CN213284968U - Dedicated lesion of dermatology seals syringe - Google Patents

Dedicated lesion of dermatology seals syringe Download PDF

Info

Publication number
CN213284968U
CN213284968U CN202021130449.7U CN202021130449U CN213284968U CN 213284968 U CN213284968 U CN 213284968U CN 202021130449 U CN202021130449 U CN 202021130449U CN 213284968 U CN213284968 U CN 213284968U
Authority
CN
China
Prior art keywords
needle
injection needle
housing
syringe
liquid outlet
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
Application number
CN202021130449.7U
Other languages
Chinese (zh)
Inventor
舒心
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Third Medical Center of PLA General Hospital
Original Assignee
Third Medical Center of PLA General Hospital
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Third Medical Center of PLA General Hospital filed Critical Third Medical Center of PLA General Hospital
Priority to CN202021130449.7U priority Critical patent/CN213284968U/en
Application granted granted Critical
Publication of CN213284968U publication Critical patent/CN213284968U/en
Expired - Fee Related legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Images

Landscapes

  • Infusion, Injection, And Reservoir Apparatuses (AREA)

Abstract

The utility model provides a dedicated lesion of dermatology seals syringe belongs to medical instrument technical field. The dermatological special lesion sealing injector comprises a shell assembly, a needle assembly and a pressure regulating assembly. The first injection needle is communicated with the liquid outlet, the fixing piece is connected with the liquid outlet, the spring is wound on the outer surface of the connecting rod, the vent pipe is connected with the fixing piece, the one-way valve is connected in the vent pipe, the second injection needle is connected outside the fixing piece, the second injection needle is communicated with the vent pipe, the second injection needle is sleeved outside the first injection needle, a ventilation channel is arranged between the first injection needle and the second injection needle, and the ventilation channel is communicated with the vent pipe. The balance of the internal and external pressure is beneficial to the injection and the medicine pushing, the condition of needle head breakage is reduced, and the probability of bringing extra pain to patients is reduced.

