, respectively). The four groups had no significant difference in vital signs (p > 0.05). CONCLUSIONS: Injection at an α angle and the application of CCLAD can be used in clinical practice to decrease the pain experienced by participants during labial infiltration anesthesia of the anterior maxilla. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20230719058849N1.

[Exploration of JI Laixi's academic thought of acupuncture and moxibustion in clinical practice].

The paper summarizes Professor JI Laixi's academic thought on acupuncture and moxibustion. Professor JI Laixi inherits and carries forward the theory and technical system of Shanxi "new nine needles", deepens its academic connotation, and promotes clinical practice. He advocates the integration of Chinese and western medicine, and the inclusion of multiple disciplines, e.g. acupuncture and moxibustion of Chinese medicine and modern anatomy. He takes the lead in proposing a new approach to the treatment of meridian diseases of limbs, "treating the neck region for the diseases of head, treating the abdominal region for the diseases of the lumbar region, and treating the lumbar region for the disease of knees". He proposes the acupoint prescription being standardized and simplified, explores the system of acupoint prescription and establishes the prescriptions for gastric diseases, intestinal diseases and antihypertension.

Tailoring of spherical nanocellulose via esterification with methionine followed by protonation to generate two different adsorbents for mercuric ions and Congo red.

Herein, we report two different adsorbents from spherical nanocellulose (SNC) in successive steps, for the adsorption of Hg2+ ions and Congo red (CR). Cellulose extracted from pine needles was subsequently converted to SNC through mixed acidic hydrolysis. As-obtained SNC was esterified with methionine at C6 of the anhydroglucose unit to produce SNC-methionine ester (SNC-ME). The amino group of methionine residue in SNC-ME was protonated to SNC-PME with positive surface charge. The SNC-ME and SNC-PME were evaluated as Hg2+ ions and CR adsorbents, respectively. The SNC, SNC-ME, SNC-PME, Hg2+-loaded SNC-ME, and CR-loaded SNC-PME were characterized by FTIR, XRD, XPS, Zeta potential, BET, FESEM, EDS, and surface charge analysis. SNC-ME showed Hg2+ ions removal efficiency of 94.8 ± 1.9 % in 40 min, while SNC-PME showed CR removal efficiency of 96.1 ± 3.8 % in 90 min. The adsorption data of both the adsorbents fitted best into pseudo-second order kinetic and Langmuir isotherm. The maximum adsorption capacity of SNC-ME for Hg2+ ions was 211.5 ± 3.1 mg/g and that of SNC-PME for CR was 281.1 ± 7.1 mg/g. The astounding recyclability of the adsorbents for ten repeat cycles with significant cumulative adsorption capacity of 760.9 ± 12.8 mg/g for Hg2+ ions and 758.8 ± 12.7 mg/g for CR endorses their spectacular potentiality for wastewater treatment.

Simultaneous Production of Biogas and Electricity from Anaerobic Digestion of Pine Needles: Sustainable Energy and Waste Management.

Power scarcity and pollution can be overcome with the use of green energy forms like ethanol, biogas, electricity, hydrogen, etc., especially energy produced from renewable and industrial feedstocks. In hilly areas, pine needles are the most abundant biomass that has a low possibility of valorization due to high lignin content. On the other hand, anaerobic digestion (AD) of lignin and animal waste has low biogas yield due to poor conductivity. This study focuses on the simultaneous production of biogas and electricity through the co-digestion of cow dung and pine needles. The digester was initially established and stabilized in the lab to ensure a continuous supply of inoculum throughout the experiment. The optimization process involved the determination of an ideal cow dung-to-water ratio and selecting the appropriate conductive material that can enhance the energy generation from the feedstock. Afterward, both batch and continuous anaerobic digestion experiments were conducted. The results revealed that the addition of powdered graphite (5 mM), activated charcoal (15 mM), and biochar (25 mM) exhibited maximum voltage of 0.71 ± 0.013 V, 0.56 ± 0.013 V, and 0.49 ± 0.011 V on the 30th, 25th and 20th day of AD, respectively. The batch experiment showed that 5 mM graphite powder enhanced electron transfer in the AD process and generated a voltage of 0.77 ± 0.014 V on the 30th day, indicating an increase of ~1.5-fold as compared to the control (0.56 ± 0.019 V). The results from the continuous AD process showed that the digester with cow dung, pine needle, and a conductive material in combination exhibited the maximum voltage of 0.76 ± 0.012 V on the 21st day of AD, while the digester with cow dung only exhibited a maximum voltage of 0.62 ± 0.015 V on the 22nd day of AD, representing a 1.3-fold increase over the control. Furthermore, the current work used discarded plastic items and electrodes from spent batteries to emphasize waste management and aid in attaining sustainable energy and development goals.

