Satisfaction of Health Professionals Regarding the Short Binasal Prong Used as a Non-Invasive Ventilation Interface in Neonatology.

Purpose: To evaluate the health professionals' satisfaction regarding the short binasal prong used in Neonatal Intensive Care Units (NICU), evaluate the difficulties related to its use, and present possible improvements in the design of this device. Patients and Methods: Observational, cross-sectional study with prospective data collection carried out in the NICU of a public hospital in southern Brazil. This research was presented into two stages. In the first stage, the Quebec User Evaluation of Satisfaction with Assistive Technology was applied with 90 health professionals to evaluate the satisfaction regarding the short binasal prong. In the second stage, the health professional's experiences and difficulties in using the binasal prongs in 14 newborns (NBs) that required non-invasive ventilation was collected. The short binasal prongs used was the Fanem® brand and the CPAP circuit was Gabisa Medical International (GMI®). Finally, improvements and recommendations were presented to optimize the device's design. Results: The mean score of the health professionals' satisfaction with short binasal prongs was 3.8 ± 0.6. Ease of adjustment (3.27) and dimensions (3.62) variables had the worst scores. The main difficulties pointed out by health professionals were: circuit disconnection (57.1%), the size of the prong did not correspond to NBs' anatomical characteristics (35.7%), air leakage (21.4%), and difficulty in fixing and positioning the prong in the NB (14.28%). The improvements suggested were: appropriate prong sizes based on the anatomical characteristics of the NBs; adjustable distance between insertion and base catheters; manufactured with malleable material, however not easily foldable; curved and adjustable insertion catheters and functional system of tracheas' connection. Conclusion: The dissatisfaction of health professionals with the dimensions and prongs adjustments and the difficulties faced in clinical practice indicate the need for improvements in these interfaces. The recommendations presented in this study may contribute to optimizing the design of the binasal prong in the future.

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.

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.

Incidence and Severity of Nasal Injuries in Preterm Infants Associated to Non-Invasive Ventilation Using Short Binasal Prong.

Short binasal prongs can cause skin and mucosal damage in the nostrils of preterm infants. The objective of this study was to investigate the incidence and severity of nasal injuries in preterm infants during the use of short binasal prongs as non-invasive ventilation (NIV) interfaces. A prospective observational study was carried out in the public hospital in a Southern Brazil. The incidence and severity of internal and external nasal injuries were evaluated in 28 preterm infants who required NIV using short binasal prongs for more than 24 hours. In order to identify possible causes of those nasal injuries, the expertise researcher physiotherapist has been carried empirical observations, analyzed the collected data, and correlated them to the literature data. A cause and effect diagram was prepared to present the main causes of the nasal injury occurred in the preterm infants assessed. The incidence of external nasal injuries was 67.86%, and internal ones 71.43%. The external nasal injuries were classified as Stage I (68.42%) and Stage II (31.58%). All the internal injuries had Stage II. The cause and effect diagram was organized into 5 categories containing 17 secondary causes of nasal injuries. There was a high incidence of Stage II-internal nasal injury and Stage I-external nasal injury in preterm infants submitted to NIV using prongs. The injuries genesis can be related to intrinsic characteristics of materials, health care, neonatal conditions, professional competence, and equipment issues.

Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial.

PURPOSE: To compare the effectiveness of the hydrocolloid and the silicone gel on the nasal protection of the newborns (NBs) during the use of noninvasive ventilation (NIV). MATERIALS AND METHODS: Thirty-three NBs were selected. They were randomly divided into three groups of 11 NBs, according to the type of nasal protection used: hydrocolloid, thick silicone gel, and thin silicone gel. The stage of the nasal injury and need for exchanging nasal protection were assessed before the connection to the NIV and every 24 h until the physician's authorization for NIV's suspension. RESULTS: The mean gestational age was 32.03 ± 3.93 weeks, and the median birth weight was 1760 g (750-3535 g). The incidence of nasal injury using hydrocolloid, thick silicone gel, and a thin silicone gel group was 36.36%, 81.81%, and 72.72%, respectively (p = 0.06). Regarding the injury stage, there was no statistical significance between the three study groups. The hydrocolloid protection type had the best adhesion (p = 0.03) on the NBs' skin. CONCLUSIONS: Although this study was conducted by local practice patterns, the results showed that the hydrocolloid could be the best choice to prevent the nasal septum base injury in the NB submitted to NIV.