Description

Dedicated lesion of dermatology seals syringe
Technical Field
The utility model relates to the field of medical equipment, particularly, relate to a dedicated lesion of dermatology seals syringe.
Background
Warts are common warts, plantar warts, flat warts, condyloma acuminatum and the like in clinical benign neoplasms of epidermis caused by Human Papilloma Virus (HPV). The method for treating verruca plantaris lesion closure comprises injecting 0.1% bleomycin or 2.5% fluorouracil injection into verruca body or verruca body root, wherein the injection needle is 0.1ml, the number of the needle is 4.5 or 5, and the injection is carried out slowly and multi-angle until the surface of the verruca body becomes white, and the total amount of each injection is not more than 1 ml. Scabbing about 1 week after treatment, decrustating after 2-3 weeks, and repeating the treatment for 1 or more times if the wart is not regressed after 3-4 weeks until the wart is removed.
The verruca plantaris body is very hard, the resistance is larger when needles are inserted or pushed, the needle tube and the needle head which are commonly equipped with the needle tube are thinner, and the needle head can be broken during the operation process of an operator, so that the treatment process is hindered, and the patient is further painful. How to invent a dermatologically-dedicated lesion closed syringe to improve the problems becomes a problem to be solved currently.
SUMMERY OF THE UTILITY MODEL
In order to make up for above not enough, the utility model provides a dedicated lesion of dermatology seals syringe aims at improving the syringe and when the needle is inserted or is pushed away medicine, because the cracked condition of syringe needle can appear in the resistance is great, has hindered the process of treatment, still brings extra painful problem for the patient simultaneously.
The utility model discloses a realize like this:
the utility model provides a dedicated lesion of dermatology seals syringe includes shell subassembly, syringe needle subassembly and pressure regulating subassembly.
The shell subassembly includes casing, push rod and liquid outlet, the push rod sets up the inside of casing, the liquid outlet sets up the one end of casing, the liquid outlet with the casing intercommunication.
The syringe needle subassembly includes first syringe needle and mounting, first syringe needle with the liquid outlet intercommunication, the mounting with the liquid outlet is connected, the one end setting of first syringe needle is in the inside of mounting.
The pressure regulating component comprises a push block, a connecting rod, a rubber pad, a spring, a vent pipe, a one-way valve and a second syringe needle, the push block is connected with the push rod, the push block is arranged in the shell, the rubber pad is connected with one end of the push rod, the rubber pad is arranged in the shell, the connecting rod is connected between the push block and the rubber pad, the spring is wound on the outer surface of the connecting rod, the vent pipe is connected with the fixing piece, the one-way valve is connected in the vent pipe, the second injection needle is connected outside the fixing piece, the second injection needle is communicated with the vent pipe, the second injection needle is sleeved outside the first injection needle, a ventilation channel is arranged between the first injection needle and the second injection needle and is communicated with the ventilation pipe.
In an embodiment of the present invention, one end of the housing is connected to a bump, and the bump are symmetrically arranged with each other.
In an embodiment of the present invention, the one end of the push rod is connected to a handle, and the outer surface of the housing is provided with scale marks.
In an embodiment of the present invention, the fixing member includes a first connecting block and a positioning block, the first connecting block is connected to the outer surface of the liquid outlet, the positioning block is sleeved to the outer surface of the first syringe needle, the first connecting block is connected to the positioning block.
In an embodiment of the present invention, the first connecting block and the positioning block are provided with a cavity therebetween, the one end of the first syringe needle is disposed in the cavity, an opening is disposed on one side of the positioning block, and the ventilation channel passes through the opening and the ventilation pipe.
In an embodiment of the present invention, the first syringe needle and the second syringe needle are externally connected to a protective sleeve, and the protective sleeve is connected to the first connecting block.
The utility model discloses an in one embodiment, the through-hole has been seted up to the one end of lag, the other end of lag is connected with the second connecting block, the lag passes through the second connecting block with first connecting block is connected.
The utility model discloses an in an embodiment, the one end of connecting rod run through in the ejector pad, the one end of connecting rod is connected with the stopper.
In one embodiment of the present invention, one side of the second syringe needle and one side of the first syringe needle are connected to each other.
In an embodiment of the present invention, the push rod and the casing are provided with an exhaust passage therebetween, and the vent pipe is provided with a gate valve.
The utility model has the advantages that: the utility model discloses a dedicated lesion of dermatology department seals syringe that above-mentioned design obtained, during the use, after injecting the liquid medicine into in the casing, drive the ejector pad through pressing the push rod and promote, thereby the ejector pad extrudees the spring and promotes the rubber pad and remove and pass through the liquid outlet with the liquid medicine in the casing and inject into to first syringe needle, through setting up the spring pressure when having increased the injection, it is internal to be favorable to the liquid medicine to inject into plantar wart. The fixing piece is arranged to increase the stability of the first injection needle, so that the needle can be kept vertical, the vent pipe enables external air to enter the vent channel through the one-way valve, when the first injection needle and the second injection needle are not easy to insert into the plantar wart body or push medicine after the first injection needle and the second injection needle are inserted, the vent channel enables the external air to enter the plantar wart body to reduce the pressure difference between the inside and the outside, so that the liquid medicine can be conveniently injected into the plantar wart body. One side of second syringe needle and one side interconnect of first syringe needle, it has improved the firm and intensity between first syringe needle and the second syringe needle to set up like this, through setting up like this, can also make when mixing the liquid medicine, also be favorable to in the liquid medicine suction casing through the breather pipe, the pressure difference between sealed liquid medicine and the outside air has been reduced, be favorable to improving medical staff's work efficiency, internal and external pressure has been balanced and has been favorable to advancing the needle and pushing away the medicine, the cracked condition of syringe needle has been reduced, the probability of bringing extra misery for the patient has been reduced.