Fabricating whole pine needles biomass with phenylhydrazine-4-sulphonic acid for effective removal of cationic dyes and heavy metal ions from wastewater.

We applied a holistic, sustainable, and green approach to develop an effective multipurpose adsorbent from whole pine needles (PNs), a forest waste lignocellulosic biomass. The PNs were oxidized and modified with phenylhydrazine-4-sulphonic acid (ɸHSO3H) to OPN-ɸHSO3H. The latter was characterized and tested as an adsorbent for cationic dyes, malachite green (MG), methylene blue (MB), crystal violet (CV), and metal ions (Hg2⁺ and Pb2⁺). The adsorption followed different kinetic models: Elovich for MG and MB, pseudo-second-order for CV, and pseudo-first-order for Hg2⁺ and Pb2⁺. Langmuir isotherm indicated maximum adsorption capacities of 303.4 ± 8.91 mgg-1 (MG), 331.4 ± 17.50 mgg-1 (MB), 376.6 ± 22.47 mgg-1 (CV), 210.8 ± 28.86 mgg-1 (Hg2⁺), and 172.9 ± 20.93 mgg-1 (Pb2⁺) within 30 min. Maximum removal efficiencies were 99.0% (MG), 98.0% (MB), 96.04% (CV), 95.5% (Hg2⁺), and 89.8% (Pb2⁺). The adsorbent demonstrated significant regeneration and reusability over ten cycles, proving highly efficient for both cationic dyes and metal ions, with wide potential for practical applications where more than one adsorbate is present.

[Professor ZHUANG Lixing's experience of integrated acupuncture and medication approach to treat motor complications in Parkinson's disease based on the alternation of "movement and stillness"].

This paper introduces Professor ZHUANG Lixing's experience in treating motor complications of Parkinson's disease (PD) with acupuncture combined with medication. Based on the characteristics of the alternation of "movement and stillness" in PD motor complications, Professor ZHUANG divides these complications into three distinct periods: "movement" stage, "stillness" stage and "alternation" stage, and proposes an integrated approach of acupuncture and medication, with staged treatment tailored to each period. The main acupoints include Jin's three needles to regulate spirit (four spirit needles, Shenting [GV 24], Yintang [GV 24+], Shenmen [HT 7], Sanyinjiao [SP 6]), along with hand tremor three needles (Hegu [LI 4], Quchi [LI 11], Dingchan), foot tremor three needles (Yinlingquan [SP 9], Yanglingquan [GB 34], Taichong [LR 3]), and Du's three needles (Dazhui [GV 14], Jinsuo [GV 8], Mingmen [GV 4]). The primary medicinal formulas include Lingjiao Gouteng decoction, Banxia Baizhu Tianma decoction, Bazhen decoction combined with Buzhong Yiqi decoction, Sini decoction combined with Yougui pills, and Xiaochaihu decoction. This integrated approach effectively alleviates the motor symptom fluctuations in PD patients, helping them maintain a stable life.

Efficacy of computer-controlled local anesthesia delivery system on pain in dental anesthesia: a systematic review of randomized clinical trials.

Computer-controlled local anesthesia delivery (CCLAD) is an innovative electronic injection device that represents a cutting-edge approach to dental anesthesia. This system is promising for painless anesthesia using controlled anesthetic injections. This review aimed to compare the discomfort experienced by patients during local anesthesia using a traditional syringe and the CCLAD system and evaluate the potential of the CCLAD system as a painless dental anesthesia solution. The inclusion criteria for this study were based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The study population, including children and adults, underwent dental anesthesia using the CCLAD system, ensuring a comprehensive and representative sample that instills confidence in the validity of the results. Fourteen clinical trials were included in the analysis after they fulfilled the eligibility criteria. We found that using computer-assisted anesthetic equipment not only led to a significantly lower pain perception score, but also had a profound positive impact on patient behavior. Patients using the CCLAD device exhibited more cooperative and helpful conduct, indicating the system's effectiveness in improving patient comfort and experience and reassuring the audience about its positive impact. In conclusion, using a computer-assisted anesthetic device such as the CCLAD system significantly reduced pain perception scores and improved patient behavior, making them more cooperative and helpful. These findings offer hope for pediatric dentistry and apprehensive adult patients, suggesting a more comfortable and less daunting dental experience with the CCLAD system.

