Best evidence summary for the management of injection site pain in subcutaneous patients / 中国实用护理杂志

Objective:To retrieve, evaluate and summarize the relevant evidence of subcutaneous injection in patients to reduce pain at the injection site, so as to provide reference for clinical practice.Methods:According to the evidence pyramid "6S" model, all evidence on subcutaneous injection and injection site pain, including guidelines, expert consensus, summary of evidence, clinical decision, systematic review, etc were retrieved from domestic and international guideline networks and databases. The search period was from database establishment to October 2, 2022. The literature quality evaluation and evidence grading system of Joanna Briggs Institute (JBI) Evidence-based Health Care Center was used to evaluate the literature quality and classify the evidence level.Results:A total of 12 articles were included, including 2 expert consensus, 6 systematic reviews, 2 best evidence summaries and 2 clinical guidelines. A total of 21 pieces of best evidence were summarized from 8 aspects, including pre-subcutaneous injection assessment, injection site, injection needle, injection position, injection method, precautions, personnel training and health education.Conclusions:This study summarized a comprehensive and practical subcutaneous injection method. Clinical practitioners can use evidence to administer subcutaneous injection to patients, reduce pain and improve patients ′ comfort.

Application value of abdominal reticular rotation positioning card for subcutaneous injection of fondaparinux sodium in abdominal surgery / 中华消化外科杂志

Objective:To investigate the application value of abdominal reticular rotation positioning card for subcutaneous injection of fondaparinux sodium in abdominal surgery.Methods:The retrospective cohort study was conducted. The clinical data of 140 patients who underwent subcutaneous injection of fondaparinux sodium in the Second Affiliated Hospital of Nanchang University from April to October 2019 were collected. There were 74 males and 66 females, aged (58±9)years. Of the 140 patients, 70 cases undergoing routine subcutaneous injection were allocated into control group, and 70 cases undergoing subcutaneous injection with abdominal reticular rotation positioning card were allocated into experimental group. Observation indicators: (1) subcutaneous injection; (2) conditions after subcutaneous injection. Measurement data with normal distribution were expre-ssed as Mean± SD, and comparison between groups was conducted by the t test. Count data were expressed as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test. Results:(1) Subcutaneous injection. There were significant differences in the subcutaneous bleeding and subcutaneous induration between the two groups ( P<0.05). (2) Conditions after subcutaneous injection. There were significant differences in pain degree and nursing satisfaction between the two groups ( P<0.05). Conclusion:Compared with the conventional subcutaneous injection, the abdominal reticular rotation positioning card for subcutaneous injection of fondaparinux sodium in abdominal surgery can reduce the rate of subcutaneous bleeding and induration of the patients, relieve the pain of the patients, and improve the satisfaction.

Ultrasonography and comparative study of needle tip reaching the target tissue with different kinds of subcutaneous injection techniques / 中国实用护理杂志

Objective:To compare the accuracy of the needle tip reaching the target tissue between two subcutaneous injection techniques under ultrasound imaging in order to provide a basis for clinical injection to make a safe and reasonable decision.Methods:This was a parallel controlled non-inferiority comparative study. A total of 68 patients who received subcutaneous injections in the outpatient injection room of Nanjing Drum Tower Hospital Affiliated to Nanjing University from June 2021 to September 2022 were selected as the research subjects, and they were divided intothe A and B group according to the random number table method, there were 34 cases in each group. Group A received pinched skin injections, and group B received taut skin injections. Unify the injection site, injection needle length, and needle insertion angle. The accuracy rate of the needle tip reaching the target tissue, namely the subcutaneous fat layer, was compared between the two groups by ultrasound imaging, and the pain scores and the imaging performance during the injection process were observed.Results:The accuracy of the needle tip reaching the subcutaneous fat layer in the group A was 97.1%(33/34), which compared with the 100.0%(34/34) in the group B, there was no significant difference ( χ2 = 0.53, P>0.05). There was no significant difference about the distribution of pain scores between the two groups ( χ2 = 0.67, P>0.05). There were no significant differences about age, subcutaneous fat thickness and the distance from the needle tip to the myofascial in patients with different pain scores ( F = 1.20, 0.44, H = 0.64, all P>0.05). Conclusions:Under certain conditions, pinching the skin and tightening the skin have the same accuracy and safety when the needle tip reaches the subcutaneous fat layer of the target tissue, and the choice should be made according to the clinical situation. Imaging observations have enlightening significance for the practice of subcutaneous injection.