Drawings
In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings that are required to be used in the embodiments will be briefly described below, it should be understood that the following drawings only illustrate some embodiments of the present invention, and therefore should not be considered as limiting the scope, and for those skilled in the art, other related drawings can be obtained according to the drawings without inventive efforts.
FIG. 1 is a schematic structural view of a dermatological lesion sealing injector provided in an embodiment of the present invention;
fig. 2 is a schematic structural view of a housing assembly according to an embodiment of the present invention;
fig. 3 is a schematic structural diagram of a pressure regulating assembly provided in an embodiment of the present invention;
fig. 4 is a schematic view of a connection structure of a first syringe needle and a second syringe needle according to an embodiment of the present invention;
fig. 5 is a schematic view of a fixing member connection structure according to an embodiment of the present invention.
In the figure: 100-a housing assembly; 110-a housing; 120-a bump; 130-a handle; 140-a push rod; 150-a liquid outlet; 160-scale line; 200-a needle assembly; 210-a first injection needle; 220-a fixture; 221-a first connection block; 222-a positioning block; 2221-opening; 223-a cavity; 230-a protective sleeve; 231-a second connection block; 232-through holes; 300-a voltage regulation component; 310-a push block; 320-a connecting rod; 322-a stop block; 330-rubber pad; 340-a spring; 350-an exhaust channel; 360-a breather pipe; 362-gate valve; 370-a one-way valve; 380-second syringe needle; 390-Vent channel.
Detailed Description
To make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the drawings of the embodiments of the present invention are combined to clearly and completely describe the technical solutions of the embodiments of the present invention, and obviously, the described embodiments are some embodiments of the present invention, not all embodiments. Based on the embodiments in the present invention, all other embodiments obtained by a person skilled in the art without creative work belong to the protection scope of the present invention.
Thus, the following detailed description of the embodiments of the present invention, presented in the accompanying drawings, is not intended to limit the scope of the invention, as claimed, but is merely representative of selected embodiments of the invention. Based on the embodiments in the present invention, all other embodiments obtained by a person skilled in the art without creative work belong to the protection scope of the present invention.
It should be noted that: like reference numbers and letters refer to like items in the following figures, and thus, once an item is defined in one figure, it need not be further defined and explained in subsequent figures.
In the description of the present invention, it is to be understood that the terms "center", "longitudinal", "lateral", "length", "width", "thickness", "upper", "lower", "front", "rear", "left", "right", "vertical", "horizontal", "top", "bottom", "inner", "outer", "clockwise", "counterclockwise", and the like indicate orientations or positional relationships based on the orientations or positional relationships shown in the drawings, and are only for convenience of description and to simplify the description, but do not indicate or imply that the device or element referred to must have a particular orientation, be constructed and operated in a particular orientation, and therefore should not be construed as limiting the present invention.
Furthermore, the terms "first", "second" and "first" are used for descriptive purposes only and are not to be construed as indicating or implying relative importance or implicitly indicating the number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include one or more of that feature. In the description of the present invention, "a plurality" means two or more unless specifically limited otherwise.
In the present invention, unless otherwise expressly stated or limited, the terms "mounted," "connected," and "fixed" are to be construed broadly and may, for example, be fixedly connected, detachably connected, or integrally formed; either directly or indirectly through intervening media, either internally or in any other relationship. The specific meaning of the above terms in the present invention can be understood according to specific situations by those skilled in the art.
In the present disclosure, unless expressly stated or limited otherwise, the first feature "on" or "under" the second feature may comprise direct contact between the first and second features, or may comprise contact between the first and second features not directly. Also, the first feature being "on," "above" and "over" the second feature includes the first feature being directly on and obliquely above the second feature, or merely indicating that the first feature is at a higher level than the second feature. A first feature being "under," "below," and "beneath" a second feature includes the first feature being directly under and obliquely below the second feature, or simply meaning that the first feature is at a lesser elevation than the second feature.
Examples
Referring to fig. 1-5, the present invention provides a technical solution: a dermatologically-specific lesion enclosing syringe includes a housing assembly 100, a needle assembly 200, and a pressure regulating assembly 300.
Referring to fig. 1-5, the housing assembly 100 includes a housing 110, a push rod 140, and a liquid outlet 150, wherein one end of the housing 110 is connected to a protrusion 120, and the protrusion 120 are symmetrically disposed. The push rod 140 is disposed inside the housing 110, one end of the push rod 140 is connected to the handle 130, and the outer surface of the housing 110 is provided with scale lines 160. The liquid outlet 150 is disposed at one end of the housing 110, and the liquid outlet 150 is communicated with the housing 110.
