Bladder dysfunction is an important cause of chronic kidney disease (CKD). It could be due to neurogenic causes mostly spinal lesion (SL), Hinman syndrome or non-neurogenic neurogenic bladder (NNNB) and following posterior urethral valve ablation named valve bladder syndrome (VBS).

Background Intra-articular glucocorticoid injections are recommended for local treatment of synovitis regardless of the disease severity or the concurrent therapy [1]. However, the accurate placement of the puncture is challenging and if not succeeded it may impair clinical outcome or even lead to complications. The accuracy rate of non-guided injections varies around 30% - 80% [2, 3] which emphasizes the need for needle guidance. In addition to established methods (e.g. ultrasound), electrical tissue properties can be utilized for needle guidance [4]. Objectives This study introduces a new real-time needle guidance method which utilizes bioimpedance spectroscopy (BIS) with standard 22G and 24G needles. In this exploratory clinical study the system parameters are tuned and performance tested. Methods The measurement system (Injeq Ltd) consisted of a conventional injection needle together with a bioimpedance probe (BIP) stylet connected to the measurement device (as shown in Figure). It performs bipolar BIS between the electrode at the tip of the stylet and the surrounding needle. Based on the BIS results, system classifies the tissue using mathematical model in real-time and beeps when synovial fluid is detected. Parameter tuning was performed during studies based on offline analysis. In this phase, 23 patients suffering from arthritis were injected to 31 joints by experienced rheumatologists. Success of the injection was verified by aspiration of synovial fluid, absence of resistance during injection and/or using ultrasound imaging for locating the needle. Results The electrical properties of human synovial fluid differ significantly from surrounding tissues. Small and inflamed joints do not appear to contain pure well conducting synovial fluid, but they are still distinguishable from the surrounding tissues. This kind of new class, termed Complex, was included to the model after 10 injections. After the inclusion, the device correctly detected either Complex or Pure synovial fluid in 18 out of 21 injections. One joint was dry and device provided true negative result. Remaining two injections were false negative. Conclusions BIP needle is a new, easy to use method for assisting placement of the needle during intra-articular injection. In this exploratory phase, synovial fluid detection functioned properly in 19/21 cases. Thus, BIP showed ability to provide needle guidance and the study will be continued to statistically significant phase. References Beukelman T et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care & Research 63.4 (2011): 465-482. Balint PV et al. Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J. Rheumatol. 29.10 (2002): 2209-2213. Pichler W et al. Frequency of successful intra-articular puncture of finger joints: influence of puncture position and physician experience. Rheumatology 47.10 (2008): 1503-1505. Kalvøy H et al. Impedance-based tissue discrimination for needle guidance. Physiological measurement 30.2 (2009): 129-140. Disclosure of Interest P. Parmanne: None declared, E. Kankaanpää: None declared, S. Mäki Employee of: Injeq, J. Kari Employee of: Injeq, H. Relas: None declared, R. Tuompo: None declared, R. Peltomaa: None declared, K. Kronström Shareholder of: Injeq, Employee of: Injeq, R. Luosujärvi: None declared

Biopsies are important for diagnosis and prognosis. However, the challenge is to hit the target and obtain representative tissue sample from heterogeneous organs. Bioimpedance can be utilized in needle guidance since many abnormalities change the electrical properties of tissue. Because the biopsy instrument gathers tissue even 1-3 cm forward from the needle tip during sample intake it is important that the measurement is performed in front of the needle, and tissues next to or behind the needle tip do not affect the measurement. We created an enhanced bioimpedance probe (BIP) Biopsy needle, which measures impedance in real-time from the very tip of the needle. Our eccentric geometry optimizes the spatial resolution providing 98% of measurement sensitivity on the needle facet and in front of it. Based on simulations, the improvement in spatial resolution from the previously published design is over 90 percentage points. Our enhanced BIP Biopsy needle was tested in different tissues in vivo and the results are promising.

A questionnaire-based survey, undertaken in North London state secondary schools, illustrated some stumbling blocks and a lack of knowledge that is likely to inhibit an effective use of general practice among 12-18 year olds. A review of the current arrangements and some adjustment of current services might increase the likelihood of achieving Health of the Nation targets for teenage pregnancies, and may also improve health care for this important and vulnerable section of the population.