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1.
Medicine (Baltimore) ; 99(9): e19331, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118765

RESUMO

BACKGROUND: Cricothyroidotomy is the final strategy in the "cannot intubate, cannot oxygenate" scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates. METHODS: The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant). RESULTS: Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01). CONCLUSION: During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.


Assuntos
Cartilagem Cricoide/cirurgia , Agulhas/efeitos adversos , Traqueia/lesões , Animais , Estudos Cross-Over , Modelos Animais de Doenças , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Agulhas/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Suínos/lesões , Ensino
2.
Br J Radiol ; 93(1108): 20190866, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860329

RESUMO

OBJECTIVE: This systematic review and meta-analysis investigated risk factors for pneumothorax following CT-guided percutaneous transthoracic lung biopsy. METHODS: A systematic search of nine literature databases between inception to September 2019 for eligible studies was performed. RESULTS: 36 articles were included with 23,104 patients. The overall pooled incidence for pneumothorax was 25.9% and chest drain insertion was 6.9%. Pneumothorax risk was significantly reduced in the lateral decubitus position where the biopsied lung was dependent compared to a prone or supine position [odds ratio (OR):3.15]. In contrast, pneumothorax rates were significantly increased in the lateral decubitus position where the biopsied lung was non-dependent compared to supine (OR:2.28) or prone position (OR:3.20). Other risk factors for pneumothorax included puncture site up compared to down through a purpose-built biopsy window in the CT table (OR:4.79), larger calibre guide/needles (≤18G vs >18G: OR 1.55), fissure crossed (OR:3.75), bulla crossed (OR:6.13), multiple pleural punctures (>1 vs 1: OR:2.43), multiple non-coaxial tissue sample (>1 vs 1: OR 1.99), emphysematous lungs (OR:3.33), smaller lesions (<4 cm vs 4 cm: OR:2.09), lesions without pleural contact (OR:1.73) and deeper lesions (≥3 cm vs <3cm: OR:2.38). CONCLUSION: This meta-analysis quantifies factors that alter pneumothorax rates, particularly with patient positioning, when planning and performing a CT-guided lung biopsy to reduce pneumothorax rates. ADVANCES IN KNOWLEDGE: Positioning patients in lateral decubitus with the biopsied lung dependent, puncture site down with a biopsy window in the CT table, using smaller calibre needles and using coaxial technique if multiple samples are needed are associated with a reduced incidence of pneumothorax.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X , Humanos , Incidência , Agulhas/efeitos adversos , Posicionamento do Paciente/métodos , Punções/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco
3.
Eur J Vasc Endovasc Surg ; 59(2): 288-294, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31883684

RESUMO

OBJECTIVE: Arteriovenous grafts (AVGs) typically lose patency within two years of creation due to venous neointimal hyperplasia, which is initiated by disturbed haemodynamics after AVG surgery. Haemodialysis needle flow can further disturb haemodynamics and thus impact AVG longevity. In this computational study it was assessed how dialysis flow and venous needle positioning impacts flow at the graft-vein anastomosis. Furthermore, it was studied how negative effects of dialysis needle flow could be mitigated. METHODS: Non-physiological wall shear stress and disturbed blood flow were assessed in an AVG model with and without dialysis needle flow. Needle distance to the venous anastomosis was set to 6.5, 10.0, or 13.5 cm, whereas dialysis needle flow was set to 200, 300 or 400 mL/min. Intraluminal needle tip depth was varied between superficial, central, or deep. The detrimental effects of dialysis needle flow were summarised by a haemodynamic score (HS), ranging from 0 (minimal) to 5 (severe). RESULTS: Dialysis needle flow resulted in increased disturbed flow and/or non-physiological wall shear stress in the venous peri-anastomotic region. Increasing cannulation distance from 6.5 to 13.5 cm reduced the HS by a factor 4.0, whereas a central rather than a deep or superficial needle tip depth reduced the HS by a maximum factor of 1.9. Lowering dialysis flow from 400 to 200 mL/min reduced the HS by a factor 7.4. CONCLUSION: Haemodialysis needle flow, cannulation location, and needle tip depth considerably increase the amount of disturbed flow and non-physiological wall shear stress in the venous anastomotic region of AVGs. Negative effects of haemodialysis needle flow could be minimised by more upstream cannulation, by lower dialysis flow and by ensuring a central needle tip depth. Since disturbed haemodynamics are associated with neointimal hyperplasia development, optimising dialysis flow and needle positioning during haemodialysis could play an important role in maintaining AVG patency.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/prevenção & controle , Modelos Cardiovasculares , Neointima/patologia , Diálise Renal/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Implante de Prótese Vascular , Cânula/efeitos adversos , Simulação por Computador , Desenho Assistido por Computador , Oclusão de Enxerto Vascular/etiologia , Humanos , Hidrodinâmica , Hiperplasia/etiologia , Agulhas/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Diálise Renal/instrumentação , Diálise Renal/métodos , Estresse Mecânico , Grau de Desobstrução Vascular/fisiologia
4.
BMC Complement Altern Med ; 19(1): 285, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660945