Evaluation of the Efficiency of the Newly Developed Needle in Emergency Room: A Single-Center Observational Study.

Aim of the study: Peripheral intravascular catheter (PIVC) insertion is frequently performed in the emergency room (ER) and many failures of initial PIVC insertion occur. To reduce the failures, new needles were developed. This study aimed to investigate whether the use of the newly developed needle reduced the failure of initial PIVC insertion in the ER compared with the use of the existing needle. Material and methods: This single-centre, prospective observational study was conducted in Japan between April 1, 2022, and February 2, 2023. We included consecutive patients who visited our hospital by ambulance as a secondary emergency on a weekday during the day shift (from 8:00 AM to 5:00 PM). The practitioners for PIVC insertion and assessors were independent. The primary and secondary outcomes were the failure of initial PIVC insertion and number of procedures, respectively. We defined the difficulty of titrating, leakage, and hematoma within 30 s after insertion as failures. To evaluate the association between the outcomes and the use of newly developed needles, we performed multivariate logistic regression and multiple regression analyses by adjusting for covariates. Results: In total, 522 patients without missing data were analysed, and 81 (15.5%) patients showed failure of initial PIVC insertion. The median number of procedures (interquartile range) was 1 (1-1). Multivariate logistic regression analysis revealed no significant association between the use of newly developed PIVCs and the failure of initial PIVC insertion (odds ratio, 0.79; 95% confidence interval, [0.48-1.31]; p = 0.36). Moreover, multiple regression analysis revealed no significant association between the use of newly developed PIVCs and the number of procedures (regression coefficient, -0.0042; 95% confidence interval, [-0.065-0.056]; p = 0.89). Conclusions: Our study did not show a difference between the two types of needles with respect to the failure of initial PIVC insertion and the number of procedures.

Legacy and novel brominated flame retardants in outdoor settled dusts and pine needles in a megacity of Eastern China: Interpretation of plant uptake.

Brominated flame retardants, considered emerging contaminants, are widespread and persist in the environment. This study investigated the contamination of legacy and novel brominated flame retardants in paired outdoor settled dusts and pine needles sampled from a megacity in the Eastern China. The measured total concentrations of PBDEs (∑27PBDEs) in outdoor settled dusts and pine needles were in the range of 77.4-345.2 ng/g dw and 20.7-120.0 ng/g dw, respectively, and equivalent ranges for novel brominated flame retardants (∑11NBFRs) were 25.7-1917.2 ng/g dw and 9.4-38.7 ng/g dw, respectively. BDE-209 and DBDPE dominated PBDEs and NBFRs profiles, respectively, in both dusts and pine needles. Outdoor settled dusts exhibited greater potentials to accumulate high-brominated PBDE homologues and EH-TBB while pine needles tended to accumulate low-brominated PBDE homologues, BTBPE and TBC. The plant uptake of BFRs was interpreted by McLachlan's framework on the assumption that the levels of BFRs in outdoor settled dusts and particle phase of air were positively correlated. The accumulation of PBDEs in pine needles was dominated by equilibrium partitioning between the vegetation and the gas phase when log KOA values <10 and by particle-bound deposition when log KOA values >13. However, NBFRs exhibited more complicated accumulation behavior. The predicted 50th percentile of the estimated daily intakes of ∑27PBDEs via outdoor settled dusts exposure for adults and children were 3.5 × 10-2 and 1.4 × 10-1 ng/kg body weight (bw)/day, respectively, and equivalent values for ∑11NBFRs were 1.6 × 10-2 ng/kg bw/day and 6.3 × 10-2 ng/kg bw/day, respectively. The calculated hazard index (HI) values were far <1, indicating exposure of BFRs via outdoor settled dust intake would not pose potential non-carcinogenic health risks to both adults and children.

Comparing the diagnostic adequacy of 25-Gauge fork-tip versus franseen versus reverse-bevel-type needles in EUS-guided tissue acquisition: A prospective randomized study with a retrospective control.

