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Zheng X, Wang R, Thor A, Brantnell A. Oral and maxillofacial surgeons' views on the adoption of additive manufacturing: findings from a nationwide survey. Oral Maxillofac Surg 2024; 28:869-875. [PMID: 38316694 PMCID: PMC11144670 DOI: 10.1007/s10006-024-01219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Hospitals in many European countries have implemented Additive Manufacturing (AM) technology for multiple Oral and Maxillofacial Surgery (OMFS) applications. Although the technology is widely implemented, surgeons also play a crucial role in whether a hospital will adopt the technology for surgical procedures. The study has two objectives: (1) to investigate how hospital type (university or non-university hospital) influences surgeons' views on AM, and (2) to explore how previous experience with AM (AM experience or not) influences surgeons' views on AM. MATERIALS AND METHODS An online questionnaire to capture surgeons' views was designed, consisting of 11 Likert scale questions formulated according to the Consolidated Framework for Implementation Research (CFIR). The questionnaire was sent to OMF surgeons through the channel provided by the Association of Oral and Maxillofacial Surgery in Sweden. Data were analyzed using the Mann-Whitney U test to identify significant differences among OMF surgeons in terms of organizational form (i.e., university hospital or non-university hospital) and experience of AM (i.e., AM experience or no-experience). RESULTS In total, 31 OMF surgeons responded to the survey. Views of surgeons from universities and non-universities, as well as between surgeons with experience and no-experience, did not show significant differences in the 11 questions captured across five CFIR domains. However, the "individual characteristics" domain in CFIR, consisting of three questions, did show significant differences between surgeons' experience with AM and no-experience (P-values: P = 0.01, P = 0.01, and P = 0.04). CONCLUSIONS Surgeons, whether affiliated with university hospitals or non-university hospitals and regardless of their prior experience with AM, generally exhibit a favorable attitude towards AM. However, there were significant differences in terms of individual characteristics between those who had prior experience with AM and those who did not. CLINICAL RELEVANCE This investigation facilitates the implementation of AM in OMFS by reporting on the views of OMF surgeons on AM.
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Affiliation(s)
- Xuewei Zheng
- Department of Civil and Industrial Engineering, Industrial Engineering and Management, Uppsala University, Ångströmlaboratoriet, Lägerhyddsvägen 1, 752 37, Uppsala, Sweden
| | - Ruilin Wang
- Department of Civil and Industrial Engineering, Industrial Engineering and Management, Uppsala University, Ångströmlaboratoriet, Lägerhyddsvägen 1, 752 37, Uppsala, Sweden
| | - Andreas Thor
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Anders Brantnell
- Department of Civil and Industrial Engineering, Industrial Engineering and Management, Uppsala University, Ångströmlaboratoriet, Lägerhyddsvägen 1, 752 37, Uppsala, Sweden.
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, MTC-Huset, Dag Hammarskjölds väg 14B, 1 tr, 752 37, Uppsala, Sweden.
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2
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Rodríguez-Pombo L, de Castro-López MJ, Sánchez-Pintos P, Giraldez-Montero JM, Januskaite P, Duran-Piñeiro G, Dolores Bóveda M, Alvarez-Lorenzo C, Basit AW, Goyanes A, Couce ML. Paediatric clinical study of 3D printed personalised medicines for rare metabolic disorders. Int J Pharm 2024; 657:124140. [PMID: 38643809 DOI: 10.1016/j.ijpharm.2024.124140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
Rare diseases are infrequent, but together they affect up to 6-10 % of the world's population, mainly children. Patients require precise doses and strict adherence to avoid metabolic or cardiac failure in some cases, which cannot be addressed in a reliable way using pharmaceutical compounding. 3D printing (3DP) is a disruptive technology that allows the real-time personalization of the dose and the modulation of the dosage form to adapt the medicine to the therapeutic needs of each patient. 3D printed chewable medicines containing amino acids (citrulline, isoleucine, valine, and isoleucine and valine combinations) were prepared in a hospital setting, and the efficacy and acceptability were evaluated in comparison to conventional compounded medicines in six children. The inclusion of new flavours (lemon, vanilla and peach) to obtain more information on patient preferences and the implementation of a mobile app to obtain patient feedback in real-time was also used. The 3D printed medicines controlled amino acid levels within target levels as well as the conventional medicines. The deviation of citrulline levels was narrower and closer within the target concentration with the chewable formulations. According to participants' responses, the chewable formulations were well accepted and can improve adherence and quality of life. For the first time, 3DP enabled two actives to be combined in the same formulation, reducing the number of administrations. This study demonstrated the benefits of preparing 3D printed personalized treatments for children diagnosed with rare metabolic disorders using a novel technology in real clinical practice.