Establishment of mouse models of lymphoma with dual-labeled EBV-immortalized lymphoblastoid cell lines by intravenous versus subcutaneous injection / 中国肿瘤临床

Objective:To establish a green fluorescent protein(GFP)and firefly luciferase(Luc)double-labeled Epstein-Barr virus(EBV)infec-ted B lymphoblastoid cell lines(B-LCL)and apply them to mouse models,then compare the advantages and disadvantages of models inocu-lated by intravenous(IV)or subcutaneous(SC).Methods:B lymphoblastoid cell lines double-tagged with GFP/Luc(B-LCL-GL)were con-structed through lentivirus transduction,puromycin intervention.Subcutaneous xenograft and hematogenous metastasis models were re-spectively established by subcutaneous or intravenous injection of B-LCL-GL cells at three concentrations in(NOD)/Prkdcscid/IL-2Rγnull(NPG)mice for in vivo bioluminescence imaging.Results:In the B-LCL-GL group,the ratio of the GFP-positive cell population was 92.5%,and the average luminescence intensity was as high as 4.80E+08 Photons/s,which was considerably higher than that of untreated B-LCLs.In the hematogenous metastasis models,tumor bioluminescence was initially located in the peritoneal area and then spread throughout the en-tire body between 7 and 28 days.In the subcutaneous xenograft models,strong central and weak peripheral tumor-related biolumines-cence signal was detected on day 7 in the three groups,which then spread throughout the body on day 28 in the high-dose group.Taken to-gether,there was no significant difference in tumor progression between the two routes of administration when using the same dose of B-LCL-GL cells.However,the survival analysis indicated that the IV injection group,in which all the mice ultimately died,had a shorter time frame for testing than that of the SC injection group,in which the mice survived until day 100 in the low-dose and medium-dose groups,thus allowing for long-term testing.Conclusions:GFP and Luc dual-positive B-LCLs were successfully established to generate hematogenous metastasis and subcutaneous xenograft models,which allow the monitoring of the location and size of lymphomas in vivo.It provide plat-form for the study of tumor characteristics and selecting anti-tumor drugs.

Effect of insulin intraperitoneal injection combined with dietary intervention on blood glucose regulation in KKAy mice with spontaneous type 2 diabetes / 国际生物医学工程杂志

Objective:To study the effect of insulin intraperitoneal administration combined with dietary intervention on glycemic regulation in in KKAy mice with spontaneous type 2 diabetes.Methods:An animal model of type 2 diabetes was established, and healthy C57BL/6J mice were selected as the normal control group and healthy KKAy mice as the non-disease group. The successfully modeled KKAy mice were randomly divided into the subcutaneous group, the intraperitoneal group, and the untreated group. The non-disease group was given a maintenance diet, and all other groups were fed a high-fat, high-sugar diet. The daily feeding time was from 08:00 to 20:00, with one feeding at a 4-hour interval, for a total of four times. The subcutaneous and intraperitoneal groups were given subcutaneous and intraperitoneal insulin injections before feeding, and recombinant glargine insulin injection (subcutaneous group: 0.125 IU/g; intraperitoneal group: 0.250 IU/g) was injected before the first feeding, and biosynthetic human insulin injection (subcutaneous group: 0.075 IU/g; intraperitoneal group: 0.125 IU/g) was injected after a 0.5 h interval; the rest 3 times before feeding, the biosynthetic human insulin injection (subcutaneous group: 0.075 IU/g; intraperitoneal group: 0.125 IU/g) was injected for 4 weeks. The dietary intake, body mass, fasting blood glucose, and 1 and 2 h postprandial blood glucose of mice in each group were tested regularly, and an oral glucose tolerance test was performed.Results:The total dietary intake of mice in the intraperitoneal group was lower than that in the subcutaneous group. Compared with the initial body mass, the body mass of the mice in the subcutaneous and intraperitoneal groups decreased by 5.05 and 3.59 g at week 4, respectively. The changes of fasting blood glucose in the subcutaneous and intraperitoneal groups ranged from 5.4 to 9.4 and 5.4 to 6.4 mmol/L, respectively, and the changes of 1 h postprandial blood glucose ranged from 4.6 to 12.3 and 5.7 to 8.9 mmol/L, respectively, and the changes of 2 h postprandial blood glucose ranged from 2.5 to 9.8 and 3.8 to 7.1 mmol/L, respectively. For the glucose tolerance index, the intraperitoneal group showed improvement at all time points, and the subcutaneous group showed a decrease at all time points except for 0 and 60 min.Conclusions:In combination with dietary intervention, insulin intraperitoneal injection was more effective in controlling blood glucose in KKAy mice with spontaneous type 2 diabetes compared with subcutaneous insulin injection, and had a significant improvement in glucose tolerance.

