Virtual 3D planning and prediction accuracy in two bimaxillary face transplantations in Helsinki.

BACKGROUND: The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in predicting the end-result of face transplantation. METHODS: The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. Computed tomography (CT) scans of the recipient and donor were used to define the osteotomy lines and perform the virtual face transplantation and to 3D print customized osteotomy guides for recipient and donor. Differences between cephalometric linear and angular measurements of the virtually simulated and the actual postoperative face transplantation were calculated. RESULTS: No changes to the planned osteotomy lines were needed during surgery. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1-5.6 mm and 0.7°-4°. The postoperative skeletal relationship between maxilla and mandible in both patients were almost identical in comparison to the predictions. CONCLUSIONS: 3D planning is feasible and provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation.

Modified apple polysaccharide capped gold nanoparticles for oral delivery of insulin.

The study entailed formulation of gold nanoparticles (AuNPs) upon reduction of chloroauric acid by modified apple polysaccharide (MAP). AuNPs were conjugated with insulin (INS) for its oral delivery to treat type 1 diabetes mellitus (DM). The size of MAP conjugated AuNPs loaded with INS was 124 ± 8.55 nm with zeta potential -10.5 ± 0.54 mV. The animal study carried out in streptozotocin induced rat model revealed that AuNPs conjugated insulin (AuNPs-INS) in high dose caused 3.36 folds decrease in blood glucose level in 240 min, whereas, orally administered INS failed to decrease the blood glucose level. The 28-day study also revealed better improvement in body weight, lipid profile, urea, creatinine and liver parameters in AuNPs-INS (high dose) for which the observed value was close with respect to intraperitoneally administrated insulin followed by medium dose of AuNPs-INS, low dose of AuNPS-INS, AuNPs alone and modified apple polysaccharide.

Gold nanoparticles: New routes across old boundaries.

In recent years, gold nanoparticles have emerged as unique non-invasive drug carriers for targeting drugs to their site of action. Their site specificity has helped in increasing drugs' efficacy at lower dose as well as reduction in their side effects. Moreover, their excellent optical properties and small size offer their utilization as diagnostic tools to diagnose tumors as well as other diseases. This review focuses on various approaches that have been used in last several years for preparation of gold nanoparticles, their characterization techniques and theranostic applications. Their toxicity related aspects are also highlighted. Gold nanoparticles are useful as theranostic agents, owing to their small size, biocompatible nature, size dependent physical, chemical and optical properties etc. However, the challenges associated with these nanoparticles such as scale up, cost, low drug payload, toxicity and stability have been the major impediments in their commercialization. The review looks into all these critical issues and identifies the possibilities to overcome these challenges for successful positioning of metallic nanoparticles in market.

Formulation and optimization of intranasal nanolipid carriers of pioglitazone for the repurposing in Alzheimer's disease using Box-Behnken design.

Growing evidence suggest that Alzheimer's disease (AD), the most common cause of dementia among the elderly is a metabolic disorder associated with impaired brain insulin signaling. Hence, the diabetic drug can be a therapeutic option for the management AD. The researches in this area are ongoing and Pioglitazone (PIO) is one of the most investigated diabetic drug in AD. Eventhough PIO treatment was found to improve AD significantly in the preclinical models, the poor blood-brain barrier (BBB) permeability and serious peripheral side effects limited its success in the clinical trials. The objective of the present study was to formulate and optimize intranasal (IN) nano lipid carriers (NLC) of PIO for its targeted delivery to the brain. A Box-Behnken design was employed to optimize the effect of three independent variables on two dependent variables. The optimized formulation had a particle size (PS) of 211.4 ± 3.54 nm and zeta potential of (ZP) of 14.9 ± 1.09 mv. The polydispersibility index (PDI) and entrapment efficiency (EE) was found to be 0.257 ± 0.108 and 70.18 ± 4.5% respectively. Storage stability studies performed has confirmed the stability of NLCs at 4 °C and 25 °C. The in-vitro drug release study has exhibited a sustained release of drug from the NLC. The formulation was observed to improve the nasal permeability of PIO ex-vivo significantly. Toxicity studies were performed to confirm the safety of formulation for the in-vivo administration. In-vivo biodistribution study in rats has shown a direct transport of drug from the nose to brain from the IN-NLC.