RESUMO

BACKGROUND: Electroacupuncture (EA) is often used in clinical settings due to its analgesic effect, but its safety has not been verified due to the lack of clear criteria. This study examined the critical range of the corrosion of stainless steel types STS304 and STS316, which have been used clinically, and the relationship between needle corrosion and cell necrosis. METHOD: The critical point of corrosion for STS304 and STS316 was identified by varying the time, frequency, and stimulation intensity. In a tissue necrosis experiment, EA stimulation was applied to rats using STS316 needles with different thicknesses at maximum intensity for 60 min, and the presence of corrosion and tissue necrosis was determined. A cytotoxicity experiment was also conducted and assessed the needles and tissue necrosis. RESULTS: The results showed that STS316 was more stable than STS304 and that only coated needles corroded. Furthermore, tissue necrosis was observed regardless of corrosion, and slight cell necrosis was associated with needles with corrosion. CONCLUSIONS: This study demonstrated that non-coated STS316 was the most stable for EA stimulation and that corrosion byproducts and cell necrosis were not directly related.


Assuntos
Eletroacupuntura/instrumentação , Agulhas/efeitos adversos , Pontos de Acupuntura , Animais , Eletroacupuntura/efeitos adversos , Eletroacupuntura/métodos , Masculino , Necrose/etiologia , Necrose/patologia , Ratos , Ratos Sprague-Dawley , Aço Inoxidável/efeitos adversos , Aço Inoxidável/análise
5.
Zhonghua Shao Shang Za Zhi ; 35(8): 619-621, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474046

RESUMO

On January 1st 2018, a male 44 years old diabetic patient with subcutaneous soft tissue infection in right thigh was admitted to our hospital. The patient repeatedly used the same needle to inject insulin subcutaneously in the unsterilized right thigh, and his blood glucose was badly controlled in the long term. Severe subcutaneous soft tissue infection of the right thigh occurred after his fatigue, accompanied with ketoacidosis. Then he received conservative treatment in the local hospital for one month, but the infection persisted. After being transferred to our hospital, we highly suspected the diagnosis of necrotizing fasciitis according to previous test indicators and local B-ultrasound results, but suggestion of aggressive surgery was refused. So we treated him with conservative therapies using sensitive antibiotics and supportive remedies. The patient was basically healed after treatment of 1 month and he was recovered well during the follow-up 2 months after discharged from our hospital. This case emphasizes the importance of standard injection of insulin and early diagnosis of severe subcutaneous soft tissue infection.