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Affiliation(s)
- Lucía Rodríguez-Pombo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - María José de Castro-López
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, IDIS, RICORS, CIBERER, MetabERN, Spain
| | - Paula Sánchez-Pintos
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, IDIS, RICORS, CIBERER, MetabERN, Spain
| | - Jose Maria Giraldez-Montero
- Pharmacy Department, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Travesía Choupana s/n, Santiago de Compostela 15706, Spain
| | - Patricija Januskaite
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Goretti Duran-Piñeiro
- Pharmacy Department, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Travesía Choupana s/n, Santiago de Compostela 15706, Spain
| | - M Dolores Bóveda
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, IDIS, RICORS, CIBERER, MetabERN, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Abdul W Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FABRX Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK; FABRX Artificial Intelligence, Carretera de Escairón, 14, Currelos (O Saviñao), CP 27543, Spain
| | - Alvaro Goyanes
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FABRX Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK; FABRX Artificial Intelligence, Carretera de Escairón, 14, Currelos (O Saviñao), CP 27543, Spain.
| | - Maria L Couce
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, IDIS, RICORS, CIBERER, MetabERN, Spain.
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Sandler Topelius N, Shokraneh F, Bahman M, Lahtinen J, Hassinen N, Airaksinen S, Verma S, Hrizanovska L, Lass J, Paaver U, Tähnas J, Kern C, Lagarce F, Fenske D, Malik J, Scherliess H, Cruz SP, Paulsson M, Dekker J, Kammonen K, Rautamo M, Lück H, Pierrot A, Stareprawo S, Tubic-Grozdanis M, Zibolka S, Lösch U, Jeske M, Griesser U, Hummer K, Thalmeier A, Harjans A, Kruse A, Heimke-Brinck R, Khoukh K, Bruno F. Automated Non-Sterile Pharmacy Compounding: A Multi-Site Study in European Hospital and Community Pharmacies with Pediatric Immediate Release Propranolol Hydrochloride Tablets. Pharmaceutics 2024; 16:678. [PMID: 38794340 PMCID: PMC11125381 DOI: 10.3390/pharmaceutics16050678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/26/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Pharmacy compounding, the art and science of preparing customized medications to meet individual patient needs, is on the verge of transformation. Traditional methods of compounding often involve manual and time-consuming processes, presenting challenges in terms of consistency, dosage accuracy, quality control, contamination, and scalability. However, the emergence of cutting-edge technologies has paved a way for a new era for pharmacy compounding, promising to redefine the way medications are prepared and delivered as pharmacy-tailored personalized medicines. In this multi-site study, more than 30 hospitals and community pharmacies from eight countries in Europe utilized a novel automated dosing approach inspired by 3D printing for the compounding of non-sterile propranolol hydrochloride tablets. CuraBlend® excipient base, a GMP-manufactured excipient base (pharma-ink) intended for automated compounding applications, was used. A standardized study protocol to test the automated dosing of tablets with variable weights was performed in all participating pharmacies in four different iterative phases. Integrated quality control was performed with an in-process scale and NIR spectroscopy supported by HPLC content uniformity measurements. In total, 6088 propranolol tablets were produced at different locations during this study. It was shown that the dosing accuracy of the process increased from about 90% to 100% from Phase 1 to Phase 4 by making improvements to the formulation and the hardware solutions. The results indicate that through this automated and quality controlled compounding approach, extemporaneous pharmacy manufacturing can take a giant leap forward towards automation and digital manufacture of dosage forms in hospital pharmacies and compounding pharmacies.