Referring to fig. 1-5, the needle assembly 200 includes a first needle 210 and a fixing member 220, the first needle 210 is communicated with the liquid outlet 150, the fixing member 220 is connected with the liquid outlet 150, and one end of the first needle 210 is disposed inside the fixing member 220. The fixing element 220 includes a first connecting block 221 and a positioning block 222, the first connecting block 221 is connected to the outer surface of the liquid outlet 150, the inner surface and the outer surface of the first connecting block 221 are both provided with threads, the outer surface of the liquid outlet 150 is provided with external threads, the first connecting block 221 is in threaded connection with the liquid outlet 150, the positioning block 222 is sleeved on the outer surface of the first injection needle 210, and the first connecting block 221 is connected with the positioning block 222. The stability of the first injection needle 210 is improved by the positioning block 222, which is beneficial to keeping the needle vertical, the cavity 223 is arranged between the first connecting block 221 and the positioning block 222, one end of the first injection needle 210 is arranged in the cavity 223, the opening 2221 is opened on one side of the positioning block 222, and the ventilation channel 390 is communicated with the ventilation pipe 360 through the opening 2221. A protective sleeve 230 is connected to the outside of the first injection needle 210, the protective sleeve 230 is connected to the first connecting block 221, a thread is formed inside the protective sleeve 230, and the protective sleeve 230 is in threaded connection with the first connecting block 221. Through-hole 232 has been seted up to lag 230's one end, and lag 230's the other end is connected with second connecting block 231, and lag 230 is connected with first connecting block 221 through second connecting block 231. Shield 230 is provided to shield first needle 210 and reduce contamination of first needle 210.
Referring to fig. 1-5, the pressure regulating assembly 300 includes a push block 310, a connecting rod 320, a rubber pad 330, a spring 340, a vent tube 360, a check valve 370 and a second syringe needle 380, the push block 310 is connected to the push rod 140, the push block 310 is disposed inside the housing 110, the rubber pad 330 is connected to one end of the push rod 140, the rubber pad 330 is disposed inside the housing 110, the connecting rod 320 is connected between the push block 310 and the rubber pad 330, the spring 340 is wound on the outer surface of the connecting rod 320, one end of the connecting rod 320 penetrates through the push block 310, and one end of the connecting rod 320 is connected to a limit block 322. Make push rod 140 drive ejector pad 310 promote through squeezing handle 130, ejector pad 310 extrudees spring 340 and promotes rubber pad 330 and removes thereby pour into the liquid medicine in casing 110 into to first syringe needle 210 through the liquid outlet, pressure when having increased the injection through setting up spring 340, be provided with exhaust passage 350 between push rod 140 and the casing 110, breather pipe 360 is connected with mounting 220, check valve 370 is connected in breather pipe 360, make gas can only flow in to breather pipe 360 through setting up check valve 370, can not follow the inside outflow of breather pipe 360, be provided with gate valve 362 on the breather pipe 360. The second needle 380 is connected to the outside of the fixing member 220, the second needle 380 is communicated with the vent pipe 360, the second needle 380 is sleeved on the outside of the first needle 210, one side of the second needle 380 is connected with one side of the first needle 210, so that the stability and strength between the first needle 210 and the second needle 380 are improved, the outer part of the second needle 380 is connected with the protective sleeve 230, the vent channel 390 is arranged between the first needle 210 and the second needle 380, the vent channel 390 is communicated with the vent pipe 360, whether external air can enter the vent channel 390 through the one-way valve 370 can be controlled by controlling the on-off between the gate valve 362 and the vent pipe 360, and when the first needle 210 and the second needle 380 are not easily inserted into the verruca plantaris body or medicine is not easily pushed after the first needle 210 and the second needle 380 are inserted into the verruca plantaris body, the gate valve 362 is opened to enable the external air to enter the verruca plantaris body through the vent channel 390 to reduce the internal and the difference in intensity facilitates the injection of the liquid medicine into the plantar wart body.
The work principle of the special lesion closed injector for the dermatology department is as follows: when the injection device is used, after liquid medicine is injected into the housing 110, the handle 130 is squeezed to enable the push rod 140 to drive the push block 310 to push, the push block 310 squeezes the spring 340 and pushes the rubber pad 330 to move, so that the liquid medicine in the housing 110 is injected into the first injection needle 210 through the liquid outlet, the pressure during injection is increased by the arrangement of the spring 340, and the liquid medicine is favorably injected into the plantar wart body. The stability of the first injection needle 210 is improved by arranging the positioning block 222, the needle is kept vertical, whether external air can enter the vent channel 390 through the one-way valve 370 or not can be controlled by controlling the on-off between the gate valve 362 and the vent pipe 360, and when the first injection needle 210 and the second injection needle 380 are not easy to be inserted into the plantar wart body or medicine is not easy to push after the first injection needle 210 and the second injection needle are inserted into the plantar wart body, the gate valve 362 is opened, so that external air can enter the plantar wart body through the vent channel 390, and the internal and external pressure difference is reduced, so that liquid medicine can be injected into. One side of second syringe needle 380 and one side interconnect of first syringe needle 210, set up like this and improved the firm and intensity between first syringe needle 210 and the second syringe needle 380, through setting up like this, can also make when mixing the liquid medicine, also be favorable to in the liquid medicine suction casing 110 through breather pipe 360, the pressure difference between sealed liquid medicine and the outside air has been reduced, be favorable to improving medical staff's work efficiency, the syringe has been improved when advancing the needle or pushing away the medicine, because the cracked condition of syringe needle can appear to the resistance is great, the process of treatment has been hindered, still bring extra painful problem for the patient simultaneously.
The above description is only a preferred embodiment of the present invention and is not intended to limit the present invention, and various modifications and changes may be made by those skilled in the art. Any modification, equivalent replacement, or improvement made within the spirit and principle of the present invention should be included in the protection scope of the present invention.