Successful Dose Titration to Cancer Pain by Continuous Subcutaneous Injection of Hydromorphone Hydrochloride: A Retrospective Analysis

Background: The efficacy and safety of continuous subcutaneous injection (CSCI) of hydromorphone hydrochloride (HM) for titration of moderate to severe cancer pain have yet to be evaluated. Methods: We retrospectively analyzed the patients underwent CSCI of HM from Feb. 2020 to Oct. 2021 in Kitano Hospital, Osaka, Japan. The concentration of HM was 0.20 mg/ml to 1.0 mg/ml in saline depending on the patient. Haloperidol was added to a concentration of 0.5 mg/ml for a total of 10 ml. CSCI was performed using a portable small syringe driver. The dose was titrated between 0.05 ml/h and 1.0 ml/h to achieve adequate relief of pain without unacceptable side effects. Results: A total of 37 patients including 1 opioid-naive patient were examined. The median dose of HM at the initiation and completion of titration was 1.92 and 2.40 mg/day, respectively. The median time to titration completion was 2 days. Titration completion rate within 3 days was observed in 33 patients (89%). Remarkable effect to pain (at least 66% improvement in numerical rating scale [NRS]) was observed in 33 patients (89%), efficacy (33 to 66% improvement in NRS) in 3 patients (8.1%), and inefficacy in 1 patient (2.7%). Adverse events included Common Terminology Criteria for Adverse Events Grade 2 drowsiness in 3 patients (8.1%) and Grade 2 hypotension in 1 patient (2.7%), both of which improved with reduction or discontinuation of HM. Conclusion: CSCI of HM was simple and safe, and produced rapid and effective pain control for moderate to severe cancer pain.

Ivermectina subcutánea en el tratamiento de un síndrome de hiperinfección por Strongyloides stercoralis / Subcutaneous ivermectin for the treatment of the hyperinfection syndrome by Strongyloides stercoralis

La estrongiloidiasis es una enfermedad causada por el nematodo Strongyloides stercoralis, endémico en las regiones rurales de los países tropicales y subtropicales. Los pacientes inmunosuprimidos tienen un mayor riesgo de infección con este parásito y pueden terminar desarrollando un síndrome de hiperinfección que conlleva un alto riesgo de muerte. En el tratamiento se utiliza la ivermectina, pero, ni en Colombia ni en el mundo, existe una presentación parenteral del medicamento para uso en humanos, lo cual es un problema en aquellos pacientes que puedan tener comprometida la absorción intestinal, como es el caso de aquellos con obstrucciones intestinales. Se reporta el caso de un síndrome de hiperinfección por S. stercoralis en Colombia tratado con ivermectina subcutánea; la idea al presentarlo es incentivar los estudios de farmacocinética y farmacodinamia que analicen esta vía de administración como alternativa para el tratamiento de pacientes con riesgo de fracaso terapéutico con la vía oral.