Background and Objectives: EUS-guided fine-needle biopsy (FNB) is an established technique for the acquisition of tissue to diagnose lesions of the gastrointestinal tract and surrounding organs. Recently, newer-generation FNB needles have been introduced, including a second-generation reverse-bevel and the third-generation fork-tip and Franseen needles. We aimed to determine if there was any difference between these needles in terms of cytopathological diagnostic yield, sample cellularity, or sample bloodiness. Methods: One hundred twenty-seven consecutive patients undergoing EUS-guided FNB of any solid lesion were randomized to use either a Franseen or fork-tip needle in a 1:1 ratio and were compared with 60 consecutive historical cases performed with reverse-bevel needles. Patient and procedure characteristics were recorded. Cases were reviewed by a blinded cytopathologist and graded based on cellularity and bloodiness. Overall diagnostic yield was calculated for each study arm. Results: One hundred seventy-six cases were eligible for analysis, including 109 pancreatic masses, 24 lymphoid lesions, 17 subepithelial lesions, and 26 other lesions. The final diagnosis was malignancy in 127 cases (72%). EUS-guided FNB was diagnostic in 141 cases (80%) overall and in 89% of cases where malignancy was the final diagnosis. There was no difference in diagnostic yield, sample cellularity, or sample bloodiness between the different needle types. There was no difference in adverse events between groups. Conclusions: EUS-guided FNB performed using 25-gauge Franseen, fork-tip, and reverse-bevel needles resulted in similar diagnostic yield, sample cellularity, and sample bloodiness. Our results may not be extrapolated to larger-caliber needles of the same design.

Optical Fiber-Based Needle Shape Sensing in Real Tissue: Single Core vs. Multicore Approaches.

Flexible needle insertion procedures are common in minimally-invasive surgeries for diagnosing and treating prostate cancer. Bevel-tip needles provide physicians the capability to steer the needle during long insertions to avoid vital anatomical structures in the patient and reduce post-operative patient discomfort. To provide needle placement feedback to the physician, sensors are embedded into needles for determining the real-time 3D shape of the needle during operation without needing to visualize the needle intra-operatively. Through expansive research in fiber optics, a plethora of bio-compatible, MRI-compatible, optical shape-sensors have been developed to provide real-time shape feedback, such as single-core and multicore fiber Bragg gratings. In this paper, we directly compare single-core fiber-based and multicore fiber-based needle shape-sensing through similarly constructed, four-active area sensorized bevel-tip needles inserted into phantom and ex-vivo tissue on the same experimental platform. In this work, we found that for shape-sensing in phantom tissue, the two needles performed identically with a p-value of 0.164 > 0.05, but in ex-vivo real tissue, the single-core fiber sensorized needle significantly outperformed the multicore fiber configuration with a p-value of 0.0005 < 0.05. This paper also presents the experimental platform and method for directly comparing these optical shape sensors for the needle shape-sensing task, as well as provides direction, insight and required considerations for future work in constructively optimizing sensorized needles.

A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles.

The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children's Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.

Effects of the Irrigation Needle Design on Root Canal Disinfection and Cleaning.

INTRODUCTION: This ex vivo study evaluated the disinfecting and cleaning effects of root canal preparation using sodium hypochlorite irrigation with 3 different needle designs. METHODS: Mesial roots from extracted mandibular molars with Vertucci class II configuration were anatomically matched based on micro-computed tomography (micro-CT) analyses and distributed into 3 groups (n = 18/group). The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation using 2.5% sodium hypochlorite irrigation with open-ended flat needle (3 mm short of the working length - WL), closed-ended side-vented irrigation needle (1 mm short of the WL), or a closed-ended plastic needle with 2 lateral outlets (TruNatomy) (1 mm short of the WL). Bacteriological samples were taken from the canals before (S1) and after preparation (S2). After another micro-CT scan, the roots were sectioned and samples were also taken from the apical canal segment (S3). Bacterial reduction was assessed by quantitative real-time polymerase chain reaction. The amount of accumulated hard tissue debris was evaluated by micro-CT. RESULTS: A substantial reduction in bacterial counts was observed in all 3 groups when comparing S1 with S2 (99.95%, 98.93%, and 98.90% in the open-ended, closed-ended, and TruNatomy needle groups, respectively) (P < .01). No significant differences were observed between groups for bacterial reduction in the full and apical canal (P > .05). There were no intergroup differences in the amount of accumulated hard tissue debris either (P > .05). The open-ended needle group showed significantly more specimens with quantitative real-time polymerase chain reaction negative results for bacteria in S3 than TruNatomy (P < .05). CONCLUSION: When used up to an appropriate insertion depth, the 3 needle types result in similar antibacterial and cleaning performance, provided variables such as needle size and irrigant type, volume and flow rate are controlled. Exclusive analysis of the apical segment, including the isthmus, revealed that the open-ended needle yielded more cases negative for bacteria.