Assuntos
Contaminação de Equipamentos , Fasciite Necrosante/etiologia , Agulhas/efeitos adversos , Infecções dos Tecidos Moles/etiologia , Adulto , Glicemia , Humanos , Injeções/efeitos adversos , Insulina , Masculino , Coxa da Perna
6.
Curr Opin Anaesthesiol ; 32(5): 638-642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31415044

RESUMO

PURPOSE OF REVIEW: Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. RECENT FINDINGS: The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks. In this kind of blocks, the target for injection is the plane itself and not a nerve in particular. transversus abdominis plane, pectoralis muscles, erector spinae plane blocks are some examples of fascial blocks. Because injecting into a fascial plane is not controversial, these blocks are not included in our discussion of optimal placement of the needle.To determine optimal needle placement, it is important to have a clear definition of what constitutes intraneural. Although, there is almost universal agreement that the violation of the epineurium defines the intraneural concept, the literature include several studies where this assessment is erroneous.Although intentional intraneural injection is still considered objectionable, some literature suggests that injecting intraneurally, especially if extrafascicular, may be benign. This evidence is limited and anecdotal. SUMMARY: It is necessary to have a better understanding of what intraneural injection is when dealing with any type of nerve blocks, be that single nerve, plexuses, or the sciatic nerve. Perineural injections provide successful anesthesia without putting the nerve integrity at risk. That practice is supported by years of experience and common sense. Currently, there is no evidence to support any kind of intraneural injections, intrafascicular or extrafascicular.


Assuntos
Agulhas/efeitos adversos , Bloqueio Nervoso/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervos Periféricos/anatomia & histologia , Humanos , Injeções/efeitos adversos , Injeções/instrumentação , Injeções/métodos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/diagnóstico por imagem , Ultrassonografia de Intervenção
7.
Soft Matter ; 15(37): 7390-7397, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31469148

RESUMO

Needle-induced cavitation (NIC) locally probes the elastic and fracture properties of soft materials, such as gels and biological tissues. Current NIC protocols tend to overestimate properties when compared to traditional techniques. New NIC methods are needed in order to address this issue. NIC measurements consist of two distinct processes, namely (1) the needle insertion process and (2) the cavitation process. The cavitation process is hypothesized to be highly dependent on the initial needle insertion process due to the influence of residual strain below the needle. Retracting the needle before pressurization to a state in which a cylindrical, tube-like fracture is left below the needle tip is experimentally demonstrated to reduce the impact of residual strain on NIC. Verification of the critical cavitation pressure equation in this new geometry is necessary before implementing this retraction NIC protocol. Complementary modeling shows that the change in initial geometry has little effect on the critical cavitation pressure. Together, these measurements demonstrate that needle retraction is a viable experimental protocol for reducing the influence of residual strain, thus enabling the confident measurement of local elastic and fracture properties in soft gels and tissues.


Assuntos
Reação no Local da Injeção/etiologia , Modelos Teóricos , Agulhas/normas , Módulo de Elasticidade , Injeções Subcutâneas/efeitos adversos , Agulhas/efeitos adversos , Pressão , Silicones/química
9.
Biomed Microdevices ; 21(3): 66, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31273476

RESUMO

Developed within the last few decades, microneedles (MNs) have only recently seen wide-scale use among the general population, especially in the area of cosmetics. With the FDA only starting to regulate microneedling devices and the many new microneedling products that enter the modern global market, it is of utmost importance to establish the safety profile and reasonable expectations of the microneedling practice and its products. In our review of current literature, the authors searched the keyword "microneedle" with the following terms: "safety", "side effect", "toxicology", "adverse effect", "adverse event", "infection", "dermatitis", "granuloma", "scarring", and "hyperpigmentation". Despite wide-scale implementation of MNs, we are likely only beginning to understand the potential of MNs as a medical and consumer product, and we should, therefore, be aware of any potential adverse events associated with the product.