Strongyloidiasis is a disease caused by the nematode Strongyloides stercoralis that is endemic in rural regions in tropical and subtropical countries. Immunosuppressed patients have an increased risk of infection by this parasite and are at risk of developing a hyperinfection syndrome which involves a higher risk of death. The syndrome is treated with ivermectin, however, there is no parenteral presentation of this medication for human use in Colombia or the world, which is an important problem in patients who have compromised enteral absorption, for instance, those with intestinal obstructions. We present a case of hyperinfection syndrome by Strongyloides stercoralis in Colombia, which was treated with subcutaneous ivermectin. Our purpose is to encourage pharmacokinetic and pharmacodynamic studies to establish this route of administration in the future as an alternative for those patients who have a high risk of therapeutic failure with the oral route.

Efficacy and Safety of Subcutaneous Levetiracetam Injection for Terminally-ill Cancer Patients: A Case Report

Introduction: Antiepileptic drugs were occasionally administered to manage seizures in terminally-ill cancer patients. When enteral route is no longer feasible due to dysphagia or depressed level of consciousness, subcutaneous route could be an option. We reported three cases of terminally cancer patients who received subcutaneous levetiracetam (LEV) due to an inability to administer via intravenous route. Cases: The age of 3 cases was 83, 75, 82 years, respectively. In all cases, the prognosis prediction at the start of subcutaneous LEV was about 1 month. In all cases, the route of administration of LEV was changed from intravenous to subcutaneous. No exacerbation of convulsions, or injection site reaction was confirmed after subcutaneous LEV administration. Discussion: We believe that subcutaneous LEV administration may be one of the treatment options for seizures in patients with terminal cancer for whom intravenous administration of LEV is no longer feasible.

Low molecular weight heparin modified injection method in patients with acute myocardial infarction application / 中国实用护理杂志

Objective To investigate the application of low molecular weight heparin modified injection in the nursing of patients with acute myocardial infarction. Methods A total of 90 patients with myocardial infarction who underwent subcutaneous injection of low molecular weight heparin from May 2017 to May 2018 were enrolled in the study. The patients were divided into the control group and the observation group according to the different injection and treatment methods. The control group used the traditional injection method of low molecular weight heparin, and the observation group used the low molecular weight heparin modified injection method. Forty-five patients were observed and compared for the degree of subcutaneous hemorrhage, incidence of induration and pain. Results The incidence of subcutaneous induration and subcutaneous hemorrhage in the observation group were 10.16% (64/630) and 19.84% (125/630), respectively. The control group was 16.19% (102/630) and 31.11% (196/630), respectively. The difference between the groups was statistically significant (χ2 =10.019, 21.073, both P<0.05). The pain score of the observation group was 1.29±0.21, and the control group was 1.86±0.28. The difference between the two groups was statistically significant (t=40.877, P<0.05); the subcutaneous mild, moderate, and severe bleeding in the observation group were 17.30% (109/630), 2.54% (16/630), and 0, respectively, and the control group was 21.90% (138/). 630), 8.41% (53/630), 0.79% (5/630), the difference between the two groups was statistically significant (χ2=4.235, 20.990, 4.019, all P<0.05). Conclusions Low molecular weight heparin modified injection method for myocardial infarction patients can effectively reduce the incidence of subcutaneous hemorrhage and induration, reduce the degree of subcutaneous hemorrhage and pain, suitable for clinical promotion.

Low molecular weight heparin modified injection method in patients with acute myocardial infarction application / 中国实用护理杂志

