Cicatrization of oncological wounds by autologous fibrin biopolymer dressing treatment: a case series.

INTRODUCTION: Traditional therapies used to treat chronic wounds are often expensive and, in general, are not adequate to support healing. A promising alternative to conventional dressings is the autologous biopolymer FM, full of cytokines and growth factors that accelerate the healing process of wounds of various etiologies. MATERIALS AND METHODS: The authors report 3 cases in which FM was used to treat chronic oncological wounds that had been conventionally treated for more than 6 months with no sign of healing. RESULTS: Among the 3 reported cases, there was complete healing of 2 wounds. The other lesion did not heal, mainly due to the location (at the base of the skull). However, it significantly reduced its area, extension, and depth. No adverse effects or hypertrophic scar formation were recorded, and the patients reported an absence of pain from the second week of FM application. CONCLUSIONS: The proposed FM dressing approach was effective in healing and speeding up tissue regeneration. It can also be considered one of the most versatile delivery systems to the wound bed, as it is an excellent carrier of growth factors and leukocytes.

Investigation of the Use of Hollow Elastic Biomodels Produced by Additive Manufacturing for Clip Choice and Surgical Simulation in Microsurgery for Intracranial Aneurysms.

BACKGROUND: Intracranial aneurysms (IAs) are dilatations of the cerebral arteries, whose treatment is commonly based on the implant of a metallic clip on the aneurysm neck. Despite the dissection and understanding of the surgical anatomy of the IA when often only parts of it are visible, the choice of the ideal clip to be used is one of the surgical difficulties. Although current imaging tests guarantee IA visualization, currently there is no planning method that allows for a real three-dimensional (3D) visualization for optimal choice of clip prior to surgery. The aim of this study is to evaluate whether IA biomodels generated by additive manufacturing methods are useful for surgical clip selection in microsurgeries for IA. METHODS: Three-dimensional (3D) IA biomodels of 10 patients with IA were evaluated using computerized tomography, surgical microscope, and 3D printer. The research was divided into 4 phases as follows: development of the 3D biomodels, evaluation of the biomodel dimensional characteristics, surgical planning evaluation with the biomodel and its clipping effectiveness, and evaluation of the actual surgical simulation process within the models. RESULTS: Ten 3D biomodels were obtained, made of a malleable and hollow part, formed by the IA and related arteries, and another rigid part, mimicking the skull and other arteries of the skull base. Based on these 3D models, 10 clips were chosen during the surgical planning, and all exactly matched the clip characteristics used during the actual surgeries. The surgical simulation with the biomodels performed by 2 neurosurgeons still in training obtained 100% accuracy in the identification of the clips that were eventually used during the actual surgeries. CONCLUSIONS: 3D biomodels generated by additive manufacturing methods were effective for surgical clip selection in microsurgeries for IA, reducing surgical time, increasing cerebral angioarchitecture understanding, and providing more safety in this type of surgery.

Multi-Sensing Techniques with Ultrasound for Musculoskeletal Assessment: A Review.

The study of muscle contractions generated by the muscle-tendon unit (MTU) plays a critical role in medical diagnoses, monitoring, rehabilitation, and functional assessments, including the potential for movement prediction modeling used for prosthetic control. Over the last decade, the use of combined traditional techniques to quantify information about the muscle condition that is correlated to neuromuscular electrical activation and the generation of muscle force and vibration has grown. The purpose of this review is to guide the reader to relevant works in different applications of ultrasound imaging in combination with other techniques for the characterization of biological signals. Several research groups have been using multi-sensing systems to carry out specific studies in the health area. We can divide these studies into two categories: human-machine interface (HMI), in which sensors are used to capture critical information to control computerized prostheses and/or robotic actuators, and physiological study, where sensors are used to investigate a hypothesis and/or a clinical diagnosis. In addition, the relevance, challenges, and expectations for future work are discussed.

Finite element analysis to predict temperature distribution in the human neck with abnormal thyroid: A proof of concept.