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Affiliation(s)
- Niklas Sandler Topelius
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Artillerigatan 6A, 02520 Turku, Finland
| | - Farnaz Shokraneh
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Artillerigatan 6A, 02520 Turku, Finland
| | - Mahsa Bahman
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Artillerigatan 6A, 02520 Turku, Finland
| | - Julius Lahtinen
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
| | - Niko Hassinen
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
| | - Sari Airaksinen
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
| | - Soumya Verma
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
| | - Ludmila Hrizanovska
- CurifyLabs Oy, Salmisaarenaukio 1, 00180 Helsinki, Finland; (F.S.); (J.L.); (S.V.)
| | - Jana Lass
- Tartu University Hospital, 50406 Tartu, Estonia;
| | - Urve Paaver
- Institute of Pharmacy, Tartu University, 50411 Tartu, Estonia;
| | | | | | | | | | - Julia Malik
- Asklepios Klinik Nord, 22417 Hamburg, Germany;
| | | | | | - Mattias Paulsson
- Department of Women’s and Children’s Health, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden
| | - Jan Dekker
- UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Maria Rautamo
- HUS Helsinki University Hospital, 00029 Helsinki, Finland;
- Faculty of Pharmacy, University of Helsinki, 00100 Helsinki, Finland
| | - Hendrik Lück
- UKSH Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany;
- UKSH Universitätsklinikum Schleswig-Holstein, 24105 Lubeck, Germany
| | - Antoine Pierrot
- Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland
| | | | | | - Stefanie Zibolka
- Universitätsklinikum Magdeburg A.ö.R., 39120 Magdeburg, Germany;
| | - Uli Lösch
- Universitätsspital Basel, 4031 Basel, Switzerland;
| | | | - Ulrich Griesser
- Institute of Pharmacy, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Karin Hummer
- Landeskrankenanstalten-Betriebsgesellschaft—KABEG (Klagenfurt), 9020 Klagenfurt am Wörthersee, Austria
| | | | - Anna Harjans
- Universitätsklinikum Heidelberg, 69120 Heidelberg, Germany
| | | | - Ralph Heimke-Brinck
- University Hospital Erlangen (Apotheke des Universitätsklinikums Erlangen), 91054 Erlangen, Germany;
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4
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Zanata SM, El-Shafai NM, Beltagi AM, Alshehri S, El-Sherbiny M, El-Mehasseb IM. Bio-study: Modeling of natural nanomolecules as a nanocarrier surface for antioxidant and glucose biosensor. Int J Biol Macromol 2024; 264:130634. [PMID: 38460624 DOI: 10.1016/j.ijbiomac.2024.130634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/25/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
The nature of nano molecules as a self-assembled nanocomposite surface depends on the nanoparticles of sodium butyrate, cellulose, and pycnogenol; the synthesis is achieved via precipitation and grinding methods. The excellent functionalized surface of nanocomposite (NCP) enables the loading of the selected drugs, where the efficiency of the NCP surface arrived at 92.2 %. The electrochemical behavior emphasized the success of a functionalized NCP surface for incorporation with drugs for the drug delivery system, the results of cytotoxicity detect the effect of NCP on the mouse normal liver (BNL) cells, where the high and low concentrations on the BNL cells have a safe dose. Cell viability with BNL cells was reported at 101.8 % with10 μL and 100.12 % with 100 μL, the interaction between the NCP and the human serum albumin (HSA) at room temperature. The low interaction rate with the glutamate and increased binding with the oxidized glutathione disulfide (GSSG) and reduced glutathione (SGH) reflect the antioxidant activity of NCP. The strong binding of NCP with biomolecules such as glucose is referred to as the biosensor property. The results recommend that NCP is an excellent nanocarrier for drug delivery and glucose biosensors for diabetes.