Objective@#To investigate the application of low molecular weight heparin modified injection in the nursing of patients with acute myocardial infarction.@*Methods@#A total of 90 patients with myocardial infarction who underwent subcutaneous injection of low molecular weight heparin from May 2017 to May 2018 were enrolled in the study. The patients were divided into the control group and the observation group according to the different injection and treatment methods. The control group used the traditional injection method of low molecular weight heparin, and the observation group used the low molecular weight heparin modified injection method. Forty-five patients were observed and compared for the degree of subcutaneous hemorrhage, incidence of induration and pain.@*Results@#The incidence of subcutaneous induration and subcutaneous hemorrhage in the observation group were 10.16% (64/630) and 19.84% (125/630), respectively. The control group was 16.19% (102/630) and 31.11% (196/630), respectively. The difference between the groups was statistically significant (χ2=10.019, 21.073, both P<0.05). The pain score of the observation group was 1.29±0.21, and the control group was 1.86±0.28. The difference between the two groups was statistically significant (t=40.877, P<0.05); the subcutaneous mild, moderate, and severe bleeding in the observation group were 17.30% (109/630), 2.54% (16/630), and 0, respectively, and the control group was 21.90% (138/). 630), 8.41% (53/630), 0.79% (5/630), the difference between the two groups was statistically significant (χ2=4.235, 20.990, 4.019, all P < 0.05).@*Conclusions@#Low molecular weight heparin modified injection method for myocardial infarction patients can effectively reduce the incidence of subcutaneous hemorrhage and induration, reduce the degree of subcutaneous hemorrhage and pain, suitable for clinical promotion.

Inyección subcutánea de mercurio elemental. Importancia de la remoción precoz / Subcutaneous injection of metallic mercury. The importance of early removal

La inyección subcutánea o intramuscular de mercurio elemental, sea accidental o intencional, es una forma poco frecuente de intoxicación. Presentamos el caso de un hombre de 22 años de edad, con antecedentes de rasgos psicóticos y lesiones autolíticas, que se inyectó mercurio elemental en el tejido celular subcutáneo del cuello, tórax y abdomen, tres meses antes de su internación. Las áreas afectadas fueron localizadas mediante el examen físico, radiografías y tomografías. Se realizó el dosaje de mercurio en sangre y orina. Se resecó quirúrgicamente el mercurio de las zonas comprometidas. La detección y remoción precoz del mercurio, mediante cirugía y eventual quelación, es necesaria para prevenir complicaciones a corto y largo plazo.

Accidental or intentional subcutaneous or intramuscular injection of metallic mercury is an uncommon form of intoxication. We present the case of a 22 year-old man, who had psychotic disorders and autoaggressive behavior, with a preceding history of self-injection of mercury into the soft tissues of the neck, thorax and abdomen. Clinical examination, radiographs, and computed tomography showed the affected area. Mercury was measured in blood and urine. The mercury was surgically resected from the affected areas. Early detection and removal of mercury from the body by physical removal or chelation is required to prevent short- and long-term toxicity.

Adverse reactions of subcutaneous injection of low molecular weight heparin: a comparative study between two injection methods / 介入放射学杂志

Objective To compare the incidences of skin ecchymosis,skin induration and pain degree occurring after subcutaneous injection of low molecular weight heparin between two injection methods in order to determine the optimal subcutaneous injection method and provide the basis for standardizing the nursing process.Methods A total of 123 patients,who received subcutaneous injection of low molecular weight heparin during the period from March 2016 to September 2016 at authors' department,were enrolled in this study.Self-contrast method was used to compare the results.Each patient received low molecular weight heparin with two different subcutaneous injection methods.On the left abdomen,used as the experimental side,slow injection of heparin,lasting for 10 s,was conducted,then,after the needle stayed there for 10s the needle was pulled out,and no compression was applied on the injection site.On the right abdomen,used as the control side,slow injection of heparin,lasting for 10 s,was carried out,and the needle was pulled out immediately after the injection was finished,then compression was applied on the injection site for 3 min.Two hours and 12 hours after injection,visual analogue scale (VAS) was used to assess the degree of pain at injection site,and the incidences of skin ecchymosis and subcutaneous induration on the experimental side and the control side were documented.Results Two-hour and 12-hour VAS pain scores of the experimental group were (0.88±0.66) and (0.34±0.47) respectively,which were significantly lower than (2.02±0.65) and (1.19±0.63) of the control group (P＜0.05).The incidence of skin ecchymosis in the experimental group was 10.5％,which was strikingly lower than 23.5％ in the control group (t=2.736,P＜ 0.05).The incidence of subcutaneous induration in the experimental group was 0.04％,which was remarkably lower than 15.4％ in the control group (t=2.946,P＜0.05).Conclusion Slow injection of low molecular weight heparin,lasting for 10 s with needle staying for 10 s,and no use of compression after the needle is pulled out can decrease the incidence of skin ecchymosis and subcutaneous induration,and this injection method can reduce the pain degree as well.