BACKGROUND AND OBJECTIVE: Hyperthyroidism, hypothyroidism, goiter and cancer are some of the dysfunctions that can occur concerning the thyroid, an important body homeostasis regulatory gland located in the cervical region. These disorders are mostly caused by changes in metabolism and can impair quality of life. This study presents a non-invasive approach that can detect changes in thyroid metabolism through the finite element analysis and medical images. The objective of this work was to develop a numerical model to represent the temperature distribution in the human neck with and without the presence of thyroid nodules. The patient-specific computational model for the case with thyroid nodules was calibrated with infrared thermography. METHODS: A three-dimensional geometrical model of the neck was constructed based on the segmentation of magnetic resonance (MR) images. The Finite Element Method (FEM) was used to simulate heat diffusion and convection in the cervical region. The infrared thermography image was used to calibrate the heat transfer constants to obtain the surface temperature of the human neck model containing the enlarged thyroid with nodules. Subsequently, another case for the entire neck with an abnormally large thyroid without the nodules was simulated using the calibrated physical constants. RESULTS: Results of the simulations with and without the presence of thyroid nodules were compared, showing the influence of the generation of heat from the nodules, allowing observation of the thermal differences on the cervical surface and at the thyroid itself. The model with nodules presented higher skin temperature distribution in the anterior triangle region when compared to the case without nodules. An average of 0.36∘C of absolute error and 1% of relative error was obtained for the calibration between the simulated model and the infrared image. CONCLUSIONS: This research consists of an innovative approach by comparing the results obtained via FEM simulation and the corresponding infrared image of the same neck region under study. Since there are great variability and uncertainties in the determination of the thermal constants, we applied a procedure for calibrating them based on a patient-specific case, which involves a multinodular goiter accompanied by hyperthyroidism. This proof-of-concept study allows the creation of comparative scenarios between the FEM simulations and the corresponding infrared image. Thus, it is expected that, in the future, this approach could be used to include the effect of drugs in the treatment strategies of thyroid diseases and disorders.

Clinical Applications of Additive Manufacturing Models in Neurosurgery: a Systematic Review

Introduction Three-dimensional (3D) printing technologies provide a practical and anatomical way to reproduce precise tailored-made models of the patients and of the diseases. Those models can allow surgical planning, besides training and surgical simulation in the treatment of neurosurgical diseases. Objective The aim of the present article is to review the scenario of the development of different types of available 3D printing technologies, the processes involved in the creation of biomodels, and the application of those advances in the neurosurgical field. Methods We searched for papers that addressed the clinical application of 3D printing in neurosurgery on the PubMed, Ebsco, Web of Science, Scopus, and Science Direct databases. All papers related to the use of any additivemanufacturing technique were included in the present study. Results Studies involving 3D printing in neurosurgery are concentrated on threemain areas: (1) creation of anatomical tailored-made models for planning and training; (2) development of devices and materials for the treatment of neurosurgical diseases, and (3) biological implants for tissues engineering. Biomodels are extremely useful in several branches of neurosurgery, and their use in spinal, cerebrovascular, endovascular, neuro-oncological, neuropediatric, and functional surgeries can be highlighted. Conclusions Three-dimensional printing technologies are an exclusive way for direct replication of specific pathologies of the patient. It can identify the anatomical variation and provide a way for rapid construction of training models, allowing the medical resident and the experienced neurosurgeon to practice the surgical steps before the operation.

Autologous Matrix of Platelet-Rich Fibrin in Wound Care Settings: A Systematic Review of Randomized Clinical Trials.

Platelet-rich fibrin (PRF) consists of a matrix that provides the necessary elements for wound healing, acting as a biodegradable scaffold for cell migration, proliferation, and differentiation, in addition to the delivery of growth factors and angiogenesis. This study aims to determine the effectiveness of the autologous PRF in the treatment of wounds of different etiologies. We carried out a systematic review of randomized clinical trials, guided by the recommendations of the Cochrane Collaboration using the following databases: Pubmed/MEDLINE, EMBASE, Web of Science, and CENTRAL. The search strategy resulted in the inclusion of ten studies that evaluated the use of PRF dressings for the healing of acute or chronic wounds of multiple etiologies. Among the 172 participants treated with PRF in wounds of varying etiologies and different segment times, 130 presented favorable events with the use of the intervention. Among the 10 studies included, only two of them did not demonstrate better results than the control group. The studies showed clinical heterogeneity, making it impossible to perform a meta-analysis. The findings do not provide enough evidence to support the routine use of PRF dressings as the first line of treatment for the healing of acute or chronic wounds of different etiologies. There was great variability in the application of the various protocols and the ways to prepare the PRF, resulting in clinical heterogeneity. Therefore, it makes it impossible to synthesize and to collect evidence from different types of studies in the meta-analysis, which affects the results and their proper discussion.

Development and Evaluation of a Customized Wrist-Hand Orthosis using 3D Technology for a Child with Cerebral Palsy - A Case Study.

Cerebral Palsy (CP) is a disability that affects more than 100 million children. More than 60% of these children have significant difficulties within their hand abilities, affected by involuntary movements and spasticity. So, to overcome this issue, orthoses are being employed as therapeutic intervention and can allow children with CP to have an opportunity to better use their hands. Three-dimensional (3D) technologies provide the generation of high-quality orthopedic products. Although, there are limited studies related to the evaluation of such assistive devices, especially for children. Therefore, the purpose of this research was to design, develop and evaluate a customized wrist-hand orthosis using 3D technologies for a child with CP. So, it was used a high-level 3D scanning to acquire the wrist-hand anatomy, a free software for 3D modelling and a low-cost 3D printer for manufacturing the orthosis. The Jebsen-Taylor Test of Hand Function (JTTHF) was used to evaluate unilateral hand abilities. We noticed improvements while wearing the orthosis at the affected hand, in the following subtests: writing (13 s), lifting small objects (0.9 s) and simulated feeding (69.3 s). The customized orthosis was able not only to improve some functional hand skills, but also to provide comfort, better fitting and with an appealing aesthetic design.