Simulating plastic surgery: from human skin tensile tests, through hyperelastic finite element models to real-time haptics.

In this paper, we provide a summary of a number of experiments we conducted to arrive at a prototype real-time simulator for plastic surgical interventions such as skin flap repair and inguinal herniotomy. We started our research with a series of in-vitro tensile stress tests on human skin, harvested from female patients undergoing plastic reconstructive surgery. We then used the acquired stress-strain data to fit hyperelastic models. Three models were considered: General Polynomial, Reduced Polynomial and Ogden. Only Reduced Polynomial models were found to be stable, hence they progressed to the next stage to be used in an explicit finite element model aimed at real-time performance in conjunction with a haptic feedback device. A total Lagrangian formulation with the half-step central difference method was employed to integrate the dynamic equation of motion of the mesh. The mesh was integrated into two versions of a real-time skin simulator: a single-threaded version running on a computer's main central processing unit and a multi-threaded version running on the computer's graphics card. The latter was achieved by exploiting recent advances in programmable graphics technology.

Patient satisfaction with receiving skin cancer diagnosis by letter: comparison with face-to-face consultation.

Providing patients with clear and concise information is central to modern medical practice. Patients diagnosed with skin cancer are traditionally told their result by face-to-face consultation in the outpatient clinic. Previous studies have shown poor patient satisfaction with the traditional outpatient consultation. The skin oncology service at Kingston Hospital uses two different methods to inform selected patients of their skin cancer diagnosis. Those diagnosed with thin melanoma (MM) or squamous cell carcinoma (<2 cm) (SCC) are informed by letter (with an accompanying information leaflet), or seen in outpatient clinic for a face-to-face consultation. However, it is unclear which of these methods patients prefer. We performed a retrospective postal questionnaire survey to elicit the views of patients that had been informed of their skin cancer by these two methods. Patients had been diagnosed with either MM or SCC between February 2005 and March 2006. Demographic details and patient satisfaction using five-point Likert scales were determined. Of the eligible 118 patients, 90 (76%) completed the questionnaire. Questionnaires from five respondents were incorrectly completed and excluded from further analysis. Of the final 85 patients, 41 (48%) were told their diagnosis via face-to-face consultation (clinic) and 44 (52%) by letter. The demographic profile of both groups was similar (P>0.05). Patients of both groups had a similar expectation of being told a skin cancer diagnosis (P>0.05). A high level of satisfaction was expressed for both methods of communication, with no difference between the groups (P>0.05). In the letter group, patients placed more value on convenience than preference to seeing a doctor (P<0.001). The option of contacting a support nurse was also cited as a reassuring feature. The findings of this study suggest disclosure of skin cancer diagnosis by letter has high satisfaction, for selected patients. Using this method of communication may ultimately lessen the burden on outpatient service.

Pyloromyotomy through circumbilical incision with fascial extension.

Extending the fascial incision underlying the circumbilical approach to the shape of an 'inverted T' permits easy delivery of the pyloric tumour for Ramstedt's pyloromyotomy. This modification was used in 51 consecutive infants (42 male, 9 female) with a mean age of 4.7 weeks. Extension of the skin incision or conversion to the right hypochondrium approach was not necessary in any patient and the mean operating time was 31.4 min. Mild wound infection occurred in two infants (3.9%) that resolved with antibiotic treatment. Follow-up at 3 months did not detect any incisional hernia. This modification allows delivery of small or large pyloric tumours, is associated with a low rate of wound infection and does not alter the excellent cosmetic finish.