Construct a safety implementation process of domiciliary subcutaneous injection of biological agents in the department of rheumatology / 中国实用护理杂志

Objective To ensure the effectiveness and safety of domiciliary subcutaneous injection of biological agents, a safety implementation process was constructed for the treatment of patients with rheumatic diseases by domiciliary subcutaneous injection of biological agents. Methods Based on analyzing the existing clinical work and consulting the relevant documents, using Delphi expert consultation method, 10 experts and 30 patients were treated with 2 rounds of questionnaire to conduction. Results After 2 rounds of expert consultation, the safety implementation process was developed, including 7 items and 27 sub-items. The positive coefficient of the experts was 100％ and 90％respectively, the authority coefficient was 0.84, and the sub projects coordination coefficient was 0.454. Conclusions On the clauses in the safety implementation process of the domiciliary subcutaneous injection of biological agents in the Department of rheumatism which constructed with the Delphi method, experts opinions was consistence, having high credibility of the research results. By systematically managing the home patients who receiving the injective biological agents, transferring the part of the simple treatment from the hospital to the home was acceptance, the effectiveness and safety of domiciliary injection was improved.

Effects of human-computer interaction intelligent compression package for heparin injection in patients with orthopedic surgery / 中华护理杂志

Objective To test the effects of human-computer interaction intelligent compression package for heparin injection in patients with orthopedic surgery.Methods From July 2015 to June 2016,108 patients with orthopedic surgery were enrolled in the study,and were divided into the experimental group (54 cases) and the control group(54 cases) by random number table.The experimental group was given heparin injection with human-computer interaction intelligent compression package for 3 min,while the control group was given manual compression for 3 min.We evaluated the incidence and severity of subcutaneous hemorrhage and nurses' operating time of two groups.Results The incidence of subcutaneous hemorrhage was 3.9％ in the experimental group,12.4％ in the control group(P＜0.05).The operating time was(100.4±8.7 s) for the experimental group and(233.8±15.3 s) for the control group (P＜0.01).Conclusion Using human-computer interaction intelligent compression package can reduce the incidence of subcutaneous hemorrhage.It can also reduce the working hours of nurses and optimize human resources.

Effects of human-computer interaction intelligent compression package for heparin injection in patients with orthopedic surgery / 中华护理杂志

Objective To test the effects of human-computer interaction intelligent compression package for heparin injection in patients with orthopedic surgery.Methods From July 2015 to June 2016,108 patients with orthopedic surgery were enrolled in the study,and were divided into the experimental group (54 cases) and the control group(54 cases) by random number table.The experimental group was given heparin injection with human-computer interaction intelligent compression package for 3 min,while the control group was given manual compression for 3 min.We evaluated the incidence and severity of subcutaneous hemorrhage and nurses' operating time of two groups.Results The incidence of subcutaneous hemorrhage was 3.9％ in the experimental group,12.4％ in the control group(P＜0.05).The operating time was(100.4±8.7 s) for the experimental group and(233.8±15.3 s) for the control group (P＜0.01).Conclusion Using human-computer interaction intelligent compression package can reduce the incidence of subcutaneous hemorrhage.It can also reduce the working hours of nurses and optimize human resources.