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Affiliation(s)
- Samar M Zanata
- Nanotechnology Center, Chemistry Department, Faculty of Science, Kafrelsheikh University 33516, Egypt
| | - Nagi M El-Shafai
- Nanotechnology Center, Chemistry Department, Faculty of Science, Kafrelsheikh University 33516, Egypt.
| | - Amr M Beltagi
- Nanotechnology Center, Chemistry Department, Faculty of Science, Kafrelsheikh University 33516, Egypt
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohamed El-Sherbiny
- Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh, 11597, Saudi Arabia
| | - Ibrahim M El-Mehasseb
- Nanotechnology Center, Chemistry Department, Faculty of Science, Kafrelsheikh University 33516, Egypt
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5
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Tong H, Zhang J, Ma J, Zhang J. Perspectives on 3D printed personalized medicines for pediatrics. Int J Pharm 2024; 653:123867. [PMID: 38310991 DOI: 10.1016/j.ijpharm.2024.123867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/06/2024]
Abstract
In recent years, the rapid advancement of three-dimensional (3D) printing technology has yielded distinct benefits across various sectors, including pharmaceuticals. The pharmaceutical industry has particularly experienced advantages from the utilization of 3D-printed medications, which have invigorated the development of tailored drug formulations. The approval of 3D-printed drugs by the U.S. Food and Drug Administration (FDA) has significantly propelled personalized drug delivery. Additionally, 3D printing technology can accommodate the precise requirements of pediatric drug dosages and the complexities of multiple drug combinations. This review specifically concentrates on the application of 3D printing technology in pediatric preparations, encompassing a broad spectrum of uses and refined pediatric formulations. It compiles and evaluates the fundamental principles associated with the application of 3D printing technology in pediatric preparations, including its merits and demerits, and anticipates its future progression. The objective is to furnish theoretical underpinning for 3D printing technology to facilitate personalized drug delivery in pediatrics and to advocate for its implementation in clinical settings.
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Affiliation(s)
- Haixu Tong
- School of Pharmacy, and State Key Laboratory of Applied Organic Chemistry, Lanzhou 730000, China
| | - Juanhong Zhang
- School of Pharmacy, and State Key Laboratory of Applied Organic Chemistry, Lanzhou 730000, China; College of Life Science, Northwest Normal University, Lanzhou 730070, China
| | - Jing Ma
- School of Pharmacy, and State Key Laboratory of Applied Organic Chemistry, Lanzhou 730000, China
| | - Junmin Zhang
- School of Pharmacy, and State Key Laboratory of Applied Organic Chemistry, Lanzhou 730000, China.
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6
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Elbadawi M, Li H, Basit AW, Gaisford S. The role of artificial intelligence in generating original scientific research. Int J Pharm 2024; 652:123741. [PMID: 38181989 DOI: 10.1016/j.ijpharm.2023.123741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Abstract
Artificial intelligence (AI) is a revolutionary technology that is finding wide application across numerous sectors. Large language models (LLMs) are an emerging subset technology of AI and have been developed to communicate using human languages. At their core, LLMs are trained with vast amounts of information extracted from the internet, including text and images. Their ability to create human-like, expert text in almost any subject means they are increasingly being used as an aid to presentation, particularly in scientific writing. However, we wondered whether LLMs could go further, generating original scientific research and preparing the results for publication. We taskedGPT-4, an LLM, to write an original pharmaceutics manuscript, on a topic that is itself novel. It was able to conceive a research hypothesis, define an experimental protocol, produce photo-realistic images of 3D printed tablets, generate believable analytical data from a range of instruments and write a convincing publication-ready manuscript with evidence of critical interpretation. The model achieved all this is less than 1 h. Moreover, the generated data were multi-modal in nature, including thermal analyses, vibrational spectroscopy and dissolution testing, demonstrating multi-disciplinary expertise in the LLM. One area in which the model failed, however, was in referencing to the literature. Since the generated experimental results appeared believable though, we suggest that LLMs could certainly play a role in scientific research but with human input, interpretation and data validation. We discuss the potential benefits and current bottlenecks for realising this ambition here.