Nasal Prongs: Risks, Injuries Incidence and Preventive Approaches Associated with Their Use in Newborns.

PURPOSE: To assess the incidence of nasal injury in newborns submitted to non-invasive ventilation (NIV) via binasal prongs, to identify risks that come with using this interface, and to present actions for nasal injury prevention. PATIENTS AND METHODS: Observational and descriptive study performed in neonatal intensive care unit (NICU) of a public hospital in the south of Brazil. This research was divided into three stages. In the first one, nasal injury incidence was assessed in 148 newborns, using data collection from medical records. In the second stage, injury incidence, severity and a preliminary analysis of risks associated with the prescription of binasal prongs were analyzed in 33 newborns who required NIV. In the third stage. recommendations were presented to prevent nasal injury during NIV with short binasal prong. RESULTS: The incidence of nasal injury in the first stage was 37.16%, and 63.64% in the second one. As for severity, 68.42% of the injuries showed Stage I severity, and 31.58% Stage II. The main risks associated with the use of binasal prongs were inappropriate prong size, inappropriate prong model, interface reuse, prolonged NIV use exclusively with binasal prongs, incorrect prong position and NIV circuit pulled. A total of 17 preventive approaches were recommended: 13 related to newborns care and not dependent on prior investment. Among them: to choose appropriate prong size; to keep the prong and the NIV circuit well positioned and periodically massages with circular movements in the nasal septum and columella. CONCLUSION: The inappropriate prong size, interface reuse, prong model, prolonged NIV use with binasal prong and incorrect prong and NIV circuit position may be associated with the high occurrence of injury in the NICU studied. Simple approaches concerning clinical staff care actions towards the newborn in NIV, which do not require a financial investment, can prevent nasal injury.

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.

From the past to the future of therapeutic orthoses for upper limbs rehabilitation

Abstract Introduction The expansion of assistive technologies has been increasing significantly, involving almost all the daily activities, performed by disabled people. One of the highlights to be mentioned is the robotic orthoses, which are being used to amplify movements, to replace amputated limbs, and for a variety of rehabilitation therapies, among others. This study aims to present a review about upper limbs' orthoses, discussing their weaknesses, potentialities, and pointing out for future perspectives under the motor rehabilitation. Methods For this research, it had been identified 161 papers, based on the bibliographic bases from IEEE and Science Direct, which were filtered by the keywords orthoses, hand, upper-limbs and technology. After the appropriate exclusions, 22 papers were analyzed. Results This review indicates that most of the orthoses have been developed for rehabilitation therapies to be employed by people who have suffered stroke, cerebral palsy or spinal cord injury. This research summarized that the upper limbs movements are effectively produced by electric or pneumatic actuators, having a variety of degrees of freedom. Conclusion This review has shown that, although there are many orthoses styles, ranging from electric to pneumatic actuators; also there are some technical restrictions that prevent their use by most people. However, upper limb orthoses seem to be a great solution for the rehabilitation of people who have suffered a stroke.