Effect of subcutaneous treatment with human umbilical cord blood-derived multipotent stem cells on peripheral neuropathic pain in rats

In this study, we aim to determine the in vivo effect of human umbilical cord blood-derived multipotent stem cells (hUCB-MSCs) on neuropathic pain, using three, principal peripheral neuropathic pain models. Four weeks after hUCB-MSC transplantation, we observed significant antinociceptive effect in hUCB-MSC–transplanted rats compared to that in the vehicle-treated control. Spinal cord cells positive for c-fos, CGRP, p-ERK, p-p 38, MMP-9 and MMP 2 were significantly decreased in only CCI model of hUCB-MSCs-grafted rats, while spinal cord cells positive for CGRP, p-ERK and MMP-2 significantly decreased in SNL model of hUCB-MSCs-grafted rats and spinal cord cells positive for CGRP and MMP-2 significantly decreased in SNI model of hUCB-MSCs-grafted rats, compared to the control 4 weeks or 8weeks after transplantation (p<0.05). However, cells positive for TIMP-2, an endogenous tissue inhibitor of MMP-2, were significantly increased in SNL and SNI models of hUCB-MSCs-grafted rats. Taken together, subcutaneous injection of hUCB-MSCs may have an antinociceptive effect via modulation of pain signaling during pain signal processing within the nervous system, especially for CCI model. Thus, subcutaneous administration of hUCB-MSCs might be beneficial for improving those patients suffering from neuropathic pain by decreasing neuropathic pain activation factors, while increasing neuropathic pain inhibition factor.

Cost-Minimization Analysis of Biologic Disease-Modifying Antirheumatic Drugs Administered by Subcutaneous Injections in Patients with Rheumatoid Arthritis

BACKGROUND: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. METHODS: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. RESULTS: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. CONCLUSION: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.

Diffuseness comparison of two kinds of botulinum toxins type A on the forehead / 中华医学美学美容杂志

Objective To evaluate the diffuse characteristics of two types of botulinum toxin type A (BOTOX and CBTX A) in the forehead and the effect of intradermal (ID) and subcutanous (SC) infections on their diffusion.Methods Healthy volunteers (n =20) were recruited to receive a 0.05 ml (2 U) injection of botulinum toxin type A at four forehead sites [both sides of medial forehead (SC) and temporal forehead (ID)],one side for BOTOX and another for CBTX-A.On day 14,the Minors' iodine starch test was performed and photographs were taken for calculating the area and dimensions of anhydrotic area.Results The areas of anhidrosis ID were significantly greater with CBTX-A (180±15) mm2 than that of BOTOX (144±14) mm2.The same conditions occurred in vertical dimensions (14.4±1.1) mm vs.(15.8±1.0) mm and horizontal dimensions (10.8±0.6) mm vs.(12.5±0.7) mm.There was significant variation between the both for diffuseness in the two anhidrotic halos observed after ID injection (P＜0.05).The areas of anhidrosis by SC were significantly greater with CBTX-A (207±17) mm2 than that in BOTOX (183±18) mm2.The mean horizontal dimension was greater with CBTX-A by SC (13.2±0.6) mm than that of BOTOX by SC (12.2±0.7) mm,but not statistically significant (P =0.06).The mean horizontal dimension in BOTOX was significantly greater with SC than that with ID (P＜0.05).There was no statistically significant difference between SC and ID administration of CBTX-A.Conclusions BOTOX diffuses less than CBTX-A.ID injection technique may result in less diffusion than SC.

Inducción de hiperglucemias moderadas en ratas wistar por inoculación neonatal de estreptozotocina: ¿Inyección subcutánea o intraperitoneal? / Moderate Hyperglycemia Induction in Wistar Rats by Neonatal Streptozotocin Inoculation: Subcutaneous or Intraperitoneal Injection?