Assuntos
Microtecnologia/instrumentação , Agulhas/efeitos adversos , Pele , Humanos , Pele/imunologia , Pele/microbiologia , Pele/patologia , Dermatopatias/etiologia , Dermatopatias/imunologia , Dermatopatias/microbiologia , Dermatopatias/patologia
10.
Pain Physician ; 22(4): 353-360, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337166

RESUMO

BACKGROUND: The incidence of intervertebral disc (IVD) degeneration has increased in recent years. A simple, reliable, and reproducible animal model is critical for understanding the underlying mechanisms of IVD degeneration. The caudal discs of rats have been proposed as a common puncture model in which to induce IVD degeneration. However, there is still no consensus on the size of needle to be used. OBJECTIVES: The present study aimed to identify the appropriate needle size to establish an IVD degeneration model. STUDY DESIGN: A randomized, experimental trial. SETTING: Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, China. METHODS: Validity was verified by magnetic resonance imaging (MRI) and histology. RESULTS: From T2-weighted MRI imaging and histological examination, the IVD punctured by the 16-gauge needle degenerated acutely one week after the operation, whereas the 26-gauge needle puncture did no harm to the IVD. An 18-gauge needle showed a progressive degeneration in IVD. LIMITATIONS: The observation period was not very long (4 weeks). CONCLUSIONS: An 18-gauge needle can be used to induce IVD degeneration in rats. Therefore, an 18-gauge needle is the optimal selection to establish the degenerative IVD model on rats, whereas the 26-gauge needle failed to cause IVD degeneration. Thus, to study the prevention and treatment of IVD degeneration, a 26-gauge needle can be used for IVD injection of growth factors, plasmids, and drugs. A 16-gauge needle may be used to induce acute disc injury, but not IVD degeneration. KEY WORDS: Low back pain, degenerative intervertebral disc, animal model, puncture needle, rat model, optimal choice.


Assuntos
Modelos Animais de Doenças , Degeneração do Disco Intervertebral , Disco Intervertebral/patologia , Agulhas , Animais , China , Degeneração do Disco Intervertebral/etiologia , Masculino , Agulhas/efeitos adversos , Punções/efeitos adversos , Ratos , Ratos Sprague-Dawley
12.
PLoS One ; 14(6): e0218004, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31181132

RESUMO

BACKGROUND: Atraumatic needles are proposed to lower complication rates after lumbar puncture (LP). Only a minority of physicians use such needles. Here we aimed to assess the impact of specific training in LP during clinical clerkship on the proportion of medical students using atraumatic needles. METHODS: We performed a case-control study comparing medical students undergoing clinical clerkship and students undergoing specific LP training. The 176 students of a class underwent training in LP just before beginning their clinical rotations. This training consisted of 45 minutes of theoretical training and a 90-minute practical session with a dummy. Twenty students were selected from the class at random, and their competence was assessed with a multiple choice questionnaire (MCQ) and an objective structured clinical examination (OSCE), nine months after the specific training. These 20 cases were compared with 20 students randomly selected from a class of 180 students who had not undergone specific training in LP and were at the end of their clinical clerkship. RESULTS: We found that 60% of the students with specific training and 25% of those with classic clinical training used an atraumatic needle during the OSCE (p = 0.025). The mean MCQ (/100) scores obtained were 57±15 and 60±15 for the specific and classic training groups, respectively (p = 0.35). Overall OSCE score was similar in the two groups (63.5±9.3 vs. 65.8±9.3; p = 0.20). CONCLUSION: Very few practicing physicians use atraumatic needles, which limits the teaching of their use to medical students. Specific training durably increases the use of appropriate needles.


Assuntos
Estágio Clínico/métodos , Punção Espinal/métodos , Estudos de Casos e Controles , Competência Clínica , Educação Médica/métodos , Feminino , Humanos , Masculino , Agulhas/efeitos adversos , Estudantes de Medicina , Inquéritos e Questionários , Adulto Jovem
13.
J Pediatr ; 209: 160-167.e4, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31047650

RESUMO

OBJECTIVE: To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice. STUDY DESIGN: In 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised. RESULTS: In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy. CONCLUSIONS: In children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358p.