Proliferation and differentiation of stem cells in contact with eluate from fibrin-rich plasma membrane / Proliferação e diferenciação de células-tronco em contato com eluato de membrana de fibrina

ABSTRACT Objective: To evaluate the ability of the eluate from fibrin-rich plasma (FRP) membrane to induce proliferation and differentiation of isolated human adipose-derived stem cells (ASCs) into chondrocytes. Method: FRP membranes were obtained by centrifugation of peripheral blood from two healthy donors, cut, and maintained in culture plate wells for 48 h to prepare the fibrin eluate. The SCATh were isolated from adipose tissue by collagenase digestion solution, and expanded in vitro. Cells were expanded and treated with DMEM-F12 culture, a commercial media for chondrogenic differentiation, and eluate from FRP membrane for three days, and labeled with BrdU for quantitative assessment of cell proliferation using the High-Content Operetta® imaging system. For the chondrogenic differentiation assay, the SCATh were grown in micromass for 21 days and stained with toluidine blue and aggrecan for qualitative evaluation by light microscopy. The statistical analysis was performed using ANOVA and Tukey's test. Results: There was a greater proliferation of cells treated with the eluate from FRP membrane compared to the other two treatments, where the ANOVA test showed significance (p < 0.001). The differentiation into chondrocytes was visualized by the presence of mucopolysaccharide in the matrix of the cells marked in blue toluidine and aggrecan. Conclusions: Treatment with eluate from FRP membrane stimulated cell proliferation and induced differentiation of the stem cells into chondrocytes, suggesting a potential application of FRP membranes in hyaline cartilage regeneration therapies.

RESUMO Objetivo: Avaliar a capacidade do eluato proveniente da membrana de plasma rico em fibrina (PRF) de induzir proliferação e diferenciação das células-tronco humanas isoladas de tecido adiposo (CTDAh) em condrócitos. Método: As membranas de PRF foram obtidas por centrifugação de sangue periférico de dois indivíduos saudáveis, cortadas, colocadas em poços de placa de cultivo por 48 h para obtenção do eluato de fibrina. As CTDAh foram isoladas do tecido adiposo por digestão com solução de colagenase e expandidas in vitro. As células foram expandidas e tratadas com meio de cultivo DMEM-F12, meio comercial para diferenciação condrocítica, e eluato de fibrina durante três dias e marcadas com BrdU para avaliação quantitativa da proliferação celular com o uso do sistema de imagens High-Content Operetta®. Para o ensaio de diferenciação condrogênica, as CTDAh foram cultivadas em micromassa por 21 dias e coradas com azul de toluidina e agrecana para avaliação qualitativa em microscópio óptico. As avaliações estatísticas foram feitas por meio dos testes Anova e Tukey. Resultados: Houve uma maior proliferação das células tratadas com o eluato de fibrina comparativamente com os outros dois tratamentos, nos quais o teste Anova apontou significância (p < 0,001). A diferenciação em condrócitos foi visualizada pela presença de mucopolissacarídeos na matriz das células tratadas com meio de diferenciação ou eluato e marcação positiva para agrecana. Conclusões: O tratamento com o eluato da membrana de fibrina estimulou a proliferação celular e induziu a diferenciação das células-tronco em condrócitos, o que sugere uma potencial aplicação da membrana de PRF nas terapias de regeneração de cartilagem hialina.

Proliferation and differentiation of stem cells in contact with eluate from fibrin-rich plasma membrane.

OBJECTIVE: To evaluate the ability of the eluate from fibrin-rich plasma (FRP) membrane to induce proliferation and differentiation of isolated human adipose-derived stem cells (ASCs) into chondrocytes. METHOD: FRP membranes were obtained by centrifugation of peripheral blood from two healthy donors, cut, and maintained in culture plate wells for 48 h to prepare the fibrin eluate. The SCATh were isolated from adipose tissue by collagenase digestion solution, and expanded in vitro. Cells were expanded and treated with DMEM-F12 culture, a commercial media for chondrogenic differentiation, and eluate from FRP membrane for three days, and labeled with BrdU for quantitative assessment of cell proliferation using the High-Content Operetta® imaging system. For the chondrogenic differentiation assay, the SCATh were grown in micromass for 21 days and stained with toluidine blue and aggrecan for qualitative evaluation by light microscopy. The statistical analysis was performed using ANOVA and Tukey's test. RESULTS: There was a greater proliferation of cells treated with the eluate from FRP membrane compared to the other two treatments, where the ANOVA test showed significance (p < 0.001). The differentiation into chondrocytes was visualized by the presence of mucopolysaccharide in the matrix of the cells marked in blue toluidine and aggrecan. CONCLUSIONS: Treatment with eluate from FRP membrane stimulated cell proliferation and induced differentiation of the stem cells into chondrocytes, suggesting a potential application of FRP membranes in hyaline cartilage regeneration therapies.