Community pharmacists' attitudes toward and practice of pharmacy-based harm reduction services in Pittsburgh, PA: a descriptive survey.

BACKGROUND: In Pittsburgh, PA, legal changes in recent decades have set the stage for an expanded role for community pharmacists to provide harm reduction services, including distributing naloxone and non-prescription syringes (NPS). In the wake of the syndemics of the COVID-19 pandemic and worsening overdose deaths from synthetic opioids, we examine knowledge, attitudes, and practices of harm reduction services among community pharmacists in Pittsburgh and identify potential barriers of expanded pharmacy-based harm reduction services. METHODS: We provided flyers to 83 community pharmacies within a 5-mile radius of the University of Pittsburgh Medical Center to recruit practicing community pharmacists to participate in an anonymous electronic survey. We used a 53-question Qualtrics survey consisting of multiple-choice, 5 or 6 point-Likert scale, and open-ended questions adapted from 5 existing survey instruments. Survey measures included demographics, knowledge, attitudes, and practices of harm reduction services (specifically naloxone and NPS provision), and explored self-reported barriers to future implementation. Data was collected July-August 2022. We conducted descriptive analysis using frequencies and proportions reported for categorical variables as well as means and standard deviations (SD) for continuous variables. We analyzed open-ended responses using inductive content analysis. RESULTS: Eighty-eight community pharmacists responded to the survey. 90% of participants agreed pharmacists had a role in overdose prevention efforts, and 92% of participants had previously distributed naloxone. Although no pharmacists reported ever refusing to distribute naloxone, only 29% always provided overdose prevention counseling with each naloxone distributed. In contrast, while 87% of participants had positive attitudes toward the usefulness of NPS for reducing disease, only 73% of participants ever distributed NPS, and 54% had refused NPS to a customer. Participants endorsed a lack of time and concerns over clientele who used drugs as the most significant barriers to offering more comprehensive harm reduction services. CONCLUSIONS: Our findings highlight that while most community pharmacists have embraced naloxone provision, pharmacy policies and individual pharmacists continue to limit accessibility of NPS. Future expansion efforts for pharmacy-based harm reduction services should not only address the time and labor constraints identified by community pharmacists, but also fear-based policy and stigma toward people who inject drugs and harm reduction more broadly.

[Nape seven needles combined with pressing moxibustion for cervical vertigo: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of nape seven needles combined with pressing moxibustion for cervical vertigo (CV). METHODS: A total of 70 patients with CV were randomized into an observation group and a control group, 35 cases in each group. In the observation group, nape seven needles combined with pressing moxibustion was delivered, once a day, 6 times a week, for consecutive 2 weeks. In the control group, betahistine hydrochloride tablet and aceclofenac dispersible tablet were given orally, for 2 weeks and 3 days respectively. Before and after treatment, the evaluation scale for cervical vertigo (ESCV) score was observed, the plasma levels of neuropeptide Y (NPY), endothelin-1 (ET-1) and calcitonin gene related peptide (CGRP) were detected, the hemorheologic and hemodynamic indexes were measured, and the clinical efficacy was evaluated after treatment in the two groups. RESULTS: After treatment, the scores of dizziness, daily life and work ability, psychological and social adaptability, and headache, as well as the total scores of ESCV were increased compared with those before treatment (P<0.01, P<0.05) in the two groups, and the score and total score of neck and shoulder pain of ESCV was increased compared with that before treatment (P<0.01) in the observation group; each sub-item score and total score of ESCV in the observation group were higher than those in the control group (P<0.01, P<0.05). After treatment, the plasma levels of NPY and ET-1 were decreased compared with those before treatment (P<0.01), while the plasma levels of CGRP were increased compared with those before treatment (P<0.01, P<0.05) in the two groups; the plasma levels of NPY and ET-1 in the observation group were lower than those in the control group (P<0.01), the plasma level of CGRP in the observation group was higher than that in the control group (P<0.01). After treatment, the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity were decreased compared with those before treatment (P<0.01, P<0.05), the mean velocity of basilar artery (BA), left vertebral artery (LVA) and right vertebral artery (RVA) were increased compared with those before treatment (P<0.05) in the two groups; the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity in the observation group were lower than those in the control group (P<0.01), and the mean velocity of BA, LVA and RVA in the observation group were higher than those in the control group (P<0.05). The total effective rate in the observation group was 91.4% (32/35), which was superior to 71.4% (25/35) in the control group (P<0.05). CONCLUSION: Nape seven needles combined with pressing moxibustion can effectively alleviate the clinical symptoms, and improve the hemorheology and hemodynamics in CV patients.