Three-Dimensional Hollow Elastic Models for Intracranial Aneurysm Clipping Election - A Case Study.

We describe a method for fabricating a three-dimensional hollow and elastic aneurysm model, which is useful for surgical clipping simulation. In this paper, we explain the generation of such hollow elastic model, based on 3D printing. Also, we report on the effects of applying it to presurgical clipping election and simulation. The advantages of this methodology are: (1) it generates a hollow and flexible 3D biomodel, represented as the vascular areas, apart from having together the skull, as a reference system; (2) it employs an inexpensive and easy to reproduce methodology; (3) it helps not only for training neurosurgeons, but also for planning and guiding the actual surgery clip's insertion.

Combining 3D models with 2D infrared images for medical applications.

Infrared images are very useful for providing physiological information, although the representation is two-dimensional. On the other hand, a 3D scanning system is able to generate precise 3D spatial models of the area under study. This paper presents a methodology for combining both imaging modalities into a single representation. The Structure from Motion (SfM) technique is used in order to find the correct infrared camera's positioning and rotations in the space. Then, those 2D infrared images generate a 3D SfM model. Following this stage, the SfM model is replaced by an accurate 3D model from a scanning system, which is wrapped around by the infrared images. The experiments performed with a volunteer's face have shown that the proposed methodology successfully reconstruct a unique 3D surface model, which is able to deliver potential clinical applications.

Assessment of techniques of massage and pumping in the treatment of breast engorgement by thermography.

OBJECTIVE: to evaluate techniques of massage and pumping in the treatment of postpartum breast engorgement through thermography. METHOD: the study was conducted in the Human Milk Bank of a hospital in Curitiba, Brazil. We randomly selected 16 lactating women with engorgement with the classification lobar, ampullary and glandular, moderate and intense. We compared the differential patterns of temperature, before and after the treatment by means of massage and pumping. RESULTS: we found a negative gradient of 0.3°C of temperature between the pre- and post-treatment in the experimental group. Breasts with intense engorgement were 0.7°C warmer when compared with moderate engorgement. CONCLUSION: massage and electromechanical pumping were superior to manual methods when evaluated by thermography. REBEC: U1111-1136-9027.

Image fusion improvements applied at the generation of 3D thermal models.

The application of multimodal image registration to various medical applications has been investigated. Image fusion involving 3D thermal and MRI/CT images allows the extraction of both functional and anatomical information, which may become a powerful tool to aid in clinical diagnoses. This paper presents innovations at the image fusion methodology, which currently requires that both imaging modalities are represented and visualized at the same 3D viewing projection. The proposed solution is based and compared with two different viewing projections: orthogonal and perspective. The methodology requires that the thermographic images (or photographs) are visualized in the orthogonal view, in order to match with the 2D projected images (using range images) from MRI/CT. The results obtained have shown significant improvements in the 3D thermal models, when compared and evaluated with the perspective approach. This allowed the generation of more accurate 3D models, which match both the geometry and texture (functional temperature information). Since it is desirable to combine or unify more than one imaging modality, these 3D multimodal models may have a strong impact in many clinical applications.

Growth hormone, gender and face shape in Prader-Willi syndrome.

Prader-Willi syndrome is a neurodevelopmental disorder resulting from the absence of expression of paternally expressed gene(s) in a highly imprinted region of chromosome 15q11-13. The physical phenotype includes evidence of growth retardation due to relative growth hormone deficiency, small hands and feet, a failure of normal secondary sexual development, and a facial appearance including narrow bifrontal diameter, almond-shaped palpebral fissures, narrow nasal root, and thin upper vermilion with downturned corners of the mouth. Anecdotally, the face of individuals with PWS receiving hGH treatment is said to "normalize." We used dense surface modelling and shape signature techniques to analyze 3D photogrammetric images of the faces of 72 affected and 388 unaffected individuals. We confirmed that adults with Prader-Willi syndrome who had never received human growth supplementation displayed known characteristic facial features. Facial growth was significantly reduced in these adults, especially in males. We demonstrated that following human growth hormone (hGH) supplementation, vertical facial growth of affected individuals falls within the normal range. However, lateral and periorbital face shape and nose shape differences in affected children who have received hGH therapy remain sufficiently strong to be significantly discriminating in comparisons with age-sex matched, unaffected individuals. Finally, we produced evidence that age at initiation and length of treatment with hGH do not appear to play a role in normalization or in consistent alteration of the face shape of affected individuals. This is the first study to provide objective shape analysis of craniofacial effects of hGH therapy in Prader-Willi syndrome.