OBJETIVO: Avaliar a capacidade do eluato proveniente da membrana de plasma rico em fibrina (PRF) de induzir proliferação e diferenciação das células-tronco humanas isoladas de tecido adiposo (CTDAh) em condrócitos. MÉTODO: As membranas de PRF foram obtidas por centrifugação de sangue periférico de dois indivíduos saudáveis, cortadas, colocadas em poços de placa de cultivo por 48 h para obtenção do eluato de fibrina. As CTDAh foram isoladas do tecido adiposo por digestão com solução de colagenase e expandidas in vitro. As células foram expandidas e tratadas com meio de cultivo DMEM-F12, meio comercial para diferenciação condrocítica, e eluato de fibrina durante três dias e marcadas com BrdU para avaliação quantitativa da proliferação celular com o uso do sistema de imagens High-Content Operetta®. Para o ensaio de diferenciação condrogênica, as CTDAh foram cultivadas em micromassa por 21 dias e coradas com azul de toluidina e agrecana para avaliação qualitativa em microscópio óptico. As avaliações estatísticas foram feitas por meio dos testes Anova e Tukey. RESULTADOS: Houve uma maior proliferação das células tratadas com o eluato de fibrina comparativamente com os outros dois tratamentos, nos quais o teste Anova apontou significância (p < 0,001). A diferenciação em condrócitos foi visualizada pela presença de mucopolissacarídeos na matriz das células tratadas com meio de diferenciação ou eluato e marcação positiva para agrecana. CONCLUSÕES: O tratamento com o eluato da membrana de fibrina estimulou a proliferação celular e induziu a diferenciação das células-tronco em condrócitos, o que sugere uma potencial aplicação da membrana de PRF nas terapias de regeneração de cartilagem hialina.

Biocompatible glassceramic applied in drug release system / Vitrocerâmico biocompatível aplicado em sistemas de liberação de medicamentos

A anortita é um material inteligente que se degrada apenas em meio ácido. Este comportamento, juntamente com a sua biocompatibilidade, é interessante para aplicações clínicas onde a degradação do biomaterial é desejável, como em sistemas de liberação de medicamentos. O objetivo deste trabalho é avaliar a aplicabilidade das cápsulas de anortita como sistemas de liberação de medicamentos,usando L-Dopa mais benserazida como medicamento de teste. Cápsulas esféricas foram confeccionadas, pesadas, preenchidas com o medicamento, seladas e imersas em solução tampão com pH = 3,5 durante 120 horas, mantida em movimento constante para simular o ambiente corpóreo. No final do ensaio as cápsulas foram esvaziadas, lavadas, secas e pesadas novamente. A perda de massa média foi de 0,004 mais ou menos 0,001 g, demonstrando a degradação do vitrocerâmico em meio ácido. Um espectrofotômetro UV/VIS foi usado para medir a quantidade de medicamento liberada na solução, através de amostras coletadas em períodos de 24, 72 e 120 horas após o início do ensaio. O medicamento foi detectado na solução após 24 horas, com concentração crescente até 72 horas, quando a taxa de liberação do medicamento pareceu diminuir. Através das amostrasanalisadas, foi possível concluir que ocorreu uma liberação contínua do medicamento através das paredes das cápsulas devido à sua porosidade. Os resultados mostraram a possibilidade de utilização da anortita em sistemas de liberação de medicamentos mantendo a liberação contínua da droga no organismo.

The anorthite is an intelligent material which degrades only in acid medium. this behavior along with its biocompatibility is interesting for clinical applications where degradation of a biomaterial is desired, such as in a drug delivery systems. The aim os this work is the assessment of the application of anorthite capsules as drug delivery system...