Claims (10)

1. A lesion closed injector special for dermatology is characterized by comprising
A housing assembly (100), the housing assembly (100) comprising a housing (110), a push rod (140), and a liquid outlet (150), the push rod (140) being disposed inside the housing (110), the liquid outlet (150) being disposed at one end of the housing (110), the liquid outlet (150) being in communication with the housing (110);
a needle assembly (200), wherein the needle assembly (200) comprises a first injection needle (210) and a fixing member (220), the first injection needle (210) is communicated with the liquid outlet (150), the fixing member (220) is connected with the liquid outlet (150), and one end of the first injection needle (210) is arranged inside the fixing member (220);
pressure regulating subassembly (300), pressure regulating subassembly (300) includes ejector pad (310), connecting rod (320), rubber pad (330), spring (340), breather pipe (360), check valve (370) and second syringe needle (380), ejector pad (310) with push rod (140) are connected, ejector pad (310) sets up the inside of casing (110), rubber pad (330) is connected the one end of push rod (140), rubber pad (330) sets up in casing (110), connecting rod (320) connect ejector pad (310) with between rubber pad (330), spring (340) winding is in the surface of connecting rod (320), breather pipe (360) with mounting (220) are connected, check valve (370) are connected in breather pipe (360), second syringe needle (380) are connected the outside of mounting (220), the second injection needle (380) is communicated with the vent pipe (360), the second injection needle (380) is sleeved outside the first injection needle (210), a vent channel (390) is arranged between the first injection needle (210) and the second injection needle (380), and the vent channel (390) is communicated with the vent pipe (360).
2. A dermatological lesion sealing syringe as claimed in claim 1, wherein a protrusion (120) is connected to one end of the housing (110), and the protrusion (120) are symmetrically arranged.
3. The dermatological lesion sealing syringe of claim 1, wherein a handle (130) is connected to one end of the push rod (140), and the outer surface of the housing (110) is provided with scale lines (160).
4. The dermatological lesion sealing syringe of claim 1, wherein the fixing member (220) comprises a first connecting block (221) and a positioning block (222), the first connecting block (221) is connected to the outer surface of the liquid outlet (150), the positioning block (222) is sleeved on the outer surface of the first needle (210), and the first connecting block (221) is connected to the positioning block (222).
5. The dermatological lesion sealing injector of claim 4, wherein a cavity (223) is formed between the first connecting block (221) and the positioning block (222), one end of the first injection needle (210) is disposed in the cavity (223), an opening (2221) is formed in one side of the positioning block (222), and the vent channel (390) is communicated with the vent pipe (360) through the opening (2221).
6. A dermatological lesion sealing syringe as in claim 4, wherein a protective sleeve (230) is attached to the outside of the first needle (210) and the second needle (380), said protective sleeve (230) being connected to the first connecting block (221).
7. The dermatological lesion sealing syringe of claim 6, wherein a through hole (232) is formed at one end of the protective sleeve (230), a second connecting block (231) is connected to the other end of the protective sleeve (230), and the protective sleeve (230) is connected to the first connecting block (221) through the second connecting block (231).
8. The dermatological lesion sealing injector of claim 1, wherein one end of the connecting rod (320) penetrates through the pushing block (310), and a limiting block (322) is connected to one end of the connecting rod (320).
9. A dermatological lesion sealing syringe as in claim 1, wherein one side of the second needle (380) is interconnected with one side of the first needle (210).
10. A dermatological lesion sealing injector as in claim 1, wherein an air discharge passage (350) is provided between the plunger (140) and the housing (110), and a gate valve (362) is provided on the air vent tube (360).
CN202021130449.7U 2020-06-17 2020-06-17 Dedicated lesion of dermatology seals syringe Expired - Fee Related CN213284968U (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CN202021130449.7U CN213284968U (en) 2020-06-17 2020-06-17 Dedicated lesion of dermatology seals syringe