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Affiliation(s)
- Moe Elbadawi
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK.
| | - Hanxiang Li
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Abdul W Basit
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Simon Gaisford
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK.
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Pan S, Ding S, Zhou X, Zheng N, Zheng M, Wang J, Yang Q, Yang G. 3D-printed dosage forms for oral administration: a review. Drug Deliv Transl Res 2024; 14:312-328. [PMID: 37620647 DOI: 10.1007/s13346-023-01414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Oral administration is the most commonly used form of treatment due to its advantages, including high patient compliance, convenient administration, and minimal preparation required. However, the traditional preparation process of oral solid preparation has many defects. Although continuous manufacturing line that combined all the unit operations has been developed and preliminarily applied in the pharmaceutical industry, most of the currently used manufacturing processes are still complicated and discontinuous. As a result, these complex production steps will lead to low production efficiency and high quality control risk of the final product. Additionally, the large-scale production mode is inappropriate for the personalized medicines, which commonly is customized with small amount. Several attractive techniques, such as hot-melt extrusion, fluidized bed pelletizing and spray drying, could effectively shorten the process flow, but still, they have inherent limitations that are challenging to address. As a novel manufacturing technique, 3D printing could greatly reduce or eliminate these disadvantages mentioned above, and could realize a desirable continuous production for small-scale personalized manufacturing. In recent years, due to the participation of 3D printing, the development of printed drugs has progressed by leaps and bounds, especially in the design of oral drug dosage forms. This review attempts to summarize the new development of 3D printing technology in oral preparation and also discusses their advantages and disadvantages as well as potential applications.
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Affiliation(s)
- Siying Pan
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Sheng Ding
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Xuhui Zhou
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Ning Zheng
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Meng Zheng
- Huiyuan Pharmaceutical Co., Ltd, Huiyuan Medical Health Industrial Park, Heping Town, Changxing County, Huzhou, 313100, China
| | - Juan Wang
- Huiyuan Pharmaceutical Co., Ltd, Huiyuan Medical Health Industrial Park, Heping Town, Changxing County, Huzhou, 313100, China
| | - Qingliang Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China.
- Huiyuan Pharmaceutical Co., Ltd, Huiyuan Medical Health Industrial Park, Heping Town, Changxing County, Huzhou, 313100, China.
| | - Gensheng Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China.
- Huiyuan Pharmaceutical Co., Ltd, Huiyuan Medical Health Industrial Park, Heping Town, Changxing County, Huzhou, 313100, China.
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8
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Ullah M, Bibi A, Wahab A, Hamayun S, Rehman MU, Khan SU, Awan UA, Riaz NUA, Naeem M, Saeed S, Hussain T. Shaping the Future of Cardiovascular Disease by 3D Printing Applications in Stent Technology and its Clinical Outcomes. Curr Probl Cardiol 2024; 49:102039. [PMID: 37598773 DOI: 10.1016/j.cpcardiol.2023.102039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of death worldwide. In recent years, 3D printing technology has ushered in a new era of innovation in cardiovascular medicine. 3D printing in CVD management encompasses various aspects, from patient-specific models and preoperative planning to customized medical devices and novel therapeutic approaches. In-stent technology, 3D printing has revolutionized the design and fabrication of intravascular stents, offering tailored solutions for complex anatomies and individualized patient needs. The advantages of 3D-printed stents, such as improved biocompatibility, enhanced mechanical properties, and reduced risk of in-stent restenosis. Moreover, the clinical trials and case studies that shed light on the potential of 3D printing technology to improve patient outcomes and revolutionize the field has been comprehensively discussed. Furthermore, regulatory considerations, and challenges in implementing 3D-printed stents in clinical practice are also addressed, underscoring the need for standardization and quality assurance to ensure patient safety and device reliability. This review highlights a comprehensive resource for clinicians, researchers, and policymakers seeking to harness the full potential of 3D printing technology in the fight against CVD.