La experimentación en modelos animales es una herramienta importante para comprender los mecanismos fisiopatológicos que caracterizan la diabetes mellitus. Dado que es necesario conocer la implicación de cada variante seleccionada en la concepción del modelo de diabetes a utilizar, en este caso de hiperglucemias moderadas, proponemos evaluar en ratas adultas el efecto de la administración neonatal (subcutánea o intraperitoneal) de estreptozotocina (STZ) sobre su estado metabólico y oxidativo. Se indujo diabetes en gazapos hembras de dos días de nacidos mediante la inoculación de 100 mg/Kg de peso corporal de STZ. Los grupos, de 10 animales cada uno, se definieron según la vía de inoculación subcutánea (SC) o intraperitoneal (IP). Los neonatos designados como controles recibieron (SC o IP) únicamente vehículo. El fenotipo se manifestó a las 6 semanas de vida en ambos grupos. El grupe STZ SC mostró un promedio semanal de glucemias significativamente mayor y un peor control glucémico durante el experimento, reflejado por los valores de hemoglobina glicosilada. A las 12 semanas se realizó la eutanasia y se estudiaron indicadores del perfil renal, lipídico y estrés oxidativo. En los grupos tratados con STZ, respecto a los tratados solamente con vehículo, no existen diferencias significativas en el lipidograma y uricemia; únicamente la creatininemia y la uremia son significativamente mayores en STZ SC vs. CONTROL SC y STZ IP. El análisis estadístico de los parámetros del estado oxidativo [malonildialdehído (MDA) y productos avanzados de la oxidación a proteínas (PAOP)] no muestra diferencias entre los grupos estudiados. Se concluye que, si bien por ambas vías de inducción se logra instaurar el modelo deseado, desde el punto de vista metabólico los animales en los que se utilizó la vía SC el fenotipo se manifiesta con mayor similitud a lo que ocurre en el síndrome diabético humano, fundamentalmente en lo referido a los parámetros de la función renal. Rev Argent Endocrinol Metab 51:178-184, 2014 Los autores declaran no poseer conflictos de interés.

Animal experimentation is an important tool for understanding the pathophysiological mechanisms characterizing diabetes mellitus type 2 (DMT2). Based on the fact that it is necessary to know the implication of each variant selected in DMT2 models, in this case of moderate hyperglycemias, we propose to evaluate the metabolic and oxidative stress status in adult rats after neonatal [subcutaneous (SC) or intraperitoneal (IP)] administration of streptozotocin (STZ). Thus, DMT2 was induced by either SC or IP injection of 100 mg/Kgbody weight of streptozotocin (STZ) in 2 day-old rat female offsprings. Neonates designated as controls received only vehicle in a similar schedule. Groups of 10 animals were defined by the route of injection (SC or IP). Hyperglycemia developed at 6 weeks of life in both experimental groups; however, rats from the group receiving STZ SC displayed a significantly higher weekly average of blood glucose levels and a poorer glycemic control during the experiment (indicated by the peripheral glycosylated hemoglobin levels). At 12 weeks of age, euthanasia was performed, and indicators of kidney function, peripheral lipid profile and oxidative stress parameters were studied. In STZ-treated rats, there were no significant differences in circulating concentrations of lipids, uric acid, MDA and PAOP, compared with controls. Interestingly, peripheral creatinine and urea concentrations were significantly higher in STZ SC-treated rats than in both CONTROL SC and STZ IP rats. We conclude that, although the DMT2 phenotype could be obtained by neonatal STZ administration by either route, the phenotype developed by animals inoculated with STZ by the SC route was more similar to that occurring in the human diabetic syndrome, mainly as regards renal function parameters. Rev Argent Endocrinol Metab 51:178-184, 2014 No financial conflicts of interest exist.

Effects of subcutaneous injection duration of heparin on side effects: A Meta-analysis / 中国实用护理杂志

Objective To evaluate the effect of injection duration on bruising and pain after the subcutaneous injection of heparin.Methods The relevant randomized controlled trials,quasi-randomized controlled trials about subcutaneous heparin injection duration of ≥30 s and ≤ 10 s were searched in the databases of CNKI,CBM,VIP Database for Chinese Technical Periodicals,PubMed,Highwire,ScienceDirect,Chinese Cochrane Library,Wanfang database and Google.The quality of RCTs was assessed and Metaanalysis was conducted by RevMan 5.0 Software.Results Twelve RCTs involving 1 986 injections were included.The results of Meta-analysis showed that:There was significant difference between the two groups in the occurrence of bruising.The injection duration of 30 s was much better to prevent bruising.Statistical differences existed in pain intensity between the two groups.Conclusions Prolonging the injection duration to 30 s may reduce the occurrence of subcutaneous bruising.There is no enough evidence to draw a conclusion on pain intensity.Adequately,the current study is limited to a small sample,powered and high quality randomized controlled trials are still needed to be conducted.