Current trends in needle-free jet injection: an update

Daniel Barolet,1,2 Antranik Benohanian3 1RoseLab Skin Optics Research Laboratory, Laval, QC, Canada; 2MUHC Dermatology Service, Department of Medicine, McGill University, Montreal, QC, Canada; 3CHUM Service de Dermatologie, Université de Montréal, Montréal, QC, Canada Background: Jet injection can be defined as a needle-free drug delivery method in which a high-speed stream of fluid impacts the skin and delivers a drug. Despite 75 years of existence, it never reached its full potential as a strategic tool to deliver medications through the skin. Objective: The aim of this review was to evaluate and summarize the evolution of jet injection intradermal drug delivery method including technological advancements and new indications for use. Methods: A review of the literature was performed with no limits placed on publication date. Results: Needleless injectors not only reduce pain during drug delivery but also confine the drug more evenly in the dermis. Understanding skin properties of the injection site is a key factor to obtain optimal results as well as setting the right parameters of the jet injector. Until the advent of disposable jet injectors/cartridges, autoclaving of the injector remains the only reliable method to eliminate the risk of infection. Needle-free intradermal injection using corticosteroids and/or local anesthetics is well documented with promising indications being developed. Limitations: Limitations of the review include low-quality evidence, small sample sizes, varying treatment parameters, and publication bias. Conclusion: New developments may help reconsider the use of jet injection technology. Future studies should focus on measurable optimized parameters to insure a safe and effective outcome. Keywords: needle free, injector, jet injection, xylocaine, triamcinolone, PD

Predictors of radial artery size in patients undergoing cardiac catheterization: Insights from the good radial artery size prediction (GRASP) study

Background: Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter. Methods: Using ultrasound, we prospectively measured radial, ulnar, and brachial artery diameters of 130 patients who presented for elective percutaneous coronary intervention or diagnostic angiography. Using prespecified candidate variables we used multivariable linear regression to identify predictors of radial artery diameter. Results: Mean internal diameters of the right radial, ulnar, and brachial arteries were 2.44 ± 0.60, 2.14 ± 0.53, and 4.50 ± 0.88 mm, respectively. Results for the left arm were similar. The right radial artery was larger in men than in women (2.59 vs 1.91 mm; P \u3c 0.001) and smaller in patients of South Asian descent (2.00 vs 2.52 mm; P \u3c 0.001). Radial artery diameter correlated with wrist circumference (r2 = 0.26; P \u3c 0.001) and shoe size (r2 = 0.25; P \u3c 0.001) and weakly correlated with height (r2 = 0.14; P \u3c 0.001), weight (r2 = 0.18; P \u3c 0.001), body mass index (r2 = 0.07; P = 0.002), and body surface area (r2 = 0.22; P \u3c 0.001). The independent predictors of a larger radial artery were wrist circumference (r2 = 0.26; P \u3c 0.001), male sex (r2 = 0.06; P \u3c 0.001), and non-South Asian ancestry (r2 = 0.05; P = 0.006; final model r2 = 0.37; P \u3c 0.001). A risk score using these variables predicted radial artery diameter (c-statistic, 0.71). Conclusions: Wrist circumference, male sex, and non-South Asian ancestry are independent predictors of increased radial artery diameter. A risk score using these variables can identify patients with small radial arteries. © 2014 Canadian Cardiovascular Society

Light Emitting Diodes and Low Level Laser Light Therapy

Low level laser therapy (LLLT), including coherent and non-coherent light sources, also known as photobiomodulation, is a non-ablative treatment modality that alters cellular biochemical processes through its action on the mitochondria and by changing the cellular redox state. Treatment is delivered by exposing cells or tissue to light of low energy densities for a specific amount of time. This process has been reported to have beneficial therapeutic effects on a wide variety of conditions that benefit from alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration. LLLT’s use in dermatology is still considered experimental and investigational, hence it is currently used primarily as an adjunct therapy. Skepticisms mostly stem from ambiguities in its mechanism of action and the complexity of its dosimetry. For the same reasons, guidelines directing its use are not yet well established. Nonetheless, many recent studies have reported favorable outcomes achieved with LLLT in a number of indications (e.g. wound healing, hair growth, skin rejuvenation, fibrosis) with minimal adverse events