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Affiliation(s)
- Muneeb Ullah
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Ayisha Bibi
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wahab
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Shah Hamayun
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Mahboob Ur Rehman
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Shahid Ullah Khan
- Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, Khyber Pakhtunkhwa, Pakistan.
| | - Uzma Azeem Awan
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Rawalpindi, Punjab, Pakistan
| | - Noor-Ul-Ain Riaz
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Naeem
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Rawalpindi, Punjab, Pakistan.
| | - Sumbul Saeed
- School of Environment and Science, Griffith University, Nathan, Queensland, Australia
| | - Talib Hussain
- Women Dental College Abbottabad, Abbottabad, Khyber Pakhtunkhwa, Pakistan
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Seoane-Viaño I, Pérez-Ramos T, Liu J, Januskaite P, Guerra-Baamonde E, González-Ramírez J, Vázquez-Caruncho M, Basit AW, Goyanes A. Visualizing disintegration of 3D printed tablets in humans using MRI and comparison with in vitro data. J Control Release 2024; 365:348-357. [PMID: 37972762 DOI: 10.1016/j.jconrel.2023.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023]
Abstract
Three-dimensional (3D) printing is revolutionising the way that medicines are manufactured today, paving the way towards more personalised medicine. However, there is limited in vivo data on 3D printed dosage forms, and no studies to date have been performed investigating the intestinal behaviour of these drug products in humans, hindering the complete translation of 3D printed medications into clinical practice. Furthermore, it is unknown whether conventional in vitro release tests can accurately predict the in vivo performance of 3D printed formulations in humans. In this study, selective laser sintering (SLS) 3D printing technology has been used to produce two placebo torus-shaped tablets (printlets) using different laser scanning speeds. The printlets were administered to 6 human volunteers, and in vivo disintegration times were assessed using magnetic resonance imaging (MRI). In vitro disintegration tests were performed using a standard USP disintegration apparatus, as well as an alternative method based on the use of reduced media volume and minimal agitation. Printlets fabricated at a laser scanning speed of 90 mm/s exhibited an average in vitro disintegration time of 7.2 ± 1 min (measured using the USP apparatus) and 25.5 ± 4.1 min (measured using the alternative method). In contrast, printlets manufactured at a higher laser scanning speed of 130 mm/s had an in vitro disintegration time of 2.8 ± 0.8 min (USP apparatus) and 18.8 ± 1.9 min (alternative method). When tested in humans, printlets fabricated at a laser scanning speed of 90 mm/s showed an average disintegration time of 17.3 ± 7.2 min, while those manufactured at a laser scanning speed of 130 mm/s exhibited a shorter disintegration time of 12.7 ± 6.8 min. Although the disintegration times obtained using the alternative method more closely resembled those obtained in vivo, no clear correlation was observed between the in vitro and in vivo disintegration times, highlighting the need to develop better in vitro methodology for 3D printed drug products.
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Affiliation(s)
- Iria Seoane-Viaño
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Paraquasil Group (GI-2109), Faculty of Pharmacy, iMATUS and Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela 15782, Spain
| | - Tania Pérez-Ramos
- Radiology Department, University Hospital Lucus Augusti (HULA), Rúa Dr. Ulises Romero, 1, Lugo 27003, Spain
| | - Jiaqi Liu
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Patricija Januskaite
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Elena Guerra-Baamonde
- Radiology Department, University Hospital Lucus Augusti (HULA), Rúa Dr. Ulises Romero, 1, Lugo 27003, Spain
| | - Jorge González-Ramírez
- Radiology Department, University Hospital Lucus Augusti (HULA), Rúa Dr. Ulises Romero, 1, Lugo 27003, Spain
| | - Manuel Vázquez-Caruncho
- Radiology Department, University Hospital Lucus Augusti (HULA), Rúa Dr. Ulises Romero, 1, Lugo 27003, Spain.
| | - Abdul W Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FabRx Ltd., Henwood House, Henwood, Ashford TN24 8DH, UK.
| | - Alvaro Goyanes
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FabRx Ltd., Henwood House, Henwood, Ashford TN24 8DH, UK; Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela (USC), Santiago de Compostela 15782, Spain.