Assessment and Treatment of Pain in Hospitalized Children at a Tertiary Children's Hospital: A Cross-Sectional Mixed Methods Survey.

(1) Background: Acute pain in hospitalized children remains under-recognized and under-treated. Our objective is to benchmark pain assessment, documentation, treatment, and patient experience in children admitted to a US children's hospital. (2) Methods: A cross-sectional, mixed-method survey of pain for children hospitalized ≥24 h. Charts were reviewed for modalities of pain assessment and treatment for all inpatients. If pain was documented, patients/caregivers were surveyed regarding their experience with pain and its management. (3) Results: Chart review: All 107 patients had ≥1 pain score documented. A total of 47 patients had a pain score ≥0, 35 (74.5%) of whom had ≥1 moderate-severe score. Seventy (65.4%) patients received ≥1 intervention for pain, including medications from ≥1 class (e.g., opioids) (n = 55, 51.4%) and/or integrative/non-pharmacologic intervention(s) (n = 39, 36.4%). There were assessment and documentation gaps. Patient survey: A total of 39 (83.0%) interviews were attempted; 25 (53.2%) were completed. The worst pain was mostly caused by acute illness (n = 13, 52%) and painful procedures (n = 10, 40%). Suggestions for improvement included increasing the use of integrative modalities and optimizing patient-clinician communication. (4) Conclusions: All patients admitted ≥24 h had ≥1 pain score documented; however, gaps in documentation were common. Multimodal treatment and integrative modalities were underutilized. Procedures were a frequent cause of under-treated pain, prompting an institution-wide quality improvement project.

Fear of Needles and Seasonal Influenza Vaccine Acceptance Amongst Adults in the United Arab Emirates: A Cross-Sectional Study and Implications for Nursing.

Introduction: Seasonal influenza remains a challenge in the United Arab Emirates, and vaccination is an important preventive measure. However, fear of needles may be an obstacle in vaccination efforts. Objective: The purpose of this study was to determine, in a non-clinical sample obtained from the UAE, how much of an impact fear of needles has on the decision to receive the seasonal influenza vaccine. Methods: In the period September-December 2022, 372 participants were surveyed on their willingness to be vaccinated, their level of vaccine knowledge, and their level of fear of needles. Logistic regression models were used to assess the impact of fear of needles and vaccine knowledge on the decision to accept the seasonal influenza vaccine. Results: Fear of needles and vaccine knowledge are significant predictors in the decision to receive the vaccine. There were no gender or ethnic differences in fear of needles, but there were differences in the decision to receive the vaccines, with women and non-Arabs being more hesitant. Conclusion: Fear of needles may be an important variable to account for in public policies designed to improve vaccination rates in the UAE. For public health policy in the UAE, this implies that authorities must dedicate efforts to manage fear of needles in the general population. Efforts to address fear of vaccines in the general population must be made with proper training of nurses. Alternatively, authorities may need to seek oral alternatives for the administration of the seasonal influenza vaccine.

An Integrated Strategy Based on 10-DAB Extraction and In Situ Whole-Cell Biotransformation of Renewable Taxus Needles to Produce Baccatin III.

Baccatin III is a crucial precursor in the biosynthesis pathway of paclitaxel. Its main sources are extraction from Taxus or chemical synthesis using 10-deacetylbaccatin III (10-DAB) as substrate. However, these preparation approaches exhibit serious limitations, including the low content of baccatin III in Taxus and the complicated steps of chemical synthesis. Heterologous expression of 10-deacetylbaccatin III-10-O-acetyltransferase (TcDBAT) in microbial strains for biotransformation of 10-DAB is a promising alternative strategy for baccatin III production. Here, the promotion effects of glycerol supply and slightly acidic conditions with a low-temperature on the catalysis of recombinant TcDBAT strain were clarified using 10-DAB as substrate. Taxus needles is renewable and the content of 10-DAB is relatively high, it can be used as an effective source of the catalytic substrate 10-DAB. Baccatin III was synthesized by integrating the extraction of 10-DAB from renewable Taxus needles and in situ whole-cell catalysis in this study. 40 g/L needles were converted into 20.66 mg/L baccatin III by optimizing and establishing a whole-cell catalytic bioprocess. The method used in this study can shorten the production process of Taxus extraction for baccatin III synthesis and provide a reliable strategy for the efficient production of baccatin III by recombinant strains and the improvement of resource utilization rate of Taxus needles.