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
CN202021130449.7U CN213284968U (en) 2020-06-17 2020-06-17 Dedicated lesion of dermatology seals syringe

Publications (1)

Publication Number Publication Date
CN213284968U true CN213284968U (en) 2021-05-28

Family

ID=76018075

Family Applications (1)

Application Number Title Priority Date Filing Date
CN202021130449.7U Expired - Fee Related CN213284968U (en) 2020-06-17 2020-06-17 Dedicated lesion of dermatology seals syringe

Country Status (1)

Country Link
CN (1) CN213284968U (en)

Similar Documents

Publication Publication Date Title
CN101612425B (en) Disposable automatic heating and pressurizing transfusion device
CN204543206U (en) A kind of Anesthesia Department injection device
CN206081307U (en) Gynecology dosing device
CN213284968U (en) Dedicated lesion of dermatology seals syringe
CN212089835U (en) Continuous syringe for veterinary epidemic prevention and treatment
CN109550115A (en) A kind of reverse syringe of the combination of self-regulating function
CN215504748U (en) Push-rod type enemator for children
JP7250174B2 (en) Easy-to-operate large inner diameter triple indwelling needle device and its application
CN212141142U (en) Gynecological drug delivery device
CN214181337U (en) Remaining needle capable of preventing blood return
CN212282543U (en) Device for injecting medicine into scar by carbon dioxide dot matrix laser
CN211024025U (en) Disposable portable eye flusher
CN211271024U (en) Medical oncology device of dosing
CN209770998U (en) Automatic liquid-stopping and automatic-exhausting dropping funnel
CN213191655U (en) Disposable enema device with liquid storage and injection auxiliary assembly
CN212090430U (en) Anesthetic injection device
CN213284994U (en) Puncture needle for anesthesia
CN221751728U (en) Multifunctional transfusion system
CN215690511U (en) Infusion fixer for pediatric emergency treatment not prone to falling off
CN213432090U (en) Drainage device for hepatobiliary surgery
CN212327104U (en) Clinical navel blood infusion device that uses of gynaecology and obstetrics
CN218833377U (en) Improved craniocerebral injury postcerebral-ventricular outdoor drainage tube
CN213609353U (en) Drip chamber for nursing bone traction needle hole
CN211513048U (en) Local anesthesia device for operation of anesthesia department in hospital
CN215134593U (en) Novel urethral catheterization device for bladder perfusion

Legal Events

Date Code Title Description
GR01 Patent grant
GR01 Patent grant
CF01 Termination of patent right due to non-payment of annual fee

Granted publication date: 20210528

CF01 Termination of patent right due to non-payment of annual fee