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10
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Carou-Senra P, Rodríguez-Pombo L, Monteagudo-Vilavedra E, Awad A, Alvarez-Lorenzo C, Basit AW, Goyanes A, Couce ML. 3D Printing of Dietary Products for the Management of Inborn Errors of Intermediary Metabolism in Pediatric Populations. Nutrients 2023; 16:61. [PMID: 38201891 PMCID: PMC10780524 DOI: 10.3390/nu16010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The incidence of Inborn Error of Intermediary Metabolism (IEiM) diseases may be low, yet collectively, they impact approximately 6-10% of the global population, primarily affecting children. Precise treatment doses and strict adherence to prescribed diet and pharmacological treatment regimens are imperative to avert metabolic disturbances in patients. However, the existing dietary and pharmacological products suffer from poor palatability, posing challenges to patient adherence. Furthermore, frequent dose adjustments contingent on age and drug blood levels further complicate treatment. Semi-solid extrusion (SSE) 3D printing technology is currently under assessment as a pioneering method for crafting customized chewable dosage forms, surmounting the primary limitations prevalent in present therapies. This method offers a spectrum of advantages, including the flexibility to tailor patient-specific doses, excipients, and organoleptic properties. These elements are pivotal in ensuring the treatment's efficacy, safety, and adherence. This comprehensive review presents the current landscape of available dietary products, diagnostic methods, therapeutic monitoring, and the latest advancements in SSE technology. It highlights the rationale underpinning their adoption while addressing regulatory aspects imperative for their seamless integration into clinical practice.
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Affiliation(s)
- Paola Carou-Senra
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
| | - Lucía Rodríguez-Pombo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
| | - Einés Monteagudo-Vilavedra
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, RICORS, CIBERER, MetabERN, 15706 Santiago de Compostela, Spain;
| | - Atheer Awad
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
| | - Abdul W. Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
- FABRX Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK
- FABRX Artificial Intelligence, 27543 O Saviñao, Spain
| | - Alvaro Goyanes
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
- FABRX Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK
- FABRX Artificial Intelligence, 27543 O Saviñao, Spain
| | - María L. Couce
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, RICORS, CIBERER, MetabERN, 15706 Santiago de Compostela, Spain;
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11
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Alzoubi L, Aljabali AAA, Tambuwala MM. Empowering Precision Medicine: The Impact of 3D Printing on Personalized Therapeutic. AAPS PharmSciTech 2023; 24:228. [PMID: 37964180 DOI: 10.1208/s12249-023-02682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
This review explores recent advancements and applications of 3D printing in healthcare, with a focus on personalized medicine, tissue engineering, and medical device production. It also assesses economic, environmental, and ethical considerations. In our review of the literature, we employed a comprehensive search strategy, utilizing well-known databases like PubMed and Google Scholar. Our chosen keywords encompassed essential topics, including 3D printing, personalized medicine, nanotechnology, and related areas. We first screened article titles and abstracts and then conducted a detailed examination of selected articles without imposing any date limitations. The articles selected for inclusion, comprising research studies, clinical investigations, and expert opinions, underwent a meticulous quality assessment. This methodology ensured the incorporation of high-quality sources, contributing to a robust exploration of the role of 3D printing in the realm of healthcare. The review highlights 3D printing's potential in healthcare, including customized drug delivery systems, patient-specific implants, prosthetics, and biofabrication of organs. These innovations have significantly improved patient outcomes. Integration of nanotechnology has enhanced drug delivery precision and biocompatibility. 3D printing also demonstrates cost-effectiveness and sustainability through optimized material usage and recycling. The healthcare sector has witnessed remarkable progress through 3D printing, promoting a patient-centric approach. From personalized implants to radiation shielding and drug delivery systems, 3D printing offers tailored solutions. Its transformative applications, coupled with economic viability and sustainability, have the potential to revolutionize healthcare. Addressing material biocompatibility, standardization, and ethical concerns is essential for responsible adoption.