Assuntos
Cateterismo/efeitos adversos , Agulhas/efeitos adversos , Dor Processual/etiologia , Dor Processual/prevenção & controle , Flebotomia/efeitos adversos , Realidade Virtual , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Resultado do Tratamento
15.
J Oncol Pharm Pract ; 25(6): 1425-1433, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30924737

RESUMO

BACKGROUND: Lanreotide and octreotide acetate suspension for injectable (LAR) are both recommended for clinical use in patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors. However, each agent possesses unique attributes in terms of their drug-delivery characteristics. The study objective was to compare overall drug-delivery efficiency between lanreotide and octreotide LAR in gastroenteropancreatic neuroendocrine tumor patients. METHODS: This study employed an observational time and motion design among patients treated with lanreotide or octreotide LAR across five US cancer centers. Baseline patient data collection included age, disease grade and duration, prior therapies and performance status. Drug-delivery time (drug preparation and administration), total patient time and resource use data were collected for gastroenteropancreatic neuroendocrine tumors receiving lanreotide (n = 22) or octreotide LAR (n = 22). Following each administration, qualitative data on the drug-delivery experience was collected from patients and nurses. RESULTS: Lanreotide was associated with a significant reduction in mean delivery time (2.5 min; 95% CI:2.0 to 3.1) compared to octreotide LAR (6.2 min; 95%CI: 4.4 to 7.9; p = 0.004). The mean total patient time for lanreotide and octreotide LAR was comparable between groups (32.1 vs. 36.6 minutes; p = 0.97). Nurses reported increased concerns with octreotide LAR related to needle clogging (p = 0.034) and device failures (p = 0.057). Overall, lanreotide had a median satisfaction score of 5.0 compared to a score of 4.0 with octreotide LAR (p = 0.03). CONCLUSIONS: Lanreotide was associated with significant reductions in drug-delivery time compared to octreotide LAR, which contributed to an improvement in overall healthcare efficiency. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03017690.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Intestinais/tratamento farmacológico , Sistemas de Medicação/organização & administração , Tumores Neuroendócrinos/tratamento farmacológico , Octreotida/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Peptídeos Cíclicos/uso terapêutico , Somatostatina/análogos & derivados , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Composição de Medicamentos , Falha de Equipamento , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Satisfação do Paciente , Estudos Prospectivos , Somatostatina/uso terapêutico , Estudos de Tempo e Movimento
17.
J Infus Nurs ; 42(2): 91-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817425

RESUMO

The use of local anesthetics to relieve pain associated with intravenous cannulation and arterial blood gas sampling is given low priority in many health institutions. This review sought to identify factors influencing nurses' use of local anesthetics for these procedures. The Database Syntax Guide for Systematic Reviewers was used; health-relevant studies were critically assessed with appropriate Critical Appraisal Skills Programme tools. Significant factors influencing the use of local anesthetics for parenteral procedures were identified, including the level of effectiveness among types of local anesthetics, the perceived benefits of facilitating needle insertions and patient satisfaction, the underestimation of pain associated with needle punctures, time concerns, physician authorization, and costs.


Assuntos
Anestésicos Locais/administração & dosagem , Artérias , Cateterismo Periférico/efeitos adversos , Papel do Profissional de Enfermagem , Dor , Veias , Cateterismo Periférico/métodos , Humanos , Agulhas/efeitos adversos , Dor/prevenção & controle , Satisfação do Paciente
18.
Ther Deliv ; 10(1): 63-80, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30730825

RESUMO

Under many circumstances, prophylactic immunizations are considered as the only possible strategy to control infectious diseases. Considerable efforts are typically invested in immunogen selection but, erroneously, the route of administration is not usually a major concern despite the fact that it can strongly influence efficacy. The skin is now considered a key component of the lymphatic system with tremendous potential as a target for vaccination. The purpose of this review is to present the immunological basis of the skin-associated lymphoid tissue, so as to provide understanding of the skin vaccination strategies. Several strategies are currently being developed for the transcutaneous delivery of antigens. The classical, mechanical or chemical disruptions versus the newest approaches based on microneedles for antigen delivery through the skin are discussed herein.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Absorção Cutânea , Pele/metabolismo , Vacinação/métodos , Vacinas/administração & dosagem , Administração Cutânea , Ensaios Clínicos como Assunto , Humanos , Tecido Linfoide/metabolismo , Agulhas/efeitos adversos
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