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Affiliation(s)
- Lorca Alzoubi
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid, 21163, Jordan
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid, 21163, Jordan.
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln, LN6 7TS, UK.
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12
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Tang P, Shen T, Wang H, Zhang R, Zhang X, Li X, Xiao W. Challenges and opportunities for improving the druggability of natural product: Why need drug delivery system? Biomed Pharmacother 2023; 164:114955. [PMID: 37269810 DOI: 10.1016/j.biopha.2023.114955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/14/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023] Open
Abstract
Bioactive natural products (BNPs) are the marrow of medicinal plants, which are the secondary metabolites of organisms and have been the most famous drug discovery database. Bioactive natural products are famous for their enormous number and great safety in medical applications. However, BNPs are troubled by their poor druggability compared with synthesis drugs and are challenged as medicine (only a few BNPs are applied in clinical settings). In order to find a reasonable solution to improving the druggability of BNPs, this review summarizes their bioactive nature based on the enormous pharmacological research and tries to explain the reasons for the poor druggability of BNPs. And then focused on the boosting research on BNPs loaded drug delivery systems, this review further concludes the advantages of drug delivery systems on the druggability improvement of BNPs from the perspective of their bioactive nature, discusses why BNPs need drug delivery systems, and predicts the next direction.
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Affiliation(s)
- Peng Tang
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China
| | - Tianze Shen
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China
| | - Hairong Wang
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China
| | - Ruihan Zhang
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China
| | - Xingjie Zhang
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China
| | - Xiaoli Li
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China.
| | - Weilie Xiao
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan University, Kunming, China; School of Pharmacy and School of Chemical Science and Technology, Yunnan University, Kunming, China; Yunnan Characteristic Plant Extraction Laboratory, Yunnan Provincial Center for Research & Development of Natural Products, Kunming, China; State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, Yunnan University, Kunming, China.
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13
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Jørgensen AK, Ong JJ, Parhizkar M, Goyanes A, Basit AW. Advancing non-destructive analysis of 3D printed medicines. Trends Pharmacol Sci 2023; 44:379-393. [PMID: 37100732 DOI: 10.1016/j.tips.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023]
Abstract
Pharmaceutical 3D printing (3DP) has attracted significant interest over the past decade for its ability to produce personalised medicines on demand. However, current quality control (QC) requirements for traditional large-scale pharmaceutical manufacturing are irreconcilable with the production offered by 3DP. The US Food and Drug Administration (FDA) and the UK Medicines and Healthcare Products Regulatory Agency (MHRA) have recently published documents supporting the implementation of 3DP for point-of-care (PoC) manufacturing along with regulatory hurdles. The importance of process analytical technology (PAT) and non-destructive analytical tools in translating pharmaceutical 3DP has experienced a surge in recognition. This review seeks to highlight the most recent research on non-destructive pharmaceutical 3DP analysis, while also proposing plausible QC systems that complement the pharmaceutical 3DP workflow. In closing, outstanding challenges in integrating these analytical tools into pharmaceutical 3DP workflows are discussed.
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Affiliation(s)
- Anna Kirstine Jørgensen
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Jun Jie Ong
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Maryam Parhizkar
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Alvaro Goyanes
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; FabRx Ltd., Henwood House, Henwood, Ashford TN24 8DH, UK; FabRx Artificial Intelligence, Carretera de Escairón 14, 27543 Currelos (O Saviñao) Lugo, Spain.
| | - Abdul W Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FabRx Ltd., Henwood House, Henwood, Ashford TN24 8DH, UK; FabRx Artificial Intelligence, Carretera de Escairón 14, 27543 Currelos (O Saviñao) Lugo, Spain.
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